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Posts tagged ‘GP’

4 months late

This blog post was going to be posted in January, but life and politics got in the way and I actually thought I had posted it. It was only when I went to write the post on essential oils that I discovered it was still unpublished.

So here is the missing January blog:

New Year blogs are supposed to be about plans, ideas, looking forward and even making resolutions. 

But what happened just before Xmas 2017 has crept into the New Year and will impact on our lives for some months and maybe years to come.

Part way through December my partner Eve, had a mental health crisis. The worst is now over, and she is doing well. But the outcome could have been very different.

Eve been vulnerable to depression all her adult life. I had noticed that she had been getting increasingly “down” and was sleeping very badly. I presumed most of this was down to a foot injury that had caused Eva a lot of pain. But once her foot was better her mood did not improve. She had a lack of energy, little enthusiasm, no motivation and her sleep pattern got worse.

We received a difficult email to which Eve totally over-reacted, she plunged into what I can only describe as a dark, murky pool.

This is how she described herself:

“I was furious and frantic. I could not eat or sit still. I had to visit my GP premises that afternoon to make an appointment. I realised when I got there that I was in a very bad state and the receptionist arranged for me to speak to a GP then and there. We spoke and she made a regular appointment for me the following Friday.

The weekend was dreadful.  

From this point on I had a constant dry mouth, very poor sleep and appetite. I  saw a friend on the Saturday and again on the Monday morning – I could not speak to Fran, though I wanted to, it was so hard. 

The following Monday afternoon I went back to the GP practice to ask for the antidepressants that had helped me a few years previously. The GP prescribed Prozac 20mg.”

For the rest of that week Eve continued to be profoundly depressed. 

We were able to talk and Eve said more about how she felt. That was good, but Eve was not sleeping and found it increasingly hard to distract herself with reading or listening to the radio.

By Friday when Eve saw her GP she asked for some sleeping tablets. Unfortunately they were useless.

This is Eve’s description of the next two days:

“Friday,  Saturday and Sunday night were pure nightmare.

I woke in the very small hours bombarded by intense negative feelings and associated thoughts. Grief and despair. I tried to block them by reading the ‘easy reading’ books that had been all I could cope with all week and by trying to  listen to the radio. Nothing was effective. 

Friday night almost technicolour, black, red, flashes of bright yellow. Saturday night, dark  browns and purples. Sunday night, paler colours, but the thoughts clearer. Definite suicidal thoughts. I blocked myself from thinking about how I might kill myself.

Later in the morning I’d be tired but relatively calm. In the afternoons the anxiety would build up. I’d pace up and down or sit and twitch. Sunday night I managed to eat two mouthfuls of banana, Monday morning, one bite  banana, one of bread.

During the weekend I’d talked with Fran about how I might need a hospital admission.”

First thing Monday I phoned our GP and she gave Eve an appointment at 10.30am.

It turned out that the only way to get urgent mental health help is via A&E.  The GP gave us a letter, explaining she wanted Eve seen by a Psychiatrist to review and possibly change her medication.  We drove straight to St Thomas’s, and after a 15 minute wait got a car park space, and rushed quickly inside.

A& E were brilliant. Very helpful and caring. We must have seen about five people before we got to the liaison nurse, they found a quiet room for us to sit etc.

The liaison nurse was empathic, helpful, and clearly very expert. 

She referred Eve to the Community Mental Health Team and the Home Treatment. team. She advised against admission. Even the elderly people’s ward is very disturbed – not a good place unless you are really out of contact with reality.

As Eve recalled; 

“My thinking was distorted, rational but not reasonable, but I was not hallucinating or delusional.

Unfortunately it was too late for the teams to see me at the hospital that day,  but they would visit me at home the next day. The hospital also gave me stuff to help me sleep for the next two nights.

I felt reassured and a lot less desperate.  I slept. I ate a little.

Unfortunately after that things fell apart.

The following day, after Fran phoned to chase them, two people from the CMHT (Community Mental Health Team) and HTT (Home Treatment Team) arrived late afternoon. They appeared to be uncaring and unprofessional, were very reluctant to give us their names and we never were told their job titles. 

They asked me if I was actively suicidal – I wasn’t and my partner was protecting me.  I would be ‘reviewed’ by their teams some time that week. Then they might do something. No possibility of a medication review or charge of prescription. Nothing to help me sleep.”

I was so angry. I tried to explain how ill Eve was, but they didn’t want to listen to me, and actually told me not to join in their conversation. 

Luckily Eve had enough savings for another option to be available. I had previously worked at the Priory in Roehampton. One phone call later, we were told we could have a next day appointment and all that was needed was for our GP to email a referral over. 

Within 24 hours we were sitting in the waiting room at Roehampton.

Eve explains what happened next:

The Psychiatrist was good. A careful and sympathetic assessment. I could stay on the same antidepressants, plus a prescription for a small dose of an atypical antidepressant with some sedative action. I was given a second appointment in January when the psychiatrist said he would recommend therapists.

I slept that night. The nightmare rapidly receded. The antidepressants kicked in.

I continued to feel a bit shaky and very tired for a few days.

I’m staying on the antidepressants, and I’ll be looking for a councillor soon.

Without Fran I dread to think what would have happened. If I’d depended on the NHS entail health services, I’d have been in serious trouble.

As it is I’m OK thanks to my partner, friends GP A&E and private psychiatry. 

No thanks to NHS mental health services!

UPDATE

Thankfully Eve is continuing to do well and she is enjoying life again.

Getting the best from your GP – Part 2

Medication and more

6 Know your meds

Understand what medication you have been prescribed. Know their names and how they work. Also be aware of both the generic (scientific) and proprietary (Pharmaceutical or trade) names.

There are lots of online resources. I find this one the bestYou can also try this NHS site which gives more of an overall view. 

By understanding what your medication does, you are also able to be alert to side effects. But beware – these can sound very scary. Also, not everyone suffers from these side effects and you certainly won’t get all of them. If you are someone who is aware that you may be easily influenced, give the information leaflet to a close friend or family member who can check side effects for you if you are worried.

7 Always report drug side effects

If you are having side effects from your medication, note them down. Use your notes when you go back to see your GP. If you feel you are getting more side effects than benefits from a medication – don’t be afraid to ask if you can try something different.  

The same medication can work differently on different people. Just because someone you know had side effects from a medication doesn’t mean you will too. 

8 Don’t be afraid to say no!

If you really cannot cope with the side effects from a medication, it is your right to say if you no longer want to take that medication. You should always discuss this with your GP first. But ultimately, it’s your body and your choice.

One of the most common drugs prescribed in the UK are statins. They are very cheap, and are given to patients who have raised cholesterol. One million people were prescribed statins in 2011

But thousands of people also suffer side effects from statins. The most common of these side effects are muscle pain and cramps. There is also a risk that statins can increase your chances of getting type 2 diabetes. Statins are often prescribed to reduce a risk of heart attacks caused by high cholesterol. Opinion on statins is divided, even between doctors themselves. 

My own, non-statistical, view talking to friends and family members who have taken statins, is that the side effects some people experience are considerably worse than the risk involved by not taking statins. 

That is my personal choice. If you need to make a decision about statins, or any other medication please discuss your options with your GP first. 

9 Check about supplements 

Many of us now take vitamin and other supplements to improve our health. But did you know they can interact with prescribed medication?

Check out what you are taking or considering buying with your GP. The same advice applies if you are seeing a hospital consultant. Please also tell the doctors or nurses if you are going to have investigations or surgery. 

10 Not all GPs or practices are good

Sometimes things go wrong. Try and resolve you concerns with the GP themselves. If your concern is about one of the reception staff, speak to the practice manager. Your complaint may help them deal with an ongoing issue. 

Where I previously lived in West London, there was an arrangement for my the nearest Chemist to pick up scripts from my GP’s surgery at least once a day. Usually this system worked well. I would order my meds on line and the script would be at the Chemist two days later. The following day I could have my meds delivered. 

However on several occasions prescriptions went missing or couldn’t be found. If I phoned to check what happening there was one particular receptionist who used to get very angry and defensive. On two separate occasions she accused me of lying about what the Chemist had said to me. 

The first time I just thought she was having a bad day. But on the second occasion I spoke to the Practice Manager. It turned out there were some ongoing issues with this particular staff member. Not only was the prescription collection system improved but the incident was used to try and help the Receptionist’s skills training. I stayed with that practice till I moved

Learn about the care other GP practices give disabled people. If you find you have chosen the wrong GP – find a better one. Poor care is not acceptable and you have a right to change your GP.

 

Getting the best from your GP – Part 1

Having great interactions

Finding a good GP is essential if you are to get good support and the right medication. It also matters when you need a hospital referral. Because of my nursing background, I also expect visits to my GP be an equal two-way conversation about medication or treatment.

Most GP’s surgeries allow you to order regular medication and book appointments on line. It’s well worth learning how to do this – it really isn’t difficult. Booking non-urgent appointments and ordering medication from home saves time and energy too.

I use the Health app in my iPhone to store all my medical informations. There are similar ones for other phones and they can be accessed even if your phone is locked. If you don’t trust technology make sure you have information available in case of emergency. Some people use Message in a Bottle.

If you have life-threatening conditions or allergies you may want to consider MedicAlert. They do charge a yearly fee, but provide a great service.

1 Do your research

Ask friends and neighbours, especially those with health problems.  If you need a GP who speaks your language, make sure that there are at least two GPs in the practice you choose that you can talk to. The same rule applies if you prefer to always see a woman GP. 

Check the Surgery out on line: the CQC is an indepedent inspection body who rate all GP practices on a variety of standards 

There is a totally independent site. It’s a great place to check. Their reviews are straightforward and give clear percentages for each question.

This NHS run site allows patients to give their own ratings on different services. I don’t find it as helpful as it tends to cite only the best or worse experiences.

2 Don’t think the nearest GP is best

Never chose a Surgery because it’s the nearest one to get to. I have to pass two GP practices to get to see my GP and it’s well worth the extra time. 

My friend Sue who lives the other end of London to me, chose her GP because he was nearby. Sue has type 2 diabetes and in the last 3 months has had 3 leg infections with blisters on her skin. Her GP wouldn’t send her to specialist Diabetic Nurse. He refused to give her a glucose monitoring kit. She was told she couldn’t see a specialist Tissue Viability Nurse about her dressings. She was also told to pay for the wound dressings.

The way she was treated not only broke NHS guidelines, but could have severely endangered her health. Because the NHS is short of money, Sue presumed that what she was being told was ok. She felt she didn’t ‘deserve’ any more care because it was too expensive. I was furious when I heard about this.

I spoke to Sue and explained the care she should be getting. She is now with a better GP. Although the surgery is a 10 minute bus ride away, Sue is getting referred to the right specialists and she will get the right care.

3 Speak to a GP before signing up

If at all possible, ask to speak with one of the GPs at the practice you are considering. This is especially important if you have a rare condition or multiple interacting conditions. You can often get an idea of they way you will be treated in future by the response you get to your request.

Also GPs who are training practices are often more up to date on new treatments and complex conditions. 

4 Find more than one good GP

Most GPs work in group practice settings. So whilst you maybe registered with a specific GP you can be seen by any GP who works there. You will probably easily find one GP who you have a great rapport with. But, GPs have holidays, are sick themselves or they go on training courses. So find at least one more GP in your practice who will know you and can look after you if you need something urgent when your GP is away. 

5 The power of paper

When seeing a new GP or hospital doctor for the first time I always take with me a concise medical history of the 12 operations I’ve had as an adult, my current medication and the allergies I have. This paper also lists the 8 conditions I’ve been diagnosed with and a summary of my current issues. This makes consultations much more focussed and doesn’t waste valuable time going over irrelevant stuff. It also means the Doctor has everything in front of them if they need to write referral letters or evidence letters for Social Services and the DWP.

Part 2 coming soon.

 

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