Depression - what help should I be getting?

[Nystagmite]

I am looking into relocating. I have various long term disabilities and health problems. One of which is currently undergoing investigation. I don't want to be in the situation whereby, they restart the investigation again - so far, it has been painful and I don't want to go through that again.

 

So, what exactly would happen if I did move? Also, I was put on Medication in January 2010, changed medication in April 2010, moved in June and am due a medication review in June. (where I am, it's done yearly. where I was previously, it was every 6 months) If I moved before June, I would've been on medication for 14 months and had no review - that can't be right, can it?

[Night Owl]

Hi Nystagmite.

 

If you are on medication and register with a new GP when you have relocated, your new GP can get the information from your old GP.

Take time to chat to your GP. If you need a longer appointment ask the receptionist to make a longer appointment for you to see a GP. If you like the GP's service then register with him/her.

It is always advisable to get your condition and medication regularly reviewed. 14 months seems a long time.

This allows you and your GP to tweek medication as things improve or deteriorate, or, as new medication becomes available.

Some medications require levels to be monitored.

 

Good luck.

[Nystagmite]

Thanks Night Owl. The medication I'm on is a gel; so I don't need blood tests or other than medication reviews, any regular check-ups for this medication.

[Nystagmite]

In July, I was referred to a neurologist and was given proposed treatment of botox injections. In September, neurologist saw me, gave me a diagnosis and referred me to a neurologist. Saw neurologist in January, who disagreed with everything, said he didn't know what was wrong and sent me for an MRI scan. He said he'll see me in 3 months. In February, I was given my MRI and 4 weeks later, was given the results by my GP. In the letter to my my GP, he said he'll see me in 3 months time.

 

I still haven't heard anything and am still in pain and am still rather squeaky. Who is it I need to talk to, to ask where this referral is?

 

I've had problems for 4 years now and am fed up of lack diagnosis, being fobbed off (I was told there was nothing wrong, when there clearly is) and fed up of waiting around.

[Night Owl]

Hi Nystagmite,if you know the Consultants name you could phone the secretary........the hospital switchboard could put you through to the right number.

[honeybee13]

Nightowl knows best, but if your GP referred you and you don't have other information, you could ask their secretary to tell you what's happening and either chase it up for you or let you have contact details.

 

HB x

[Nystagmite]

Thanks. I have been seem at two different hospitals for this; so wasn't sure which one I had to phone. Will phone GP on Monday and see what they say.

[honeybee13]

I hope it works out, Nystagmite. Please let us know it's OK or come back for more advice.

 

HB x

[Nystagmite]

I won't bore you with all the details.

 

Short version is, I am no closer to getting any answers regarding what started off as a neck injury and have been told I have a problem with my brain - hence eyesight difficulties.

 

They've suggested that I be examined by medical students. This won't affect my current treatment with NHS.

 

Has anyone else has this, please?

[citizenB]

Erm, are these medical students going to be supervised by a Fully qualified professional/consultant ?

 

TBH, I cant see how letting a bunch of students examine you will get you any further with your injury!

[silverfox1961]

I have been assessed many times by medical students.

 

In my cases, the students come in blind (no information about the condition) and then they ask the questions and perhaps do a cursory exam (generally nothing intrusive) They then go back to the registrar, SHO or consultant with their findings.

 

Any treatment that they may give you will have to have been approved first by the boss

 

 

You do have the right to say that you feel uncomfortable with medical students and they can be withdrawn.

 

As an aside, nearly all the students with me got my condition wrong but if they don't have patients to practice on, they will struggle to learn

[Nystagmite]

Thank you. Had a student with me today who did a test on me. Think he worked out the stiff joints and that was it.

[BazzaS]

There are 2 conflicting pressures here ; making sure we have the next generation of doctor's against "I don;t want a student prodding and poking me".

 

If you are uncomfortable with the thought of a student, decline. It should be made clear when you are told that there are medical students that i) you can decline, and ii) your treatment will under no circumstances be any less good after declining than if you'd agreed.

 

I'd ask anyone to balance against that the thought that for every consultant they see ...... that consultant only got there by being a medical student once, and if every patient had declined, they'd never had passed their exams!.

 

If someone agrees to be examined by a medical student and finds them polite, careful to treat you with care and respect .... tell their bosses. They deserve the positive feedback, and it'll help create the next generation of caring doctors.

 

If you find a medical student clumsy, careless, or disrespectful (and I hope you don't!) - make a judgement call .... are they very new? having a bad day? deserve some slack? If so, let them know where they are going wrong ... if they are caring, they'll apologise, and you'll know your experience has helped shape tomorrow's doctors.

 

If the student doesn't respond well to any feedback, and is too downright rude or non-caring to listen, (or you've got the impression that'd be their response) ... ask to speak to their supervisor ..... I'd not want to be the student in that situation who doesn't shape up, 'fess up, and apologise PDQ.

 

Edited to add, I'm assuming you know that the exam was for the student's benefit, not as part of diagnosing you, as any diagnostic conclusion would have to be checked by someone qualified anyhow!.

[Nystagmite]

Edited to add, I'm assuming you know that the exam was for the student's benefit, not as part of diagnosing you, as any diagnostic conclusion would have to be checked by someone qualified anyhow!.

 

I assumed this. I, in the nicest way possible, am not too sure if I really want to diagnosed (or try) by someone who is still in training.

 

I was told that this is to help the students more than myself.

[Janie1962]

My Mum was assessed by a student a couple of years ago for a recurrent problem, which her GP was treating with very limited success. The student proposed a program of treatment which actually alleviated the problem.......I think perhaps looking through fresh eyes really helped.

 

Anyway, best of luck whatever you decide!

 

Janie

[BazzaS]

I assumed this. I, in the nicest way possible, am not too sure if I really want to diagnosed (or try) by someone who is still in training.

 

I was told that this is to help the students more than myself.

 

OK...... First and foremost, if you don't want a student, don't accept a student. That is your ABSOLUTE right.

 

(It's also your right to decline an FY1, and FY2, a core trainee, or even a Registrar if you don't want to be seen by a 'doctor in training'') ..... But expect a long wait if you say "I want a Consultant only", unless your condition is such that you need to be seen by a Consultant. (and seen quickly). A registrar a day off being a consultant is still (technically) in a "training grade".

 

However, I accept that it is a big (psychological) difference between a medical student and a doctor, even though they might be a medical student one month, and a doctor the next ... At least if they've made that transition it means they've been assessed as having reached the standard to make that leap!.

 

So, when might you be seen by a medical student?. Early on in their training they'll be learning the basics of assessing a patient, by:

a) getting the "story" of what has happened to bring the patient to that point,

b) learning how to examine a patient. They also need to learn what is "normal" before they start learning to spot what is "abnormal"

c) learning about what tests are useful in what situations, and

d) learning how to apply the facts they know about illnesses so that the info they get from a) to c) gives them a diagnosis, or list of possible diagnoses, which leads them on to

e) the management of the problem (they need to work out what they need to treat for, so that they can decide what to treat with).

 

The process is the same for the medical students as for the doctors, and the junior doctors as well as the consultants (although the consultants should be quicker / slicker at it, although they'll often rely on the juniors doing "the grunt work".

 

Depending on where the student is in their training, and what the person asking you if you can be seen by a student expects you to "offer" that student, will determine what the student might ask of you.

 

If they are very new they might be tasked to just ask you what has been happening to you.

If they are further on in their training they might be asked to examine you and "present" their findings to their supervisor.

If you have an unusual "sign" that they need to learn to spot, they might be asked to examine you, so that they learn both about that sign and spotting that sign. However, if this is the case, then you'll have been seen by a qualified Dr first : otherwise they wouldn't know you had that sign, if that makes sense. So, if it is a medical student seeing you first - someone has at least made a decision that it is safe for you to be seen first by a student.

 

Similar applies to the more junior of the "Dr's in training" ..... except more is expected of them, and they may be empowered to do more before they feed back to their bosses .. The more senior they are, the more they can do without asking someone senior!

 

So, you can decline outright. Again, that is your absolute right, and you shouldn't feel at all constrained from using it.

Equally, if you might accept a student but aren't sure, you can ask what the student will be being asked to do, and how you'll be helping them, before making your decision.

If you do decide to allow a student, you can change your mind at ANY stage in the process.

Edited September 9, 2011 by BazzaS

[zippygbr]

i have to agree totally with what Bazza Has said , the fact is that without Patients who are willing to share their experiences and symptoms and allow Students to examine themand find signs of their problem how do you expect Health Professionals to learn ?

[BazzaS]

i have to agree totally with what Bazza Has said , the fact is that without Patients who are willing to share their experiences and symptoms and allow Students to examine themand find signs of their problem how do you expect Health Professionals to learn ?

 

Thanks, zippy.

 

There are the 2 sides of the coin, though.....

For some people, they are already anxious, shy or embarrassed, and a student might be "the straw that breaks the camel's back". So, it has to be a balance, and in the end, the patient has to choose what is right for them.

 

If a patient has a particularly "good example" of a sign, or something rare ... Chances are they'll get asked, and a wise Consultant will choose a good moment to ask . Someone who might refuse early on, when anxious or concerned that a student might be making their diagnosis, might be more likely to agree later, when they've got their diagnosis and know what is going on

[Kitten1]

I've been on both sides of the coin in this situation - I'm a nurse. But, there are situations where I will not let a student be involved after a mortifying incident a few years ago.

 

I didn't work in the hospital at that time but attended ward rounds for various service users. I had been at a ward round earlier this particular week, which had had several medical students in. As a nurse or doctor, we can encounter so many students that they all start to look alike.

 

My husband and I had attended the fertility clinic for further tests etc and we were asked if we'd be happy for some students to be involved in the consult as observers only. I agreed. I then found myself on the couch with my nethers exposed and half a dozen people down the business end. I was just chatting away when one of the male students started asking me about my job.....

 

Turned out he'd been at the ward round earlier that week that I had attended and remembered me!!!!!!

 

Needless to say, the doctor I was seeing quickly dispatched him on a spurious errand to simply get rid of him!!!!!

 

I have seen students since then and don't have a problem with it normally but 'delicate' situations are kept between myself and the professional now!! The thought of sitting in a ward round etc and thinking that a student there has seen my unmentionables just makes me feel physically sick!!

 

But, we all have to learn somehow and book learning isn't everything x

[Kitten1]

Stupid iPod!! Mergers should read nethers!! Lol

[silverfox1961]

Stupid iPod!! Mergers should read nethers!! Lol

 

Hi,

I have edited your post to make it clearer and for more hilarity at your expense

[Kitten1]

I can laugh about it now but it was mortifying at the time. I actually refused to attend ward rounds for about two weeks afterwards!!!

[BazzaS]

Ideally, the student should have excused himself earlier on, if he realised he knew you.

It is possible he didn't realise straight away, or he too was embarrassed, and tried to cover it by asking you about your job, rather than excusing himself.

 

My student story(ies) relates to when I was asked if I'd help with an OSCE (Objective structured clinical examination - it is objective and structured - they get marked according to a set tick box sheet, so there is no room for favouritism or subjective opinion open to bias) for medical students early in their training

 

One candidate came in and got very flustered ... As we knew each other. She got that flustered as she was supposed to be examining me for the blood supply system in my legs ... Including feeling for the pulse in my groin!. She scored poorly, but I explained the background to the examiner, who assured me they had mechanisms for such situations... If she scored well on the other stations they could disregard that one given the circumstances.

Another candidate introduced himself as "doctor" ... Not "medical student" nor "student doctor" - I mentioned it after to the examiner, who showed me where he'd noted it already .... My subjective view was that he was too brash and over confident (even if he had a Ph.D and was entitled to that title, he was giving the impression he was a qualified medical Dr when he wasn't) but it is an objective exam, so it's hard to score for that. However, "correct introduction" was an objective scoring point which he was marked down for, and it was highlighted for feedback to him.

[Nystagmite]

Thanks.

 

Where I normally attend for eye infirmary, they do have students present - but that's it. They sit there and just listen.

 

I have been told a lot of this is to do with my medical history - the short version is, I spent a lot of my child hood being fobbed off with "there's nothing wrong" and was told on Friday mum was right all along. Was also told that I had epilepsy as a child, which went undiagnosed as they believed mum was over reacting. (she's only seen me have a seizure once) When I had tests for epilepsy, it came back normal.

 

I am also in the wonderful situation of having 2 rare conditions, which basically means that part of my optic nerve is missing.

 

I am now in the situation of, last year, going to see GP about neck problem. It has now turned into having excess brain fluid and a few other issues.

[Nystagmite]

So, there are no services for diagnosing adults with Autism in my area. The closest we can get to that is screening, which I've had done and quite frankly, it was a waste of time. I was told nothing that I didn't already know.

 

First GP told me I don't need a diagnosis. Second GP doesn't know what to do with me. Originally, he referred me to CMHT and I ended up with huge problems due to the way I was treated and the refusal to give me anything other than a confirmation that there's a high chance I'm on the spectrum somewhere.

 

When I saw him the second time, he said that he'll talk to the childrens service at the local develop centre.

 

I have received a letter from my GP basically telling me there's nothing he can do to help me. CMHT just discharged me, (which I found out 3 months after they discharged me) and have left me with no support at all. They said I can go to social services (whose budget is being cut) and there's a local group I can attend. But the local group isn't a substitute for services that NHS are meant to provide. They can't provide things like counselling, a diagnosis and the other support that I may need.

 

Will NHS pay for a private diagnosis? I can't afford it myself and there's no help from the psychiatrist for this. The closest centre on the NHS is Southampton. I'm in Plymouth. I'm not even sure if I can get referred there.

 

The Autism Act says that a diagnosis must be provided; but there are no services in Devon for Adults.

 

University won't help because it's medical and not an educational need. It's because of the lack of diagnosis and support that I've struggled with my education.