Multibollock.

After a bit of soul-searching about whether or not I really wanted to go, and right-up-to-getting-in-the-car wobblies about coming home early, I actually went on holiday.

 

It’s increasingly a yearly tradition – Me and Best Friend and his parents get a holiday cottage somewhere (First one was at Ullswater in a converted barn, second was at Whitby in a big shed on a caravan park, this one was a ground-floor flat in what had been a gentleman’s residence overlooking Esthwaite) and have a nice, chilled-out week doing touristy stuff.

 

This time, even more so than the previous times, it was fucked up by me being incredibly mentally ill.

 

Day one, I stayed in my room and refused to talk to anyone, having a full-on “I want to take my body off and never put it back on again” level of badness.

Day two was good – Finding somewhere to sit around the banks of Coniston, with lots of damselflies and Herdwick sheep and generally just nice weather and scenery.

Day three was a boat trip on Ullswater, on the same steamer as the first time, which was wonderfully relaxing – Just sitting on the quarterdeck, admittedly spending part of the time lying flat on my back and staring up at the sky because sitting upright was too much for my spine. Then trying to go up the path to the youth hostel on Helvellyn, which I failed and basically collapsed during, needing such a vast amount of morphine that I was entirely a turnip on the way home.

Day four was recovering from that, pootling about the grounds of the house where there was so much wildlife; Tree-creepers, greater spotted woodpeckers (A whole family of them!) a young buzzard, an osprey catching a fish from the lake and then slowly circling up, giving us a good view of it as it flew off, a muntjac looking very furtive, a young slow-worm basking on the wall, a vole that wasn’t even slightly scared of humans, and plenty of swifts and swallows and other birds that would have been a headline-spot back home. Still, largely, just sitting in the corner and wibbling a bit, and planning to go home early.

Day five was rowing boats on Esthwaite, variously taking turns to try to row and/or paddle, which I did surprisingly well at and didn’t end up in the water at all. Desperately wanting to go home, but electing to stay because however stressed I felt, I’d probably feel worse if I wasn’t allowed to show how worried I was about politics. And then, at 21.50, we instituted a media blackout, so as not to get completely caught up in the referendum (us all having postal-voted weeks ago). Instead, we watched Rome and enthused about the Marian reforms and ancient mass-production of things like segmented lorica and single-use amphorae. We got to sleep at about 02.00.

At 04.30 on day six I woke up to go to the toilet and checked my phone to see how the results were coming in. I then lay back down, making an uncontrollable noise of distress, which woke up Best Friend. I tried to pass it off as just a shoulder spasm, letting him sleep a bit longer, but within about fifteen minutes he was waking up, and asked point-blank if I knew the result yet, since I was reading. I told him, and then we were both awake and miserable and angry. At about 5.30, we heard the others moving around the kitchen, getting coffee, so apparently nobody had any sleep that night.

 

Not to be deterred, but wanting to avoid all people, we went to the miniature railway at Ravenglass and Eskdale and avoided getting on it, instead taking plenty of photos in the station and the rail yard, then slowly made our way down to the ruins of the Roman bath at Muncaster. Despite the first half of the day having tiny locomotives – Combining two of my favourite things, trains and things which are the wrong size – I actually think that the bath was my favourite part of the day. They’ve got the distinction of being the tallest standing Roman ruins in England, and they were both amazingly complete and amazingly empty and untouched; Other than a tiny signpost saying roughly what they were, they were just some stone walls standing in a field. Stone walls, with square relieving arches, and surviving Roman plaster, and alcoves for the god of the bath, and the remains of the hypercaust visible near the caldarium, and a long green depression in the grass where the frigidarium would once have been, and just generally a wonderful sense of peace and being far away from the horrors of modernity. And we got to the Cumbrian coast, with its odd green clay pebbles and huge plates of broken bivalve shells, and happy Friesian cattle and alpacas grazing right up to the tide line.

 

On the way back to the flat, there were buzzards everywhere, and pretty bikes on the road, and generally the world seemed fine as long as we just avoided all human contact. But, well, all human contact needed avoiding.

 

The Sunday after getting back home, I went for a long ride out on the bike, basically circumnavigating the county before ending up in the biker cafe on the border. It was, frankly, a beautiful day. Blue skies, grass and fields just starting to turn from green to gold in places, and a cafe and field and car park full of happy bikers and their families, eating ice creams, enjoying the sunshine, snoozing on the grass, admiring each other’s machines. I parked up between a glorious triked Rocket 3 and a red Aprillia that looked like a wasp, bought a baked potato and a bottle of Lucozade, then sat on the hill overlooking the entire field, generally enjoying simultaneously being surrounded by people and being left basically alone.

 

Then the Monday was Attempt Two on the Mod 1 – Did not pass; Honestly think I was set up to fail, having not had a chance to ride the bike at all beforehand, but at least I had a nice paper of chips and nearly witnessed my riding instructor buying a lifesize fibreglass gorilla for the garden. Have booked back in for the 19th of July, at 08.00, which feels a bit early in the day to be doing anything at all. But needs must when the devil drives.

 

Tomorrow is an appointment at rheumatology- Firstly, I have no idea what for, but presumably this is my usual standing appointment, and secondly, I really don’t want to go since I don’t want to think about being ill right now any more than I really have to.

Advertisements

Other People

This was an article on Pulse Today today, and it annoyed me so much that I thought I’d rewrite it, showing instead a model of how the same theoretical appointemnt would go as an “ideal interaction” as a patient.

 

I’ve reproduced the full text of the original at the bottom, in case it gets mysteriously deleted.

 

My version goes here, keeping the same title for continuity’s sake;

Treating a Chronic Sense Of Self-Entitlement

She’s new to the surgery, so I’ve booked her a long appointment, knowing that a change of practice means that I’ll get a whole flood of complaints and ongoing issues that need chasing up from her last doctor. I know that I should have read at least the brief precis of her notes before she got here, but they’ve not been uploaded yet, so I’m going to have to wing it.

She launches straight in as soon as she arrives, knowing that a fifteen-minute appointment isn’t much time in which to cover everything;

‘I need a prescription for all my usual meds plus some extra sleepers. And supplies of milk for the baby. My sickie’s overdue and I need a letter from you to help my appeal. How can I work with these knees? I need them X-rayed. And you need to do something about my weight. And while you’re doing the prescription, you can put on some nicotine patches,’ she pauses for breath, ‘And you can do me a rehousing letter. I need a ground-floor flat coz for some reason they’ve put me on the second floor and the lift never works.’

I lean back a bit in my chair, slightly taken aback by the machine-gun fire patter (She’s evidently been running the list over in her head for a while) and start sorting things out in my head.

“Hang on a minute” I say “That’s a lot to take in at once – If we can’t cover everything in this session, can you book a second one for…” I click through my calendar, finding a few slots in the next fortnight “…Either Monday at 9am, or Thursday at 3.45?”

She nods at one of these, which I quickly grey-book.

“Right, sorry. Admin. Which is the most important to you then, that needs to be done today?”

She takes a deep breath.

“Sick note first, my manager has been harping on for a week to get it up to date, and if I don’t get it today, I’m out of work.”

I nod, and queue up the form to type a sick note.

“What exactly is the problem then?” I ask “Is that your knees?”

Assent, again. I ask how long they’ve been bothering her, and to describe the problem a bit. She does so, saying that they affect her ability to work, and I surmise that this is why she wants a flat on the ground floor. I book her in for the community physio, warning her that the first thing they’ll do is to tell her to lose weight and eat better, which will help her weight as well as taking the stress off her knees, and book her in for the aforementioned imaging as well – An x-ray at the walk-in within the week, and a waiting list for an MRI.

I give her an exercise prescription card and, remembering that she said she had a baby, tell her which of the council leisure centres nearby has a creche.

And then I print out the sicknote, saying in half a dozen words that her knees are in pain and are being investigated by her GP.

 

I do a mental checklist. That covers “ My sickie’s overdue“, “I need them X-rayed” and “do something about my weight“. What’s left…

 

“You asked about a repeat prescription – Have you got an old slip on you?”

She has, so we look through it together, and she tells me how each of the medications help her, and what their side effects are. Together, we work out two medications that could be streamlined into one, one which she stopped taking months ago but forgot to stop refilling, and one where she’s happy to try a different medication in the same family since it has a slightly gentler set of side effects.

“You mentioned needing extra sleepers” I say, reading the exact medication off the list “Do you ned more of the same, or a different one?”

She shrugs, and I realise that I should have known that she wouldn’t know, because she’s not a doctor and might not even know how they work. I ask a few questions – Have they stopped working? Do you need more to get the same effect? Have your sleep problems got worse? Did they just not work very well in the first place? And quickly work out what she actually needs, and amend her prescription accordingly, making sure that she can pick up the whole new prescription on the way home (Nobody likes having their medications out-of-synch).

I look up at the clock – Ten minutes left, we’re actually doing well for time, and this is what long appointments are for.

“Nicotine patches, you say? Are you quitting smoking?” She nods proudly, and I smile, more than happy to help.

I dive back into the questions – Have you tried to quit before? How much do you smoke per day? And offer her the “smoking cessation” booklet that I know has all the information in that I don’t have time to share, along with advice to ask her pharmacist for more advice if she needs it, a prescription for her first course of patches, an invitation to come back in a month to see how she’s doing, and a hearty wish of good luck and goodwill.

I ask her again what’s left on her list, since I can’t remember all of it, and she’s more likely to remember what’s troubling her than I am.

“Milk, for the baby” she says, and I wonder why she needs prescription milk – Again, the notes aren’t through yet, so I ask her what the prescription milk is, and determine if it’s something that we can actually supply or not, and check that she’s got an appointment with the New Mothers’ clinic, which does basic health checks for both the baby and the parent, and ask if she wants some literature for the new parents’ group that the clinic runs.

I rack my brains, to see what’s left.

“You said you needed a letter for rehousing?”

She replies;

“Yeah, I’m on the second floor, the lift’s always broken, and it’s playing havoc with my knees.”

I think quickly; If this is only a temporary problem, she won’t need to be rehoused, but it’s definitely worth getting on to the council to get them to fix the lift. I bring up her address, look up the number for buildings maintenance on the council website, and tell her to phone them, writing it down clearly on a piece of paper along with the words “Reasonable accommodation”. If this is a permanent problem… Hmm. I’m already going to see her again in a month, but I tell her to book a long appointment for then as well, to cover both her knees – which since she’s off work and unable to climb stairs are evidently really affecting her quality of life – and her smoking.

 

I look back up at the clock. Three minutes to go.

“Does that cover everything?” I ask. She counts on her fingers;

“Bad knees, weight loss, milk, housing, sickie, smoking, repeat prescriptions.”

I reply;

“On the physio waiting list, booked in for imaging within the next month, got the gym card, booked in for the mother and baby class, you’re going to phone your landlord about the lift and I’ve given you the number, you’ve got your sicknote there in your hand, we’ve gone through your prescription and changed a few things – including giving you nicotine patches – and you’re coming back in a month to tell me how the physio and the quitting are going, and to see what your x-ray has brought up.

“Sorry, I know it’s a lot to remember, but everything that you need to remember is in one of those papers in your hand, and you’ll get a letter from the Trust to tell you when your appointment is once it’s booked. Is that all all right?”

She smiles, looking honestly relieved;

 

“Yes, thank you. Right, see you in a month.”

 

I wish her good-bye, and off she goes. As she gets to the door she says;

 

‘Any chance of a prescription for Calpol?’

It clicks – Prescription for milk, prescription for Calpol; She’s struggling financially, both of these being things that you can buy comparatively cheaply, but that (If you get free prescriptions due to being on an out-of-work or low-earnings benefit, which she may well be since she’s ben sick for long enough to need more than one sick note) a doctor could prescribe. And being on half-pay for sickness, or possibly even needing to take the sicknotes to the jobcentre, will wreck anyone’s sense of financial stability. Thankfully, the council have some advice leaflets and a service to phone to get a foodbank referral and help from the local credit union, and the Citizens Advice Bureau can do the rest. Along with the prescription for Calpol, I give her that information.

 

 

***

Am I naive in thinking that’s both a much nicer interaction, and not completely above-and-beyond the call of duty? The GP sees someone who’s “learned helplessness” and “sufferring from a chronic sense of self-entitlement”, based solely on the idea that they’re working class, have poor social graces, are fat, and are concerned about their weight and joint pain, and seem to be at a loose end financially. I see someone who’s trying to quit smoking, trying to manage their weight, trying to get to the bottom of a health problem that’s bothering them and has stopped them from both working and sleeping, and is running up against an obstreperous GP who won’t even point them in the right direction. This is a GP who sees someone who is in pain and distressed and decides it’d be “fun” to call them names.

I’m baffled by the idea that going to your GP with a long term health-problem is “Being entitled to anything and everything”.

 

 

Treating a Chronic Sense of Self-Entitlement

“She’s sunburnt, elephantine and heavily tattooed. Which may or may not be relevant, but is a fact. She’s also new to the surgery.

Waiving all the conventional niceties, she launches straight in: ‘I need a prescription for all my usual meds plus some extra sleepers. And supplies of milk for the baby. My sickie’s overdue and I need a letter from you to help my appeal. How can I work with these knees? I need them X-rayed. And you need to do something about my weight. And while you’re doing the prescription, you can put on some nicotine patches,’ she pauses for breath, ‘And you can do me a rehousing letter. I need a ground-floor flat coz for some reason they’ve put me on the second floor and the lift never works.’I take a step back mentally if not physically, though the latter’s tempting. This, I reckon, could be fun.

‘I think I can see the overall problem here,’ I say, ‘You’re suffering from a chronic sense of entitlement.’ She narrows here eyes, but I plough on, ‘You’re confusing wants with needs, and because no-one has ever explained the difference, you’ve developed a learned helplessness and dependency which you’re locked into. I suspect no one has ever had the time or inclination to liberate you, but that’s what I’m going to do. Your freedom lies in one word, and that word is, “No”. So that’s what I’m saying. No. To everything.’

I sit back and wait for the fallout. The fact that I’ve folded my arms really isn’t a sign of smug self-satisfaction. It’s actually self-protection. So’s the tin hat.

She leans forward, looks me in the eyes, and begins: ‘I think I can see what you mean, doctor. You’re saying that over the years, I have developed the attitude, perhaps reinforced by health professionals, that I’m entitled to anything and everything. In turn,’ she continues, ‘This has undermined any vestigial ability or inclination I might have had to sort out my own problems, with the result that I’ve developed this unrealistic level of expectation and intractable passivity. The fact that everyone has bowed to my demands has simply, in the long term, led to my own disempowerment. I’ve become a victim of those who have tried to help me, because they have effectively rendered me helpless. So I understand why you’re saying “no”. Indeed, I appreciate the irony that your refusal is, after all, simply a reflection of your own entitlement, as a responsible professional, to tell what you see as the truth. I respect the stand you’re taking and will try to move on from here. I bid you good day.’

With that, she got up to leave.

 
 

Hand on doorknob, she turns and asks, ‘Any chance of a prescription for Calpol?’

‘Sure,’ I say.”

Dr Tony Copperfield is a GP in Essex. You can follow him on Twitter @DocCopperfield