At Your Service: Getting Past The GP’s Gatekeepers

I couldn’t tell you how many times I’ve heard people complain about the attitude of the reception staff at their local doctors surgery.  Not just at one particular surgery but at several, all over the country.  As a hypochondriac (brain tumours, pulmonary embolisms and good old breast cancer, I’ve had ’em all…almost) I’ve tested out the receptionists in towns and cities from London to Nottingham, Woking to Castle Donington, and can honestly say that the vast majority have been pretty horrible.

Yesterday I called my local surgery, the Market Harborough Medical Centre – let’s name and shame, to book an appointment.  I was going away for four days had four days of my regular medication; anti-anxiety drug Pregabalin and mood stabiliser Lithium, left.  The maths is pretty straight forward, I needed a repeat prescription sooner rather than later. I also wished to speak to a doctor because, let’s face it, a regular supply of Diazepam never hurt anybody (er…) and I’m getting a couple of unpleasant side effects.  A ten minute appointment with a GP is a fair request, right?  Five’d do, I’m an experienced GP hassler.

But if I thought I’d just be given an appointment because, as a British tax payer and registered patient of MHMC, I’m entitled to one, I was obviously living in cloud cuckoo land, surrounded by a herd of pink unicorns frolicking beneath rainbows.

The wonderful, sweet and caring receptionist I was unfortunate enough to be put through to had other ideas about how I should be managing my illness and medications.  With her phone set to ‘Voice of God’ volume so I needed to hold it away from my ear – I wouldn’t want to put her out by needing a second appointment for Tinnitus – she informed me with a irritated sigh that my usual GP wasn’t available until next week ‘and ANYWAY we’re not booking for Dr Yates until Friday’.

I explained my plight to no avail. ‘So you want a repeat prescription?’ yes please, oh merciful one, ‘well, you have to have a blood test.  You were SUPPOSED TO have had one in February.’

That was when I started losing my rag.  I shouldn’t have, I know, but seriously? I don’t think I told you it was a repeat prescription for Lithium (which does indeed require a regular blood test).  And besides, if you nosey in to my medical records further you’ll find I had the tests in March and my prescription states that it’s review with the doc time.  Also isn’t this filed under None Of Your Business?

She went on to advise me, in loud, exasperated voice, ‘you know you don’t have to have an appointment, you can still get your repeat prescription even if it says you’re due for review’.  I’m sorry but what?  You’re advising me to ignore the advice of the doctors and at the same time you’re trying to talk me out of booking the appointment that I called for?  I get that you’re busy but…but…*head explodes*

Eventually I was begrudgingly granted my appointment, not before being asked in the most condescending way possible; ‘don’t you think it would be better to wait until Dr Yates is back so you can see him?’ (I didn’t think of that, what a complete IMBECILE I am.  I’ll do this the right way and hold fire on the medication that stops me from LOSING MY MIND until he’s free), just so I was aware that I, pathetic minion, was being given something against the better advice of the highly qualified health professional manning the phones.

I hung up, I sat down in my kitchen and I cried.  I felt like I’d been bullied and belittled, like I’d lost control and worst of all, I felt uncomfortable at the idea of my medical records being open to this woman, in a small town where gossip is traded like sweets, especially by certain types of women.  The conversation went round and round in my head all afternoon and I was shaky, tearful and snappish for several hours. I was nervous about my visit to the GP – something I’ve learned to brave out and normally find fairly easy to do – and asked Mr H to go with me for moral support.

Actually, I should say here that since writing this I’ve seen the locum GP who happened to be pleasant, professional, interested in my condition and very helpful indeed.

My reaction to a situation like this is an extreme one, but that doesn’t excuse the receptionist’s behaviour, or the similar behaviour of others in her position. I wouldn’t expect anybody to guess that I have Social Anxiety and, specifically a phobia of the phone (I struggle to call my mum and it’s pretty much unknown for me to phone my best friend). However I think it’s fair to expect a level of patience, empathy and, well, just a smidge of professionalism from someone paid to speak to people who potentially have a life threatening illness, are scared for their health or have a mental disorder. Should not every call be answered under the assumption that the patient at the other end falls in to the category of ‘To Be Treated With Kid Gloves’?

The job of a receptionist at a doctors surgery is doubtless a stressful one and I imagine the women at MHMC encounter all sorts of not in the least wonderful people.  Nobody expects them to be infallible, but they are paid tax money to take it all on the chin and smilingly greet the next person. It’s just part of the job and if you can’t manage it try something else. You know how it always seems to me? It seems like these gatekeepers have been given the tiniest bit of power and it’s gone straight to their heads.  Pull your necks in girls, nobody’s impressed

So if the idea of being polite to everybody is just too much could the surgery’s computer system not flash up a warning for those who most need the special treatment? Not that long ago the unhelpful attitude of MHMC staff led to me not pushing for drugs I needed and in the past Mr H has dealt with my requests and requirements because, shot down in flames on a phone call, I timidly retreat. I can’t be the only one. At least the receptionists receiving a warning that a particularly vulnerable or awkward patient is on the phone would allow them to save their niceness quota for those who need it the most.

Have you experienced the Gatekeeper treatment at your GP’s surgery?  Or perhaps somewhere else? How do you think NHS services could be made more accessible to patients? 

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Mental Illness on Screen: Homeland, Bipolar and ECT

Watching C4 drama Homeland over the last few weeks I’ve been intrigued by – as well as the teeniness of Damian Lewis’s mouth – the portrayal of bipolar disorder which began as an incidental aspect of lead character Carrie’s (Claire Danes) life, later becoming a major plot changer.

wow, that really *is* a tiny mouth

It’s rare to see mental disorders, especially bipolar, represented in a serious manner by TV. Usually we’re a bit of a joke, seen as losers and undesirables, the ones shouting ‘gerbils!’ at the side of a road. So it was refreshing to see Carrie, in early episodes, portrayed as somebody with strengths as well as weaknesses, managing a successful career as well as a personality disorder.

The realism of Carrie’s need to cover up her condition in order to maintain that career especially rang true, and while I’m certainly not a high flying CIA spy or working in any industry requiring one not to be a card carrying nutcase, I have often debated whether or not to confess all (perhaps not all) on an application form and have met people who keep their condition a secret from employers. It’s an interesting debate – should those with mental illnesses be exempt from certain jobs? – though sadly not one that was explored during the course of the series.

During the latter episodes of Homeland, as Carrie’s ascent towards mania continued I felt that the sensitivity was lost somehow. While Danes’s performance was impressive it felt at times that she’d been directed with ‘you’re mad, really mad! MORE crazy eyes!’ to fit in with a script plucked from Wikipedia’s ‘Bipolar’ page.

While I wouldn’t for a moment deny that the symptoms of Carrie’s bipolar – promiscuity, obsessiveness, an inability to look after oneself, risk taking – were true to bipolar life, they were lazy choices that barely scratch the surface of the complexity of the condition. It certainly appeared that Homeland’s scriptwriters had little experience of bipolar and had they took the time to explore further they may have created a more nuanced character and one who was infinitely more likable. It says a lot that for the most part the obsequious wannabe terrorist was a more sympathetic character than the mentally ill woman he was conning.

Even less believable was Carrie’s final scene. I mean, ECT, seriously? I understand that the series is set in the US and doubtless mental health care works differently there, but I find it hard to believe that somebody would walk off the street to be administered a serious, highly controversial treatment that here in the UK is an absolute last resort. Carrie appeared to have requested the ECT but in reality would somebody in a high state of mania have been considered fit to choose? And would her sister, also a health care professional, have allowed her to jump directly from medication to fizzing the fuck out of her brain? Hadn’t she heard of CBT? Perhaps she might have suggested a few lifestyle changes, you know; more sleep, eat right, less shagging of married, high profile ex-hostages?

yep, sign me up for some of that!

What really overshadowed all of these ‘uh?’ moments though was the portrayed administration of the ECT. I know that my horror at this is entirely due to my own morbid fear of being carted off to be electrocuted until I’m a vegetable (but at least a sane vegetable), but did we need a graphic version of ECT on our screens? Was the fact that in real life anti-convulsants are administered prior to ECT, that the treatment is stopped after a only a few seconds to avoid the good old Jack Nicholson convulsions, just too inconvenient when a crazy woman fitting on a bed provided a wonderfully shocking finale?*  While I accept that in terms of realism Homeland’s version of shock therapy was an improvement on films of the past (although it should be remembered that many of those films were made at a time when ECT was a far more torturous procedure), only ever so slightly exaggerated, it felt almost worse to see it taking place so casually, just an addendum to a story.  At least those films – One Flew Over The Cuckoo’s Nest, The Snake Pit, Requiem for a Dream – pushed us to question the brutality of such a treatment.

To my mind, what was an opportunity to really explore bipolar in a form that would reach a wide international audience became an exercise in shock tactics, the realities of mental illness buried beneath a lot of fast-talking and crazed expressions, Carrie’s only trump card, the only thing that proved that she wasn’t entirely insane – the truth about Brody – was even snatched away by the writers (alright, they had to do it, I want series two as well) at the last minute. It felt as if Homeland went from offering the first realistic bipolar TV character to dropping a final curtain scrawled with ‘and this is why we can’t trust nuts’.

*information courtesy of several morbid hours a month spent checking out ‘all the things they might do to me’.

Incidentally if you’ve ever experience Electroconvulsive Therapy I’d love to hear your thoughts – did it work?  Who made the decision to administer ECT? If it was you, why?…