Monday, September 04, 2006

I like my job

Well, I've had a week off but today I'm back at work and running late already...

It seems the more things change the more things stay the same: same old faces, same old problems. A bit like a favorite old jumper.

My most recent patient (whom I shall call Daphne, as that is of course not her name) has been suffering from anxiety. Doesn't sound too major, does it?

Except that Daphne has had symptoms for years. It stops her going out, predominantly because she gets diarrhoea whenever she gets anxious. It makes her go home early for the same reason. She avoids doing things she used to enjoy just in case she gets diarrhoea while she's out. She suffers palpitations on a regular basis, which make her feel even more anxious in case there is something wrong with her heart. Her appetite could best be described as "variable", which becomes a problem when you realise that she hovers at a BMI of 19-20 (so any weight loss makes her underweight, although there are of course arguments about the validity of Body Mass Index as an appropriate measure of health in isolation). She smoked to help herself cope. She used to argue frequently with her husband and felt abandoned by her friends. She couldn't sleep because she kept mulling things over in her mind.

Three months ago, Daphne came to see me about her tummy problems. It had taken her a long time to summon up the courage to do that. After all, she said, I'm a very busy man. I don't need frauds like her taking up my time when there are people who are actually poorly who need me, rather than just people like her, "being stupid". She was sure that it was "just nerves". She asked why she couldn't just pull herself together. She asked me if there was anything I could give her and then followed that question immediately with a statement that there was nothing that could be done for her as she was just a pathetic waste of space. She didn't want a sedative or an antidepressant or anything like that, apparently.

I felt very sorry for her. Given she had said she didn't want anything which would actually help, I explained that she might like to reconsider, but that in the mean time we could try an antispasmodic.

She came back to see me about a month ago. The antispasmodic hadn't worked. She was now prepared to try something else.

Anxious people often have poor self-esteem. They sometimes don't come to see me when they should because of this. Which is a shame. Sometimes (as with Daphne) they come with something else, an excuse if you like.

Anxiety is usually very treatable. There are a variety of non-pharmacological therapies available, some with an evidence base, some without. However, in todays NHS, certainly where I work (at the moment, but there may be a post on this at a later date), the only readily available therapy involves pills on prescription from me.

Mind you, that isn't necessarily a bad thing.

Daphne, for example, left me after about 25 minutes with a prescription for a few diazepam and a month's supply of citalopram. I asked her to come back after a fortnight to see how she was getting on. When she came back, things weren't quite so bad, but she still couldn't go out for fear of an episode of diarrhoea. She was sleeping better though. Oh, and she'd stopped smoking.

She came back to see me this morning, after a further two weeks.

She tells me she hasn't felt so good in years. The diarrhoea has gone. She went into the local shopping centre early in the morning with her husband over the weekend for the first time in several years and apparently burst into tears because she was so relaxed. She feels normal again. Her husband says she is the calmest he's seen her in years, much more like the woman he married 40-odd years ago. She had a new hair-do. She is also wearing a new smile.

She's not there yet. But she is getting there.

I like my job.


Surgeon in my dreams said...

Glad to see you back!!

GOod for "Daphne". I have the same thing and it is so lonely and horrible. You only want to be "normal" and it is hard not to give up.

You're gonna make a good doc!

Lucy said...

It's great to hear you were able to help Daphne. For some people, medication is the way forward but it's appalling that the evidence-based talking therapies are basically not available to many people in the UK due to the huge waiting lists for cognitive behaviour therapy through the NHS.l