Iatrogenesis

Iatrogenesis

I know I’m not the only one who dreads a visit to the doctors. I generally dislike GP surgeries, although I’m not phobic of them in the way I am of hospitals, but it isn’t the sitting in an overly-warm badly decorated waiting room surrounded by sick people, or even the mind boggling rudeness of the average receptionist that fills me with dread. It’s the fact that I always, always end up feeling worse upon leaving than when I went in.

I’ve been consulting my GP (ha! Actually many because it is a group practice and I have never successfully managed to book successive appointments with the same doctor), primarily about the significant weight loss I’ve undergone over the last year. I am now underweight by some margin and look and feel like death. I’ve had a bunch of blood tests to rule out anything nefarious and thankfully, my body doesn’t seem to be the cause: I had been worried that my thyroid had been playing up again. I stepped on the scales again and my weight was the same it had been four weeks ago – that it hasn’t gone down further is a reassuring sign.

While that is a relief, it also means that my weight loss is tied to either my anxiety, or breastfeeding, or most likely both. I have been calorie tracking and I do eat ‘enough’, but probably not enough if we factor in lactation and the high metabolism that comes with anxiety. 

I have been receiving CBT with an aim to challenging the anxiety and OCD since June. I will probably only have one or maybe two more sessions. My PHQ9 and GAD7 scores show that I haven’t made significant progress, and while the tools I have been learning (or rather relearning as I’m no stranger to CBT) are useful,  they haven’t made a big difference yet. So I ask my doctor, what can we put in place for when these sessions end? 

His response was firstly to explain CBT and anxiety to me like I didn’t understand what I had been experiencing, and then summed up by saying that I had to wait until I had a crisis and then request further therapy. I pointed out that I have two very young children and that I was not willing to let myself get to that point, especially keeping in mind it had been a six month wait to get this lot of therapy even though I was supposedly a high priority patient. 

‘Hmm’

I sigh and bite the bullet – does he think it would be sensible for me to perhaps restart on an SSRI? I had not taken any since being pregnant with my second child, but now she is well over a year old I have less misgivings about potential effects on her. Oh yes! That’s a good idea (it was by this point clear he’d not actually looked at my notes at all, and knew nothing of my long history with mental illness or even if I was taking medication). He then tried to put me on a different SSRI than the one I had taken successfully before but I managed to persuade him to stick to the old drug as I know I have almost no side effects on it after the initial few weeks. 

When I ask for a note to send off to the DWP to make sure my ESA payments continue for the next four weeks, he pouts, and doesn’t look me in the eye for the rest of the appointment. He requests I book another appointment in four weeks to assess the SSRI dosage. He doesn’t say goodbye as I leave the room.

At no point did he attempt to make any kind of human contact. No, how are you? How are you finding it? What are your worries? How are your kids? A prescription and an instruction to call the crisis helpline if I relapse further once my therapy is cut off. 

I left the surgery feeling like the biggest pile of shit. I was more convinced than ever that I was somehow going to have to fix myself because no medical professional (therapists not included) I have seen has seemed remotely interested in my actually getting better – they just want me out of their hair. It’s like they know it’s hard, that it’s outside of their comfort zone, so they don’t even extend the courtesy of trying. Take the pills and bother the non-existent MH team. This can’t be because they don’t care. I think they are probably good people. But because they know there’s fuck all they can do they just put a barrier up to protect themselves. 

But it left me feeling entirely worthless. Like I was totally on my own. I’ll take the meds but I know from before they just leave me pretty vacant – they don’t alter my thought patterns or anxiety symptoms. If I’m hung out to dry with no access to further therapy I am really scared about how I’m going to get through the winter.

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