My NHS pdoc is evil. Can I get a new one?

October 31, 2007 6:07 AM

NHS filter: I just had a horrible experience with an NHS psychiatrist consultant. Can I get a different doctor?

I'm in the UK and I have depression. I've been on SSRI's for years, and occasionally they stop working and have to be replaced with a different pill. My GP referred me to the mental health clinic and I had the appointment today. I was insulted to the point that I've been in tears for two hours. All of the stereotypes that are held about depression were trotted out: 'You shouldn't count on a pill to fix you.' 'Why aren't you doing anything to change your situation?' 'Anti-depressants don't just stop working.' 'You shouldn't just go to bed in the evenings--you need to do something productive.'

She finally agreed to change my medication, but gave me a very low dose of a tricyclic with no plans to see me again until January. I suspect that she's using this as a placebo rather than because she thinks it will do anything, because it seems that despite being a psychiatrist, she doesn't believe in medicating depression.

Is it possible to see a different specialist on the NHS or am I stuck with this horrible woman?

posted by happyturtle to health & fitness (10 comments total)

Your referring GP can arrange for you to get a second opinion. Explain what happened to them about your session, and they can take the necessary steps.
posted by Smart Dalek at 6:24 AM on October 31, 2007 [1 favorite]

http://www.pfc.org.uk/node/633#access

You have the right to:...
be referred to a consultant acceptable to you, when your GP thinks it is necessary, and to be referred for a second opinion if you and your GP agree this is desirable.

Go back to your GP with your concerns. Hope you get a good quick resolution to this.
posted by edd at 6:29 AM on October 31, 2007

Oh wait, scratch that. 'The Patient’s Charter was abolished as part of changes to the NHS implemented in the year 2000 under the 10-year “NHS plan”.'

Still, GP is probably the best option right now?
posted by edd at 6:30 AM on October 31, 2007

It may be worth writing to your original pyschiatrist to request a copy of your hospital notes now. That information is usually very useful to your new consultant.
posted by roofus at 7:19 AM on October 31, 2007

You absolutely have the right to be seen by another consultant. Tell your GP what happened, that the therapeutic relationship with this one is damaged and get a new referral.

Dealing with depression is very hard. Sometimes you only see the negatives in what the doctor said to you, but you will have taken that into account I feel in writing this question.

In my opinion the consultant (or more likely senior reg ) you were seen by is going through the motions as a result of a backed up clinic. It is not abnormal to have 25 depressed people in an afternoon clinic which is NOT conducive to the patient's needs. Time becomes an issue and the behavior you describe a product.

If you really feel very poorly treated when you've taken some time to action a solution with your GP, do let the PALS at your Trust know about this. They will be linked from your Trust's website.

all the very best, e-mail is in the profile if you want to talk.
posted by Wilder at 8:16 AM on October 31, 2007

Could you describe the insulting part of the behavior in clearer detail? As I read it, you asked for a different pill and got it, in a low dose which seems reasonable to minimize initial side effects. Switching classes of drugs can be helpful. Is it that you wanted a different SSRI? Did you have a specific therapeutic plan in mind that was rejected by the shrink?

Rather than being "stereotypes of depression", staying active, having a plan to improve your life and acting on it are examples of successful maneuvers to treat mild to moderate depression.

There's no longer any doubt that pills + cognitive therapy generally are more successful at treating symptoms than either one alone. Check your bookseller or library for books on cognitive behavior therapy, most of which will list some of the surprising perceptual errors that go along with the difficult emotions of the illness. I think you'll find a good deal of comfort in the fuller understanding of this medical condition.

In an overburdened health care system, the success of your therapy and the quality of your life will be dependent even more on how actively you work on your own behalf, going beyond strategies with limited effectiveness like biennial pill switching. The good news is that effective answers and approaches are within your reach. Best wishes!
posted by bbranden1 at 9:52 AM on October 31, 2007 [1 favorite]

Thanks everyone. I've left a message for my GP to call me.

bbranden1, the insulting part is that I went to her for help and instead was lectured over the course of 45 minutes (most of the time with me in tears) about how I'm not trying hard enough. Her attitude was contemptuous and she completely discounted my physical symptoms. When I say she was insulting, I don't just mean that she disagreed with me. I mean that she treated me as if I caused all my own problems by having the audacity to go to bed early when I'm so fatigued that I can barely function, and if I'd just do something else instead of not going to bed, I wouldn't need pills. She may have said a few useful things during the appointment, but her dismissive attitude and her complete lack of compassion were far more prominent.

Wilder, she was indeed a Psychiatrist Consultant. I saw it printed on her ID tag. This is what is so shocking to me. I could understand a doctor in another field not being fully aware of the difficulties of depression, but for a psychiatrist to treat me this way completely blindsided me.
posted by happyturtle at 1:05 PM on October 31, 2007

bbranden1: "actively working on your own behalf" can be really hard, or impossible, when you're depressive. That's, basically, what depression is all about...
Your "good news" of "effective anwers and approaches", implies that every case of depression is completely curable if the patient is compliant. This is simply not true, and in many cases "just" switching meds, and accepting that it will not go away completely, is the best one can do.

Good Luck, happyturtle!
posted by The Toad at 4:27 AM on November 1, 2007

Just checking in here to say Best of Luck!

And completely agreeing with The Toad's point. The difference in depression is the almost complete inability to take that action even though you know as a matter of certainty that you should, or that it would be good for you.
It is, quite literally, crippling.

Just taking on the system here and changing Psychiatrist is a hugely positive step on happyturtle's part.
posted by Wilder at 6:28 AM on November 3, 2007

Just a followup to say that my GP has been very supportive, and I'm doing a lot better. There are some antidepressants that GPs are allowed to prescribe without referring to a psychiatrist, so he's agreed to use one of those medications and manage my care himself rather than sending me back to the demon doc.
posted by happyturtle at 4:46 PM on November 9, 2007