Sunday, February 8, 2015

Mind games

Her name was Sian. and at every single visit, all she did was cry. No noise..just tears poured down her cheeks. 7 visits later, she looked up and said,"I need some help. I can't live with this diabetes anymore. Can you help?" And for the first time in many a year, I winced. What help could I possibly give her? Send her to whom- re refer back to GP? Walk away from it? Send to a psychiatrist? Or a psychologist? I simply didn't know

Let me be honest, I have never been a believer when I finished my training- perhaps a flaw of our training that rarely if ever, one gets the chance to see a psychologist at work, understand the nuances, the support or even be given the training to understand what patients need. Too often, its about the number to hit, the complication to screen, the perfunctory chat about "how's everything?" before moving on to the next patient on the assembly line. But time is a fantastic gives you experience, teaches you things most books can't, most training programmes can't give you access to and certainly no lectures can educate you about.
In between is the issue of evidence based medicine- and as ever, in this country, we lose perspective when we debate evidence. You will have the EBM evangelists who will spare no one who strays from it, you will have the ones who experiment with anything- while juxtapositioned are the ones who appreciate EBM but also understand the need to stray from it - based on the person in front of you, based on the needs of the patient who just needs some help- and doesn't quite understand how big or small the standard deviations are on a research project. Someday I shall write a blog about EBM and its flaws, its tight constraints and the essential issue of not being able to replicate research in a financially constrained work environment- but that's for later. Let me put it to you simplistically, if we followed EBM to the tee as regards Type 2 diabetes, this would be quite a nihilistic world indeed.

Mental Health or simply put psychological support has always been a bit like modern NHS hashtag campaigns- always talked about but rarely implemented. Yes of course there are centres like Bournemouth, of course there are places like Kings who do amazing stuff- but the majority of places have little to no psychological support for patients with type 1 diabetes care. It's always been our achilles heel too..what's the point of having screening tools to assess someone if you don't know who or where to send them to? I see patients who sit in front of you, tears welling up, struggling to deal with the issue of having to inject themselves every day- and I have found myself helpless. I have tried but there's been a limit- and its rare for me to feel that way...spare a thought then for the patient who has to live it every day, eh?

So, it's been a minefield to try and set something up- different providers, different CCGs, different ways of working but this has always been something on my list to complete- and in one of patient engagement events, I had promised to deliver 7 day diabetes service and psychology service. Stepping down recently thus had come with this last twinge of regret- so it has been singularly satisfying to get this through. I must say the support from colleagues in partner organisations, the willingness to help and constant support from our commissioners have been nothing short of astounding- and without them, this wouldn't have been possible- so thank you so much.

There have been many things we have done, irrespective of what NHS structures have changed irrespective of who has won what contract, irrespective of number of providers, belief of other specialists- but this has been one of singular pleasure. It's because tomorrow if another Sian ask me that same question, I can at least smile and know what to do. i can at least get someone who is trained more than me to help Sian. For that, I thank you all..all of the who have flagged it to me, helped me to deliver and been there to support when needed. It has been much appreciated.

To colleagues around the country, you can use many many reasons why it can't happen..if its the HSCA today, it will be something else tomorrow. Try..and then try again. As specialists, we are the advocate of patients in meetings, forums etc where patients don't get access due to a multitude of reasons. If you believe in something that will hep your patients, let's not play mind games...let's not play hashtag hoola-hoops...lets deliver. From personal experience, there are plenty of like minded people- whether they be managers , nurses, fellow doctors- who are keen to join forces to make it happen. Go...give it a try.

(Real name of patient changed for purpose of blog)

1 comment:

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