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Susan

Brief Outline: As a child Susan saw the GP mainly for minor problems. As she got older, she saw the doctor because of several ongoing problems including ear infections, irregular periods, fungal infections and a rare eye condition.
Background: Susan is a medical student and lives in a shared house. Ethnic background / nationality: White British.

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As a child Susan saw the GP mainly for minor problems. As she got older, she visited the doctor for several ongoing problems including ear infections, irregular periods, fungal infections and a rare eye condition. 

When she was 13, Susan went back and forth and saw a few different GPs for a fungal infection of the feet. She was prescribed three or four different creams over time, none of which worked very well, so she gave up for a while. She went online and found some alternative treatments, including vinegar and yoghurt, but these didn’t work either. She was given very little advice on how to prevent fungal infections, which she felt would have been helpful. Susan also wished she’d known how long infections could take to get better as the appointments took place over a number of years and she still has problems to this day. 

Susan also saw the GP about irregular periods when she was around 17. She preferred to see a female GP about this as she felt she would be able to ‘relate to the problem better’. Susan was unsure what caused the problems but thought that it could be because she played a lot of sport and ate small amounts of food when she was younger. She felt that GPs had just wanted to ‘do some tests’ and ‘put her on the pill’ to regulate her periods. For a long time Susan did not see a GP and ‘just accepted’ that she had very irregular periods, believing that the GP was ‘not going to do anything for me’. 

Susan also went to see the doctor for what turned out to be a rare eye condition. In 2013 she woke up one day and had very blurry vision. She also had headaches but left the problem for three days, thinking that it was a migraine. She was also busy with exams. Eventually, Susan went to the out of hours GP and was impressed with how quickly she was able to see someone. The GP told her that she probably had a migraine and gave her painkillers. She was also advised to go to the eye hospital for a check-up after a couple of days. Susan went sooner, though, as she became increasingly worried and her headache had become severe. She hadn’t taken the migraine medication as she doubted that it had been a migraine. 

Being at the eye hospital was very stressful as Susan was given ‘hundreds of different tests’ and ‘many professionals’ tried to look at her eyes. Susan felt very disorientated and had no idea why she needed all the tests. She was diagnosed with an autoimmune condition and immediately put on a high dose of steroids. Susan was told that her blindness could be irreversible, which was very frightening. 

Susan had to take time off from university as she couldn’t see for several weeks and the steroids made her feel very ill. She became anxious and depressed during this time, particularly as she was worried that the eye problem would not improve and she would be unable to continue her studies and career. She was also told that the condition could cause inflammation of the brain, and her fungal infection deteriorated because of the steroid treatment. 

Susan felt that the eye problem ‘pushed her over the edge’ and that perhaps she had been struggling with ‘sub threshold mental health’ for years. After her eyes recovered a bit, she managed to get some counselling through university, which she felt ‘really helped’ and made a ‘big difference’. 

Over the years, Susan saw different GPs but felt that seeing the same person for ongoing issues would have been helpful. She believed that a good GP listens and has genuine concern for patients. She also felt that doctors should make patients aware of the different services available, and focus more on prevention and offering peer support. 
 

In medical school there is a ‘culture of denial’ about mental health problems. Susan felt embarrassed and bottled things up.

In medical school there is a ‘culture of denial’ about mental health problems. Susan felt embarrassed and bottled things up.

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I ended up getting counselling because I was feeling very stressed, and there was a lot of work for me to catch up with, yeah.

And was that through the university, through the [name of] Division?

I went online and I found, yeah it was via the university. So I didn’t actually see my GP, maybe because I didn’t have someone that knew me. But I still…I felt very embarrassed that I was anxious, and I've always bottled that up. And I didn’t…I think part of it as well I didn’t want another healthcare professional to see me being like that as well.  So I'd…but for some reason it was OK to see a counsellor [laughs].

Through the university?

Through the university, yeah.

Yeah, a few people have mentioned something similar. So you would have preferred …because it feels more anonymous?

Yeah and just…especially being a medic, I felt uncomfortable seeing a doctor. I think there is a bit of a culture of denial of mental health problems at medical school. And yeah, I guess I didn’t even give the GP a chance. And maybe if I had I would have been surprised.  But yeah I wanted to just stay out of that.

Yeah. Did you know that you could have seen the GP?

I think so but actually, before I did all the reading on the internet, and before I actually did my GP placement, I wouldn’t have considered it as my first point of call. I'd always seen the GP more as physical problems – the kind of quick fix prescriptions like my fungal infection, just go in, get the drug, or go in and get a referral. I didn’t…because I'd never had that much continuity of care, I didn’t see them as someone who would be well placed to see me over time and treat anxiety sort of thing yeah.
 

Susan felt a bit nervous seeing the GP on her own. It was often a different doctor each time and she wondered what they might think of her.

Susan felt a bit nervous seeing the GP on her own. It was often a different doctor each time and she wondered what they might think of her.

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So, as you got older from about sixteen onwards did you say?

Teenage years I would say, yeah.

You went to the GP by yourself. Was it something you discussed with your mum at all, or you just said, "Right, I'll make my own appointment." Can you remember how it might have come about that, first she used to go with you but then you started going on your own?

Yeah. I guess once I started driving it was really easy because I could get there myself. But I think I would normally talk to her about it. Obviously as I got older, like once I was at Uni, I’d just go. But yeah normally we'd talk about it.

So were you driving at that point, as a teenager?

Once I was eighteen yeah, yeah.

Before that did you go to the GP by yourself, walking, or taking the bus or, or your mum dropped you off and waited?

My mum would drop me off and she'd wait in the waiting room, yeah.

And when you went to see the GP by yourself at that age – I don’t know if you can remember – were you comfortable doing it, or looking forward to doing it, or did you have any thoughts about that at all, not having your mum there now and you were doing it on your own?

Yeah, I think to begin with I was quite nervous. I would never…I mean my mum kind of made me do it, I didn’t really want to. One thing is that I never really had a continuous GP, I'd often go and see different GPs. So, although I'd see one more regularly, it was very choppy and changey, which I think probably made it harder because they didn’t know me, so every time I'd be a bit worried like what are they going to think of me or whatever, yeah.
 

Susan’s infection was severe. She wished she’d been told that tablets would be more effective than creams. She’s had fungal infections for over 6 years.

Susan’s infection was severe. She wished she’d been told that tablets would be more effective than creams. She’s had fungal infections for over 6 years.

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I mean ideally I would have liked to just have a cream that worked, but I don’t…I think that probably mine was quite a severe one [infection] so I think…I think maybe if someone had been quite clear that oral was really the only thing that was going to work. 

The other thing is maybe just expectations because I think I was expecting it would get better all the time I was using the creams. When actually I think probably by the second or third cream it was quite clear that the cream wasn’t going to clear it. But no-one actually said, you know, ‘You’ve just…you’ve either got to live with this or just take the risk of the medication.’ It was more just, "Oh don’t worry we'll give you the cream and it will go," yeah.

Can you remember the time, the number of years or months or years-

Yeah years, definitely years, yeah, yeah.

So at one point you felt like giving up, so you were trying things that you'd read about on the internet, that wasn’t working either. So did you decide at any point to just give up completely or to go back or to see someone else, what happened?

Yeah, for a couple of years I stopped completely and it just kind of rumbled along at a low level, so I was fine. And then I had to have high dose steroids for another medical condition and it became very out of control, and that was quite recently. So now I'm actually considering going onto the oral medication [laughs] after all of that.

Oh so it's been going on for quite a long time -

It's still going on.

So it's been going on for a good five/six years or so?

Longer probably, yeah absolutely.
 

Susan was on a high dose of steroids. She was worried when she started having migraines again. The GP suggested she phone the hospital consultant for advice.

Susan was on a high dose of steroids. She was worried when she started having migraines again. The GP suggested she phone the hospital consultant for advice.

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The only time I actually went to see my GP was when my fungal infection got really bad because I was on the steroids. And it just got to the point where I couldn’t sleep because it was so itchy, it spread to all my nails. And I went to the GP but actually they didn’t really know what to do because it was quite a complex condition and they didn’t know how to address it really. And they said that any treatments they gave me wouldn’t control it because I was on the steroids at the same time, so it was a bit disappointing [laughs].

So did they give any cream or anything at all, nothing at all?

No, they didn’t give me anything. I think they got a bit freaked out when they heard the dose of steroids I was on. And they just said, "Sorry, you’ve got to speak to the hospital." And actually I was getting episodes of headaches as well which, again, I was really worried about. And now I think back, I did go and see the GP about that as well. And again, they just told me to go back to the hospital.

Yes, did they say what it may be or might be, or just it was, "Go back to the hospital, it's best to go and speak to them?"

Yeah, they…I think they were very careful. I think they were quite scared of saying anything because they knew that it was quite a complicated condition. But yeah, they didn’t really give me anything. I felt…I think, if anything, I felt more panicked after going to see them because they told me to go to the hospital, and didn’t really, yeah....

So did you phone the hospital or go there or?

I phoned, yeah.
 

Susan talked about tough times she’d had during childhood. It made a big difference and she found it ‘amazing’. It does take time, though, and isn’t ‘a quick fix’.

Susan talked about tough times she’d had during childhood. It made a big difference and she found it ‘amazing’. It does take time, though, and isn’t ‘a quick fix’.

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It was quite a weird experience, I didn’t…it wasn’t quite what I expected actually. So I had quite a few things in my childhood that were quite tough, but I'd never realised they'd affected me. And that was almost the first thing she talked about, and I had gone in wanting to talk about how stressed I'd been at university and how I'd had this awful condition in my eyes. And this was all making me sad. And that’s what I'd been expecting to talk about, and it wasn’t quite that. 

And it was really hard to realise kind of how things in the past had affected you. And so yeah it surprised me, and part of me felt very uncomfortable with it. But once I'd overcome that initial phase, it just made such a difference, yeah it was amazing actually.

So would you recommend counselling to other people around your age group who are feeling anxious, stressed, maybe not talking about it, keeping busy?

Definitely, because I mean, I thought that I had a…I thought I was fine and I thought that there was no need for it, and that I was just being silly. And actually it helped me so much.

Can you talk about some of the ways it helped?

Yeah. So I think the main thing was just admitting to myself that there was something wrong. Because I was in denial for a long time and you just kind of live with it, and you think, 'No, this is normal, you know it's OK, I can carry on like this.' And every time you kind of reach almost a crisis point you think, 'That’s it I'm going to do something.' And then it passes and you think, 'No, no it's nothing, I'm fine.' So I kept putting it off, I kept telling myself I was fine, yeah.

But talking to her, looking at things in a different way.

Yeah

How did the feelings of anxiety, were they there still a lot more at first, or how…you know, because you weren't expecting to talk about some of the things, how did it go over the sessions – were you allowed to have as many as you like, or was it like six or?

Yeah, so she was very good, she said I could have as many as I'd like. And actually she never really said the number of sessions, it was more like, she would leave me after a session and just let me get in touch. And I felt that was really good because it did take a long time, and it was not a quick fix at all. And I think just realising that early on that actually you're not going to go in and feel great after the first one. It really takes a long time and I think she gave me kind of bite sized amounts of things that I could do to make things better. 

And that was all I could really cope with, and I think just changing that expectation to, 'OK, I'm just going to do these small bits at a time.' And gradually just I changed things about my lifestyle. Things, the way I saw things, and it does give you strategies, and I feel like they’ll stay with me forever. And I, maybe I'll slip into bad things in the future but I think now I'm so much more aware, I won't kind of put them to the background, yeah.
 

Susan needed help when the surgery was closed. She was advised to go to the out of hours service. She was impressed with how quickly she could see a doctor.

Susan needed help when the surgery was closed. She was advised to go to the out of hours service. She was impressed with how quickly she could see a doctor.

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I called 111, it was over the weekend that I just decided I can't, and yes they told me to go and see the GP. 

So, you called 111 - they told you to go to see the GP – this was a weekend? 

Yes. 

So did you know what to do in that situation? 

They told me that there was a special practice that has…where I could go so it was really good actually. They told...and it was really convenient and close by and I could go in really quickly, so I was really impressed with how quickly I could see someone actually, yeah. 

So you spoke to somebody on the phone. Once you put the phone down did you go more or less straight away? 

I did. At this point I was quite panicked, especially that I think having that confirmation that I did need to see the GP made me think, 'I can't keep denying this', yeah. 

Did you go by yourself or? 

I went by myself, yeah. 

And so this was an out of hour's service. Whereabouts was it, you mentioned it was close, it wasn’t your actual GP's surgery? 

No, it was just down the road from here, so it was about a twenty minute walk for me from home, yeah. 

Were you OK walking? 

I was fine, yeah, I could see enough. 

You could see enough to.... 

Yes, I could. 

Was it all blurry though? 

It was, yeah. Well I had just these black patches where I couldn’t see anything, yeah. 

That’s quite scary in a way isn't it? 

It was, I was quite panicked to be honest, yeah. 

So you went then to see a doctor there? 

Yeah. 

Can you remember if you had to wait a long time, or were you seen quite quickly? 

I think I waited about half an hour, which I guess is what I was expecting. They told me that it might be a wait. I was just happy to be there to be honest, yeah. 
 

The out of hours GP thought Susan might have a migraine. She prescribed some tablets but also gave her a hospital appointment time to attend.

The out of hours GP thought Susan might have a migraine. She prescribed some tablets but also gave her a hospital appointment time to attend.

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So you then got seen. Can you remember who you were seen by? 

I can't remember their name or anything, I can remember she was a female GP, yeah. 

And you told her what was happening? 

Yes. 

What did she say or do, did she…? 

It was interesting – so she thought it was a migraine as well. She didn’t really know what to make of it to be honest, which you wouldn’t expect her to because it's such a rare thing. But actually, I mean she didn’t actually formally test my vision which I was really surprised about. So she looked at my retina, couldn’t see anything, and just, she prescribed me some migraine medication and told me that it might be a migraine. But said that I should go to eye casualty, and gave me a little slip to go and see them at a certain time. 

I actually ended up going a lot earlier than she'd given me the slip for because by this point I was really worried. I had quite a bad headache and things were just getting worse, and I just thought, 'I've got to go into hospital,' yeah. 
 

Not everyone with mental health issues will visit the GP. It would be good if a telephone service was also available in schools.

Not everyone with mental health issues will visit the GP. It would be good if a telephone service was also available in schools.

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If the NHS could do something, provide more services for younger people in their GP's surgeries, do you think that could be helpful and what kind of things could they provide?

I certainly think mental health things, but then I think it's really hard to actually get yourself to the stage where you want to see someone. Even though…I mean I know that the counselling service was advertised to me at Uni, but it really took me to be like, 'I have to sort this out,' and that took a long, long time. And maybe part of that was thinking that I wasn’t…it wasn’t serious enough, so maybe just, yeah it's really tough. 

I think it is helpful to have people that, not specialists, but people that have experience talking to young people, and just understanding their needs better because then I think that would help with just the general…I think once young people feel that GPs are good, then everyone will go. And I think…but it would take a while to spread round, yeah.

Would it be helpful at all if there was a telephone number available, almost like a helpline number specifically for young people, where they could phone and talk about mental health problems?

I think so, yeah, definitely. And especially something quite direct access where you don’t have to wait for ages I think would be really good. The other thing I think is in schools because if you're not someone that goes to the GP, you're not almost going to be exposed to it. Whereas everyone goes to school, or at least most people go to school, so that would probably be a…yeah.
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