A useless doctor

I went to see a psychiatrist today. It was the third time I’ve seen one. I don’t think I’ll be going back.

I asked my GP to refer me for help with my mental health because I have depression that has not responded to anti-depressants. It includes frequent negative thoughts that keep me stuck in a loop for hours and fairly serious thoughts of suicide. I want help to stop getting caught up in these negative thought spirals and regain some control over my mind.

Unfortunately, the doctor that is now in charge of my mental health seems to think that trying to fix my chronic fatigue is more important than stopping me planning my own death. I have M.E. but he always refers to chronic fatigue which is a symptom of M.E. The first time I saw this doctor he focussed entirely on chronic fatigue. He told me that I shouldn’t be taking pregabalin (Lyrica) as “that is for neuropathic pain not chronic fatigue.” He seemed to ignore the fact that I was taking pregabalin because I am suffering from neuropathic pain. He proposed that I take amitriptyline instead as that is normally given for chronic fatigue syndrome. I actually interrupted him to inform him that I had M.E. which is a physical neurological condition of which chronic fatigue is a symptom but he simply acknowledged this and then carried on. I grudgingly decided to try the amitriptyline since it IS normally the first drug given to patients with M.E. – it helps with muscle pain and headaches and better sleep, but it is an anti-depressant and so I thought it might be worth trying again. If it shut the doctor up and it helps me sort the depression too then it might be worth it.

My visit to this doctor today was completely useless. He started by recalling that we “discussed” my chronic fatigue and that he gave me amitriptyline. I informed him that apart from making me sleep all day, every day, and having more suicidal thoughts, it had done nothing at all for me. He then went in to a long winded speech about how pacing works and is good for chronic fatigue. I pointed out that I had been to lots of sessions at an M.E. clinic a few years ago to learn about pacing, that I had had M.E. for eleven years and managed to pace as best I could as the illness got better or worse, and that I knew pacing well enough to write about it for other people. I said “I’ve had M.E. for eleven years and know how to manage it, but I really need to know how to stop the loops of negative thought and the suicidal thoughts.”

I don’t think I could have been clearer, but he carried on, talked about disuse syndrome and said I need to exercise otherwise I will get fatigue caused by doing too little. I told him that my pacing routine includes as much exercise as I can do at any given time. Not to be outdone, he then talked about free radicals, told me to take anti-oxidants and vitamins, and finally blamed my fatigue on my diabetes, which seems to be the only other thing apart from depression that he doesn’t think is his job to treat.

So I’ve been referred for help with mental health, and instead have been told not to take drugs that save me from searing pain, given a drug that put me to sleep all the time, and had the psychiatrist try to treat my M.E. while consistently referring to it as Chronic Fatigue. What I haven’t had is any advice on preventing or getting out of negative thoughts, or stopping me thinking about suicide. It isn’t even relevant whether my M.E. is physical or mental in nature; I desperately need help to regain control of my mind before I hurt myself, and all this doctor cares about is my fatigue.

Author: Latentexistence

The world is broken and I can't fix it because I am broken. I can, however, rant about it all and this is where I do that when I can get my thoughts together. Most of the time you'll find my words on Twitter rather than here though. I sometimes write for Where's The Benefit too.

14 thoughts on “A useless doctor”

  1. I’d request to be referred to another psychiatrist for a second opinion. He sounds completely useless, his job is to treat your depression, not your physical health problems. I’m so sorry you have to deal with yet another hurdle. 🙁

  2. I’d ask your GP for another referral for a second opinion, and i’d seriously see a new GP if this doesn’t happen. As ever you have to be pro active in your own health care as they treat everyone as a generic case. Amytrip will do nothing but make you blank, and make you sleep all day everyday that you could even miss major important events without caring, i know i took it for years for pain, (it didn’t work except for sleep!)

    You are depressed because the government wants to say your fit enough for work and to make ATOS strip you of you hopes and dreams and brand you a worthless scrounging scum that should get off his backside (i know they say it too me, i’m on my second appeal and awaiting tribunal, even though i’ve had 3 pelvic breaks, my femur lengthened by 2 inches, and soon i’m in for a femur derotation on the other hip. i can’t walk but apparently i’m fit for work) This depression can and will be lifted if you get the right help, you’d be better off buying a book called (Feeling Good off amazon) than getting more tablets, these just made me worse personally, if i wasn’t depressed i was feelingless, i was numb to everything, so no lows but also no highs either. This book totally cured me within a month. For the first chapter i felt better and in total.

    Hugs Debbie xx

  3. Possibly the problem lies with the fact that he is a psychiatrist, and you would need a psychotherapist or someone else who does talking therapies, for the kind of therapy you are talking about.  This sounds a bit snippy, I don’t mean it to be, but I’m tired and can’t think of a better way to phrase it..  I hope you find some good help soon.

      1. Its a reasonable assumption.. however, it took several years for my MH problem to even be diagnosed properly. That said, my psychiatrist then did have the sense to refer me on to an appropriate therapist. The hurdle in my case was getting that initial referal to a psychiatrist, before that I was getting fobbed off with ‘assertiveness workshops’ and the like. Its a ridiculous game, you have to pretty much know what you want and what to ask for.

      2. I think the way it’s supposed to work is that the psych does a psychiatric assessment and refers you on for appropriate talking treatment, adjusts medication, schedules more detailed assessments if appropriate, and possibly keeps tabs as you go through all of that. Does sound like what he was trying to do…

  4. I’d make sure your GP knows that this isn’t working, and see if they can get you a different referral. I’ve been getting great help through a Primary Care Mental Health service, their Psychological Therapies team. Non-psychiatrist therapists who are great, has been my experience. Psychiatrists are mostly only useful to either diagnose psychotic issues, diagnose interesting variants of depression (that inform therapy and medication choices), and play with medication in creative (and sometimes useful) ways, in my experience. Good therapists on the other hand can really help get a handle on the way you’re thinking.

    Of course, most therapy offered now is CBT, which I consider massively over-rated. I’m having CAT – cognitive analytic therapy. It’s about causes, and why sometimes the unproductive patterns do make some sense, or used to. I’ve found it really helpful. Before that, I was in a group therapy that got a bit chewed up by administrative and personnel changes, though I still found it helpful, and probably wouldn’t have been as ready for the CAT without it. Also, CAT has diagrams.

    Oh, and if you think the psychiatrist was really out of order, consider a formal complaint. It might do someone else some good, at least.

  5. Your experience is sadly not uncommon.  Frankly, I think most Psychiatrists are so absorbed with their own pet theories that actually treating the patient is quite low on their list of priorities!  I’ve been where you are in terms of the negative thought loops and the ONLY thing that has helped me has been prolonged and intensive therapy/counselling with a good Clinical Psychologist.  Can you get access to one through your GP?  Self-harming – or the constant desire to self harm – should ring plenty of bells and get you bumped up any waiting lists!  Psychiatry as a discipline is patchy in terms of quality and a bad one can do more harm than good.  I believe Psychology has helped me with the self-harming more than anything.  Yes, I still get the images in my head but I’ve learned excellent “coping strategies” and as long as I apply them I get through to the next day!  My heart goes out to you – don’t give up!

  6. I would agree with others recommending a second opinion. I would have thought that even a fairly basic psychiatric assessment should identity that at least a diagnostic session with a  psychotherapist would identify whether a course of cognitive behavioural therapy, at least initially, would be of benefit, which then may in turn open up other possible avenues which may go on to be of further benefit. 
    For your own sake, I would recommend pursuing getting the right treatment for now, rather than lodging official complaints, and this is unlikely to be helpful or constructive for yourself at this stage, and following through formal complaints can take time, energy and be very draining. It may be something to come back to and consider at a later date when you are in a more stable place – especially if you can report back on the success of getting another opinion and the treatment it led to.

    1. I would add, though, that you shouldn’t let yourself be railroaded into CBT, specifically, without some actual exploration of options, with a reason to think that it is the most appropriate therapy strategy. It’s not always the best therapy, even if it is the darling of the establishment at the moment.

  7. If you go back to your GP, ask about being referred to a community mental health team, rather than specifically to a psychiatrist. CMHT will probably allocate a community psychiatric nurse/CPNas your main contact, with a psychiatrist overseeing meds.

    My CPN is far more use than any psychiatrist I’ve ever seen. She’s a lot more practical, whereas the psychiatrists always seem to have their head stuck up their bum, closely followed by a textbook. My CPN accepts that my life is the way it is, and I need help to deal with the consequences of that, instead of the psychiatrist telling me how my life should be…

    I’ve also seen a clinical psychologist who was frankly brilliant. She helped me a lot – not any one particular style of therapy, just looking at why I felt/reacted as I did, in what ways it was helpful now, in what ways it wasn’t, and what could be changed to make it work better. I’m still using what she taught me now and I probably always will do.

    Best of luck, you do need to see someone, anyone! else.

  8. Very sorry to hear about your experience. It sounds extremely similar to something that I have recently gone through, so I feel empathy.
    I would suggest that there are several strands to your problem. I’ll try to tackle them as best I can. I’m not the brightest of people, always, so you’ll have to bear with… Mind you, you’re free to pick and choose when it comes to advice, so be selective, pick the bits that may work for you, and discard the rest!

    1. I suspect that there is an issue with your G.P. At the end of the day, G.P.s are there to attend to patients, and to listen to YOU and take YOU seriously. After all, you are the one with the health problem – you know your own body, and your own symptoms better than anyone else. A good G.P. will listen to what you say, and be interested in your perspective. It sounds to me more like your G.P. does NOT listen, and therefore only has a limited understanding of your problems. Furthermore, I get the impression that your G.P. thinks he/she knows better than you. To deal with this problem you could try the following: 
    a. Are there ways you could make yourself clearer at appointments? Could you write down specific things you wish to ask the G.P. or discuss with them? Might this enable the G.P. to focus in better on what you want to communicate to them? ALWAYS do your prep before appointments.
    b. If the G.P. remains a problem, are there other doctors within the same practice that you may be able to see instead? If there are, do you think you could build a better rapport with any of them?
    c. If you have absolutely NO joy with the above, maybe you could move to another G.P. practice in your locality and start afresh. If you have any concerns about doing this, you cold contact your local PCT (Primary Care Trust) who could advise. Or you could try telephoning round a few surgeries in your area to see if they are registering new patients. When you do this, ask the receptionist things you want to know. For example, if seeing a same-sex G.P. is important to you, ask if this is possible. Or, if you need repeat prescriptions, ask if they offer these. 

    2. You need to ensure that you are getting the RIGHT treatment. It looks like one of the biggest problems you are facing is that you have MORE than one coexistent health problem. Not only do you have M.E., but you also suffer from long term pain, and from depression. From my perspective, this is NOT surprising. Chronic health conditions can LEAD to depression (i.e. they cause it, in their own right), but they can also exist alongside depression caused by other factors. 
    The difficulty is that many doctors, when faced with this, do not seem to have a clue how to deal with multiple problems. Then they just end up focussing on one (usually the most obvious, or easiest to tackle!). 
    YOU need to know that ALL your health conditions are being addressed, each in their own right. However, you also need to be aware of the effects that one can have on the other – and so does any doctor treating you!

    3. I know from personal experience that it is very difficult to get the right sort of care and treatment, of you suffer from a number of health conditions simultaneously. I, too, suffer from M. E. (diagnosed by my G.P. as Post Viral Syndrome). I also have Endometriosis (a gynaecological condition), which causes chronic pain and infertility. I have chronic respiratory problems due to Asthma, and also have Anaemia. As you can well imagine, I have suffered too from depression. In MY case, all my G.P. has tended to focus on is the depression (caused by a history of childhood abuse). I’ve come to the conclusion that the G.P. does this because it is easy, then, to dismiss the rest of my physical symptoms as being “all in my head” (i.e. symptoms of depression, rather than genuine physical illness). As a result, I have recurrent chest infections, and my chronic pain is poorly managed.

    4. What I have found helps is to become as “expert” in my own right as possible. There are innumerable sources of advice and assistance out there, other than just the G.P. To help me better understand and manage my own health conditions, I have tried the following (which you could also try, if you think it might help)…
    a. Get advice and information from charities and voluntary organisations, e.g. British Pain Society (tel: 020 7269 7840), MIND mental health advice (0300 123 3393), and other organisations that deal with things like pain, M.E. and the like. You can google many of them – just type in headings like “chronic pain”. Lots of organisations also have on-line advice for you to download, and some have chat rooms where you can discuss real life problems.
    b. Find out if there are any support groups in your local area run by people with similar problems or health concerns as yourself. Sometimes these are a great informal source of support, and you get great tips on how other people coped in similar situations as yourself. Also, they are not as stigmatising, as the people there have the same experiences as you, so they know just what it feels like.
    c. Keep a symptoms and mood diary. This helps you record what you experience, and how you feel. It also helps identify certain issues, such as whether there is a pattern to your symptoms, or moods, whether worse symptoms go hand in hand with lower mood, and what exactly are the issues that most affect you. Record whether it is severity of symptoms, or duration, or both that affects you worst. Record whether it is symptoms, or mood, that makes you feel worst. By keeping such a log, you are in a better position to understand the pattern of your physical illness, and whether this corresponds with any psychological symptoms you experience.
    d. Keep a medication and side effects record. This way, you will gradually become ware of what works for you. You can also clearly demonstrate to your doctor what does not, and why.

    5. Finally, remain clear (as you are) about what you want. You identify at least 2 clear areas of concern. One is PAIN MANAGEMENT, and the other is MANAGING PSYCHOLOGICAL DISTRESS. It might help you to know that both areas could be effectively addressed:
    a. Many areas have specialist PAIN SERVICES for the management of chronic pain. You might benefit from referral to such a service (if this has not already taken place). Such services offer a range of support, from assessment of mobility and physical needs, to physiotherapy, to reviewing of medication, to counselling for the effects of pain and effect on body image. I really would advise that you discuss such a referral.
    b. It is clear that you also want to better manage your psychological symptoms, and you are very articulate as to what they are. GOOD. It is very promising that you acknowledge and recognise your pattern of negative thought. Many people with severe mental health problems DO NOT. This would suggest to me that you are experiencing more what I would call “psychological distress” – this can be helped and treated, because you acknowledge and are open about it. However, it is a difficult and sometimes painful process, and you need to ensure that you are getting the right sort of support. If you are thinking about any kind of TALKING THERAPY, you may benefit from doing research first into the variety available. This may help you identify what might work for you. You also need to select a therapist carefully, and ensure that they have good standards of care and patient confidentiality. Most importantly, make sure you feel safe to talk to them, that you feel supported, and NOT judged.
    To find out more about talking therapy, try the following:
    a. British Association of Counselling and Psychotherapy (they list reputable counsellors, and can advise about types of therapy) – tel: 01455 883300. Or website – bacp@bacp:twitter.co.uk
    b. MIND (helpline above) might also be able to tell you more about talking therapies, and if you phone them, they may be able to send you information by post. Alternatively, google their website and download some of their advice publications.

    Sorry to have written SO MUCH! But I really DO hope that some of it may be helpful. 
    If there is anything else I can assist with, you can e-mail me personally, as I am at the moment just setting up my own website to offer support and advice to people who have suffered at the hands of the health care system.

    Best of luck,
    Elaine.
    (elaine-ellis1@hotmail.co.uk)

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