"Problems with Consultant Communications"

About: Advocacy Support Cymru Cardiff & Vale University Health Board

(as the patient),

I have again read what I believe to be is an appalling letter written by my consultant psychiatrist to my GP which grossly misrepresents what I said and contains many other problematic elements.

They say that their findings are limited to what I have observed during her treatment under my care in 2014

there are already a number of problems with this single statement. Why are they only basing their findings on 2014 when I have an 18 year history recorded in my notes? Surely any sensible clinical approach would take my history into account? Why does the consultant see their role as being limited to observation? Surely a basic part of being a medical doctor is that you need to gather information about symptoms? In other areas of medicine this could include scans and blood tests but in psychiatry surely the main way of examining a patient is by asking them questions?

There is an implication here that they had provided “care”. That has not been my experience. The consultant turned me away when I explained that I needed to increase my anti psychotic to the maximum dose and that my GP had needed to prescribe the maximum dose of lorazopam. They did not ask any questions such as what was happening to you that made you feel you needed to increase your medication? If they asked this I would have been able to respond by saying that I was hardly sleeping at all, was finding it hard to concentrate and focus on anything at all including following a TV programme, that I was sending very long emails to my friends late at night and spending far more money that usual. I already had a diagnosis of bi polar disorder so for me it seems only sensible for them to check out if I was experiencing any symptoms of bi polar disorder, especially if we take into account that I become so unwell I had been sectioned and in intensive care only a year earlier. All the psychaitrist did was tell me to continue with the maximum dose of qutirepine and then dismissed me knowing that my next planned appointment was not for another 2 months. They did not put in place any care or support from any other member of the team. This highlights another problem in relation to observation. My condition deteriorated rapidly after this appointment as I was being expected to manage a psychosis alone with no support other than provided my GP practice. My consultant did not see me during this 2 months as this happened therefore they were not able to “observe” this.

And if we examine the concept of treatment I am left with more questions and confusion that the psychiatrist has never answered. In the next paragraph they describe me as “relatively stable”. If they believe this why did they advise me to continue on the maximum dose of anti psychotics which was nearly twice the dose I had been taking previously? If they did not believe I was suffering from a relapse of my bi polar disorder why did they not discuss this change in my medication with me and why were they so angry with me when I told them at a later date that I had decreased it because I was suffering severe side effects? If the psychiatric opinion was that I was not suffering a relapse and therefore did not need this dose of mediation they should have shared that opinion with me. Yet they advised the complete opposite and to continue with the maximum dose.

The psychiatrist implied that a diagnosis of borderline personality disorder was made which is not the case. I feel strongly that a diagnosis of personalty disorder has been implied by them and any confusion I have about the issue of my diagnosis has happened because they have consistently refused to engage in any open and honest discussion about this and this has left me in a situation where I have to find out what they are thinking by reading the letters to my GP. I thought the purpose of these letters was to inform the GP not the patient?

I have been told by the clinical director that my diagnosis has not been changed which means that throughout 2014 my contact with the CMHT was because I suffered from bi polar disorder for which I need care and treatment. I did not receive this from that team in 2014.

What I said was that clearly my illness is potentially life threatening given that I have been sectioned because I have been a danger to myself while suffering from mania and psychosis twice, once only 2 years before this letter was written. That is all factually correct and is recorded in my medical records which the consultant told me they do not have time to read. I went on to say that we are dealing with potentially life threatening situations. It is because I know this, have always known it, given how unwell I was with my very first episode when I was sectioned at the age of 20 that I work hard to recognise my early warn signs and act quickly to avoid becoming so unwell. I would have thought most doctors would embrace this way of working. The only reason my manic episode did not progress as it had done the year previously (when I had ended up sectioned) was because I increased my dose of anti psychotics rapidly myself as I have done countless times over the past 19 years. I have to do this because until the past year or so no medication had ever worked in a preventive way for me.

This is quite a rare situation for someone with bi polar disorder to be in as most people do respond to standard drug treatments. Again if my diagnosis remains bi polar disorder then it is well known to be a potentially life threatening condition. My anxiety is that I am now in a situation where there is no mental health professionals who understands how I present as unwell and over the past 2 years or so I have constantly been dismissed and in 2013 this resulted in my ending up section again, although I spent 6 day asking for help to avoid this. (see my previous stories) My anxiety is around this situation arising again and having already been in a situation last year where no one in the team realised what was happening and they did not listen to my GP practice who would have been able to tell them.

The consultant also describes me as “openly critical”. My response to this is that I am allowed to have and to express opinions about the mental health services I receive. They told me they do not have time to read my notes. This means I have formed the opinion that they are lazy and I will be critical of that. The consultant has also told me that my behaviour towards the team has been threatening because I had complained about a nurse. Given that they were not present when that incident occurred I found that comment from them unprofessional. I do have a mind of my own and I will use it. I also think I am being more straight forward than the consultant is since I have told them to their face what I find difficult and object to. This gave an opportunity to put things right. That was the whole purpose of the appointment that this letter refers to as far as I was concerned. Yet still the consultant refused any discussion.

The consultant writes that I hope my consultation has answered some of (my name) questions. I don't know how they have the nerve to write this when what they said when I asked the questions about my treatment that I raise earlier was that, I don't have to answer any of your questions because you have told me you want to change consultants therefore I am not your consultant any more and don't have answer any questions. The consultant said this in the presence of my advocate who is prepared to back me up over this. Not only did I find this response immature and inappropriate it also left me in a situation where I did not actually know who was responsible for my care for a number of weeks. Although my advocate wrote to the manager to clarify this we did not get a response.

The consultant ends by asking my GP to reassure me that the intention is to help me and build trust. How can I trust someone who has manipulated my words in such a grotesque way and has consistently refused to discuss things with me face and face and who has chosen not to believe me when I truthfully told them about all the psychotic symptoms I had experienced as soon as I was well enough and had an appointment? The Consultant has consistently shown themself to be false and insincere and I have never felt able to trust them precisely because of all these things. I have never even felt able to attend an appointment alone because they write such inaccurate letters and also becomesvery angry during the consultations.

I find the consultant attempting to dictate how my GP interacts with me further evidence of a controlling nature. My GP and I have had an extremely trusting relationship for nearly 20 years which is based on complete honestly from both of us. Our relationship has survived him sectioning me twice and on the second occasion we were able to shake hands on it. I really don't think we need any interference from anyone else with how we interact with one another. What we do need from a consultant is factual information on medication options etc.

My GP anyway did no such thing. What he did say was that it very good that I now have a consultant who has said HAIVNG READ MY NOTES that they do not doubt my diagnosis of bi polar and that this is what we need and it is also very good that this consultant is supportive of me increasing my medication myself because he understand the main thing is to prevent severe episodes of illness.

My GP went on to tell me that I do have a severe form of bi polar but the problem is that I present in an atypical way because I have taken such an active role in self management and have been doing this for so long, and that one of the reason for this situation is that standard treatment options have not worked for me. It is ironic that my self management skills have actually been disabling me over the past couple of year when dealing with practitioners who seem only able to recognise stereo typical presentations. I am hoping now that I will get the support I need to mange my severe and enduring mental illness from my new consultant who seemed perceptive and knowledgeable, as well as having an approachable manner. He also seems receptive to me being an expert patient.

I have tried to raise the issue of this consultant making inaccurate records in a meeting with the clinical director. My advocate and I know from written documents regrading this compliant that this consultant has written that-She took time to answer my questions. This is not true, as I have made clear above. My advocate was present during this consultation and made her own notes. We will therefore be taking this complaint further, as the only response from the clinical director was that there may be difference of opinion. I am talking about facts that have inaccurately recorded.

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Responses

Response from Cardiff and Vale University Health Board

We are sorry to hear that your experiences within mental health services have not been as positive as we would wish, and whilst we are pleased to read that your new consultant appears ‘perceptive and knowledgeable as well as having an approachable manner’, if you wish to write to the Concerns Department we will investigate your concerns formally.

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Update posted by dragonvoice (the patient)

While I may not have read this particular letter at that time, I have already gone through a formal complaints process regarding this consultant's behaviour and attitude towards me and attended a meeting with the clinical directer and another member of senior staff.

This is how my advocate and I know that the consultant responded to this complaint in writing saying "She took time to answer my questions." This did not happen and was not adequately addressed during the meeting.

I also found the investigation into the complaint completely meaningless as all you had been told my advocate was that I wished to complain. You did not ask me what I wanted to complain about.

I was actually trying to put my complaint into writing but before I had done so I received a response saying my complaint has been investigated. This investigation was also completely pointless as it said there had not been a breach of care as I had not been unwell.

I know, as does everyone close to me, and my GP practice that I was extremely unwell for a prolonged period of time and it is frankly shocking that no one in the CMHT picked up on this. And of course having provided no care or support it is in their interests to record that I did not suffer a relapse or as they put it: "they did not observe this."

My response to this is quite clearly that this is where the failure lies, that actually they failed to observe and failed to examine.

Response from Cardiff and Vale University Health Board

The Health Board would like to reiterate that you may wish to contact the Public Service Ombudsman, you may also wish to raise further questions via your advocate.

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Update posted by dragonvoice (the patient)

Yes thank you I am well aware of my options having been forced to go through a number of complaint processes over the last couple of years. And I will be taking this further as I said in my story.