Tuesday, September 03, 2013

While I'm at it...

To complete the picture that I began in the Letter to a Medical Professional post last year, I decided to find the other complaint letters I wrote to CPFT during that period.

Ironically, I come across as very articulate and "together" in the letters. In reality, I was a bit of a mess and I'm not sure that sending articulate letters was helpful in getting CPFT to understand how desperately I needed help. Their response to each letter was to arrange meetings and at least, I suppose, they got to see the anxious, weeping mess of a person in my presence in those meetings.

I had a brief moment of concern about whether I should include the names of the medical professionals in this post or edit it. But in the end, my voice (my writing) is all I have and it's not as though my blog is one with a massive following. I have compromised by leaving only the initials of surnames.

Anyway, here is letter 1, which was dated 8th November 2009.

"Dr Tom D,
Medical Director,
Cambridge and Peterborough NHS Foundation Trust,

Dear Dr D,

I write to share my concerns about the poor standard of treatment that I have been offered by various teams within Cambridge and Peterborough NHS Foundation Trust, after receiving many years of excellent care from Birmingham and Solihull Mental Health NHS Foundation Trust. The consultant psychiatrist in the BSMHT Eating Disorders service referred me to your Eating Disorder Service in August 2007 so that I could access regular support in Cambridgeshire, where I now live.

I was not offered an appointment until late October 2007. This assessment was conducted by a clinical psychologist and I was then paired with a counsellor (Gillian T, who has a PhD in psychology but not a clinical psychology doctorate*) for 12 sessions of Cognitive Analytical Therapy. My meetings with Gillian took place from January until August 2008; at one stage, she referred to me as ‘an anorexic with no hope of getting better’. At several points during our meetings, I asked Gillian whether I could access additional support. My specific requests were to see the consultant psychiatrist to have a review and discuss my medication, and to see a dietitian. I was told that these services were not available to me. In addition, Gillian explained that treatment was only available in discrete units so after my 12 sessions I was discharged from the service.

From August 2008 until August 2009, I was supported by my GP. However it has become increasingly clear that I need further treatment and so a referral was made to the community psychiatry team. This resulted in an appointment with Dr Nikolett K, staff grade to Dr Claire D, on 7th October. Dr K was extremely helpful and indicated that she would see me monthly, and that she would liaise with the Eating Disorder service to see whether anything could be arranged with them. She asked me to register with the University Counselling Service so that I could have regular support in the interim. I did this on 9th October and was contacted, via email, by Lisa H, senior counsellor for the service, who asked my permission to speak to Dr K, which I gave. Once Ms H had conversed with Dr K, she emailed to ask me to meet her in person. In this meeting, she explained that the UCS could not give me counselling but that Dr K would be speaking to the Eating Disorder service to ensure that I would get the specialist help that I need. I enclose a copy of this letter for your reference.

I was encouraged by these developments but this turned to disappointment when I rang Dr D’s secretary to ask why I had not received a letter for my next appointment. The secretary told me that Dr had left the service. Instead I was offered an appointment with a locum, Dr O, on Friday 6th November. I attended this appointment and it was a very unsatisfactory experience. It appeared that Dr O had not read my notes before meeting me; at one stage he asked how old I was, which either indicates a failure to read basic details or that he believes me to be insufficiently compus mentis to retain such information. I was forced to reiterate all the treatment history and aetiology of my illness that I had discussed so productively with Dr K. In contrast, Dr O appeared to be taking me through the standard lists of diagnostic questioning without tailoring it to my specific circumstances. Like Lisa H, he was labouring under the misapprehension that I had discharged myself from the Eating Disorder service; I was, in fact, told by Gillian T in August 2008 that treatment was offered in discrete units and that my unit had come to an end. Once he learned that I am happy to re-engage with the ED team, he said that he would write a referral letter. Disappointingly, the contact with the ED team that Lisa H believed Dr K would make seems not to have happened and a letter from a community dietitian, which delineates my current difficulties and that I entrusted to Dr K, has been lost. Furthermore, while Dr K had indicated that I could remain a patient of the community team while receiving specialist Eating Disorder treatment, Dr O told me that his remit with me would be over once he had referred me.

All of these circumstances have combined to leave me with very little confidence that I will receive any help from your Trust. I have previously defended the NHS to friends based on the exceedingly good treatment available during my time under the care of Dr R in Birmingham; now though I feel very let down by the services on offer to me and wish to make sure that this catalogue of problems comes to the notice of senior figures within CPFT. I hope that my bad experiences may, at least, contribute to improvements in the consistency of care that you offer to vulnerable people with eating disorders and other mental health difficulties."

On Twitter the other day, I entered into a discussion with some medical professionals over whether notes should be read prior to appointments. My answer is: yes, always. And the experience with Dr O. goes a little way to explain why. The follow-up letter after my next outpatient appointment at the same clinic goes even further!

*reading this back, I can see that this may seem a bit intellectually snobbish of me! But my point is/was that one can obtain a PhD in psychology through research; it does not entail the same level of intensive clinical practice as the clinical psychology doctorates. 

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