D: How Are You Doing

26/1/15 AM – Consultation 4

Duration: 09:49

P - patient

D - doctor

(u.c.) - unclear speech

D: hello

(2.0)

P: hello [hiya

D: [hi

P: hiya

D: how are you doing

(.)

P: er (.) I’m okay I- (.) had a bit of a (.) stressful (u.c.) appointment last week or the week before erm (.) and they just said you will be in pain (.) for quite a bit lo- he said up to six months (.) so at the moment they’re still saying (.) wait with the pain and I’m kind of like I don’t want to wait (.) anymore cos I’m so fed up

D: okay

P: errm (.) so the th- one thing he- I saw a registrar there he’s put me onto ne- naproxen

D: yeah

P: erm so he said to come in to get a prescription for that (.) erm he did also suggest taking a mini pill (.) I think but I’m not (.) sure about taking that really cos I’ve already got the coil

D: yeah

P: so I don’t know if that would really be of use (.) the other thing was I’ve got erm (.) through a family (.) member has erm asked a gynecologist in London if he’ll see me for a second opinion (.) just to talk through (.) the possible treatment options next (.) and he’s asked whether you could do a letter of referral for that

D: as a private or a-

P: I’m [not actually sure erm does it make a difference (.) for the [letter or-

D: [NHS [erm (1.5) sometimes it can be harder to refer out of area (.) [but I can see

P: [okay [yeah

D: [erm I [mean

P: [sure

D: cos we- we’re normally MRI (.) and [Wythenshawe [and occasionally it’s

P: [yeah [yeah

D: erm (.) Salford [so Sta- Stockport (.) I was like ooh will they won’t they

P: [yeah yeah

D: a little bit [anyway erm but I know he’s probably the best person I know

P: [sure

D: locally [for that so erm-

P: [yeah absolutely (.) no and I think he [is very good (I-)

D: [the other option- (.) the other option is that I write back to (.) Mr XXX and say (.) you’re still in a lot of pain you’re see- looking at wanting a second opinion but I wonder whether (.) you’ll be better just to speak directly to him

P: yeah

D: I d- I mean that’s another-

P: yeah

D: a second option for [you basically

P: [he’s- he’s booked me back in on the seventeenth of March I think so kind of have a two month waiting [period (.) erm and then

D: [right

P: come back in and [say (.) is it any better I think then (.) I’ve got the opportunity

D: [okay

P: to say I’d actually like to talk to Mr XXX [directly before (.) I change treatment

D: [XXX right

P: cos what the registrar was suggesting was (.) having an injection that would induce the menopause

D: yeah

P: temporarily

D: [yeah

P: [and that [seems quite drastic (.) and especially when I’m getting married in

D: [interesting

P: September so I don’t really want to be going through lots of mood swings (.) in the six months before [my wedding

D: [yeah I mean it can be a diff- a variable [thing cos

P: [yeah

D: sometimes being tired with lots of pain

P: yeah

D: can make [y- I’m not saying it makes you moody can [make one moody

P: [yeah (u.c.) [no it does haha

D: [hahaha

P: [it absolutely does

D: so [yeah so I think there’s a bit of a-

P: [ahaha [yeah that’s true

D: [risk benefit thing and sometimes if you’re not in l- constant pain

P: that’s true

D: you’re actually surprisingly less moody

P: yeah

D: than (.) having everything switched off

P: yep

D: erm (1.0) so erm it does sound like a d- in your mind it can sound like a [drastic thing but erm a lot of women get really good relief from it

P: [it does yeah yeah

(.)

D: so erm (.) yeah

P: and certainly if there’s nothing better I’d like to think about trying it [but I’d just

D: [yeah

P: like to know if there’s-

D: yeah [the other thing is you can get is a shorter one so you could get it as a

P: [what general things there would be

D: three month injection

P: okay

D: so and you have it as a shorter injection and then you can see what it’s like

P: yeah

D: so almost if you have it now soonerish (.) then you know don’t you

P: it (.) what to [do later on yeah

D: [if it’s okay for later

P: sure

D: I suppose [would be the other benefit but yes they’ll talk to you about all the

P: [sure

D: pros and [cons (.) erm (.) what do you want to do about this consultant in

P: [yeah

D: London then [do you want to-

P: [so he ha- he has agreed to see me

D: [yeah

P: [erm I’m not sure if he’s fitting me into a private or NHS [clinic if it’s easier for

D: [could you check for

P: [private

D: [me yeah

P: erm that’s fine

D: [okay

P: [if you want- if that makes a difference to the referral process (.) he’s erm (.) penciled me in for the tenth of February

D: right

P: erm his name’s XXX (.) he’s at Kings College Hospital

(2.0)

D: XXX XXX or [X-

P: [yep

D: yep (.) at Kings

P: yeah

(3.5)

D: could you double check with me

P: [yeah

D: [and just le- er for me and leave me a message

P: [sure

D: [erm I’m in again on Thursday so I can then sort the [referral then

P: [okay brilliant

D: yeah which [one

P: [yeah

D: he’s actually put you in to

P: yeah I mean if it’s easier to do it private (.) because the out of area (.) that’s [fine

D: [or it may be that he’s put you- booked you in to [his private clinic

P: [yeah (.) yeah

D: do you [see what-

P: [I think he’s NHS

D: is [it

P: [on the basis that it’s in the day I think erm

D: they can still [do- do private yeah (.) just check for [me and then we know it’s-

P: [huh do they yeah [I will yeah

okay

D: not gonna be a palava and get- go a bit wrong

P: okay brilliant

D: erm and w- anything else

P: just the naproxen

D: your [naproxen yes

P: [and (1.0)

P I wonder if it’s worth doing the clarithromycin review now as well cos I know that’s coming [up (.) while I’m here **5 Mins**

D: [yeah how’s it going

P: it’s really good today of course erm hahaha it’s [perfect hahaha (.) [(u.c.)

D: [(u.c.) [that’s the way [it is

P: [ha I know so I might book in to see you every week [hahah

D: [when it’s bad

P: just as a- (.) just [(u.cs.) like sorts itself out erm (.) I- I dunno s- it seems to be

D: [(u.c.)

P: very hormonal (.) [that’s- so (.1.0 just kind of comes and goes depending on

D: [is it

P: the cycle erm it was bad (.) a couple of weeks ago but now it’s totally cleared up (.) so [I don’t know if it’s working better than (azithromycin) (.) I wonder if

D: [w- what would you like to do

P: it’s worth carrying on for a tiny bit longer (.) [with the clarithromycin and just

D: [yeah that’s absolutely fine

P: seeing how that works

D: yeah

P: cos it’s only been a couple of months now

D: yeah let’s see hang on (2.0) yeah (.) yeah it’s probably not even- it’s only just over a month [now

P: [yeah

D: yeah (.) that sounds reasonable (.)

D: and do you find the naproxen better than the ibuprofen

P: I’ve only been taking it for a week (.) [erm so (.) not entirely convinced yet but

D: [okay

P: (.) did say it might take a while to build up (1.0) and th- just taking three a day which o- of two hundred and fifty which I think you could actually take a higher dose than that

(2.0)

D: I thi- for you though cos you’re having it quite a lot

P: yeah

(.)

D: y- you’re probably tryna- you know it’s balancing the [side effects isn’t it (.)

P: [yeah

D: how’s your heartburn

P: that’s much better since I upped the omeprazole

(1.0)

D: is it

P: yeah much better

(1.0)

D: if you find it’s any worse just come back (1.0) erm (.) I’ll put that on repeat then

P: brilliant thank [you

D: [er- (3.0) so what do you need today your- just your [clarithromycin

P: [just er- erm (1.0) yeah the naproxen (.) please (1.0) and would you- what would you recommend with the- (.) with the mini pill and I think the registrar recommended it because he said it could help reduce (.) bleeding but I don’t really have a lot of bleeding

D: it’s the [pain isn’t it

P: [so yeah I mean I do have more (.) pain when I’m bleeding but my bleeding’s minimal (2.0) and I have tried it in the past (.) but it didn’t seem to make much difference

(1.0)

D: did you have it here

(.)

P: no it was years ago now (.) I tried a kind of (.) variety of the pills and then went onto the depot injection (.) and I ended up on the coil which worked better than it- any of the others cos it’s a bit more constant

D: yeah (5.5) I think- I’d say it’s up to you really whether you want to try it or not [try it erm (.) it’s another tablet

P: [yeah yeah

D: erm it’s some different hormones (.) erm (1.0) it may work it may not work

P: yeah

D: the benefit might be that if you go to- I don’t think you’ll notice any benefit before you go to this appointment [on the tenth

P: [yeah yeah

(.)

D: so it may be worth going to the appointment on the tenth-

P: and then just [asking

D: [and then (.) have that conversation and then make a decision cos [then-

P: [yeah

D: they’ll look at all your treatment options (.) and if you go actually I’ll go for the mini pill we’ll do it and then you’ve got six weeks of that before-

P: the next appointment [(u.cs.) yep

D: [your next appointment and then you can say whether it’s working or not

P: yeah

D: erm might be one way to go [about it

P: [yeah [sure

D: [erm (1.0) because you’re not- you’re gonna go to this appointment not knowing whether it’s- (.) [working or not and

P: [yeah

D: [I-

P: [yeah

D: you know prostat might be a really- really reasonable option to be fair

P: yeah

D: because you’ve had this for such a long time

P: yeah

D: you’ve tried lots of things

P: yeah

D: let’s just switch it off (.) have a rest

P: yeah

D: switch it off have a rest of it (.) feel a bit better and then make a decision

P: yeah

D: and sometimes switching it off for a bit does help it longer

(.)

P: okay

D: cos even- a- when you’ve switched it off it doesn’t necessarily- for someone it doesn’t come back as bad (.) and it takes a while to build up [again

P: [yeah

D: so

(1.0)

P: okay (.) that sounds yeah more encouraging

D: yeah

P: yep

D: did it sound like a terrible [option or-

P: [just sounded so- yeah terrifying so or induce the menopause or (.) said you can get endometriosis in your womb and then all we can do is a hysterectomy and I was like oh great this is cheering for-

D: yeah

P: a woman in their twenties to [be told but

D: [yeah about to get married in [September

P: [yeah exactly

D: yeah

P: but-

D: yeah I thi- you know get that appointment (let me know when they’re seeing you) [definitely (.) leave a message for me

P: [yeah brilliant

D: talk about your options (.) it’s only you know what is it fourteen days [two

P: [yeah

D: weeks or something [before you’re gonna see him (.) and then decide

P: [yeah yeah

D: erm (.) and you know maybe they’ll be able to give you the (prostat) on the day

P: [yeah

D: [which is what we would- (when I did- gynae-) you know if that’s what (woman) decide we just give it to you that day [(job done)

P: [okay (.) [okay brilliant

D: [sorted ha

P: thank you very much

D: anything else

P: no that’s [great that’s great

D: [okay okay

P: thank you

D: good (.) [carry on

P: [thanks very much [yeah

D: [fingers crossed for this appointment then on the [tenth

P: [yeah thanks I’ll just- (.) I’ll leave a message for you just to confirm that

D: [yeah perfect alright XXX see you later

P: [thanks very much (.) thank you bye

D: bye