26/1/15 AM–Consultation 6
Duration: 21:05
P - patient
D - doctor
(u.c.) - unclear speech
P:ah right
D:I just called you I was [like where has he gone and I knew you were relatively
P:[(u.c.)
D:new to the surgery (.) so I didn’t know if it was cos you didn’t know (.) [that the
P: [oh no
D:[buzzer works
P:[I’ve been- no (.) I’ve been here plenty of times before so
D:that’s fine
(3.0)
P:err right well basically I’ve er been suffering with (.) well anxiety for a long timeerr
D:[yeah
P: [and recently it’s got (.) really really bad (.) [err with regards tojust general
D: [has it
P:day to day (.) things like I’ve lost my job because of it as [well
D: [ahh
P:er I lost my job well I got given my notice period last week (.) err (.) it’s been difficult to get in (.) to be fair and the reason why I’ve lost my job is basically because I haven’t been (.) going into work I’ve had a lot of sick days over the last probably three months (.) err going back from- yeah probably (.) err November time (.) err and basically I need to (.) get it
(.)
D:[sorted
P:[sorted because I’ve- it’s gone- I’ve been controlling it for such (.) a long period of time that it’s- (1.0) it’s not going away it’s j- it’s just been controlled (.) err and it’s been coming back- creeping back slowly but now it’s probably the- the worst it’s (.) been since I’ve had it (.) [effectively yeah err (.)yeah so
D: [is it
P:and losing my job was basically the (.) final straw with regards to it (.) [so
D: [how bad’s it been
(.)
P:it’s- (.) I’ve had trouble (.) just g- like going out just day to day activities have been (.) a struggle just get- generally just getting up I’m not sleeping I’m not eating (.) err (1.0) as I said I found it very very difficult to go to work everyday was basically like a- a new start with it all (.) I gotth- it got to a certain period of the day when I’d start to feel a little bit better
D:yeah
(.)
P:but then the next day it’d all start again and I’d have to go through that and it was just making me worse I’m just mentally and physically tired (.) err I just feel absolutely drained at the moment
D:I saw on your notes you’d had some CBT and stuff before
P:yeah [er-
D: [are you managing to (u.c.) those or (.) have they sort of been wiped from your [memory
P: [it’s- no I think it- like CBT I know er I know how to- (.) to use CBT it’s- (.) it hasn’t really ever worked for me as such CBT some a- some areas do but others- the majority hasn’t err I went to- a while back I went to see (.) wasn’t- wasn’t a councilor as such (.) err (.) but that was just a- (.) I- well even my doctor said it’s- it was a waste of time me going ha really because it didn’t do anything for me I think he said basically the (.) medication is probably the way forward for it and [that’s- he was the one who got me onto err [KW1]
D:[okay
P:amitriptyline I think (.) and this is- I’ve been on amitriptyline for (.) probably seven years
D:right
P:now er and I can honestly say I don’t think it’s working anymore [ha
D: [yeah
(.)
P:err I’m only on a low dose erbut yeah I don’t think it’s working anymore [KW2](.) so
(.)
D:what would you like to do
(1.0)
P:I’d like to just try whatever it is to- (.) to actually just get rid of it
D:okay
P:whether it’s seeing somebody whether it’s going down- you know trying to take a new medication err [KW3]I just- I need to get rid of it because I can’t be (.) going through this every-
D:mm
(.)
P:year it- like it’s be- it’s been- like I was in my job forerr so I think probably seven or eight months no nine months I think I was in cos I relocated back from XXX
D:oh okay
P:err and it was alright and then it’s just slowly (.) just crept [up on me and now
D: [(right)
P:it’s-
D:what job do you do[KW4]
(.)
P:well I did- I did work in facilities (.) facilities [management (.) basically dealing
D: [(facilities)
P:with err day to day running of an office
D:okay (with-)[yeah
P: [yeahyeah not working f- like at a- at a desk [but basically
D: [right
P:anything that needs doing we- we [deal with (.) err so it’s- it’s a- you know it-
D: [okay
P:it’s- it was a tough job [it’s a tough role (.) but I’ve always done roles like that
D: [yeah
P:and that’s-I couldn’t sit at a desk I’d go out my head if I was-
D:[yeah
P:[sat at a desk
(.)
D:so what- how long have they gi- have you got left in work then
P:I’ve- well today is m- was my- (.) I’m [now officially unemployed [yeah I (was)
D: [oh is it [right okay
P:given a week’snotice last week
D:okay
P:and I was told you know y- we’re giving you a week’s notice pay you don’t have to go in (.) we don’t expect you to come in but
D:okay
P:and unfortunately that was written into the contract ha which I didn’t realisethat within the first year they can give me a week’s notice (.) so I’ve probably had err seven days off in the last three months
D:ahh [tricky
P: [and I think that was- it got to- at first you know they- (.) theyput up with it and then it was- yeah then they didn’t (.) so that was a bit of a- (.) bit of a blow er but (.) like I said to my partner it was either a case of- it was either gonna go two ways I was either gonna quit or [they were gonna sack me (.) and it
D: [yeah
P:was the-
(.)
D:the other
P:the latter yeah [erm
D:[what do you want to do for work now then
(.)
P:well (.) in the long run I need to- (.) err (.) well in the short term I need to get this sorted (.) my anxiety before I go into- to anything (.) errr (.) the only problem is that I’m- basically I’d like to be signed off
D:okay
(.)
P:until I’m ready to- to look for work [because I know that I’m gonna be- I’m
D: [okay
P:gonna have to go every other week to the job centre they’re gonnabe trying to push me into work which I don’t necessarily want to do (.) err I did li- (.) I- I was unemployed basically when I moved from XXX for s- (.) I think six months maybe a little bit longer (.) and it was an absolute nightmare (.) cos I was getting pushed into everything- anything they tell you to go for anything they don’t look at you know (.) if you’re not signed off for they’ll just put you forward for [anything (.) err Ineed to make sure that (.) like with- my partner said as
D: [yeah
P:well that it’s now a case of me getting (.) better
D:yeah [better yeah
P: [as such yeahyeah
D:the only thing is isrealistically
P:mm
D:it’s a- (.) I’ll be honest with you I want you to promise that if you end up in a job and you get really anxious again you will [come quickly
P: [yeah [yes yeah
D: [the reason isis that we’ve got a really good service so that you can see someone within about a [week
P: [mhm [yeah
D:[if you’re in work (.) but once you’re out of work we can’t access the service
P:right (.) right
D:so
P:mm
D:[make sure- no you [won’t know it (.) no I mean it- and you- you wouldn’t
P:[I didn’t know that [I’ve never been told this no
D:necessarily know [but it’s just there’s- they’re trying to help people stay in their
P: [mm
D:jobs
P:yeah [mm
D: [which is good really [good erm (.) but yeah it’s just important that you
P: [mm
D:know that when you get another job that you come when [you start to feel
P: [yeah
D:wobbly [cos if we then do a- you know a modified fit note [to say you might
P:[mm [mm
D:need some timeoff or altered hours or [whatever
P: [yes yeah
D:then we can access that service you can get seen really quickly
P:mm
(.)
D:cos the slight difficulty is for face to face stuff is it’s three to four months
P:yes yeah well I think that’s always been the case hasn’t it
D:[so (.) it just means that you might have (.) and that’s where we’ll have to look
P:[mm
D:at the- how we use the fit note to help you because sometimes
P:mm
(1.0)
D:the longer you’re out of work (.) the harder it is to get back [into work and it’s
P: [oh yeah t- yeah
D:[awful isn’t it
P:[well that’s why I was- like when I- when I came back from Norwich it was an absolute nightmare I thought oh yeah I’m fine I’ll walk straight into a job (.) and I didn’t
D:[yeah
P:[and it took me- you know it took me a good probably six to eight months to find work
D:[yeah
P:[and then I fi- find a job thinking oh I’m actually comfortable with this [and then
D: [yeah
P:i- it goes
(.)
D:so I’m- I’m [wondering whether like in terms of a plan like [you’ve talked about
P: [(u.c.) [mm
D:medicines you’ve talked about talking things or [whatever i- cos you [want to
P: [mm [yeah
D:get- (.) basically give yourself the skills backto manage it
P:[yeah yeah
D:[so I think it- it’sdefinitely gonna be a face to face talking [thing (.) and it might
P: [mm
D:be that you have a bit and then every year you have to keep [refreshing
P: [topping it up
D:[because you- you know your habits are not (.) the ones (.) that stop it [your
P:[mm [yes
D:[habits are-
P:[yes yeah [mm
D: [to feel those anxiety feelings and for [that to sort of stop you doing
P: [mm
D:stuff so
P:yeah
D:the plan would probably be- I mean it’s up to you what you want to do but you have mentioned medicines so sometimes the best option is to get you onto other medicines[KW5]
P:yeah
D:get you feeling a bit better (.) while you’re on the waiting list
(.)
P:mm
D:erm (.) there is a bit of an option erm let me just see if we can access it I’ve just got a- a list of things I don’t know whether I [can-
P: [I’ll be honest with ya everybody I’ve- like my- as I said my doctor-err Doctor XXX a long- like six years- he was- he was originally my me- my doctor when I was a (.) little kid
D:a kid yeah yeahyeah
P:and i- you know he put me on amitriptyline and err (.) it was good at the time (.) and now it’s- it’s just not working I was- I was on twenty-five milligrams at first then it went down to ten (.) cos I was feeling absolutely shattered because of it (1.0) err but I’ve been given- I’ve been (.) doctors have tried to put o- me on other things and I’ve taken them and then I can’t see them again (.) and-
D:okay
P:have trouble seeing them err and (.) it’s a case of finding like yourself that (1.0) I’ll be able to see every time instead [of different peo[ple
D: [yeah [generally here- yeah you’re right you[get much better- you’ll get better quicker and better ha
P: [mm yes [yeah
D: [if you see the same person generally [here (.) the w- the w- the set up is
P: [yeah
D:that we’ve got two nurse practitioners who see all the emergencies-
P:yeah I saw- I’ve seen the- [(I think)
D: [you’ve seen XXX [before haven’t you I think
P:[yeah that’s it yeah a couple of [times yeah
D:[ermand then the GPs see the more ongoing stuff so the [r- appointments are
P: [mm
D:kept for at least two weeks in advance and if you [phone up two weeks in
P: [yep
D:[advance you can almost always get in
P:[yeah [mm
D: [with who you’re gonna see
P:[yeah well I generally do it online now
D:[unless they’re not in that weekokay [yeah
P: [I’ve got the online thing found it a
[bit easier
D:[good (.) right so I’ll refer you (3.0) if I refer you (1.5) in ter- just one screening question it doesn’t sound like it but (.)just so I know
P:[mm
D:[until we’ve talked about it (.) is your anxiety so bad that you’re wanting to hurt yourself [or (u.c.) harm yourself
P: [no I’ve- I feel like I am depressed (.) er to a- to a slight extent but it’s not- I don’tfeel any (.) thoughts of harming myself [or anything
D: [okay (.)
P:like that
D:[okay
P:[no I just want to get it sorted ha
D:and how supportive is your partner
P:yeah she’s very supportive luckily err you know she’s- as I said to you she’s said that (.) at the moment it’s not about me going straight into a job it’s about me getting myself sorted so I can go into a job and stick at it
D:yeah
P:like my last job I was [with for five and a half years
D: [okay good (.) okay so [that’s-
P: [so it’s- [and
D: [so you
P: [that’s a long- (.) so I can do it
D:[can [yeah (1.5) [so what do you think your trigger is
P:[err [for some reason-
D:for the all youranxiety do you know
(1.5)
P:I thi- ah I do- at the moment I’ll be honest with you it’s been- a lot of it’s been health related
(.)
D:about your own health
P:yeah which I’ve never really had before like I think in er N- N- err October November I had- I came down with like a- (.) quite a bad (.) err (.) well like I say chest infection whatever it was (.) err and ever since then it just- that’s when it really reallywent bad (.) err (.) but generally it’s busy pla- I don’t like busy places (.) err being [in-
D: [okay
P:crowded environments where I feel like I just- (.) like when I s- first started having it I felt like I n- got to get out of places and that’s feeling the same sometimes I’ll just go where I know nobody’s gonna be
(1.0)
D:right just so you get a bit of peace and quiet
P:that’s it yeah
(.)
D:okay (3.0) right let me- I’m just checking how we upwards titrate you cos I think you’re- you’re probably better to swap you off amitriptyline
P:yes
D:[erm right (.) before I dothat I’ll just show you this (.)erm the- this is the little
P:[yeah
D:sort of leaflety thing that I’ve made of things around here that are available (.) erm so it sounds a bit like you’ve got a bit of like health anxiety things going on (1.0) so er if you go onto this website I’m assuming you’ve got the [internet
P: [yes
D:[at home yeah (.)if you go onto- this website’s really nice the anxiety one’s
P:[yeah
D:really nice (.) erm and they’ve got relaxation exercises in there
P:[yes yeah
D:[ermand I’m sure you- it’s all familiar but sometimes it’s just [worth-
P: [it’s worth
[having a look mm
D:[starting again and going right let’s just dedicate a bit of time (.) erm you’ll obviously be doing your CV applying for jobs but an hour a day
(.)
P:yeah
D:try and have a go at doing all this your relaxation stuff (.) the- these are really nice I think these are great it’s a nice Northumberland accent
P:[right
D:[but it’s- talks you through relaxation exercises
P:yes
D:[so it’s just a voice and you just do what they say (.) you don’t really have to
P:[yeah
D:think
P:[mm
D:[and erm (.) I’ve- I’ve had them on in the background just to- so I know what they areand I just think oh right [I feel quite nice now
P: [yeah yeah
D:so they’re quite nice and they just talk you through those (.) similar relaxation exercises but i- i- you know it’s a bit easier
P:yeah
(.)
D:the normal lifestyle things now (1.0) erm (.) I think a CBT appr- type approach will probably be the best sort of approach for you rather than counseling
P:yes
D:cos it sounds more like you need the skills for you to manage the symptoms as opposed to it being (.) a traumatic thing that you need to get off your [chest
P: [get off- yes yeah
D:so counseling would be better if that’s (.) the main issue but it [sounds more
P: [yeah
D:like it’s your brain overthinking stuff
P:it i- oh yeah my b- it doesn’t switch off
D:yeah
P:yeah doesn’t switch off whether it’s three o clock in the afternoon or four o clock in the morning
D:yeah so it’s [getting those skills to listen to it and then go thank you put it back
P: [mm
D:in a [box
P: [yes yeah
D:so erm (.) the quickest thing in terms of- cos w- it sounds like we need to quickly get you back earning some money in [(more or less t-) as much as
P:[I need- yeah I need to
D:[possible (.) erm (.) is the ECBT (.) and you can just go onto that website or
P:[yeah
D:ring them and that’s quite a quick thing
P:is it self- (.) self-taught is it [or (u.c.)-
D: [it’s- it’s a computer programme [that you go
P: [yes
D:through butweirdly and I can’t- well I- I’ve got some hypotheses about why but it has better results than the face-to-face CBT
P:oh right
D:I think probably cos you can go it at- go through it at your own pace
(.)
P:yes yeah
D:and you don’t- if you’re feeling anxious you don’t have someone going (.) w- w- you know think- over thinking going what are they thinking about me [or
P: [yes
yeah
D:you know those sort of [things
P: [yeah (.) yeah I knowI know
D:so that’s really good and it’s really easy to access and that’s very quick (.) whereas [the face to face stuff is much longer
P: [mm (.) yeah
D:so I would be a bit more tempted to .hhh do all these things for now (.) see if you can sign up for that
P:yeah
D:start some medicines and then come back in a couple of weeks and tell us where you’re up to
P:yeah
D:erm and then if (.) you- cos if you see them and go through the assessment process if they say oh actually you’d be better with this then they can just refer you to it
P:oh right yeah
D:ermand put [you in touch (.) there’s obviously other things here there’s like a
P: [yeah
D:you [know emotional resilienceand [emergency phone numbers to ring if you
P: [yeah [it’s alright yeah
D:[need them
P:[don’t need the Samaritans just yet
D:no but (.) that’s [good I’m pleased to hear that (.) but it’s there [if you just think
P: [yeah [yes
D:you know
P:[yeah
D:[I’m having a really bad day erm for whatever reason (.) [and you know
P: [yeah
D:there’s other things as [well hahayou know erm (.) people just to chat to if
P: [yeah
D:you want to have a [discussion (.) and if you’re a nighttime waking up in the
P: [yeah
D:night person (.) there’s this sanctuary thing
P:[oh right
D:[so if your head whirrs a lot at night
P:mm
D:then err they’re open eight pm till six am and you [can just go down and
P: [oh right
D:there’s people there to talk to you face to face and there’s couches and- (.) [you can just sit there if- you [know you (.) feel like you’re losing your mind
P:[oh right [yeah
D:pacing up and down [at home (.) erm(2.0) it says there’s a sleeping thing
P: [yeah
D:here as well so if you’re finding that you- d- are you waking up at night
(.)
P:no I’m just not [getting to sleep
D:[(u.c.) yeah
P:full stop I’m just not- (.) not sleeping at all (.) [well I do probably about four
D: [(u.cs.)
P:five o clock in the morning I get to sleep
D:okay
P:I’m getting three hours (.) a day
D:[right