Health Anxiety clogging up A&E

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Im really pleased that finally someone within the NHS has come out and said this.

Having been treated myself in A&E, in the corridor (outside triage) due to lack of cubicles, I was genuinely shocked at the amount of patients that attended who shouldn’t have been there. I’m not talking about those that were genuinely ill and couldn’t see the GP and had no other choice but the ones that were clearly anxious about their health and symptoms that didn’t warrant an A&E visit. They were all sent on their way but it still was time that was taken away from those patients that genuinely needed help. I wonder what the answer is to this, because something has to change.

Health anxiety not emergencies clogging-up A&E

Fixation to the body and arising thoughts absolutely fuel health anxiety. Problem is people absolutely believe they have the feared health issues and refuse to step outside the cycle of anxiety they are maintaining despite being stuck in a pattern of this where it amounts to nothing.

But this is where it gets complicated as I have a lot of serious physical conditions to so I struggle to differentiate what's anxiety and what's real. The danger is when drs see health anxiety on your records and dismiss your symptoms that turn out to be serious and life threatening and then this decreases trust in drs and increases anxiety. Luckily I now have have a good team of drs who understand how much iv been screwed over by the nhs so completely understand why I am the way I am so know now to actually listen to me and take what I'm saying seriously which has lowered my anxiety, cut down on a&e visits, hospital admissions and unnecessary scans and tests. This approach is working. That bit of extra time saves time and money overall. I have tried to address the health anxiety I'm on medication iv been in and out of therapy for years iv also been under the cmht for years it doesn't work as even they admit it's hard because you kind off have a point and can't ignore certain symptoms because of your medical conditions

I confess I don't really understand health anxiety. As in, if you are aware you suffer from health anxiety you are also aware that it's most likely that and not a heart attack or brain tumour. And this will be based on the fact of multiple presentations at A&E thinking you have a brain tumour, heart attack, stroke etc and discovering it wasn't - it was health anxiety.

I'm not trying to be a dick. But after understanding that and labelling it as such when you present at A&E are you presenting as with health anxiety or with say MS or skin cancer?

I'm trying to understand the level of awareness of the condition and whether it but if there was walk in mental health services they would work better for you since you already have the awareness by naming your condition that's it's probably from experience not going to be a physical illness? Or is it simply the neurological switch not being there to prevent the - this time it might be, what if I miss it?

And out of interest what explains the increased prevalence in health anxiety in recent years? Is it proliferation of health info online and social media; rising vax hesitancy and alternative therapies; declining trust in health professionals and declining access to GPs and/or impact of the pandemic ?

I'm aware of my health anxiety as a whole but in the moment of chest pain and headaches etc the what ifs start creeping in. Everytime iv gone to a&e iv truly believe in the moment my life is in danger. The problem with walk in mh services the same as mh staff they have in a&e they won't see you until you have been cleared physically as even people with health anxiety do have genuine medical emergencies. I can't answer why it's got worse recently as I have always had it for years. The cause of mine was spending a lot of time in hospital as a child being told I wouldn't live past a certain age and then repeatedly as an adult being misdiagnosed, having serious medical conditions missed such as a pulmonary embolism and a bleed on the brain. Being overdosed multiple times by incompetent hospital staff. Being diagnosed with cancer when I didn't have it. Repeatedly told things are anxiety and then turned out to be actual physical conditions. I was diagnosed with medical ptsd and health anxiety due to the way I have been treated over the years. It's a debilitating condition to live with and the treatment options are very limited. On top of this you get treated terribly by any medical staff you come into contact with who don't know you enough to truly understand why you are the way you are and just see health anxiety on your medical records.

Not me it’s my observations with my children who have had the misfortune to experience all 3 levels of care. Who and when is assessment happening in the first level? It now seems to be a generic steering towards CBT. CBT is all you hear about which is ridiculous when you consider that ND people are statistically more likely to have MH and anxiety difficulties and be the least likely to be able to access CBT.

You are in no position to yourself identify health anxiety from sitting as a patient in A and E. How ridiculous.

There may have been, but you wouldn't know either way.

It's a circular issue. Health services are overwhelmed because of massive increase in health anxiety causing compassion fatigue, error and mismanagement. This causes complete lack of trust from the public increasing anxiety and round and round we go.

You situation is more complex and learning to distinguish between the physical symptoms and their co-occurances from the physical symptoms of anxiety is key.

Knowing how to manage the anxiety and cope with chronic conditions is key, as they both can contribute to an increase in the other.

I think I must be very lucky with my GP as I have never had an issue with getting an appointment for me or the DCs.

You submit an online form with lots of detailed information eg what medications you have already used, any other information like high temperature (I have a digital thermometer so can give fairly accurate data).

You may then be sent an email asking for photos if relevant.

Usually I will get a call back that day or the next day. GP then decides whether to refer for further tests, give a prescription, or book a face to face appointment. I think it’s a very efficient system.

When it’s been urgent (eg when I had a bad chest infection) I got seen and a prescription the same day. When it was not urgent but still important I got an appointment in 2/3 weeks. I have fortunately rarely needed to go to A&E.

However I only ever contact the GP after I have exhausted other options - treated at home, been to pharmacist etc. I keep a very good first aid kit at home.
Pharmacists can actually prescribe quite a lot of things.

I do wonder if we will start having to pay for medical appointments as they do in other countries like France.

I can't understand why you say everyone is eligible for these services then go on to say many aren't for "legitimate reasons".
By definition, not everyone is eligible then, are they?

You mention people who apparently refuse a lower step of care, and I don't disbelieve you that these people exist.

But you don't mention those who have been told they need a higher step but are told by those services they are not severely ill enough and to self-refer to your type of service again... ending up not eligible for any help. I've read a lot of things from professionals about this gap in services.

This is actually the experience of me and my family and friends too.

Thing is people cba to send an econsult and await a response because mumsnetters have told them they have sepsis and to get to A&E now. Maybe even call an ambulance if for some reason public transport isn't available.

Pharmacies, practice nurses, econsults, book routine appointment for 2 weeks times all perfectly acceptable solutions but nope, people want bloods taking now and they want a Dr to see them today. Despite having a bit of earache or some dizziness. Both indicative of a brain tumour of course.

Ours use an e-consult form but it's a race to see who fills it out the quickest before it closes for the day.

You have no idea, do you? It can be very hard to access primary health care if you live in a densely populated area. I am the opposite of “rush to A&E” and in fact, I often leave it far too late to seek medical help. That said, trying to get a GP appointment is impossible. The e consult opens at 7:30 and it is closed due to overwhelm within the hour. I duly would ensure I put one in and it gets triaged within 48 hours which is unhelpful if it’s a Friday. It is also a problem if you develop symptoms later in the day.
I am categorically not blaming the GP practice, they are swamped with too many patients and too few HCPs. It really can be no mean feat to get access to primary health care in some areas though.
I am also not condoning misuse of A&E but I really don’t think it’s the cause of the downfall of the NHS. It’s easy to blame vulnerable people and not the systemic failures.

I live in London and there are lots of demand on services but pharmacies are easily accessible and there are many nearby.

I have no idea? Yes, I do . I access healthcare as everyone else does. I use econsults, pharmacy, UTC, 111. There is so much available.

I of course would go to A&E if I or a family member had a life threatening or very serious illness. I certainly wouldn't use it as a GP practice.

This thread has really exposed how vastly healthcare provision varies across the country

My town of 25k has one doctor's surgery. 10 doctors, a couple of ACPs, a nurse and one receptionist.

That's 2500 people per GP. the form opens at 8am and slots will be filled by 8:01. I have waited weeks for an appointment before.

We have one hospital to serve upwards of 500k people, and that isn't a large hospital.

Pharmacies still operate on the 9-5 schedule. Most will refuse to treat you. We have two urgent care centres, both of which operate 8-6.

I'm happy for those of you who have all of these resources. But not all of us do.

Our GP practice is utterly useless. They don't offer e-consult or online bookings at all. It's all the old "phone at 8am" service and if you're too far back in the queue, all that day's appointments have gone and you're told to ring back tomorrow, however urgent/serious. Advance bookings are for at least 6 weeks ahead, and that's if they have any spare, as they get put on their system randomly so you can't even find out if there's a best time or day to phone for them. Their phone system also randomly cuts you off, so sometimes you wait and then get told you're third in the queue and then suddenly it cuts you dead and you have to ring again, to find you're back to 27th in the queue! It's not in a high density/deprived area either so it's not just sheer number of patients. It's also a multi-surgery practice, in a rural area, so if you do manage to get an appointment it can be in a different town/village upto half an hour's drive away so you either need access to a car or to be able to call a taxi to get to it as there are no buses between the villages.

People asking where they should go if they have health anxiety

Therapy. You go to therapy.

NHS therapy is extremely hard to get and not everyone has the money available to go private.

Because everyone is eligible for step 1 support - what this is varies from area to area or could be that we provide you with access to our online cbt programme and you compete this yourself, so guided self help. Everyone is eligible for that.
for steps 2+ there is criteria, very low for step 2 but as you go up the steps the services are for more severe presentations so that’s often where people find them selves ineligible or, needing to take other steps first.

I don’t deny there’s a gap. At step 2&3 we can not take clients where there is immediate risk or likelihood of immediate risk, we’re not trained to help with that. The services that we refer to for severe and enduring mental health aren’t the same service as us, they aren’t commissioned by us, they’re completely separate so I can’t comment on their decision-making but when they reject their referrals, unless there is serious risk, we often find ourselves offering support. We don’t want to leave clients without support it often then means us evidencing that we’ve tried Step 2, we’ve tried step 3, we link in with their GPs and together put forward a rational for them accepting the referral.

it reinforces the comments that the system is broken. It absolutely is and services often feel really frustrated with each other for the wrong reasons. It’s literally all we want to do but the infrastructure isn’t there because we are so understaffed and underfunded.

Do you know how much therapy costs?? Crap therapy from somebody crap is not worth it. It is really easy to be completely fleeced. We are struggling to pay for my son to have therapy fortnightly. Private diagnosis as to which type of therapy he should have before he even started was nearly a grand. You literally have no idea what it’s like in reality for families. Families are struggling to pay bills and cope with the additional expense MH struggles bring. We have another child who needs it too and a third who has moved down a tier after sheer hard work who is being held by a support worker waiting for the therapy they need.

MH provision in this country is a complete joke.

Exactly. So much free stuff available online too, apps etc.
People seem to expect weekly hourly sessions at a lovely venue.
We have to try and help ourselves a bit.

Step 1 is pointless for my DC as they are ND and struggle to understand and identify emotions. 1 had CBT by somebody not qualified enough with zero understanding of ND and it did a lot of documented damage. The bar is high for 2&3 and also too low.Excluding people with any risk when there are mile long wait lists for the support they need is ridiculous and makes conditions worse.

So again let’s not blame patients. Most do actually want to get better but they also want the right treatment. Expecting people to be grateful for crumbs completely wrong for them is insulting.

Nope I expect treatment that is right for my children which treats their conditions. 🤣 at the idea that one should use apps to magic away mental illness and ND.

I'm sorry but what is it with expecting people to accept the bare minimum from the health service these days