Calling medical professionals

[theturtleswims]

I'm having an internal debate at the moment.

If you had to carry out a medical procedure on a patient who had a phobia about that procedure, would you want to know in advance?

This is about carrying out an ECG on a ND young adult with severe anxiety, a phobia of stickers and who is so body conscious they won't even wear a t-shirt in the height of summer because it exposes their arms. An ECG is therefore going to be incredibly challenging.

I don't know whether emailing in advance to let the practitioner know is helpful or insulting, given that they are a professional who will be trying to put all their patients at ease anyway. Would it help to know that they needed to take extra care with that patient? Might it instead make them more anxious?

The appointment is tomorrow morning and I am wondering whether I should email the surgery to give them a heads up that this simple procedure is actually going to be incredibly challenging for the patient.

If anyone is still up and able to advise, I'd appreciate it. I also tend to overthink things, so this may be an easy answer!

please phone them and try to get through the queue first thing and ask for the message to be set on urgently to the practitioner. Emails may not be seen until too late. The practitioner will value the heads up, and they may be able to juggle things around so there is extra time or may suggest rearranging the appointment to a time where they can have a double slot or end of clinic time protected. Does the patient know what is going to happen and have some support/strategies they can use? If the person is able to cope wearing baggy clothes with baggy sleeves it should be possible to attach the leads while keeping it more or less on. Bring favourite/comforting items and maybe something else to focus on eg chewing gum or sucking ice for a different strong sensation.
Once the stickers are all on it is very quick. Using alcohol wipes can help get rid of any sticky residue sensation they may experience so you could ask the colleague for a handful to take with you.

Yes phone them.

They can increase the appointment slot as a reasonable adjustment, and can think about how to make it less anxiety provoking for them.

Thank you, and yes I can phone them tomorrow as they open an hour before we need to leave home. We have talked about the appointment properly this evening, which is what has prompted my question. She's extremely anxious but knows it needs doing. She'll have comfort items with her and knows that I will stay if she wants me to. Her standard response to distress is 'freeze'.

I will suggest the baggy clothes. One of the discussions we were having tonight is that she normally wears a binder (this is a whole other issue), and I suggested that one of her sleep bras might make things easier.

YES- I would want to know beforehand to help make adjustments.

I would have called the staff when the appointment date was confirmed, not late the night beforehand!

That aside, if I knew well beforehand, there are a few things I would have done as the clinician:

-checked if the ECG machines still had bulb attachments which aren't stickers. I'm sure these have been phased out now, but I would have checked if that was an option at the back of a cupboard somewhere
-Posted a packet of the stickers used to your home so they could be shown to the child to feel/touch (unless that would cause more distress?)
-Ensure that as much as possible, their body would be covered at ALL times, and only the necessary part would be exposed and for as little time as possible. Then covered completely with a blanket, or a duvet or other comforting item from home
-I would have advised the patient that she could bring you or another friend/relative along
-Advise on where exactly the stickers go, the purpose and also remind her that its absolutely pain free- its NOT shocking her or electrocuting her. Even some adults think that at ECG is the shockable pads you see used during CPR.
-I would have suggested bringing some calming music on her phone if that would help
-In general, patients change into a medical gown with no bra/binder/sports bra underneath. IF changing would be an issue, I'd have recommended a fairly loose, metal free sleep bra as you have suggested.

Wishing you both all the best xxx

Yes x

Thank you. A blanket from home is a good idea - she does have one that she uses for comfort and I will suggest she brings it along with the other items she already intends.

I have explained the procedure (I had one last year), she has googled it herself and we have discussed it this evening.

I have emailed the clinic and will follow this up with a phone call in the morning.

I realise now I should have contacted them before the day itself. The difficulty is that she is an adult and is always extremely keen to not do anything that she thinks will draw attention to her difficulties and to being 'different' (her word). When she was a child I would contact people in advance to give them pertinent information, sometimes without her knowledge, but now she is an adult I feel I need her permission to do so and this is not usually forthcoming (e.g. she has only just given me permission to talk to the support staff at the college she started at in September, after too many problems and finally realising she cannot manage without help). Nevertheless I should have discussed this with her before today.

I really appreciate all of your responses. Thank you.

All went well this morning. The nurse was wonderful, and ECG was performed fully clothed with cuddly weighted toy for comfort. Thank you again, all.