Scar From Accident - Consultant Recommended Psychological Support

[MelonadeAgain]

I had a car crash a few years ago and have been left with some minor facial scarring. I received cosmetic surgery to revise the scar and at the time was recommended to seek further consultation after a few years to see if further improvements could be made.

I did so, had a NHS consultation and was told it would be difficult, although possible, with uncertain results. It did however recommend that instead I be referred for psychological support as the disfigurement was subtle and it was troubling me.

Is this usual? I wouldn't say it particularly troubled me, I was simply following previous medical advice to check, and I am aware that with the NHS, if you don't say it isn't bothering you, you won't get treatment. And it is annoying although it doesn't cause me any great psychological issues!

I'm kind of thinking "Whoa! Where did that come from?!"

I have a child who has extensive and significant scaring and has been reviving ongoing treatment for about a decade.

IME yes it is usual practise and yes it is very helpful

Obviously receiving

Maybe the consultant thought that the very fact that you did go back to discuss the scarring was a strong indication that you were worried by it, and did not realise you were only acting on previous advice.

If you are not bothered by the scar, don't pursue it any further

It isn't extensive scarring though, and I've lived it quite happily for the past 7 years without any problems! I'm at a loss as to what its for or mean to help with.

Its a physical scar, I know it exists, I have no issue with living with it but If they can't treat it further on the NHS then fine, I will forget about it. Its hardly noticeable. I told the consultant this. I feel like I'm being pushed into a little box that I don't fit into. What on earth would they counsel me about? Learning to live with and accept my scar? Is this really a good use of NHS resources?

Well you don't have to use up the NHS resources if you choose not to follow up the counselling suggestion. They probably have some sort of procedure they have to follow whether it is relevant or not hence the recommendation. Just do what you are happy with.

Then decline the appointment,it's ok to do that

Don't worry about it. If you feel you don't need the help, don't take them up on it. It's no slur on you that it has been suggested - but great that it has been offered. if you need it.

Friend who does private work also told me he could improve it but to check with NHS first to see if I could get it done by them.

I just find the psychological counselling bizarre. I can't help wondering if its more because I'm a middle aged woman and there is some sort of assumption...

And wouldn't it appear on my medical records, that I'd had psychological counselling?

And what on earth would they try to counsel me about?

Melonade

Stop worrying. Plenty of us have experienced distress or psychological problems. Some have received mental health diagnoses. It's not a slur, really it isn't.

The NHS treats people who are struggling in their reactions to many issues that have caused them distress - miscarriage, bereavement, assault, accidents etc etc.
If you aren't struggling and you don't want psychological help, then don't take it.

It's not a terrible thing to have on ones medical records. Also it's fantastic that the nhs is looking more and more to helping people deal with things properly than a quick fix.

Some people with facial scarring are affected by it disproportionately. So a tiny little scar may be all they focus on when they look in the mirror. Also I'd be a wee bit cautious about a friend saying they could definitely improve it. Most (good) plastic surgery is about managing patient expectations - if it's a tiny scar improving on that may be difficult.

I don't think its fantastic at all. I simply followed medical advice by investigating the possibility of follow up treatment on the NHS.

I'm now left wondering if what I thought was a small, minor scar, which didn't particularly bother me, is far more serious than I thought and enough to warrant being referred for psychological counselling.

I would prefer if the NHS kept its valuable resources for dealing with the practical issues presented to them or for people who genuinely do need or who request such help.

I'm pretty sure the scar could be further revised by scraping or lasering it, as the surface is quite proud and uneven. Looks like I will have to get this done privately. From what I've read and heard, its a perfectly standard procedure to improve the appearance of scars.

I would understand the reference better to psychological counselling if this was something that was all in my mind or some great distress that I was suffering.

If they don't feel they can improve on its appearance then presumably they won't treat it on the NHS. No cost to them

If you don't take up psychological therapy, no cost to them

No one can force you to receive psychological treatment - you have to actively engage with it for it to be helpful anyway.

It is not as black and white as either a terrible scar or "all in your mind". People vary enormously in how they perceive exactly the same events.

Sounds like the consultant is following some sort of scripted treatment Pathway. I'd question whether there's been some sort of miscommunication and they weren't aware (or particularly interested) that you were seeing them following advice from whoever handled your original treatment.

Is it because it's a cosmetic procedure you're requesting?

By your own admission it's not a physical medical thing so for the nhs to fund a cosmetic procedure it would have to show some sort of possible improved outcome for your mental health. If there's no sort of clinically justified reason for it then tbh I can see their point.

Fwiw I think if you went along to the psychologist appointment and said what you'd said here you would be denied further nhs intervention. That's not to say somebody else in the identical situation would be if they perceived it as a massive disfigurement that was impacting on their day to day life.

In that context the psychologist has saved the nhs by noting no reason for you to need further treatment on the nhs.

It isn't a cosmetic procedure. It is the removal of superfluous raised scar tissue following a car accident.

I agree that if it was something entirely psychological or indeed very severe and life changing or limiting (and I am very glad that it is not) then psychological services might be very useful indeed.

To think that it would benefit someone suffering from my scarring, and expect that they will be willing to take time off work to attend it, is utterly ridiculous and lacking both perspective and the ability to allocate resources effectively.

If they do not have the resources or willingness to deal with the revision of minor scars (and this was not ruled out, rather counselling was the consultant's "preferred option") then it would be better if they would say so.

This is not a boob job to make me feel better, or a facelift - I have raised scar tissue on my face which I am simply trying to see if the NHS will remove. As advised by the previous NHS doctor who dealt with the scar.

I'm beginning to think that I've walked into some parallel universe where black is said to be white, until you agree. I'd be very wary of letting someone potentially damage my quite healthy psyche, thank you very much!

You are very suspicious of psychological treatment!

As I said, no-one is forcing you to go.

Iirc psychological consultation is very common before surgery of any 'cosmetic' or reparative nature.

It'll be ok, go to the consult, it won't hurt!

Is it considered a cosmetic procedure, though? I have a surgical scar that has a major impact on my life and health and stops my bowel working properly, and I've even been warned it could be considered a cosmetic procedure depending on who I see. the definition of cosmetic can be quite arbitrary.

Cosmetic refers to appearance rather than function, they want to see if they can improve appearance of the scarring on your face, and they want to make sure that's ok with you. It won't open up a can of worms love.

I think you are over-reacting a bit?

It seems like for facial scarring of your type, the NHS will not offer cosmetic improvement at this time, but will offer psychological support.

Whether they are offering this because it is scarring, because it is facial, because it was caused in a potentially traumatic way (car accident), or some combination of those, I cannot say.

They have not looked at you and thought hmm she looks like she needs counselling. They are offering you something that some people in your position might want to take up.

You do not feel it necessary or that it will be beneficial so simply decline.

Many people with quite major scarring aren't fussed by it, many with minor scarring are very upset by it. Facial scarring is especially affecting for many people for understandable reasons.

Simply say thanks but no thanks. And if you wish for the corrective surgery consult your private contact. However given that the NHS consultant feels that results would be uncertain, and you're not actually fussed by it, I would give it a lot of consideration before shelling out £££.

X-post Hissy I was suggesting to the OP that perhaps her scarring is considered cosmetic, for the reasons you suggest.

I work in this field - I counsel people adjusting to a diagnosis, adjusting to life with a health condition, coping with a difficult medical experience, childbirth trauma, stuff like that. Some people find this very stressful, and can benefit from a bit of help. It sounds like you are not in need of this, so just say no. It's not bizarre though!

Yabu. I'm sorry about your scar, but if your not bothered by it and you don't want to waste NHS resources then why are you pursuing having it corrected? It sounds like you're happy without treatment?

Thank you Hissy but it was made clear the counselling was not for a useful purpose such as you suggest but as an alternative to surgery.

Dolphin I can live with the scar but am open to having it revised if it can be done. How else would you suggest I found out if it can be done on the NHS other than have the consultation? Kind of you're damned if you do, damned if you don't.

I would prefer the NHS admitted they don't have the resources to revise scarring than to waste time sending people like me for psychological counselling. One look through my notes would have revealed that I have suffered no symptoms indicative of a need in the 7 years since the accident.

Where do they draw the line at suggesting psychological treatment instead of actual treatment for all sorts of medical complaints?