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?!"

Ah! I see! This may be a case of NHS one size fits all system. To provide the counselling for those who want/desire their scar to be gone but can't and are suffering as a result.

I think if you take the approach as you have, to find out if there is the technology/knowledge to reduce the scar on a periodic basis, then one day medical science may know enough to achieve an improvement.

If you genuinely don't need the psychological support, then i'd explain to them what your thinking is and why.

This thread is bizarre. If you don't want the counselling, don't take it. It's not compulsory, they're not "sending you", as you put it. It will just have been offered as an alternative to more surgery. As others have said, the doctor will just have been following a protocol, and may have made a very minor oversight having not - horrors! - done more than quickly scan through your notes before your consultation.

I really do not get the issue here. It is not a waste of resources if you (and others who feel the same as you) refuse the appointment. It costs the NHS nothing to offer the service. I'd rather they offered this to every single person, rather than no one at all for fear of offending someone. Mental and psychological health are largely ignored in this country, when they absolutely shouldn't be. How was the doctor to know that you going back for a second consultation was not a cry for help? Unless the scar is physically causing you problems, then surely by going back for a potential second operation, you can only be saying that the issue is a psychological one?

As someone who suffers from generalised anxiety disorder, and has to pay £50 a week (which I can't afford) to get help, because the NHS wont help me, I find it refreshing that some doctors clearly do care and understand the potential seriousness of mental health. Not a waste of resources at all IMO.

I think a lot of people are kind of misunderstanding what you're trying to say OP.

You've gone for a consultation and made it clear that x would be beneficial to you. NHS says ooooh no, sorry we can't do x, our resources are stretched... But here you go, have y instead, even though you've made it clear that y isn't what you came here for and you don't think it will benefit your situation.

Your point: y may be cheaper than x, but FFS if your resources are already stretched try not offering any treatments that simply aren't indicated for the patient and maybe overall the cash will go further!

It smacks of bad management and box ticking. 'Treatment x would actually be possible, the patient is interested, it would be beneficial. It's too expensive for us, so we're going to offer a cheaper treatment which is indicated by the patient's response and bites to be of no benefit - but it will act to show that we have 'done something'.

Notes not bites!

Everyone here is responding to OP's perceived slights on counselling type treatments and confirming to her that no, it's great use of resources and very valuable. I don't think that's what she's saying though - her point is that she's made it clear that she has no emotional concerns about the scar so counselling simply isn't of interest to her. I think that's valid and I also understand her annoyance and suspicion at the notion that she somehow 'should' have an emotional issue that needs 'dealing with' when she simply says she doesn't! It doesn't matter what the cheaper treatment is, the point is that she feels a useless option is being pushed rather than the treatment which would actually benefit her as it's possible within remits and budgets. Which is crap.

Yes I can totally that point of view Bruno, it makes a lot of sense. However reading the op's posts, it does come across that she is offended to have been offered counselling. Op, do you know for sure that you won't be given the opportunity for further surgery should you still wish to have it after the counselling?

Hissy and Bruno thank you, that is exactly how it is. I went into the consultation with a physical problem, looking for a practical solution. I now seem to have been drawn into some assessment of whether or not I can live with my scar and how much it traumatises me and how much I would benefit from mental health services, when this is not the issue at all. Having this "option" suggested to me has made me feel much worse about the scar, which barely bothered me before.

therealeasterbunny I cannot believe psychological counselling has been refused for someone like you who suffers from anxiety and offered so readily to someone like me, who does not. That's ridiculous!

Unless the scar is physically causing you problems, then surely by going back for a potential second operation, you can only be saying that the issue is a psychological one?

Well, I do think anyone with a scar involving raised tissue on their face, which they have been previously told by doctors to have assessed in the future for further revision, would be tempted to follow that advice. I don't see what sort of psychological connection there is really, beyond following medical advice. However, I will now be arranging for a private consultation, as I'm not at all happy about the outcome of the NHS one. Its hard to describe, but above the surface, because of the way it happened, its a bit like a burn with areas of proud tissue. Below the surface its just as A&E left it 7 years ago.

And as with all scars, there is substantial scar tissue below the surface which does interfere ever so slightly with my speech - every dentist I see tells me to have it revised (i.e. cut back). I haven't done so for 7 years simply because it doesn't bother me that much and I'm a bit lazy about this kind of thing.

As for being offended due to a referral to mental health services - Whaaat? I simply went to see about getting a scar revised, not to get involved in any of this.

MissDuke it was made quite clear to me that counselling was an "option" available instead of surgery and that the purpose of the counselling, as far as I could tell, was to enable me to realise that I looked good, even with the scar, etc.. I found this assumption patronising and simply wanted the scar assessed, not my whole appearance.

Unless the scar is physically causing you problems, then surely by going back for a potential second operation, you can only be saying that the issue is a psychological one?

Err, what?! How desperate are some people here for the OP to have some hidden terrible trauma? Really!

If I had a raised scar like that, I wouldn't exactly be delighted but I would simply live with it. Counselling simply would not change that at all. It wouldn't be great, I'd prefer not to have a scar but hey ho, absolutely nothing I could do. Lots of people have FAR worse things to deal with in life.

If it then became possible for a second op to improve how it looked, make it less noticeable, then I'd certainly go for a consultation to explore that. I'd then probably weigh up whether it was worth going through a second op, and the answer might indeed be yes, an op and the recovery period would be well worth having a much better looking scar.

I can't see at all how that would indicate anything but the obvious - that having a less raised/possibly painful/less difficult to put makeup on scar would be A Good Thing!

Sheesh!

I think if it is worrying you and it is quite small scarring then of course they might think to refer you it isn't traumatising but worrying you and you want to get rid of the scars medically, perhaps the Dr thought it wasn't needing any more surgery you dont need to go to any appointment but that is maybe why they wanted to refer you,