To think this GP comment was a bit daft

[Juno999]

I had a GP telephone appointment wrt to mental health issues, then a couple of months later I had an in-person appointment for a UTI.
Whilst in the GP's office, I saw my patient file was open on his pc. He left the room to get something and I had a quick scan with my eyes from where I was sitting.
He'd referred to my previous telephone appointment in which I said I'd felt depressed and he'd written 'She actually sounded bright and cheery over the phone.'
I just thought it was a strange comment really, someone can sound bright and cheery yet be going through mental health problems, or maybe that's just how I sound on the phone, or maybe I'm trying to mask it. All sorts of reasons, it just felt like he was minimising it almost.

Only when they do things right. There are terrible GPs, brilliant GPs and everything in between. The patient is allowed to share their experiences and to question the care they receive. GPs are not infallible.

In this case I don’t think the GP has done anything wrong.

That's interesting,I didn't know that, thanks.

@Rathouse I was saying I used to work in customer service so that's why I automatically go into customer service mode over the phone so I sound absolutely different to how I normally do.

I don't work at the moment and I'm under the CMHT for various of reasons but if you spoke to me on the phone, I'm like a sleeper agent and it just automatically goes into customer service mode

Medical notes speak is its own particularly strange bollocks world of its own. Some of it I see from other professionals at work drives me fucking insane - I am sick personally of a lack of eye contact being noted down negatively for autistic people which winds me up no end.

Big thing though is to comment on how it appears to you, not as if it's absolute gospel - so that distinction between "she appeared to sound bright and cheery" rather than "was bright and cheery" is the big thing.

And yep makeup is my big indicator I'm feeling like shit - one of my line managers likes to do a check in thing about ways we'd know you were struggling with mental health and mine has on it "if I rock up for work wearing make up - worry"

If you don’t speak to your gp how you speak to your family and are formal with him, how’s he supposed to know how depressed you are. He’s made a note about how you’ve presented. There’s no issue with this. He’s not minimising, he’s stating a fact based on his assessment of how you presented. I’m sure if you’d cried down the phone to him, he’d have made a comment re that.

Whilst there are advantages to telephone appointments with HCPs, there are also downsides. And this is one of them - telephone manner. HCPs will be picking up a lot of indicators about a patient's wellbeing from what they are wearing, general cleanliness, posture, walking - you name it. All subtle but all important for building a picture of the patient's state of wellbeing, state of mind.
Nothing wrong with sneaking a peek at your notes - bet many people would as well.

Hope your UTI is better

By the time I went to the GP for help I was past the point of being able to mask how I was feeling. I was a crying mess, unable to put together a coherent sentence. I assume that has been noted in my record as an observation, as it would have been if I instead appeared bright and cheery but stated that I was struggling.

Perfectly normal note from GP.
They have to take notice of patients mental wellbeing, and demeanour is part of that.
In GP land, if something is not written down, it didn't happen. So by writing down how they felt you sounded, they are evidencing that they noticed.

It may not be a case of the doctor being dismissive. You’ve phoned up presenting with depression, which has many different levels. They need to note how you present because if the next time you call back and it’s worse, they have a documented evidence that it is getting worse and your current treatment isn’t working. My doctor does similar, she leaves the screen open and I saw the comment about my complete lack of personal hygiene and my monotonous voice. I asked why, she told me it was because the last time I had come in for a medication review I was clean and displaying emotion. She could see I was deteriorating and it was useful for her to have a clear overview of my mental health at the time

Also it resulted in a massive increase in support, change of medication and my doctor changing my reviews from once a month to once a week. They’re not there to dismiss or minimise, it really does help

GPs are meant to make a note of how the patient presents. Noting that you sounded bright and cheery is relevant, because it is an indication that your depression may not manifest itself in the 'typical' way. It's not suggesting that you aren't depressed, just recording that it wasn't apparent in your demeanour. It's a neutral observation, not a judgement. A GP could just as easily write something like 'She reports that she is feeling happier now that she is on medication, although she was a little tearful during the appointment'.

Think of it this way: if someone goes to the GP with tonsillitis or an ear infection or something, the GP might make a note like 'Patient reports throat/ear pain, headache and exhaustion. However her temperature was normal'. It's not suggesting that the patient doesn't have an infection, just reporting that the one of the expected symptoms in this case wasn't present, because it is a doctor's job to record an accurate description of what they observe. Same applies with mental health conditions.

It's not worrying at all, because medical notes are for other medical professionals who are aware of what 'denies headache' means in medical terms.

Similarly, the word 'elderly primagravida' used to be applied to women who were having their first pregnancy over the age of 35 or something - a non-medical person might see the word 'elderly' and assume it meant someone of about 70, because that's its common usage, but a doctor who read that in the notes would be fully aware that it doesn't refer to a pensioner.

Obviously everyone has a right to see their medical notes, but that doesn't mean they are actually the intended audience, and they should not assume that their medical notes can be interpreted in the same way they'd interpret an ordinary conversation.

This! Its more to advise others who may be taking your appointments in future that despite having depression you still managed to sound chipper, and so in future this doesn't necessarily mean you're ok and everything is roses. It's being observational and informative, not dismissive.

I'm all for accuracy. Think of it in a different scenario. Someone being treated for something that could be an alcohol/drug abuse issue - "The patient denies she drinks excessively/abuses drugs". This doesn't usually mean (in "medical speak" or any other speak) simply that the patient doesn't do either of these things. It really means that the patient is in denial (lying to themselves therefore not helpful as part of the planning of treatment) or lying to the doctor (again not at all helpful as far as treatment strategies go).

They are making an observation and if you agree that you put on a voice then what can they do?

It's not saying you aren't depressed. Depression/ bi polar etc doesn't mean you have to sound like Eeyore, I think you are overthinking the comment.

GPs need more than one afternoon's training on mental health.

Every GP (over two different practices in two different cities) has been knowledgeable, sympathetic and effective in dealing with my mental health.

Superficial memes are not a helpful part of any grown up discussion.