Is this acceptable from a consultant ?

[mrsbyers]

A couple of years ago I moved closer to my parents mainly to be closer to them as my dad was in the advanced stages of Parkinson’s - he passed away last autumn and our family have been devastated by his loss and the struggle with the care system and his treatment a times

I have had a lot of medical issues , Crohn’s disease for 23 years and double figure surgeries , ended up with advanced kidney disease due to poor decisions by doctors who effectively killed kidney function by injecting dye into severely dehydrated kidneys and then to top it all had a small stroke in 2020.

Despite all of this I have managed to keep working and refused two attempts to have me medically retired by moving jobs and now settled in the civil service hoping to go half time in two years when my mortgage will be paid off. I’ve always been financially independent and have been able to save a lot since Covid towards retirement

Thats the background

So recently I have had issues with low magnesium and had remained under my gastro team an hour away in a different local authority , I have very high stoma output due the number of surgeries I have had and also had a bowel infection in the bottom end which is essentially redundant.

Doc suggested I get referred to a more local team and I agreed as would make it easier to access notes etc. Tonight I’ve gone onto nhs app and seen a short letter from the new gastro consultant to my GP where he has noted I am overweight on Sertraline and had started smoking again - can’t argue with all of that but then he said ‘these types of patients usually move due to social crisis’ and it’s really upset me. I’ve really struggled to maintain a career and have a nice home and this man who has never met me has labelled me in this way - I moved to be near my dad who I’m still grieving , I support my mum a lot and deal with underlying depression which is very common with IBD and I am somehow managing to work full time albeit from home and with a couple of periods of sick in the last year.

I feel like I don’t want to be under the care of someone who has so quickly labelled me in that way - am I overreacting ? I am thinking of contacting my GP tomorrow and asking to be referred to another team even if it means travelling or just stay with my long term doctor.

Thanks for reading if you got this far

Couldn't social crisis = family crisis? Why have you taken this to mean something so negative?

It could also mean that you have moved because the health care structure around you being ineffective or unsuitable. There are so many meanings to this term and none of the meanings are a negative about you personally.

It's a bit shit isn't it. Has the consultant met you? You say not but there's detail in there that he couldn't say without certainty if he didn't meet you.

I think I'd send straight over to PALS ahead of the gp. You have a right to be treated with dignity and without prejudice. You might want to move back to the previous dr but at least let the trust know about their consultant,

What is it about the dr writing code, "this spirited young mother came to see me" nonsense - surely it should be factual and helpful to the GP.

I'd second the family crisis to be a translation and not infer more than that.

The notes made aren't really for the patient and they're not dressed up as such, its their clinical assessment and professional opinion on the presentation they've seen.

Honestly we'll done for sticking with work when you could have taken other options. I see many that do drop out out work and I really think that in itself has a massive impact on mental then physical health.

No I haven’t met him , to the OP who asked about why I’ve taken it negatively the social crisis thing - my surgery is in a bit of a socially rundown area so I think he’s assumed I’ve been rehoused there or something similar just based on my profile and location

He was told by my GP that I had remained under my team in old location due to good relationship and continuation of care and I’d only been persuaded to switch due to distance and the fact their IT systems don’t talk to each other

The full quote is very often these type of patients move quickly due to social crisis and what should be a careful transfer of care doesn’t happen.

@mrsbyers I think you're being slightly paranoid about this consultant's view of you (I mean no offence when I say that). You are clearly a very accomplished and well rounded person who has been through an awful lot and you have on your own admission, overcome many of these hurdles despite all the setbacks. Why are you letting this one little comment (that has a completely different meaning in the medical field to how you have taken it) get you down? Give this consultant a fair go, and make your judgement once you've met him etc. It's a much more convenient location for you, why make life more complicated for yourself?

He's just speaking from professional experience. I wouldn't take it too personally, though I get why it's hard not to.

first question is what does it actually mean - I'd have thought it could have meant something like a social crisis in the sense of social/family/emotional crisis - as in moving to be near a dying parent, parent dies (bereavement crisis) and then the patient moves to get away from the trauma site. but accept it could mean negative social crisis in the way you've interpretted it

Second thing is whatever it means, it sounds like you've had a serious breakdown in your relationship of trust and confidence with the consultant anyway. if you had a face to face ocnversation and an explanation of a more innocent meaning, I doubt it would make any different to you.

in terms of your aIBU qu, that sort of frankness is what happens in medical notes, function of limited time and need to be direct so others understand. it's not great but its better professionals feel able to be frank rathr than pussyfoot about generally.

Personally Id find someone else as its bothered you and you won't trust him whatever he says

What does he mean by ‘these types of patients?’ It sounds as if he is stereotyping you. I’d contact PALS with a complaint, ask what he meant by social crisis and aks for the letter to be redacted and a more neutral one to be sent out in its place. It does sound as if it has negative connotations to me and I’d find it upsetting. There may be another consultant in the hospital you can see and PALS should be able to help with that. Otherwise I’d find somewhere else. The consultant should know that patients get copies of their letters and need to be more factual rather than making judgements on your behaviour.

The social crisis was your dad's advanced Parkinson's, you moved to be near him. That's how I read it.

Hi OP,

I think you have assumed wrong.

uusally social history is short hand in medical notes, and generally means the patient’s family/support network

I have Crohn's and since my last op I have piled on the pounds. I'm podgy rather than obese but that hasn't stopped a couple of doctors dismissing me saying I must have been misdiagnosed. The ulcers, fistulas resections and stoma must have been imagined then?
My latest autoimmune issue appears to be that my thyroid is giving up so I'm now heavier than I've ever been.
Doctors seem to never believe something is serious as I've not completely wasted away. To be honest I'd rather things got nipped in the bud before I end up like a skeleton again. My weight can fluctuate between 7 and 12st because of the various conditions and medications.
I would definitely be asking exactly what the consultant means by that statement and what relevance it has. How is such a sweeping statement relevant to you as an individual?

I think you have taken this wrong. I would use the term ‘social crisis’ to describe the fact that patients would be unlikely to move unless some unexpected/major life event necessitates it - like a parents becoming terminally ill. Otherwise, patients who have long term needs such as yourself tend to stay in one area precisely to stay with their existing medical team.

How about consultants write in clear English? He could have written, ‘This patient moved to be near her family’ which is clear and understandable to everyone.

Medical professionals need to be able to discuss their patients which each other. That often includes discussions of social and economic situation as it can be relevant to their overall picture, what support they have etc. Unfortunately, now due to NHS app, things that used to be between health care professionals are now seen by the patients and it's not always appropriate. Same for results and reports. They are regularly misinterpreted by non medically trained patients and this just leads to unnecessary stress and anxiety for them.

I don't read anything negative or stereotyping in what had been written. Just an outlining of your current situation with the GP and highlighting something out of concern for your care that needs to be taken into consideration i.e. your move to be near family. It sounds like you've got a lot on your plate and I would encourage you try and trust that the people looking after your health issues do genuinely have your best interests at heart.

My last consultant letter began "This charming lady" 😅 We had a phone consult, I only had to charm him for about 8 minutes! And I'm not sure I'm ladylike.

The impression I have is that they try hard to build something of a snapshot of the patient as a person into their findings. It can be important - well, "charm" isn't important but, in your case, it sounds as if he's concerned about whether you're suffering a chaotic life due to your serious health issues: in particular that you may not be getting continuity of care.

As you know, that's a big problem between health authorities. You say yourself that you switched due to distance and the fact their IT systems don’t talk to each other. It's a heads-up that they need to be mindful of getting the right information about previous treatments.

I wouldn't worry about it. I think he was taking extra care over you; he can't have known that his choice of words would give offence.

It must be disconcerting to be so glibly described by a public-sector professional but probably as you are living in a run-down area where not everyone has the flexibility of keeping their job whilst caring for others, being sick and relocating (a perk of working for the CS) you're just being lumped together with all the other people.

By your own admission you're overweight and smoke so other than being a civil servant, is there any reason that the consultant should view you differently?

It's completely insensitive and dehumanising language to use given he must be aware that you could read it. I'd be tempted to put in a complaint. Might give him a wake up call.

My last consultant letter began "This charming lady" 😅

I've had that too. I think it's code for 'seems relatively sane and reasonable'. 😀

What nonsense! Honestly, is everyone in the UK so sensitive to every little thing? I wouldn't care less if I read that in my notes, and agree with others that OP (and you) have taken the comment the wrong way.

How on earth some of you cope with life is beyond me.

It doesn't matter nor impact on your care or illness. Your only concern is the doctors competence. YABVU

I’d focus on the second part of the full quote where he’s pointing out you need a careful transfer of care (which you do because your situation is complex) and he’s aware that this often doesn’t happen.

I don’t see this as a poor reflection on you, more the sad state of the system and things get lost in the shuffle.

I’d give him the benefit of the doubt until you’ve met him.

i only bother with correcting the notes when they’ve either misinterpreted what I’ve said or made a typo where the said for example, is instead of isn’t.

@mrsbyers This.
One part is factual: by your own admission you are overweight. And by your own admission you've had a social crisis (bereavement. etc). And now Consultant wants others to know so they can be mindful when they transfer your care). Sounds like regardless of how s/he came off, s/he was looking out for your best interests and didn't want you to experience the haphazard transfer of care many experience. "The kind of patients " may be jarring and stereotyping but he is basing is advice on experiences of other patients with similarexperiences and reality is we cant always individualise care. I think he was looking out for your best interests.
However having said the above I think you've lost trust in this Consultant and that's hard to come back from. It may be best for you to change consultants. Hopefully a new one will inspire trust in you but will also advocate that your social (incl. Family, personal) situation be taken on board in care decisions as this one tried to do. Because that's what medical care should do (not just see you as a physiological specimen to treat with meds but as a social being too!)
Goodluck op