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

Doesn't this just mean you appeared on his caseload due to some change in your personal situation? As opposed to your care was transferred carefully due to medical need/request.

Anyone of any social status could have a social crisis that requires a move (especially so now that everything is broken thanks to the government).

I think 'type of patients' means 'quickly transferred' rather than 'lower class oiks'.

I think he's just covering himself/the NHS in case there is some medical detail he hasn't been made aware of.

Actually, to me they sound like a good, professional consultant who is looking at the clues and making sure that a fuckup doesn't happen.

The clues are:
You are depressed, overweight and have started smoking, and are moving areas. This points to something majorly stressful having happened recently. The most likely thing is something to do with your social support network - this is right, it's your family.

So they want to make sure your transfer is carefully done, so that on top of everything you are going through you don't end up with a problem in your care.

I think it would be a mistake to let this one go.

I think he's wanting to ensure nothing has been missed. It also seems he's thinking of you holistically which is rare in a doctor these days.

It’s normal, it’s part of ensuring holistic care for patients. Everything is considered and all aspects are mentioned if relevant

What he's actually saying is that you transferred because of your family situation.
Patients like you stay with one team usually and move drs very rarely.

But you have had a social crisis.

It's you that's construing that to have negative connotations

Consultant has done nothing wrong

You equating social crisis with socio-economic status with something bad are the person who is BU

I can see why you are upset as it can read like this person makes poor lifestyle choices and has done a moonlight flit and hasn't given time for the health care to be transferred in a timely way. Perhaps because you stayed with your old team after your move perhaps they thought this could be a factor. I would just go to your appointment and carry on with the treatment. If feeling up to it I might be tempted to write and explain what actually happened just so there is a trail but it sounds like a misunderstanding about what happened.

Thanks all ,really good to have alternative views. The consultant isn’t aware I moved a couple of years ago to be closer to parents - I don’t think I’ve even mentioned that to my GP …. I do wonder if I were a man he would have assumed my move was due to a social crisis rather than positive reasons

Social crisis is just a term for a change in circumstances for the individual or their family ie change in job, home, family background like other people's illnesses that impact you.

He's quite right that when moving from one NHS trust or hospital people fall between the cracks and was making the point was care was needed to ensure that it didn't happen.

But you have admitted you’ve had a social crisis (your family) added to that you’re overweight, on anti-depressants, smoke and you say you come from a deprived area. You kind of tick all the boxes for a doctor to make a sweeping assumption about you.

I think when people want to find negative in what people say they will always find it some people seek it out

I don’t come from a deprived area - my doctors surgery is in one though

Interesting to see what people have said about social crisis - to me crisis has an urgent chaos attached to it vs say a change in circumstances

i think it means you are not likely to move a lot
you moved because of the social crisis, that is all

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

so they need to act promptly

I've seen something written about me by a consultant once that was completely unnecessary and totally irrelevant. This was posted to me in a letter, so no wishy washy excuses about how I wasn't meant to read it are applicable. I was so upset, I didn't continue pursuing any treatment.

I'm sure people will take this in a good light, but when it's an offensive comment about you - mine was about an old injury I have from childhood that has left superficial scarring - it really can be very distressing.

Before people assume it was kindly meant - it wasn't. It was written by a rude, jumped up little twit making ludicrous assumptions. Firstly, it was a completely different part of my body to what I'd gone in for. I highly doubt a bit of ancient scarring on your leg has anything to do with abdominal pain.

And secondly, just because someone is a consultant does not mean they're a decent human being. Some of them are so used to talking to people however they like because no one can challenge them, they don't even stop to think about the harm they're doing.

I am now absolutely religious about covering up whenever I see a medical professional. And most other people too.

@TheHawkisHowling I’m so sorry that happened to you - being scarred is not something that anyone needs to highlight about a person unless you’re having treatment for them

Thank you. I really appreciate that.

He didn't ask me about it when he saw me either. Although lucky for him he didn't because I would have been pretty scathing in my response!

I'm really annoyed on your behalf. I hope it was clumsily written but experience has made me cynical.

There is a lot of judgement from medical professionals; a friend of mine has a disability and she noticed a long time ago that she gets taken much more seriously if she looks well to do. So even when she's on her knees with pain, she's got to make sure she looks middle class enough to get taken seriously. It boils my piss!!

Yes that's how I read it

I'm not sure what the consultant meant by ‘these types of patients usually move due to social crisis’ but in your case, it is true. You moved due to your father's poor health, which I would class as a social / family crisis

Well done for working through all your ill health. Not easy at all

This is absolutely as I would see it. I work with people who have long term conditions and care needs. They rarely move care, when they do move it’s usually because of a social crisis, for example to care for a family member, because of a housing issue, domestic violence or another urgent reason.

A move away from the usual care team needs careful thought, planning and handover. Medical records often don’t tell as much as the relationships that have been built up over time with the previous care team. This consultant is aware of this and has highlighted it to the GP so the GP is aware that things may need a more careful eye while the new care relationship is established.

I think this is an understandable misinterpretation on your part. I despair of people, like on this thread, who shout complain about things like this. There is plenty to complain about in our creaky underfunded NHS. This just needs you to see how the relationship develops.

I cope pretty well, thanks. And I've had dealings many consultants who are often arrogant, insensitive and dismissive. I've also had friends who are in high level NHS management who have talked extensively about the consultant culture and the problems with how they treat patients and more junior doctors and nursing staff. Many of them are not exactly renowned for their sensitivity or people skills, but they're impossible to reform or retrain.

I'm clinical (but not a consultant, and not in gastro!) and I would read that to mean,

"Very often patients with complex health needs move quickly, due to a non-clinical event (which could be something like a family bereavement) being the straw that breaks the camel's back. The result is that we - the multidisciplinary healthcare team - don't take due care in making sure that all members of the new team are properly briefed. The care is handed over in a rush and the (implied) risk is that mistakes can happen."

To me it's a warning to the HCPs involved to make sure all your records and history etc is properly transferred to the new provider(s), not a judgement of you as a person or of your social situation.

The consultant will have been aware that you can see what he's written, so while he might have phrased it a bit clumsily, I don't think his meaning was "Oh god, another one of these hot messes with their chaotic lives" - though I realise it could come across like that.

On a cold read I didn't take it the way you have. I took it that this is a carefully planned transfer of care, as opposed to what usually happens when someone relocates due to family problems?

I think the phrase social crisis has different connotations to medical and non medical folk. In hospitals it can mean anything social that disrupts your normal life e.g. divorce, job loss, bereavement. Normal human experiences that can affect your health or ability to access care.
They are distinct from medical issues/deterioration that triggered a change and that's what they were communicating to their colleague.

I think social crisis in this context means something not desirable which if it hadn't happened you would not have moved (the crisis bit) which relates to your family/friend network (the social bit). Which is absolutely accurate in this case.

100% agree.

The consultant has recognised that your situation is complex and needs careful handling. Which is both true and a good thing.

I understand why you reached a different conclusion, but hope you feel reassured that you personally are not being judged.

So yes, you are being a wee bit unreasonable, but it's not hard to see why you felt upset.

No this is not at all acceptable from your consultant.