To ask my GP to extend my fit note?

[DietCokeAddict19]

I was signed off work at the start of December for just less than a month after a relationship (which retrospectively wasn't a very healthy one) ended, and I didn't cope very well. I work for the NHS and really need to be on it and focused when I'm at work, basically my role is to be an emotional sponge for my patients, and I recognised that I wasn't coping well enough to be able to properly help people.

I also have a much, much longer standing problem with anxiety, emetophobia and OCD, which are currently probably the worst they have ever been. I am convinced that everything I eat is going to make me ill/sick, so I have a really limited list of foods that I consider safe enough to eat just now. I had an eating disorder as a teen, and since the relationship ended have lost about 3kg, which has now pushed me into the underweight category for the first time in my adult life, and although I really don't want to have an eating disorder again, I am finding myself getting caught up in the desire for the numbers on the scale to just keep going down.

I've got some therapy/counselling starting in January, I'm on the waiting list for 2 other types of support - one through occupational health and the other through the local IAPT/mental health team which is what the GP would refer me to if I hadn't already referred myself.

I'm not eating much. I forgot today that I had a tampon in for over 12 hours. I'm not looking after myself very well.

I don't think I'd be much use to my patients at work, but I also don't know how I get better, or how long that might take, or what else to do. Maybe being at work would help as it's routine, but I also find work very stressful as it's in a hospital and at this time of year with all the norovirus/covid/flu circulating my hand washing is extreme and I feel hugely anxious.

AIBU to ask my GP to extend my fit note? Do you think they even would? And if they did, what else can I do to try and get better?

I have a possibly similar role to you and I find that when I’m at my worst emotionally, it really helps to be at work and focussing outside myself on other people.
Would it be worth going back for a trial period to see how you get on?
Avoiding work (and the anxieties associated with OCD etc) may well perpetuate the problem and make things worse.
My gut feeling is that you should go back in for a bit.
Good luck

Of course they’ll extend it! Look after yourself first and foremost x

What about a phased return?

The longer you're off the harder it is to return - it builds up into this huge insurmountable scary thing.

I think there would be merit in having the conversation with them at least.

Extend your fit note and take a little more time until the support you mention is in place in January. It's going to be a fine balance between taking the time you need and not taking so much time that everything in your head takes over.

Are you on any medication? That might also be useful in the gap between now and getting more support, and also give you enough headspace to really engage in the support. Then a phased return sounds like a good idea. Take it all slow.

Your gp will most likely extend the fit note, but returning to work in some capacity may actually help your recovery. If you’re still waiting on mental health support through occupational health you may want to self refer to local services as a back up and cancel if needed. ( as this maybe quicker). Finally I’m not sure about your finances but after a period of time you will go down to half pay. So you’ll need to take this into account.

I’m a GP and I would happily extend your sick note. Those who don’t work in the NHS will never understand what a toxic environment it is to work in. You need to be firing on all cylinders before thinking about heading back.

Thanks all. A phased return might be helpful, I'll have a think about that. I don't want to go back too early and then take time off again as firstly it would probably trigger some sickness policy and secondly I'd rather feel better able to cope and perform than I currently do before I go back.

@123bumblebee thank you. Yes it's a toxic and stressful environment and I've learnt that if I don't look after myself and put myself first then nobody else will, but it's taken a long time to understand that. Is there anything you would suggest that I can do on top of what I've already put in place?

My dh has his extended every 3 months for about the past 4 years.
He's been told he will be unable to return to work ever , so his is for work related insurance payment.

@FrostyFlo hope your DH is ok. Does he have to go into the GP to extend or just over the phone? My first appointment withe the GP was over the phone but I wonder if I should go in?

@DietCokeAddict19

I am his advocate for hospital , Drs , prescription s etc , so I just phone the surgery , sometimes I collect a physical note other times they send it electronically to my phone.

Thanks @FrostyFlo I will give them a call on Tuesday. I guess it will be hugely busy next week so might have to be a phone appointment!

To the PP who mentioned medication, the GP discussed it briefly during the telephone appointment at the start of December but I wasn’t keen then. When I have taken SSRIs before I have really struggled with the side effects (mainly nausea, which for someone who is emetophobic I actually found worse than the depression/anxiety) and haven’t been able to carry on taking them. They suggested something like venlafaxine or mirtazipine but they often have weight gain as a side effect and I’m struggling with the thought of that.

Anyway I dragged myself out for a run in the rain today. It was possibly the slowest I’ve ever run a 5k but at least I went out and I did feel better for it. I used to run a lot and I do miss it, but I’m so unfit every run is painful!!

That's good going, well done - it's hard enough to persuade myself to go for a walk in the rain, let alone running.

Thanks. Trying to do things that I know in the past have helped me feel better.

Got my GP phone call today. Have been feeling really anxious the last couple of days, it’s like when I had post natal depression/anxiety after my DS2 was born, a constant reel of worry throughout the day, mainly about whether or not I will be able to cope. It’s horrible as I’m a very capable and competent person and this constant self doubt is debilitating.

Any top tips for managing anxiety?

I’m 44 now so had been wondering if perimenopause wasn’t also weighing in and not helping, but given the timing I suspect it’s more circumstantial after the relationship break down than just being peri.

Sorry you are going through this OP some great advice on here. I’m just wondering if the medication was making you feel nauseous could the be prescribed with anti nausea meds? I was unwell some years ago (mental health issues) and felt nauseous every day and in the worst times it was making me spin into a panic about being sick. My dr prescribed me I think they are called buccal tablets, small yellow tablets that I put between my gum and lip and they dissolved. Honestly worked amazingly well. In the end just knowing I had them there helped and I gradually stopped taking them, I think they helped remove some of the panic which was causing the nausea. Maybe worth a shot if you haven’t tried them before.

Thanks @Movingonup2023 I'll ask the GP about those later. Yes I wonder if I could try anti sickness tablets alongside the other medication, I ask about that too! Thanks for the suggestions.

No problem @DietCokeAddict19 good luck with your app

The GP did extend my for note for a further 3 weeks. I’ve got therapy starting next week which she thought would be better than trying meds at the moment, so that’s the current plan.

I feel anxious and tearful and sad today. Ugh everything just feels too much.