Long term health conditions (young people)
Talking to doctors and nurses
Many of the young people with chronic (long-term) conditions had a great deal of experience dealing with health professionals and clear ideas about how communication could be improved. For instance, they preferred to be asked 'How are you?' rather than 'How is your epilepsy?' or your arthritis, etc., when they went to see their doctor. They also disliked it if the consultant seemed to be in a rush or spent the appointment reading their medical notes to them (which often happened if they were seeing a doctor they didn't know). (Also see 'Getting on with your health care team'.)
She talks about the things she dislikes when she goes to see her consultant. But says that her...
She talks about the things she dislikes when she goes to see her consultant. But says that her...
But I, one thing I find really annoying when you go and see consultants is that they read you your history. And I'm like, 'Why are you reading this to me? I know. It's my life. I've lived it' you know. And they go through every like medical thing that happened in my life. And because I was a twin, and my twin died, like the fact that they'd always tell me that I found really strange, because it didn't seem relevant. They were like, 'Yes, so you were born prematurely. You were one of twins. Your twin died. Da-da-da. You had your first this here' you know. And it just, that has always bugged me about going to see the doctor, because I don't want to hear it really. Like it just seems a bit pointless. I feel like, 'Can you not read that, and then call me into your little funny room and ask me how I'm feeling?' Which I do find, like sometimes I do find what they ask you a bit like, like they say, 'How's your epilepsy?' Like I think that's a really weird question to ask. But I suppose there's no other way of putting it. Or just like, 'How are you? How have you been coping?' I suppose.
And I, the new consultant, I've only met her once. And they often like seem like they're in a bit of a rush. Which is quite annoying. Like because you don't really feel like, because often, it's often after I leave that I think of something that I want to ask them. And then like, 'Oh, God, I'm going to have to wait for another six months before I go and see them again'. And the, who's the other one that I saw? The epilepsy nurse. And I didn't go to see her the first few, like I don't remember being, going to see her initially when I first got diagnosed. And actually that would have been the most helpful. Because out of all of them she has been the nicest person. And I found her the most helpful because she's much more chatty and like she just chats to you. And you end up, she ends up finding things out and being like, 'Oh, well, you could do this'. Or, because like I wanted to go onto the pill. And with a lot of epilepsy medications you can't go onto certain pills and, because some of them don't work or they're contradict, yes, you know what I mean, they don't, they just don't work together.
They clash with your medication.
Yes. And that, she was really helpful with that and finding me the right pill to go on and stuff. She was really good at talking to me about that, and also more recently talking to me about if I ever wanted to get pregnant.
And if you have any questions, can you contact your nurse?
Yes, yes. Now I can. I only saw, but I only started seeing the nurse probably four, four years ago I think it was when I first saw her. And she's been really helpful actually. And when I was having all my problems with getting employed because of my epilepsy, I spoke to her quite a lot. And I used to phone her up and ask her what, I mean because she was a nurse as well, and she said, when I told her that I wanted to go into nursing, she said, 'That's brilliant. Go for it. You know, don't let it, you know, don't let this stop you'. And she, but I found the epilepsy nurse really helpful. I thought she, out of everyone she's been probably the most sort of honest and upfront and like just kind about it as well.
Like doctors sometimes can be quite clinical about things and sort of forget that you're a human being, and just see you as a condition rather than thinking about how your life is. That would probably be my biggest criticism of the consultants that I've seen is that a lot of the time they see you as your illness and not as your person. Which I suppose is really difficult for them because they see hundreds of people all the time. And, you know, when you go to a neurology clinic they’re, you know, pumping them through as quickly as they can.
Most of the young people we interviewed said that they wanted honesty and straight-talking from their doctors about their prognosis, treatments and the risks involved in the medical procedures. They think that it is important for the doctor to avoid medical language and explain things using simply terms. One young woman said that her consultant was vague about her prognosis and that there was a lack of clear information and advice. A sixteen year old said that he doesn't understand when his consultant talks about 'mild abrasions' and that the consultant seems to always talk to his mother rather than to him.
Newly qualified doctor want to show off what they have learned by using long and complicated...
Newly qualified doctor want to show off what they have learned by using long and complicated...
Why do you say that?
James' Well it's just my consultants I think. They don't like giving bad news. My consultant he's called [name] and he always tries to. If he has to give bad news he'll wait until he finds something good. So he could have the results in two weeks of whatever he's done and you could wait two months because he'll have to wait until there's something good to tell as well. And when he has to tell bad news he usually waits ages to do it, you know, just in case something good will happen.
Always tell what. Tell the, tell the young person everything that's going up and use small words. 'Cause sometimes doctors use all the medical terms and terminology and sometimes even the parents don't know what they're talking about. So it's like use words that every day, you know, use everyday English to explain what's going on 'cause it's a lot easier to deal with when you know what you have.
Have you had experiences of that, of not understanding when they use long words or medical terminology?
James' Well it's, it's more of that the new doctors, they like to impress people by using all these scientific terms.
What do you mean by new doctors?
James' You know just doctors that have come to a new ward or come to this hospital new and.
Mother' Newly qualified really because.
James' Yeah newly qualified.
Newly qualified ok.
James' And they like to use all these, these, this terminology because they can I think. It's like, you know, we've learnt all this stuff we might as well use it. And they, I think they forget that we have no idea what they are talking about. We do not know what they are saying. They could just be saying blah, blah, blah as all we could, as you know, for all we know.
And what about your consultant, the person that sees you?
James' Now he's always been very good. He's always used quite, he's always used small words hasn't he? But he's been with the hospital for ages, years and years.
Ok and the nurses. What's your experience of the nurses?
James' Oh they're very nice people. You know you. 'Cause I'm with the same nurses all the time, you see, 'cause it's, it's the nurses that go to the hospital, stay there for years in the same place. So you get to know the nurses and they get to become your friends rather than just nurses. You know so it's just a very friendly atmosphere, very nice people.
He doesn't always understand what the consultant is saying when talking to his mum during the...
He doesn't always understand what the consultant is saying when talking to his mum during the...
He uses language that I don't understand they're like mild abrasions. I don't get what he means by mild abrasions. And I, in the, and I do get, I understand some words like, he bruises easily, like he bleeds under the skin. And it's like and that's and just talks about that a lot of the time.
Do you say anything to him? Do you say, 'Excuse me I don't understand, can you explain this to me?'
No. I didn't get a chance because he was, he were talking to me mum all, he was talking to my mum all the time.
So he doesn't talk to you?
Well he sometimes does but not all the time but he just talks to mum mostly, my mum mostly about what he's going to do, what I'm going to do.
Ok. And then your mum explains to you?
Yeah.
Says that doctor's language is 'over the top' and thinks that some can be insensitive and...
Says that doctor's language is 'over the top' and thinks that some can be insensitive and...
Really over the top. They use lots of long words. I'm quite lucky because when I done my degree I did like psychopharmacology, and when they talk about medicines I understand it. And they talked like, I said, 'Well'. And they, they gave me one medication that was making me really drowsy. I think I said something, 'Oh, yes, it's the way it's interacting with the histamine receptors, isn't it?' You should have seen their mouth drop. It like fell to the floor. But, yes, I do think the language they use is over the top. I do feel that sometimes they should simplify things. And I do feel as well that they're really quite impersonal. Because, especially because I was waiting in the consulting room and they was talking about me outside the curtain. And I just think that's very very rude, to talk about someone and they can hear you talking about them. And I mean just because it's in a medical setting, I mean manners cost nothing. No, I think it's very very rude.
And you were not part of the team sort of speak?
No, not with the hospital. With my GPs, definitely. Because they're so supportive, like my GP. And even though my physio, he is a BUPA physio, they, they talk to each other as well. It's really really really good. But I've never really felt that when I get into the hospital. That sort of gets a bit lost because it's so busy, there are so many people in there that need help. And I understand they're just trying to quicken things up by talking to each other out there. But that still doesn't make me feel any better. So I can see why they do it, but it doesn't make me feel any better.
He has seen doctors and nurses for so many years now that he understands a lot of the medical...
He has seen doctors and nurses for so many years now that he understands a lot of the medical...
Several young people found it rude and annoying when consultants talk about them - the patient - in front of them as if they were not there. One young woman remembers that, in the children's clinic, her consultant used to ask her mother 'How are Lizzie's bowel movements?' when she was sitting there right in front of him. A young man said that his consultant doesn't like to give him bad news and so he waits until there is also some good news and gives them both together. Some young people said that, as teenagers, they were ignored by their consultants because they only talked to their parents. This made it difficult for the young person to ask questions about issues that were worrying them at the time - like drinking alcohol, side effects of medication, prognosis (future outlook for their condition) etc. Other young people had more positive experiences and said that their consultants do ask about what is going on in their lives and take a keen interest in their school or sport life. They said that consultants used this approach to engage more with the teenagers themselves.
She divides consultants between the authoritarian and the dismissive types. She prefers her GP...
She divides consultants between the authoritarian and the dismissive types. She prefers her GP...
She was diagnosed age 15 and found doctors talking to her mother instead of her. She would have...
She was diagnosed age 15 and found doctors talking to her mother instead of her. She would have...
Certainly at the beginning, yes. You know, when I was 15 and my mum was going into the consultations with me, yes, most of the information was going to her rather than me.
How did it make you feel? You were in the same room and they were not talking to you but to your mother.
Not great. You know, I didn't really feel like I was part of the consultation or part of the decision-making process. You know, I was the one who was having the seizures and taking the tablets, but I wasn't really involved in.
Just having it.
Absolutely, just, you're the one that had it but, 'Don't talk'. I think throughout I would have wanted more information and I would have wanted more opportunity to ask questions. Because it is a complicated condition and, you know, it's difficult to, to get your head around. So I would have wanted more opportunity to ask questions. When I was a teenager I think I would have appreciated some time in the appointment without my mum there, and maybe to have discussed the more embarrassing topics like sex and like alcohol, you know, without my mother there. And I think more information about different options.
And what about the language they use when communicating with young people? Did they use an easy-to-understand language? Or did they use long words?
I guess it varies from consultant to consultant. A lot of doctors I think do use terminology that maybe young people, and also adults, don't understand. You know, there's a lot of different words for seizure for example. And somebody might call seizures fits and somebody else might call them something else. So if the doctor is using terminology and isn't explaining it to you, it can be very confusing. So I think if there is something that the doctor is saying that you don't understand, then not being afraid to just say, 'Excuse me, can you just explain this?' You know, it doesn't mean you're stupid. It, it just means that, you know, you don't have a degree in, in brain surgery, you know.
Consultants have talked to him since he was 13 years old. He said that they ask about his sport (plays rugby) life and used it to explain about his asthma.
Consultants have talked to him since he was 13 years old. He said that they ask about his sport (plays rugby) life and used it to explain about his asthma.
How did they explain asthma to you, your parents, the doctor?
Explaining to me was through the doctor but with my parents there. So obviously they would explain it to them and they, then my parents would explain it to me in an easier way for me to understand. So yeah it was, was. I pretty much understood it from the start.
You had to go to the hospital?
Yeah.
Have you spent time at hospital?
I have when I was really young like, like over night and stuff. But I have spent a lot of time at, at my age now but not staying in. I have just been going back quite a lot when I, I like, seeing consultants and stuff like that about what I need to be doing. But no, I haven’t been staying in a lot now compared to when I used to when I was a lot younger.
So you have been seeing consultants quite regularly?
Yeah I have been quite recently. About in the last two years I’ve seen, I’ve been at the hospital a few times. That’s, that’s with my asthma and my allergies trying find out what new allergies I’m getting and if there’s any new medication I can go on for my asthma and just basically trying to make things better really.
You go with your mum?
Yeah, yeah I go with my mum.
Do they talk to you now or they talk to your parents?
They talk to me now. They have done since I was about thirteen, something like that. Just, I think they find now that if they talk straight to the person, like the child, that they are like looking after then they could get through to them better than their parents telling them because maybe they won’t tell you the full story or whatever and maybe they don’t understand themselves so. They tell me now, yeah.
Do they use easy to understand language?
Yeah compared to what they’ve used in the past when they actually do talk to me their language is a lot easier to understand than when they’re using like a lot of big words which are really hard to understand.
When you see, when you have your consultation are they interested in, in your life, I mean in your schooling, your friends? Do they ask questions about that?
Yeah, yeah and I think that’s how they get through to you more because they don’t talk about what you’ve got so much. They, they talk about like what’s going on in your life and they use that to explain what you’ve got basically. So like if they ask me about sport then they can use that to help explain how my asthma is going to affect that. So that’s just a bit, an easier way of actually explaining what’s going on.
Some young people have found it helpful to write down questions in a notebook in between appointments to make sure they won't forget when they see their consultant. Many have found it useful to bring a parent with them when seeing the doctor because parents could then ask the questions that they might not have thought to ask themselves.
She is 22 years old and finds it useful to take her parents along to the consultation because she...
She is 22 years old and finds it useful to take her parents along to the consultation because she...
People who were told that they could text or phone their doctors and nurses if they had any questions said that this made them feel much more secure. (Also see 'Getting on with your health care team' - for examples of good relationships between young people and their teams).
Getting treatment from the GP
Several young people we talked to said that they've developed a better and more personal relationship with their GP's than with the hospital staff. In hospital they found it hard to deal with bossy or insensitive consultants. They found their GP's easier to talk to about their emotions and problems to do with family and relationships. One young woman however, says that it's difficult to go to see a GP on your own because they don't pay attention to what you are saying. Another problem that several young people referred to was that receptionists are sometimes unhelpful and make it difficult for them to talk to their GP or get an appointment at short notice.
She feel very well supported by her GP but receptionists can be a problem when she needs to see...
She feel very well supported by her GP but receptionists can be a problem when she needs to see...
I mean my GPs are fantastic. I mean I'm so so lucky. Because there's two at the practice, and they're a husband-and-wife team. And if I can't see one, I can always go and see the other. So they're both involved in helping me. And my parents as well, they're really, they're really really supportive.
So it seems to me that when it comes to your GP you can, you have a good relationship.
Very very good.
In the doctor's surgeries in particular. You'd ring up, I mean in one of my previous doctor's surgeries, it wasn't a very good one. I mean a very very large practice, very very large population. And I used to say, 'Look, I really need to, to see someone. You know, I'm really quite in a lot of pain'. And they said, 'Okay, a week, and, and you can come in, in a week's time'. And I said, 'Well, I really do need to see, to see someone. Or can, can I speak to someone on the phone?' 'No, the doctor doesn't take no calls'. I said, 'But, you know, I really can't wait that long'. And because I've had that situation, I've ended up in Casualty. Because I've been in such an amount of pain and I can't communicate with the receptionist that I need to speak to someone like quite urgently. And I know I'm wasting people's time in Casualty. But it's because I've had no other option. And it has been a problem in the past.
What I'd do is, I have rang back and spoke to a different receptionist. I've done that quite a few times. I've also discovered as well that there's an NHS walk-in centre and you can have access to, if you're really having that much difficulty getting a GP's appointment at your practice, you can go to the walk-in centre. You wait, you may have to wait a bit, but you can have access to a GP. Also I've, sometimes I've spoken to my GP and explained to him that is it possible like to communicate to the receptionist when I call, 'You know, I'm not a time-waster. If I'm calling it's because it's a very unusual situation and I do really need some help'? So I've done that in the past as well, and that seems to have helped.
So the doctor has spoken to them?
Yes. And also I don't get angry and I don't have a strop on the phone, because that's the worst thing you could do. If, I mean before I've said, 'Look, I, I need to see someone now' and I've got quite stroppy and I've got quite rude. And if you're rude to someone on the phone, and then they don't care. They just think, 'Oh, well, they're just kicking off. They don't really need to see a GP'. So be persistent, but be persistent in a polite way.
The GP ignored her when she was talking about a new treatment. She found it rude and felt angry....
The GP ignored her when she was talking about a new treatment. She found it rude and felt angry....
And I want to know you know the different' the different types of eczema and what's caused and what, what causes them and the latest research about it. And I think I'd like to, to know more about that and not always have to depend on doing my own research on the internet which you don't know if it is reliable and things like that. So that's '
How did it make you feel?
It made feel ' one my personal response was angry because I just felt my time had been wasted really. And I was feeling positive you know about going to see somebody about the problems I was having and then coming away no better off. And thinking well they're supposed to, they're supposed to help me and I've come away you know feeling still rubbish.
The young people we talked to with asthma pointed out that their GP's had always been very supportive and had been good at providing general advice but that it's the role of the asthma nurse to give specialised and detailed information about their condition. They find GP's good at helping them to deal with sudden changes in their symptoms (due to colds and flu, allergic reactions, etc.) while a nurse helps them with the information and advice for the long term control of their condition.
Thinks that GPs and nurses have different roles when it comes to help her with the long-term and...
Thinks that GPs and nurses have different roles when it comes to help her with the long-term and...
Now regarding your GP how do you evaluate the kind of communication with him?
It's good but I think it's different with a nurse because when you go to see your GP it tends to be, you know oh this has happened this week and you know I need a fix for this. Whereas the nurse is more of a, more long-term care. You know I've gone to see my GP when and I've said, 'You know I can't breathe. I've, I think I've got bronchitis 'cause I always recognise the symptoms now'. And so he says, 'Fine you know give you some antibiotics'. And so you don't really get the sort of same care as you do with the nurse because the nurse talks to you about things in more depth and in a long-term sense. So you know, 'Are you feeling different this month to three months ago'. And you know looking at it like that rather than you know, 'Oh you're not very well today. Let's do something about it'. So sort of short-term fixes.
So it's more like an assessment, a long term?
Yeah, yeah, exactly.
Based on your experience is there anything that they should improve regarding sort of how they relate to young people with asthma or?
It would have been useful to know about the nurse a while ago because I mean I only, I was only told yeah I think it was a couple of years ago. So I didn't know about, I don't know whether that's a new thing that they're trying to do or whether it's being going for a while and I just didn't know about it. But there's, before that time there was nobody to really talk to about it and get that kind of advice. And I don't know with my GP I don't feel that I want to waste his time by talking about these things. Because I just, you know, they don't have a lot of time anyway so you just want to go in and say, 'Right this is wrong' and he can fix it so you don't go into depth and. And I don't think. They, they don't really volunteer that anyway. I think it's more of a nurse's role to give you that care perhaps [laugh].
With the exception of young people with asthma most of the other young people we spoke to said that they don't see their GP for anything to do with their condition. They see their hospital team for that. One young man with ME/CFS made the point that it's difficult for both doctor and patient to establish good rapport because there's no treatment for their condition. One young woman, also with ME/CFS, found that it was difficult to establish a relationship with her GP because she didn't have any knowledge of what was happening to her, so was unable to talk about it in a clear way.
Says that doctor-patient relationship is difficult because doctors are used to treating your...
Says that doctor-patient relationship is difficult because doctors are used to treating your...
I think doctors find it quite difficult because it is untreatable without wanting to be too negative. I mean it is treatable in the sense that you rest but doctors want to be able to give you a drug and they can't do that. I think they find that really difficult. I have had some interesting chats with medical students because they really want to learn more about it. Because you know, I think at least one person already knows at least one person who has got ME and it is getting more and more common I think and so people ought to know more about it. But it was difficult eight years ago, just because someone, a doctor telling to rest is not good enough really and I am not saying it is their fault because I understand the situation but it is not good enough just to say rest because that is not substantial enough.
A few young people prefer to avoid going to A&E departments because, in their experience, the staff there don't really understand their condition or the treatment they're following. It could be tiring for people, having to explain things to do with their health condition and treatment particularly to those not directly involved in their care.
Her diabetes and cystic fibrosis require a very specific treatment. She finds that apart from her...
Her diabetes and cystic fibrosis require a very specific treatment. She finds that apart from her...
What about GP's?
Well, GP's I just don't go and see. They're just, they've got, it is so general, they just don't, I've had a GP ask me many a time, so when did you get CF? [Laughs]. Yeah its genetic, I was born with it [laughs] and I get things like, 'Oh we need to go through your medication', and they don't understand. I've actually sat in front of a GP, and basically explained what was wrong, and what drugs I had to have, and they've just sat there. I could have said I want Black Tar Heroin and they would have wrote it down. Which isn't a good thing, but they just don't, A&E as well, I don't get on in A&E. No I tend to wait until like my consultant is available and I'll go and see them because I've been rushed into A&E before. I actually had a meconium ileus equivalent, which is basically a bowel blockage, and I had to explain that I had CF, I knew what was wrong and I had to said, 'Look I've got this, I need to get, like have gastrograffin or something, and he did tests on us to make sure I wasn't pregnant." And I was like, I wasn't happy. I was hysterical by this point because I was in so much pain, so he sedated us, and he didn't even know I had diabetes, he hadn't asked us anything, so I wasn't a happy bunny. I got, I think I left at four in the morning, and at seven I was back at the hospital to see Dr. [name], who basically just touched like the top half of my stomach, and was just like 'I can't believe he didn't know'. I don't get on with A&E.
He basically went when I told him things, he went outside, he read a book, they'd got a chapter on CF or something, came back in and told us what CF was and what treatment I was taking, I was like, 'I know that, I've just told you'.
This was a doctor or a medical student?
This was an A&E doctor. Scary [laughs]. So, I've got, I've got very little confidence in other doctors, rather than my consultants, which is, I think most people would say I was probably a pain in the arse for other doctors, other than the consultants, but they have [laughs], who wants specialist care? [Laughs].
Last updated February 2012.
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