Ambeya

Brief Outline: Ambeya had a fairly positive relationship with the family GP when she was younger, but now prefers looking up her symptoms online or going to a natural health shop rather than seeing the doctor.

Background: Ambeya is a student and cares for her mum, who has mental health problems. She lives at home with her parents and two brothers. Ethnic background / nationality: British Bangladeshi.

More about me...

Ambeya feels that most of her experiences with the GP (local doctor) have been negative, so she tries to avoid seeing a doctor ‘as much as possible’. When she was younger, visiting the GP was a more positive experience. Her local surgery was a walk-in clinic where she didn’t need to make an appointment beforehand. She prefers to ‘wait in the reception’ knowing she is ‘next in queue’ than making an appointment over the phone. Ambeya’s parents and two younger siblings used to have the same GP, which she liked because the doctor was able to get a sense of the family history of health problems. 

Ambeya’s mum has mental health issues so her GP would often make appointments for a ‘family assessment’. When Ambeya and her siblings were still at school, the GP used to book appointments to see them at home after school. She liked these family appointments because ‘it felt like the doctor wanted to help’.

Being a carer to her mum, Ambeya would often need to collect her mum’s medication from the pharmacy. As a young carer, this was difficult. The pharmacists would often ask her what the medication was for. She wanted to ‘keep the reasons hidden’ and felt that pharmacists would sometimes ‘force’ it out of her. 

Before Ambeya turned 16 she was accompanied by an adult whenever she had an appointment with the GP. Her dad used to take her because her mum’s own health problems meant that she couldn’t. He would make sure he booked the appointments after school because he didn’t want Ambeya to miss any lessons. She often found going to these appointments with her dad ‘awkward’, especially if she needed to speak to the doctor about ‘something girly’. She has occasionally asked her dad to wait outside during the appointment so she could speak to the GP more openly. She has also asked her aunt to go with her to appointments because she found it easier to open up in front of her aunt. 

Gender ‘plays a massive role’ in Ambeya’s experiences with GPs and she feels much more comfortable with a female doctor than a male. She also points out that being unable to see a GP alone until the age of 16 is ‘too late’ and that teenagers under 16 can ‘make decisions for themselves’ – they should be allowed to talk to a GP about things they might not want to discuss in front of their parents.

When Ambeya turned 16 she liked seeing the GP by herself, though her views about the surgery changed. She believes that a major reason for this is the fact that she no longer has a GP who is their family doctor. Each time Ambeya makes an appointment it’s ‘always a different doctor’. The rest of her family are also no longer under the care of the same GP, with her parents and siblings all being seen by different doctors. For this reason Ambeya finds it hard to trust doctors and feels that ‘they don’t really understand us’. She would like to have a doctor who is ‘permanent’ but feels that this is something that ‘can’t happen anymore’. 

The local surgery is no longer a walk-in clinic and it has become more difficult to get an appointment. Ambeya usually has to wait one or two weeks. To get a same-day appointment, she needs to call the receptionist in the morning and ask for an emergency appointment. To get an emergency appointment, Ambeya has to tell the receptionist the reason she needs to see a GP, which she feels breaches confidentiality. She also finds that the doctors tend to rush appointments.

On one occasion Ambeya felt she was forced to go to A&E (Accident and Emergency) because she couldn’t get a same-day appointment with a GP. She spent over seven hours at A&E but felt she had no other choice. 

Whenever possible Ambeya prefers to look up her symptoms online or visit a natural health store rather than see a GP. She also likes to speak to her friends if she has any medical issues as they are older, have ‘more experience’, and some of them are studying relevant subjects at university. Ambeya notes that her nearest surgery is quite far, making it difficult to access, so it is easier to speak to friends, find out what might be wrong using the internet, or visit a natural health shop.

Ambeya feels that health professionals started treating her differently once she turned 18. She noticed that they expected her to take more responsibility for her own health and showed less empathy. She would like health professionals to recognise that there is a ‘transition period’ between being a child and becoming an adult and that young people need time to ‘adjust to the system’. Ambeya has also noticed that GPs rarely introduce themselves, and thinks that doctors who take the time to do so and ask patients how they are doing ‘make a big difference’.

Ambeya would like GPs to know that she feels unable to speak to them about mental health issues, only physical health. She would like mental health services to be better advertised to young people so that they would have greater awareness of the range of services available to them. Her message to young people is not to be afraid to express their opinions about healthcare because it is ‘one of the most important things that we need to care about’. 

Ambeya felt that it can be hard for young carers to pick up medicines for their parent. Badges for carers are a good idea.

The one issue that I did have was obviously, as a young carer, your responsibilities from a normal child is different. And one of the main issues that we used to have when we were young was the fact that when it came to picking up medication, because obviously if my mum can't go to get her medication, we have to go. And if we're like twelve years old and go to the chemist to pick up medication, we were never allowed to go. And then the doctor, the GP, like pharmacist used to ask us, "What do you want his medication for blah blah." And yeah it caused problems. 

Like we used to have so many problems at the pharmacy when it came to picking up medication. And it's just the fact that obviously we want to keep the reasons hidden, so having to force it out of ourselves to tell a pharmacist. And then it just caused so much problems, and we didn’t like it that. And it’s the fact that we had to face them again next time, which just caused awkwardness again. 

So it was access to medicines and stuff which, if you are asking me about the health service, it was access to medication. Because I think young carers, they're not…other people don’t understand what the life is of, like of a young carer, so not being able to act as a young carer, and access the things that young carers should…they'd make life difficult for us when we were younger.

What would have made it easier when you went to the pharmacies, what could have made that trip to the pharmacy, picking up the medicine easier?

Well obviously it would have been easier if an adult would have been able to get the medicine. But if you don’t have access to an adult at the time, it would be easier just to know we could go in and just be able to collect the medicine. Or just yeah.... But I think now what they're trying to do is they're trying to get carer badges or something. So you just wear it and they know that you're a carer and that you're here to pick up medicine, which is good now. But it would have been better if it happened years ago.

Ongoing support from a counsellor is better than seeing a different GP each appointment to explain what’s wrong.

Have you ever been to your GP for any stress related things or anything that’s not necessarily physical, whether it’s mental health or…?

I haven’t gone…I don’t think I've ever attended the GP for like anything to do with stress.

Do you think it's appropriate to see your GP for issues around stress or any kind of behavioural problems at all?

I would like to, but then again I think, from like previous experience and stuff, I think when it comes to stress or anything stress related, it's better to have someone permanent rather than being moved around doctor to doctor. So I'd rather…with anything related to stress, I'd rather see a counsellor who will give me ongoing support rather than a doctor who I'll only see like once every five months.

What sort of problems do you think that, in a young people's clinic…what sort of problems do you think a lot of young people have in common that they would be going for?

I think mainly it…I think mainly it would be to do with mental health, definitely. It's definitely mental health, and I think that’s one of the…that’s…I think that’s why I'm so passionate about the NHS because it's mental health that is more worrying than physical health.

And do you think young people know that they can see their GPs for mental health issues?

No. Because I don’t think I could have…I still don’t think I can go to my GP and talk about mental health and stuff.

What could be done to improve awareness do you think?

I think there's so much that can be done. But it's just the fact that mental health is mainly aimed towards like adults, it's not aimed towards young people at all. So it's just the fact that knowing that young people can access mental health services would be so much easier. Because, so far, I know only adults get emphasised about mental health.

So where should it all start, telling young people. If someone was saying, "We'll start telling all young people that they can go and see the GP for mental health issues", where should they take the information first?

It would have to be school, definitely school, because, like I said, school is the most time spent during the whole week, and that’s the only time they’ll be able to get information like this.

Ambeya felt she had to exaggerate if she wanted to be seen by or speak to a GP over the phone, otherwise the illness might have gone by the time she got an appointment.

If you want to see a doctor on the day it's called an emergency appointment. And if you want to see just a doctor, you have to wait for like a week…You have wait a week or two, which is pointless because in two weeks' time your illness will probably go, and you'll never know what the reason was, or what the cause was. 

So now, if I wanted to call the doctor, I would have to say, "Oh I'd like an emergency appointment" just so that I could get seen on that day, or even get spoken to by the doctor on that day, because I'm pretty sure…because when I've…that’s the time when I first realised the system changed when they were like to me, "Oh if you want an appointment you have to wait two weeks." And I was like, "OK how do I get seen today?" They go like, "Well it needs to be an emergency." So now I just exaggerate just to speak to the doctor. 

You think you'll be able to do that and get to see them on the day?

Well I think so. If I want to see the doctor, I would definitely say it's an emergency appointment just so that I can have a doctor ring me, even though I don’t like having to do it on the phone, it's better than waiting two weeks.

How does that make you feel like when you think you have to wait two weeks to get seen?

Well it just forces me to like go to A&E or something. I don’t really want to go to A&E and wait there for five hours just waiting there, and they say something like, "Oh it's nothing serious." So yeah, it's just the fact that knowing that I've got to wait two weeks forces me to go to the A&E or something which is something I really don’t want to do.

Receptionists in any job should be friendly as they’re the first face a person sees. They may be busy but it’s rude to answer the phone while talking to a patient.

Well I personally think a receptionist at any job should have the same qualities, because I remember I had a part-time job as a receptionist in my secondary school, and all receptionists should have the same qualities because at the end of the day you're the first point of contact, so you have to be friendly because you're the first face that someone sees. So, I just think receptionists should just all have the same attitude. 

But I think, I personally think receptionists at GPs that don’t follow their job description…because you know on a job description it says what skills you should have, and I don’t think receptionists at the GP have been trained with those skills.

So the ideal receptionist will be friendly, approachable…?

Yeah.

Good communication skills, is that important?

Definitely and just being polite. Yeah and not having personal distractions get in the way of how you communicate with patients.

Do you ever talk to receptionists and they're sort of on the phone and doing something else while they're trying to kind of help you as well?

Yeah. Well at the end of the day I understand that it might be…feel intimidating to them because they're on the phone to someone, and then you're just staring right in their face waiting for an appointment. So I do understand that it is intimidating for receptionists, but at the same time receptionists should know…I don’t know, they should…because they're so used to it they should be able to find ways to end up dealing with it which I don’t think they do. 

Because now I know that…no, I think the rudest thing ever is when…so they’ve finished making a phone call, and then you're there waiting or saying, "Oh hi, can I book an appointment please." And then the phone rings again, and then they’ll pick up the phone call over you – I think that’s rude. I think they should finish your conversation first and put the phone call on hold, yeah.

The receptionist asks Ambeya why she wants an appointment and then decides if she needs to see the GP or speak to the doctor over the phone.

It's now got to the point where we can't even…there's no confidentiality involved – the receptionist picks up and we have to tell her over the phone what the problem is. And then they’ll ask the doctor if we need a call-back to come in, or if we need a prescription. 

So I think confidentiality barriers just… has disappeared which there was before, because before we could just book in an appointment and then we'd go and see the doctor, tell them our problems, but now it has to go through a receptionist. 

And obviously receptionists at GPs, they're like the worst… they're the most… I think they're the worst people ever. Because they're the first point of contact in the GP but they bring this negative vibe. And I think they just… they just want to get on with their job because they have to be there from eight o'clock in the morning just picking up phone calls and stuff. So I think it's the receptionists that start off the negativity and at these GPs, and then again they just try and rush as much as possible because they’ve got more patients to see.

Mm. So when you call said that you'd speak to the receptionist?

Yeah

And you're saying that they always ask you about what you're there for?

Yeah

So how does that make you feel having to tell them; having to tell a receptionist rather than a doctor what you're going to see them for?

Well it's uncomfortable because they… well obviously it's obvious that they have to… they’ve got a certain thing they need to say on the phone. When they call up they have to say, "Oh OK what do you need to see the doctor for?" Or "Is it an emergency?" So they make it feel uncomfortable, and then when it gets like in… it could like the illness, or whatever we're suffering from, could be something serious, but they don’t think it's serious. 

So it's just… it's quite, I don’t know, I feel quiet overwhelmed when, at the end, they say, "Oh it's not something important, you don’t need to see a doctor for it." Or "We'll get your doctor to call you back because they might be able to prescribe you with a prescription." And I think the fact that now we have to do like stuff that was face-to-face before is now over the phone, it's just weird. 

Patients can choose which language they want use to check-in. GPs and patients where Ambeya lives come from many different communities.

Do you have to check in with the receptionist?

Yeah, but I hate it so much and I'm so glad that they’ve got the touchscreen version where you can you just enter yourself into there because they’ve got like this touchscreen which identifies that you’ve booked an appointment. So I think that is so much easier than having to stand there with a receptionist who's just like had an argument with someone on the phone, and then they'd say, "Oh hi I'm here for an appointment" because they would just take that anger out on you. So yeah, I prefer the system where it says, 'Touch to enter.'

Mm is it just one of those that you kind of check in your date of birth?

Yeah and then it says, 'Your waiting area's upstairs' yeah.

Do a lot of people make use of the electronic version?

Sometimes they do. Well at the start, I remember when they first made it, it was just pure English. So we have a lot of foreigners and stuff in our area, so they don’t really understand how the system works, but it's good that they’ve got translations and now you can change the translation.

Oh that’s really interesting, that’s really good.

Yeah, so like at the beginning where it says, 'Touch to enter', it's got the touch buttons of every other language…like ten languages or something, so you could change the language as well to make it easier for you.

Do you know if that’s the case with GPs, do the GPs speak some kind of common languages that are…?

I think so. In like our GP, I'm pretty sure like all the doctors are from different backgrounds. Yeah there's a variety…there's a mix yeah. So I think what…I think in our GPs I think they try and allocate a doctor which is similar to your family background. So, even though our doctors have changed now, I think that’s how it worked before because I'm pretty sure we had an Asian doctor, yeah.

Ambeya found it awkward seeing the GP with her dad, especially if it was about ‘something girly’. It was awkward afterwards, too, if she needed to get medication.

It was awkward because obviously, say if there was…say if there was something I wanted to go to the doctors for and it was something girly, and my dad would have to come, where the doctor used to ask me, "OK, what's happened?" It had to get to the point where I'd have to tell my dad to like leave the room because I would like to speak to the doctor personally. 

But then it's just the awkwardness after my appointment when I have to go and pick up the medication and stuff; like my dad will ask me, "Is everything OK?" And it's just…it just creates a sense of awkwardness, like you can't even talk to your own family about issues that you have, so yeah. That’s why I think, because of the awkwardness and because of the awkwardness after when it comes to picking up medication and stuff, I used to try and get my auntie to come with me to the doctors.

Mm yeah, mm that’s interesting. 

And could you talk to your auntie about the issues or have you got any sisters or are you the oldest so…. ?

Yeah, I'm the oldest in the family and I'm the only girl, so it's just brothers, so I can't really talk to them about it.

The GPs know little about Ambeya’s medical history. She prefers looking up her symptoms online and talking to friends or going to a natural health shop.

Well I think most of my experiences with GPs have been negative. I don’t really have many good things to say about them especially for the fact that my doctor keeps changing all the time. So, every single time I book an appointment for the doctor…you know usually if you have a family doctor, they’re supposed to have a family doctor, but every single time I go, it's someone completely different. 

So, even though doctors type up their notes and stuff on the computer and all on our database or whatever it is, they don’t really understand us. Or they don’t even know how we were before, so I find it really uncomfortable. So, this is from when I was young, so now it's got to the point – I'm twenty years old now – and it's got to the point where I avoid the doctor as much as possible. 

So now it's got to the point that if I do feel ill or anything, I just have to Google my symptoms and see what that’s related to and I just look up what medication and stuff I need to take. And I'll either go to the GP or I'll just go to Holland & Barrett [natural health store] because they do all these medicine home therapy stuff. 

So, yeah, it's got to the point I've been avoiding GPs as much as I can now. Especially when after you hit eighteen, they think that you're old enough to look after yourself so, because that’s the vibe that they give off, I'd rather just not go to them at all. I'd rather just Google it.

So you said that you'd rather avoid going to the GPs?

Yeah.

And Googling. And is there anywhere that you go if you're feeling unwell – would you see a pharmacist, would you talk to your friends?

Well I do speak to my friends because most of my friends, they're either taking psychology or they're taking medicine or something. So they’ve got background knowledge of doctors and medical stuff. If I do have any health issues and stuff, the first point of contact I go to is Holland & Barrett.

Sometimes Ambeya asked her dad to wait outside the consultation room. At other times, the GP did. This allowed Ambeya to have privacy during the appointment.

Did the GP ever ask you if you wanted to have a consultation by yourself without your dad, or was it you kind of instigating that?

I don’t remember, I think I had to tell them. I think I had to tell them, "Oh is it OK for my dad to sit outside?" Yeah, I had to say it.

Hmm and was the GP open to that?

Yeah, the GP was fine with that. And the GP would be like, "Oh is it OK if you go outside?" and stuff. But obviously they were times like say if they wanted to check my stomach or something, they would tell my dad to go outside anyway. So that did make it easier because then it wouldn’t feel like I'm doing it, so it doesn’t cause problems with my dad, so that did make it easier. That was only sometimes. Most of the time I had to do it.

The school nurse’s office was next to the staff room so it was easy for pupils to find her. Ambeya still keeps in touch with the nurse.

When I was in school, there was a school nurse and if we wanted to see her we could easily just knock on her door. And she was…the other good thing about our school nurse was she was, you know how every department's like got their own office and stuff, she was connected with the youth club, and she was connected with the community worker and the social worker. So they all had an office where they were altogether, and it felt like a sense of security at the same time as well. 

The fact that she could move around different departments and still do her job, which I think was good. Because I think that if she was secluded into her own office, at like the top of the building or something, it wouldn’t give the same atmosphere with it if she was right next to the staff, like she was there. Yeah, her office was right next to the staff room so she would be there during the day and on her lunch as well, so she's always in the same area, so it wasn’t even difficult to find her.

Mm so you think accessibility is really important? 

Yeah, definitely. 

Yeah and what was she like?

She was really good, yeah. And I think it's just the fact that it's good when all your brothers and sisters go to the same school as well because then she'll get…she has a chance to see them as well if she needed to.

Mm so you feel like you're building up a relationship with your nurse that you weren't necessarily able to do with your GP?

Yeah, yeah.

So she knew about like family history and things?

Yeah, and it's nice to know that you're still in touch with them as well because the school nurse that I had back in secondary school, I'm still in contact with her now. And I still have her email address and still have her phone number and everything. So she did say if you ever need anything I am still here, like don’t think that you’ve…just because you’ve left school you can't access me. So yeah.

It would be good if GPs could work shifts, like doctors in A&E do, and stay open 24 hours.

What would be the ideal opening times for a GP's surgery do you think?

It should be like…it should be twenty four hours if it could, because you never know something could randomly happen in the night when you're sleeping, and you have access to nothing other than A&E. So, if it was twenty four hours, that would be the most perfect. But obviously that’s not possible because no GP would be able to stay in the GPs for twenty four hours. But twenty four hours would be most ideal.

Ideal. So if they could have shift systems?

Yeah.

Then you think that they should be there all night as well, and then during the day another GP?

Yeah, because that’s how A&E works right, it's twenty four hours. So if a GP was twenty four hours, that would be good.

Clinics for 13-19 year olds would be helpful. At the age of 20, Ambeya feels that she’s ‘learnt the skills to cope’ by herself now.

I think it would definitely be good because then you won't be…you won't be like put on a scale of who's more important, who's less important, because then everyone at that clinic would be equally seen or equally judged. So I think it would be a good thing, and it will be better to be after school and stuff like that, so yeah I think it would be cool.

Yeah, you mentioned that after school would be better?

Well it depends because obviously some people…if it's a really bad illness then they should be obviously…they should obviously miss school to go and see the GP. But there are like…there are like…like I know some of my friends who'd like to be seen after school because they don’t really want to miss school, knowing that was for an appointment that they had to wait like half an hour for. So sometimes after school, it doesn’t even need to be for the whole, probably like three to five or something, just to know that you can go somewhere and just come back out straight away.

Mm and what age group do you think would be most appropriate?

It depends what you mean by young people.

What would you think young people – what does it mean to you as a young person? Maybe from age twelve, maybe fourteen, maybe up to twenty, maybe twenty five?

I think it should be…I think young people should be classed from thirteen to nineteen, should be the teen years.

Hm mm. Is that the kind of area…that kind of age group that you think needs the most….?

Yeah, because obviously up to twelve you're classed as a child. And then thirteen to eighteen you're classed as a teen. Eighteen onwards you're an adult, but I think it should be increased to nineteen at least.

Yeah. That kind of transition period of between being a child and….?

Yeah, yeah, or it could even be split up by like age…not even age groups, like GCSE, A-level, Uni or something.

Now that you're twenty years old…

Yeah

…do you feel like you would benefit from something like this, a young person's clinic, or do you think you are able to…?

Yeah, I think I've got so used to doing it by myself. I'd rather just stick to doing it because I know what to do now. I wouldn’t want to try something new now that I've already learnt the skills to cope myself. Well I say that now, but obviously there are times when I would need access to stuff like this, which would be good, but I think because I've learned over the years to do things myself, I'd rather just stick to that.