Emma

Brief Outline:

Emma was diagnosed with type 1 diabetes in 2000. Her experiences with GPs have mostly been positive. She often uses the internet to get more detailed information from other people living with type 1 diabetes.

Background:

Emma is a research assistant. She lives in shared accommodation with friends. Ethnic background / nationality: Scottish.

More about me...

Emma was diagnosed with type 1 diabetes in 2000, so the GP (local doctor) is usually her first port of call if she is having a ‘tough time’ with it. When Emma was first diagnosed, her GP sent her straight to hospital. She was shocked and felt that the doctor dealt with such a life changing situation very abruptly, without properly explaining what was happening to her. Although Emma understood that the local surgery was often very busy, she felt that her doctor wanted her to leave as quickly as possible without making sure she had all the right support. She wishes her doctor had taken the time to explain the disease and signpost her to more information. She would also have liked to know why she was being sent to hospital as she didn’t understand what was happening to her and ‘didn’t really recognise how much my life would change’. 

Emma’s dad is a GP so she feels very fortunate that he could answer many of the unanswered questions she had about diabetes that her own GP had not explained. Emma met a nurse with diabetes at hospital with whom she had a much more positive experience, and who she felt was very supportive and informative. 

Besides occasional check-ups for diabetes, Emma rarely sees the GP, other than for contraception. She usually asks her dad for health-related advice and prefers to ‘just get on with it’ if she has any minor illnesses. 

Emma’s experiences of GP surgeries have usually been positive. She thinks local surgeries have a good system in place for making emergency appointments, though has often waited at least a week to get a regular appointment. Emma has no preference in terms of seeing a male or female doctor, although she would prefer to see a female doctor for sexual health screening. She also believes that a GP’s age is unimportant, but feels that younger doctors put more emphasis on communicating well with patients. 

Emma’s doctors have usually been very understanding and approachable. Occasionally, though, she feels like she is being rushed during appointments and that GPs are ‘counting down the seconds’. She believes it is important to feel welcomed by doctors and receptionists. 

Emma often goes online to get answers to questions that her GP is unable to explain, and to get more detailed information from other people living with type 1 diabetes. She has made many friends through online communities and values sharing experiences on the internet. Emma wishes that GPs would inform young patients of the vast amount of online support available for people with type 1 diabetes.

Ordering repeat prescriptions online is handy. Emma has to find time to collect the medications but ordering them is quick and easy.

I think quite a lot of GP surgeries do it now, but you, you get like a log-in and you can log in. And it’s, you have your prescription there and you just tick what it is you need on your repeat. And then that is generated to the surgery. A doctor obviously signs it off. And then that gets sent to the pharmacy.

That’s really handy.

Yeah, it’s good. Cos, well, I mean, I think just in the past what you’d have to do is just phone up the reception and get it done that way, which I think a lot of people still do. But for me it is quite handy when I’m like, “Oh, God, yeah, I’m running out of this. I’ll just quickly nip online, order it.” And then I know the next point, you know, my next action is to go and pick it up. So it’s finding the time to go and pick it up that’s the problem, as opposed to making a bloody appointment.

Emma wishes she could have more insulin on prescription but changing the prescription is ‘a faff’.

Because I’m type 1 diabetic I get things for, I get it for free. So I’ve never explored kind of asking for something. My experience with pharmacists, pharmacies, is when I order a repeat prescription, just online from my surgery, which is great. I love online services from GP surgeries. That’s definitely something that’s good. But anyway. So I just click, click some buttons and then, you know, I’ll know in the next couple of days I can go and pick up whatever I’ve ordered from the pharmacy. 

But there’ve been quite a few times where I’ve been to go to the pharmacy and whatever I’ve ordered is either not in yet or, you know, they muck up the order or like things like that. And it’s just an annoying process. 

For example, like I ordered some blood glucose test strips, which I obviously need on a daily basis. And they gave me ketone ones, which are different, for when you’re unwell. And I obviously said, you know, “These aren’t actually the ones I ordered.” And they went, “Oh, well, we’re gonna have to go back to your surgery now and get another prescription.” 

It was just, “So, right, so I’m gonna have to wait another week for this to go through.” And it’s like, “What if I needed that immediately?” If I had needed that immediately, I would have to go to a pharmacy and like pay for it and like whatever. But it’s just that kind of lack of consistency I don’t really enjoy. And I just wonder if that’s maybe the pharmacy I’ve lucked out with or if that’s quite a common occurrence, where there’s a miscommunication between the GP surgery and the actual pharmacy dispensing medicine. Who knows?

That’s frustrating.

Yeah, it can be frustrating. And what, there’s one other thing that I’ll just mention.

Yeah, please do.

That like on my prescription, for some reason there’s only four vials of insulin put on even though I’d asked for boxes of five. So every time now I only get four. And it just completely, it’s like, “Why don’t you just give me another one? You know, I’m not some kind of junkie that’s using this in other means. You know, this is my life.” It’s like the process would be for me to have to make an appointment with the GP to then change my prescription and it’s just a faff. Like it’s, it can take, those kinds of things I just can’t be bothered with. I think that’s annoying.

The university chemist was efficient and the people were helpful.

In terms of pharmacies I think it’s kind of hit or miss maybe. I don’t know. My one at university, it was totally fine.

Can you tell me more about that, why that was good?

Yes, it was just, I mean the people were quite nice, which was good. But they were just really efficient and they let you know when to come back specifically, when things would be in. Which was really helpful. And, you know, a lot of things were done there on the day anyway, so you didn’t have a problem. And, you know, they also made people aware, which I thought was good, of like kind of holidays and when things wouldn’t be available, and made sure people were prepared and stuff like that. So, yeah....

Emma sees the nurse regularly for blood tests and reviews because she has diabetes. The nurse is knowledgeable and answers all her questions.

I went to see the nurse, well, one, because they do blood tests for our like reviews and stuff for type 1 diabetes. So you don’t need to see the GP for that. So that’s usually just the nurse. 

And then also my diabetic review was done by one of the nurses as well. So, yeah, that was, that was fine, completely fine. She had all the information she needed and she was a really, a really nice lady.

Anything they can do to improve the service?

No, not that I can think of. I mean I was, I was fortunate that I had someone who was very knowledgeable, for one. And two, was just very, kind of made sure that I was okay before I left, that all my questions had kind of been answered or, if there was anything else I wanted to talk about. So, yeah, that was a good experience.

Emma was told there and then that she had diabetes, and sent to hospital. It was a shock to get such a life-changing diagnosis.

I was diagnosed about five years ago, after kind of about six to eight weeks of just feeling really run down. I was really tired all the time, struggling to get upstairs. And I was going to the toilet fairly frequently, and getting up in the middle of the night to go for a wee. And my dad’s a GP and obviously I’d been kind of saying how tired I’d been feeling. And he suggested I go to the, my GP, just to make sure that everything was okay. He thought maybe I had glandular fever or something. 

And so I made an appointment and kind of described my symptoms. And the female GP who was there at the time, she took a blood, did she take a blood sample? No, she definitely took a urine sample and asked me loads of different questions. And kind of I sat in the waiting room for five to ten minutes. Got called back in, basically to be told, “You’re type 1 diabetic. You need to go to the hospital. Here’s the number. On you go.” [laughs] That was my experience of that.

So it was a pretty immediate, “You need to go to the hospital to start an insulin regime.” Because they don’t offer those kinds of things at the GP surgery. I had to go specifically to the hospital department, diabetic and endocrinology department. Which I did. 

And, you know, at the time I didn’t really know what type 1 diabetes was, what it meant. And I found the GP was quite abrupt and just said, you know, well, this, my recollection of it was, you know, “You’re type 1 diabetic. You need to go to the hospital. Goodbye” type situation. Which, looking, like when I look backed, look back on it, you know, and obviously discuss with other people, they, you know, people are pretty shocked that that’s how someone would choose to deal with a pretty life-changing event. 

Emma’s surgery has a good system but waiting for an appointment puts her off seeing the GP. The symptoms might have gone by then and she’d never know why she had them.

I think it differs for surgeries for sure. And I think the particular one I’m at, they do have a system. I think, I think it’s a really good system. They have kind of immediate, kind of emergency appointments that once you call up, if you call up in a certain time, then you get a call back from a GP or someone or a nurse to ask kind of a bit more about what’s going on. 

And then if they believe that it is something you need immediate help with, they have set appointments during the day, like that day. So, you know, if there was an emergency, but not an emergency that you need to go to the hospital, then, you know, they have a good system. 

And then yet on the flip side, you know, if it’s not that serious or immediate or whatever, then, you know... I think anything over a week to me is a little bit of a nuisance because you wanna, I think because it does play on your mind whatever you’re gonna be wanting to seen, be seen about. And so the longer that goes on for, well, for a while like, whatever you’re going to be seen about might have gone by that point [laughs]. But then also I think it’s just a, yeah, a bit of a nuisance that you have to then factor in another week or whatever.

And do you think, as a young person, does it ever deter you from going, thinking, “Oh, I don’t wanna wait a week, I don’t wanna wait two weeks”?

It does actually, now I think about it. Just because, as I said, I mean I don’t really, I don’t really think about going to the GP a lot. You know, it’s not like, “Oh, God, you know, yeah, I’m feeling really run down. I’m going to go to the GP.” That’s just not my attitude. 

And, you know, if it, even if it were, I think, you know, that length of time, it would kind of put me off. Cos it’s just like, well, by the time I even see the GP my symptoms or whatever’s going on won’t be at their peak. And they’ll just kind of fob me off with, you know, “Yeah, go and take some paracetamol” or something. Which, you know, I then would feel was a waste of their time. Which is not the best. So it’s hard to strike the balance I think.

Some receptionists are very welcoming. Others come across as if they’re having a bad day. A welcoming receptionist might help an anxious patient feel less worried.

I’ve been in surgeries where, you know, you’re very welcomed and, you know, it’s obviously, they’re just a nice person [laughs], which is great. And then there’s, I’ve been in places where it’s, you know, “Yeah, fill in the form. Sit down.” 

And I think it does make a bit of a difference because, you know, it’s our health at the end of the day. And it’s, you know, something that is very precious and is also very important to each one of us. And, to kind of, be greeted sometimes by someone who, you know, is maybe not having a good day or whatever’s going on in their lives, you know, they’ve taken it to work and they’re portraying that energy, I think sometimes isn’t the most useful. But how can you control that? [laughs]

Well, if you had a chance to say something to a receptionist at a health centre now, what would it be?

Oh, I mean obviously I understand that you can’t smile 24 hours a day [laughs]. But I think, yeah, it would be really hard on your manners. But I don’t know, I just think there’s a certain kind of air, like there’s an air of welcomingness I think that you can give off that... Cos I think a lot of people, not myself, but a lot of people do get anxious about going to GP surgeries. And to then be greeted by a cold, kind of abrupt person, I guess that might exasperate that anxiousness. 

And, you know, as I say, that’s not, I’m not talking about myself. But I think I can definitely see how maybe just the odd kind of, appreciation of, “Yeah, here’s a pen to fill that out’ or, you know, blah, blah, blah. I think just kind of maybe a bit more effective communication wouldn’t go amiss.

The appointment felt rushed. Emma would have liked the GP to explain what diabetes was, how the diagnosis could affect her life, and ask if she had support.

I think at the time I was quite, I didn’t, I didn’t really know what diabetes was, as I said. But more so I was, I was just completely shocked that that word was kind of thrown at me and I didn’t know what it meant. And I wasn’t signposted to anywhere I could get more information at that point. 

It was more just a, priority was to get to the hospital. Because I think, you know, particularly maybe for that GP, she wasn’t, well, I’m not going to say she wasn’t specialised, cos that’s obviously like not applicable. But I think when you’re going to be going through a massive life change, you’re recommended to see the people that know the most and have got the most experience. So obviously she sent me to the hospital. 

But I did feel that I was kind of left in the lurch a bit. I didn’t know why I was going to the hospital necessarily. At that point I wasn’t aware that my, I would now be completely dependent on insulin. And so I was very fortunate that my parents were very close by at the time and so we went to the hospital together. And my dad, as I say, is a GP. So he was obviously at first very shocked, but he was able to kind of answer any questions I had in the immediate term.

What would you have liked to have happened at your appointment? What kind of information or support or anything would you have liked to have received on that day when you got your diagnosis?

I think it’s one of those feelings where someone wants you to leave as quickly as possible. That’s the kind of, that’s what I felt. I mean maybe she had had a bad day. I’ve no idea. But I just felt that it was, it could have been a lot more useful if she’d explained what type 1 diabetes was. You know, just been a little bit more understanding that this is pretty big information in someone’s life and, you know, maybe that person would do well to get some more information, as opposed to, “You need to go to the hospital”, you know. 

I felt quite, I don’t really know the word. Because it’s not, it’s definitely not as extreme as you’re hurt by that experience. But it’s more that I personally would expect a bit more from a GP that would psychologically, if nothing else, want to make sure that you were okay and had the right support available, as opposed to just kind of shipping you off and wanting to see the next patient because it’s a busy surgery.

Emma has no doubts that all her GP appointments are confidential. This might be more of a worry for younger people.

Did you ever worry about confidentiality? That this doctor may have known your parents. Did you ever worry that…?

No, never.

No?

No, never. Because like it’s just not a GP in, you know, it’s obviously not in the rule book. I think, you know, maybe slightly there was like, “Oh, my God, what if they tell my dad?” you know. Because especially if you’re a teenager or whatever, then - You know, I’ve, I had really bad acne as a teenager and, you know, I was really embarrassed about it and going to see someone was quite a big deal to me. 

And, you know, there was maybe an initial like, “Oh, God, you know, like what…?” Because she suggested like, you know, going on the pill. And like in my, in the back of my head it was, “Oh, my God, what if dad finds out about this?” You know, it was like just a completely irrational thought because of course they can’t say anything. And it, like she, obviously they would never. But in, so in that situation you maybe get a slight inkling. But you get over that, I mean especially as you grow up. It’s not a big deal at all. No, I would never, I wouldn’t have any doubt that they would keep something confidential.

Emma’s GP phoned the hospital so that she could go there straight away and get the treatment she needed. Hospital staff were expecting her.

So how quickly were you referred to the hospital then?

It was, I was seen the next, like on that day.

The same day?

Yeah, the same day, yeah.

And was it your GP who made the referral for you?

I can only assume so, yeah. Cos I think in those scenarios obviously because they need to get your blood sugar back within a, say a typically normal range as quickly as possible. You know, she obviously made the right phone calls that once I got to the hospital they were expecting me. So it was like, yeah, you know. But they knew who I was and my records had been obvious-, well, obviously they’re available to the health professionals anyway. But I guess she’d made the right calls that I would need to be seen that day. So I guess that’s a good thing.

And since then, have you, you said you regularly use your GP as the first point of contact?

Sure.

A live chat option similar to that found on the websites of some shops would be helpful. Questions should be answered by someone trustworthy, like a GP.

I think there’s a lot more kind of like online stuff going on that you could really, like maximise through a GP I think. Because as well a lot of people, as I say, are so embarrassed to go over, you know, things that maybe you shouldn’t be embarrassed about. But, you know, people obviously are entitled to whatever they wanna feel. And they would feel a lot more at ease if they could just say something, you know, get a quick response online as to what their next port of call should be. I think is, it would be really helpful.

Yeah, absolutely.

Yeah. I mean that’s obviously as long as it’s from a trusted source that, yeah, is reputable and obviously has it’s, you know, can’t just with any old man sitting there.

So how would you decide if a source is reputable?

Well, I think if those kinds of things like a GP kind of…You know how you can get, like when you go on to like Curry’s website and stuff, you can get like the live chat and it’s like ask for help, blah, blah, blah. If they had something like that, like for each surgery, that you had to log in to, I think then you would know it was legitimate. Which I actually believe that might already exist. 

But anyway I think that would be good, just to ask advice. Because, you know, it’s all good and well googling something, but that’s how people drive themselves crazy once they start a google search on something, you know. 

It’s like if you just have a known professional, potentially your own GP that you’ve been to and are familiar with, then I think that would be really helpful. You know, they could have a set amount of time during the day that they dedicate to answering questions. That people would know it was their time to log on and ask a question or something. I think that would be really helpful.

Skype consultations are a ‘great’ idea because you don’t have to take time off work and you can see the health professional that you’re talking to.

I think like more is great, less is not great. So like the more that they (GPs) can do, the better. I can’t really like pinpoint what they could do to make it a more efficient service. I guess, you know, there’s all the communication side of things from actual consultations to their trying to run on time or blah, blah, blah. But those things are sometimes out of control, aren’t they? So…

How do you think they could support people better?

How could they support people better? I don’t know. Cos it’s like it just depends on the surgery I think, how they communicate with you. Cos sometimes it’s completely all by post. Other times, you know, they have an SMS service. So I think keeping up to date with modern technology is really good. 

I know that they’re introducing like Skype consultations now. Which is great cos then, you know, you don’t have to take the time off work as I keep harping on about. But I think things like that are gonna make it a lot easier for people. Especially if like maybe they’ve got some kind of condition where they can’t physically get to the GP surgery. Then it’s great to have that resource of, “I’m actually talking to a known professional. I can see them right there” as opposed to, you know, just a message.