I've seen a psychiatrist for many years, initially because of very severe depression, but in recent years, since the depression has lifted amazingly, it has mainly been so that I have someone to off-load onto the stresses of my asthma and the regularly of facing my mortality through my severe asthma attacks. Over the years there has been terrible instability in the mental health services, particularly in acute psychiatry so it seems. Between the years of 1999 and 2003 I had nine psychiatrists! This is awful when you stop to consider that of all the medical specialities, psychiatry is probably the area where stability of 'carer' is most important - any patient needs to be able to trust their doctor and needs to be able to develop a working relationship with them, but I think it's particularly important in psychiatry where many patients have huge issues with distrust. Anyway back in 2003 I got a new psychiatrist - Dr M - who was the first permanent psychiatrist in the service (rather than a locum) for several years, and I was lucky that he was an excellent doctor. I saw him about every 4 to 8 weeks just to keep a check on things, but largely we shared jokes. In fact he once said to me that he wouldn't discharge me because I cheer him up too much! :oD That has to be the best reason not to be discharged from your pdoc! Well, the last time I saw Dr M he told me that his job had changed, and whilst he was still working within the trust, and occasionally within the same building, he was now spending more time working in different places within the trust. He told me that he now wasn't supposed to have me on his books and that really I ought to be passed on to the person whose around most of the time - Dr G. We talked about the pros and cons of this, with Dr M also saying that he didn't mind keeping me on if I wanted because '[I'm] no bother at all' and '[He's] become rather fond of me.' He mentioned that Dr G was a locum, which rang alarm bells for me after the instability in the mh services prior to Dr M's arrival, but he said that despite being a locum, Dr G had been here for two years already and seems to have set down some roots in the area. With this information, and considering my occasional need to contact my pdoc when I'm in hospital having a tough time getting my head around near-death through asthma, we decided that I'd be passed on to Dr G.
I saw Dr G for the first time today. He's nice enough, but he mumbles and is quite difficult to understand as he has a very thick European accent (he's Polish). He also seemed at a bit of a loss at what to say to me as I'm mentally so well these days. Then he told me that come July he may not be here any more, which was a bit of a blow after the discussion with Dr M only a couple of weeks ago, and it hardly seems worth my time 'getting to know' him (as much as one ever gets to know their psychiatrist) if he's going to be off again in three months time. We've made an appointment for June, by which time he should know what he's doing, or so he says. Now another complicating factor in all of this is that about two or three years ago the GP practices who Dr M saw patients from changed so that actually he no longer covered my GP practice. However, he kept me on his books because the Dr who was taking over the care of the patients from the GP practice I attend is someone I grew up with being a friend of my mothers. This would have created a very difficult situation, had I been under her care, and I would have been most uncomfortable. Well it seems that the recent restructuring and reallocation of psychiatrists is in part due to this doctor - Dr S - changing posts again. Most of her patients have been passed on to Dr G, as have many of Dr M's, including me, but it seems that there is the possibility of her returning to her prior post come July when Dr G may leave. This would mean that I would then come under the care of Dr S, which I still don't want to happen. It's not that I don't like her - I do - but I grew up knowing her; she knows me in a different way; and I know her in a dffierent way ... I almost know too much about her for her to be my doctor, and I know that wouldn't feel comfortable about it. So when Dr G told me this today I felt that I had to be clear with him and tell him that if he left and if it looked as though Dr S would take over my case, then I'd actually much prefer to put back on Dr M's case-load, even though he's no longer as available as he was. Dr G seemed to understand this, but obviously can't advise at the moment as he doesn't know for certain what his own position is going to be. It all seems rather silly, and I wish that Dr M had either known this situation or discussed this possibility with me at our last consultation. I think he probably didn't know the situation, because he's always seemed to be an honest kind of person, but it seems quite ridiculous that I may end up back on Dr M's case-load after three months brief excursion onto Dr G's.
I have to say that, for all that my mental health is good and stable these days, this is a rather unsettling situation. I really pity those who aren't psychologically well though and in need of stability in their care, because it seems that it's all going pear-shaped in the mental health services again.
I'm a little disappointed at the instability and the possibility of another succession of pdocs. How can you develop a relationship with someone in order to pour out your most inner concerns and worries, when that someone keeps changing?