36_https://www.youtube.com/watch?v=4-bH55MCa1U_changing approach to disease
gpt
Barbara Roberts?
human
Yes. Morning.
gpt
Hello, there.
human
Hello.
gpt
My name's Dr. Betty. I'm one of the new GPs in the practice. First of all, what would you like me to call you?
human
Well, you can call me Barbara. That'll be fine. Thank you.
gpt
Okay, that's fine. Okay. So, Barbara, I'm seeing you today, um, but I think it's usually Dr. Brown that sees you, is that right?
human
Yes, Dr. Brown is my doctor.
gpt
Okay. What is it that's brought you to see me today?
human
Well, I've come about my tummy problem. I've got terrible trouble with my stomach and, uh, Dr. Brown just doesn't seem to be able to get to the bottom of it. And I thought perhaps, uh, I'd come and see you to see if you could help.
gpt
All right. Okay. Can you tell me a bit more about your tummy problems?
human
Um, well, I-I have this terrible discomfort nearly all the time. Um, it very often feels bloated. I, um, uh, I swing between being constipated and having diarrhea. Um, I have sort of cramping feelings sometimes, and other times it stabs. It's a real stabbing feeling. Um, I often have the urge to go to the toilet and, um, and I pass very smelly wind.
gpt
All right. So, quite a few symptoms there-
human
Mm.
gpt
- and some of them sound-
human
Yes.
gpt
- quite troublesome to you.
human
Yes.
gpt
Okay. And how long has this been going on?
human
Well, I, uh, I've traced it back to a holiday I had in Egypt about four years ago. I had, um, a horrible bout of sickness and diarrhea, and, uh, and I don't think my stomach's ever been really right since then.
gpt
Mm-hmm. Okay. Okay. So you think it began about four years ago after this holiday?
human
Yes. Yes.
gpt
Okay. And what's- what sorts of treatments have you tried for-for this before?
human
Well, uh, Dr. Brown gave me some muscle relaxants at the beginning.
gpt
Mm-hmm.
human
Um, but I've been to the health shop and-and they've been really helpful. They've given me lots of different, um, tablets and medicines-
gpt
Right.
human
- for different things. Um, no, oh, and Immodium.
gpt
Right.
human
I have Immodium in my handbag all the time, just in case. Yeah.
gpt
Right. So, these different tablets that you've got from the-
human
Hmm.
gpt
- the herbal shop-
human
Hmm.
gpt
- how are you taking them?
human
Oh, well, different tablets, you know, I don't have the same problem every day-
gpt
Right.
human
- so I'll take some tablets for certain, uh, symptoms, and-
gpt
Right.
human
- other tablets for other things.
gpt
So, am I- am I right in thinking you perhaps decide on a day-to-day basis-
human
Hmm.
gpt
- what you're gonna take-
human
Hmm.
gpt
- depending on what your stomach's doing?
human
Yeah.
gpt
Okay. Okay. And what about tests? Have you had any tests for these problems?
human
Yes, uh, I had, uh, in the early days, I had a gastros-gas-- What are they called?
gpt
A gastroscopy.
human
That's it. Yes.
gpt
You got the tube down-down from the top?
human
Yes. Yeah.
gpt
Okay.
human
Um, and at the same time I had a barium enema.
gpt
Right.
human
That was very uncomfortable.
gpt
Okay.
human
Um, but, um, no, I've tried-- Well, you-- I don't think he's tried enough tests because he said after that, that they didn't find anything-
gpt
Right.
human
-and he-he's-he's just not sent me for anymore. That's it now-
gpt
Right.
human
- as far as he's concerned. Sent me back to the doctor.
gpt
Right. It sounds as though you're-you're not happy with that.
human
Well, you know, I think that actually, the NHS are running out of money, aren't they? And he's-
gpt
Right.
human
- decided that I've had enough tests.
gpt
Right.
human
And, um, you know, if you go on the Internet-
gpt
Mm-hmm.
human
- there's loads of tests that he could have sent me for.
gpt
Right.
human
Um, if I had a bit more money, I'd go private.
gpt
Right.
human
I just don't think he's got to the bottom of it.
gpt
Right. So you feel as though actually, enough hasn't been done in the way of-of tests?
human
No, he's not. There's loads more he could do. I'm sure.
gpt
Right. Okay. It sounds like you-you've had these problems now for about four years.
human
Mm.
gpt
You've-you've got a lot of various symptoms in your stomach.
human
Mm.
gpt
Um, you've tried a lot of tablets. Some prescribed, some herbal remedies-
human
Mm.
gpt
- and you've had some investigations, but you're not entirely happy that-that you haven't been investigated thoroughly enough.
human
Yeah.
gpt
Is that- is that about-
human
I'd say so, yes.
gpt
- if I got the story right.
human
Yes.
gpt
Okay. And can I ask you, Barbara, how-how is all of this affecting you day-to-day? How's-how's it affecting your life?
human
Uh, well, it's had quite-quite a big impact. Um, I mean, the first thing, the biggest thing, I suppose, is that I-I went from being full-time to part-time at work.
gpt
Mm-hmm.
human
I just couldn't sit all day comfortably.
gpt
Right.
human
Um, and so I went part-time, but in the end, I, uh, about a year ago, I stopped work altogether.
gpt
Right. Right.
human
Um, I miss that.
gpt
Right.
human
I miss the girls. We used to, uh, we used to go out at least once a week.
gpt
Right.
human
To the pictures or for a drink. That's one thing.
gpt
Sounds as though that's something you quite enjoyed.
human
Yeah, so I-- Yes. Yes, we used to have a laugh.
gpt
Right. Okay.
human
Um, I used to go to Swing and Shape. I used to go to an exercise class-
gpt
Mm-hmm.
human
- that was, um, I miss the exercise, actually. That was, um, once a week, but you know, the thing was I wasn't comfortable, never felt quite right doing all this exercise. I was always worried I was gonna be taken short or-- So I stopped that.
gpt
Right.
human
Um, then-- Well, my husband and I used to go out for meals.
gpt
Mm-hmm.
human
That's another thing we don't do anymore now.
gpt
Right.
human
Um, mm. Yeah, it's quite a few things, really.
gpt
Yeah, it does- it does sound as though over the last few years your life has really changed-
human
Mm.
gpt
- quite a lot because of these symptoms.
human
Yes.
gpt
It sounds- it sounds like you're doing the review of the things that you used to do.
human
Mm.
gpt
Right.
human
Mm.
gpt
So, what is it you'd spend your average day doing now?
human
Well, I potter around the house-
gpt
Mm-hmm.
human
- um, I spend perhaps a little bit too much time watching. I've got a bit hooked on daytime television, I have to say.
gpt
Mm-hmm.
human
Um, they draw you in, don't they?
gpt
They certainly do.
human
Um, I read a bit-
gpt
Mm-hmm.
human
- the old magazines, but, uh, generally, I'm at home.
gpt
Right.
human
Yeah.
gpt
Okay. Okay. And have there been any times over the last four years that you've noticed any significant changes in your symptoms? For example, have there been any times when things have been better for you?
human
Um, well, last year, um, my son got married-
gpt
Right.
human
- and I-I have to say I was worried that, um, that I wouldn't be able to cope with it.
gpt
Mm-hmm.
human
That I-I wouldn't be feeling well enough, but surprisingly enough, um, I was in good form, and I think it was about three weeks in the summer, getting ready for it-
gpt
Mm-hmm.
human
- and the whole hoo-ha of the wedding.
gpt
Mm-hmm.
human
But I was in good- in really good form for that. Yeah.
gpt
Right.
human
That was a good time.
gpt
Right. And how were you tummy symptoms then?
human
I hardly noticed them.
gpt
Right. Okay.
human
Yeah, it, uh, it seemed to, uh, clear up.
gpt
Right. Right.
human
Which was good.
gpt
Right. That's interesting.
human
Mm.
gpt
And are there any times when your-your tummy symptoms bother you more? Seem particularly bad?
human
Um, well, it's- I'm-I'm having a bit of a bad patch at the moment.
gpt
Right.
human
It's particularly, um, uncomfortable. Um, I have to say I do notice it when my husband's away. He-
gpt
Right.
human
- he travels with his job, and he-
gpt
Right.
human
- can be away a couple of times a month.
gpt
Uh-huh.
human
Um, and that's not-- It-it's very often not good then, I have to say.
gpt
Right. So you notice it's a bit worse when your husband's not around? Okay.
human
Mm. Maybe I'm thinking about it a bit more, I don't know, when he's not there.
gpt
Right. I know you've been seeing Dr. Brown about this for the last few years.
human
Mm.
gpt
What is it that he's said that he thinks might be wrong with you?
human
Well, he's-he thinks it's all in my head.
gpt
Right.
human
You know, he's- he says it's stress.
gpt
Right. Okay.
human
Mm.
gpt
And what do you think?
human
Well, I mean, it can't all be in my head. I get too much physical pain-
gpt
Right.
human
- for it to be in my head. I mean, it's real. It's-it's real pain.
gpt
Mm-hmm.
human
Um—
gpt
And have you had any thoughts yourself about what you think might be causing it?
human
Well, I mean, I-I did think that perhaps it was an infection that hadn't cleared up-
gpt
Mm-hmm.
human
- in the early stages, but, um, I think, um, I-I mean, sometimes I think it's IBS. A friend of mines has got that and it sounds similar, and then-
gpt
Right.
human
- other times I'll think, "I wonder if it's an ulcer."
gpt
Right.
human
Um, on a really bad day, I start to think it might be cancer.
gpt
Right.
human
Um, my mother-in-law- my mother-in-law died of cancer last year and she had a, um, a growth that-
gpt
Mm-hmm.
human
- the-the doctor didn't investigate.
gpt
Right.
human
But by the time they'd found it, it was the size of a football-
gpt
Oh, dear.
human
- and it was- it was too late to operate then.
gpt
Right. Right.
human
So, you know, when I go to bed at night now, um, I just feel to make sure there's nothing different going on.
gpt
Right.
human
And, uh, yeah, I worry about that.
gpt
So you're- you-you're kind of prodding, having a feel at night?
human
Oh, yes.
gpt
To see if you can feel anything?
human
Yes.
gpt
Right.
human
I just want to make sure there's nothing changing down there, you know?
gpt
Right. Okay.
human
Mm.
gpt
Okay. So just to-to make sure that I've got the-the story straight, you've-you've seen Dr. Brown for a couple of years.
human
Mm.
gpt
You've-you've tried a variety of medications-
human
Mm.
gpt
- some prescribed, some-
human
Mm.
gpt
- from the-the herbal shop. None of them really made a great deal of difference. You've had some investigations-
human
Mm-hmm.
gpt
- but you perhaps feel you've not had enough investigations. And at times, you worry that this could be something quite serious like a-
human
Mm.
gpt
- a cancer. Is that-- Have I got the-
human
Yes.
gpt
- story right?
human
Yes. Yeah.
gpt
Okay.
human
I'd say so.
gpt
Okay. Barbara, what was it that you were hoping that I'd do for you today?
human
Well, I thought, you know, you're a new doctor here-
gpt
Mm-hmm.
human
- and you've just finished your medical training. I wondered whether, you know, with new eyes and a new way of looking at-at the problem-
gpt
Right.
human
- um, you-you probably know about different tests, new tests, that my doctor doesn't know about, you know, new developments.
gpt
Right.
human
So perhaps you could send me for some different tests.
gpt
Right. Right. So you were hoping that I'd send you for more tests?
human
Mm.
gpt
Okay.
human
Well, I think there's-there's got to be something that a test might-
gpt
Right.
human
- might reveal.
gpt
Right. Okay. Well, I think, Barbara, having-having heard your story, and heard about the symptoms, I'm not sure that actually sending you for more tests at this point would be the most useful thing that we could do for you. And the reason for that is because you've-you've had some of the main investigations in the last couple of years, and-and they've not shown anything. And your symptoms haven't really changed that much. So it's very unlikely that if we were to send you for more tests now that-that they'd show anything different than what we already know. So a bit-- I think it would be a waste of time for you to go for more tests.
human
So-so like, do you think it's all in my head then? You're gonna be like Dr. Brown. You think I'm imagining all of this?
gpt
Uh, no. I think that you clearly have pain, and clearly you have lots of physical symptoms, and they're clearly getting in the way of-
human
Mm.
gpt
-your life and causing you a lot-
human
Mm.
gpt
-of disability.
human
Mm.
gpt
I guess- I guess the way I think about these things is that they're not necessarily either all in the mind or all in the body.
human
Mm.
gpt
Sometimes these things can go together. Uh, I guess I'm thinking about how you told me that last year, when your son got married, uh, and you were very busy-
human
Mm.
gpt
- and quite happy, that somehow your symptoms seemed less.
human
Mm.
gpt
And, uh, when your husband's away, which is something you don't like very much, sometimes, somehow, your symptoms then will seem greater. So, I guess what I'm wondering, Barbara, is if there might be some kind of a link with you between how you're feeling in your mind, and what's going on in your life, and-and how much your symptoms trouble you. Do you think that's a possibility?
human
Well, I can't see that my mind can be causing this amount of pain.
gpt
Mm. I'm not saying that the pain's in your mind. Um, I guess what I'm saying is that sometimes the way that we feel, and the way that our lives are going, can impact how we notice our symptoms. Given that we've tried medication for you, and we've tried investigations, and we've drawn a blank really, with those, none of those have really helped you-
human
No.
gpt
- I guess I'm wondering whether now it would be a good idea to try a different approach to your problems.
human
What-what sort of approach?
gpt
Well, I guess, thinking a little bit about those other areas of your life, um, uh, I'm thinking about the fact that over the last four years, your life's really changed. It seems to have really shrunk down.
human
Mm.
gpt
And it sounds as though you're not doing lots of the things that you used to do. That you-
human
No.
gpt
- used to get pleasure out of. Is that right?
human
Well, I just can't do them.
gpt
Yeah.
human
I can't- I can't do them anymore.
gpt
Yeah. And I guess I wonder-- Uh, it sounds as though you've-you've dropped doing those things because you felt you couldn't do them, but I wonder if, in a funny way, what's happened is the fact that you're not doing those pleasurable things now, has kind of fed into you feeling-
human
Mm.
gpt
- unhappy with the way that-that your life is at the moment. And-and I guess I wonder whether that can then make your symptoms worse for you.
human
Oh, I don't know.
gpt
Mm.
human
I don't know.
gpt
Well, I guess what I'd be wondering is whether one of the approaches we need to be using now is thinking about what you do with your life, and what you do with your day, and maybe trying to bring back some of those pleasurable things, you know, even if it's just meeting up-
human
Mm.
gpt
- with your-your female friends once a week, and whether actually doing those sorts of things might generally-
human
Mm.
gpt
- improve your quality of life. I'm also thinking about the tablets that you're taking.
human
Mm-hmm.
gpt
And the fact that you-you seem to be taking quite a lot of them, and I'm wondering whether it's worth, though, sitting and looking at them and-and maybe trying to rationalize them a little bit, and really decide which are helping you, which are doing nothing, and which may actually be making some of your symptoms worse, I guess.
human
Hmm. Yeah.
gpt
What would you think about trying that slightly different approach for say-say two or three months, just to see whether or not it makes any difference?
human
Well, two or three months is a long time if there is something going on. I mean, that's what happened to my mother-in-law, you know.
gpt
Right.
human
They-they left her and-
gpt
Mm-hmm.
human
- didn't spot it and—
gpt
Well, I guess if we- if we did decide to-to work together like this-
human
Mm-hmm.
gpt
- in this new approach, I'd be seeing you regularly. We can keep an eye on your symptoms, and if they change, then we can investigate as appropriate. But if they stay the same, then, you know, we can be-
human
Mm.
gpt
- pretty clear that there's nothing new happening that-that we're missing.
human
Mm.
gpt
How would that sound?
human
So, uh, what are you saying then? That I should come back and see you?
gpt
I think that would be a good idea. I think we've only just begun to talk about it-
human
Mm.
gpt
- and I think perhaps you need to have a bit of time to think about it and then perhaps come back. Perhaps if you're booked in for a double slot next week, and that would give us a good chunk of time to think about this new approach.
human
Mm-hmm.
gpt
And perhaps if you could also bring your-your tablets in or-or make a list of them, we can look at what you're taking and perhaps go from there. How would that sound, Barbara?
human
Okay. Well, uh, to make an appointment for next week.
gpt
Yeah.
human
And come and see you again-
gpt
Yes.
human
- and talk about it a bit more?
gpt
Yes. I think so.
human
Okay.
gpt
I think that would be a good- a good start.
human
All right. And I'll make a list of the tablets that I'm taking.
gpt
Yeah.
human
I won't bring all the bottles down.
gpt
Okay. All right.
human
Okay. All right. I'll do that.
gpt
So, shall I see you again next week?
human
I'll make an appointment for next week. Yes.
gpt
Okay. All right. Thank you, Barbara.
human
Okay. Thank you.
gpt
Bye-bye.