02/02/15 - Consultation 6
Duration: 11:59
P - patient
D - doctor
(u.c.) - unclear speech
(6.5)
D: come in (1.0) [hiya come in come and have a seat I’m so sorry to have kept
P: [hiya
D: you [waiting
P: [it’s okay
(1.5)
D: I’m not sure whether we’ve met I’m Doctor XXX [anyway
P: [no I don’t think we have (.) [don’t think we have
D: [nice to meet you
P: hiya
D: what [can I do for you
P: [hi it was just a follow up I had an appointment last week I saw- is it Becky [the nurse yeah
D: [yes I saw that as you were coming in
P: yeah [erm-
D: [how are you doing
(.)
P: a lot better than I was (.) errrm the anxiety has sort of dropped I think that week off work has been quite-
D: mm
P: nice actually
D: good
P: err (.) so yeah a lot better (.) but the headaches (.) are just ridiculous [erm
D: [really
P: yeah [erm
D: [I don’t know if she’s mentioned much about [that
P: [no I haven’t really ah- (.) do you know what (.) because I know it’s part and parcel of pregnancy I’ve just sort of like uh (.) [put up with it
D: [mm (.) [mmhm
P: [but it’s just getting worse and worse [and it’s-
D: [right
P: (.) so much so it’s just like oh (.) I need to take more paracetamol or- (.) I’ve been using (the other) forehead thing as well
D: okay yeah
P: but it’s just- (1.0) constantly I’ve got a headache or (.) feels like pretty much constantly I’ve got a headache
D: mmkay
(.)
P: so
(.)
D: so (.) we’ve got this background thing about headaches that [we perhaps
P: [yeah
D: ought to talk about a little bit (.) and of course (.) I’m reading what Becky said last time [that- so you were about fourteen weeks then [weren’t you- (.) so we-
P: [mmhm [yeah (.) yeah I’ll
D: [sixteen weeks
P: [be sixteen weeks on Wednesday [yeah
D: [so it’s coming on isn’t [it
P: [yesss
D: erm (.) and you’d had this little bleed and been-
P: yeah
D: to- they’ve scanned you they’ve said [everything was okay good
P: [everything was fine but yeah
D: have you got your date for your twenty weeks scan [and stuff
P: [yes I have
(.)
D: how are you feeling about the whole thing
(1.0)
P: a lot better than I was erm (.) I’ve stopped googling things ha
D: isn’t it dangerous
P: oh well the first time I had my two twenty years ago (.) it didn’t [exist so it was
D: [yeah yeah
P: just like you read a book and that was it
D: mm
P: and there’s all this information that’s just there and it’s just- (.) I’ll have a quick look and ah-
D: yeah
P: so I’ve just stopped (.) googling and I’ve thought whatever’s [gonna happen-
D: [sounds quite wise [haha yeah
P: [yeah it is just it’s- (.) I got meself in such a state and reading this and I was like I’ve never heard of this and-
D: yeah (.) [yeah
P: [that’s what I’ve got then but you know that- it was- (.) it was daft [erm- (1.0) I’m feeling a lot better (.) errm-
D: [okay any more bleeding
P: no [none at all it was like- it was brown up until- probably- what day are we
D: [okay which is good
P: on now Monday (.) probably till about (.) Friday Thursday or Friday so (.) it was over a week that I was [like bleeding brown but it’s completely cleared
D: [yeah
P: [now
D: [good okay [and no pain anywhere or any[thing
P: [so- [no I didn’t have any pain at all
D: good [okay (.) well it’s- it’s always (.) really reassuring isn’t it to have that scan
P: [so- yeah
D: a- and you know I’m so glad you did that (.) but it’s a big thing in your head anyway
P: [yeah
D: [I mean your anxiety levels are up here [aren’t they when you’re pregnant
P: [mmhm
D: [anyway I think and [then for things to happen it- it’s [tough
P: [yeah [yeah [I think as well because (.) the first two pregnan- it never had- I didn’t (.) know that it was quite as common as- [to have a bleed as it is
D: [yeah mm
(.)
P: and just to be faced with that and it’s like- (.) and cos I’m getting older as well it’s like (.) you know
(.)
D: well there’s all sorts of things [in your head aren’t there always
P: [yeah yeah yeah mmmm
D: and so you’ve had a week off work [are you back in work [now or
P: [yeah [back in work I’m due back today
D: how [are you feeling about that
P: [yeah (.) fii- fii- (.) oh I’d love to stay off ha (.) [hahaha I’d love to stay off (.) can’t afford it
D: [haha [yeah
P: [errm (.) yeah I- I think I do need to get (.) [back
D: [what do you do
P: I just work in a call centre it sh- (.) but it is- (.) very (.) stressful-
D: from [what I hear for- call centres are probably the most full on [thing you can
P: [it- [ah
D: do actually
P: yeah (.) people are just like oh it’s just a call centre but it’s [not and it’s sales
D: [oh no
P: and it’s cold calling
D: yeah [okay
P: [erm (.) which is fine but (.) if you’re not feeling a hundred percent (.) and so you’re not selling- you gotta get so many sales a day and if you’re not selling (.) then you get pressure
D: [okay
P: [that you’re- why you’re not doing it and it’s like- (.) so it is a bit of a-
D: tough stuff
(.)
P: work’s been okay with me me manager’s really good but it’s- it’s still not- (.) [the easiest thing
D: [mm and [you say (.) you can’t afford not to be off [for longer
P: [and- [can’t afford it (.) [yeah
D: [cos you wouldn’t get paid if you [were- right okay (.) cos I- you know (.) I
P: [no (.) no
D: was gonna say i- i- if you’re not ready we’ll sign you off for longer [but it
P: [yeah
D: sounds like there’s other pressures there [so
P: [yeah I’d- I’d- (.) I’d love to [but (.)
D: [yeah
P: yeah [it’s- (.) it’s just not feasible I mean- (.) get like some like statutory sick
D: [okay
P: pay
D: mm
P: and it’s just I can’t afford-
D: mm (.) fair enough
P: just to be on that
D: okay (.) erm (1.0) tell me about the headaches
P: the headaches (1.0) I’ve always suffered from like hormonal headaches so when it- when I’m due on I get headaches [and it’s- (1.0) it’s part of parcel it’s
D: [mm
P: (.) something that I’ve always had errm (.) if paracetamol doesn’t (.) sort it I’ll take ibuprofen [as well so- (.) because I’m not (.) able to take ibuprofen am I I
D: [mm (.) mmhm
P: just- paracetamol it’s just isn’t (.) [touching it
D: [it’s not doing it mmhm
P: errm (.) got one Friday evening (.) and it’s still (.) there now it’s [not-
D: [okay
P: s- as good as gone but it’s still there
D: so do they feel like the headaches that you’ve had [before
P: [yeah [yeah (.) they feel
D: [yeah
P: very much (.) hormonally headaches errm (1.0) I mean I suffer from migraine I’ve not had a migraine but I’m- I wasn’t sure whether this may have been a migraine cos I sort of had a sleep and so-
(.)
D: mm
(.)
P: because I get the aura with my migraines
D: okay
P: so if I’m asleep obviously I don’t know that I’m getting [the aura do I (.) erm (.)
D: [yeah okay
P: but it’s just (.) they’re there all the time
D: yeah [and-
P: [erm (.) working in the call centre doesn’t help [either
D: [I was gonna say do you notice anything that’s making it worse [or
P: [yeah I think (.) working in there (.) doesn’t help I do wear glasses (.) erm I do make sure I wear my glasses in
[work (.) it’s very noisy in there as well and stuffy and-
D: [mm mm
P: erm (.) that doesn’t- (.) but it’s just- (.) it’s- (.) say (.) I’ve almost always got- (.) I know me head’s there [if you know what I mean
D: [yeah yeah
P: yeah
(.)
D: and [that’s definitely been worse since the pregnancy
P: [so- yeah
D: [yeah
P: [yeah or even- (.) I’ve always taken (.) paraceta- I’ve always had headaches say (1.0) work brings headaches on erm (.) I’ve always got paracetamol in me bag (.) you know [and- (.) and I know that- (.) say when I’m due I always-
D: [mm
D: mm
P: before I come on as soon as I get a headache I know right I’m- I’m due on you know I’m [gonna come on (.) erm (.) and I think it’s just that I can’t take
D: [mm
P: anything stronger and-
D: mm mmhm
P: the [paracetamol
D: [it’s tricky that [situation isn’t it
P: [yeah mmhm
D: erm I suppose I’m thinking about other things that might help as well there’s- there’s been some new (.) headache guidelines [recently about things like
P: [mmhm
D: migraine stuff specifically (.) but also about wider headaches and w- interestingly one of the things that they mention a lot is erm acupuncture
(.)
P: [right
D: [in that (.) now it was interesting- I haven’t looked at the evidence-
P: [mmhm
D: [for that myself but (.) when you’re in a situation where you haven’t got much choice about medicines [you start to think about the alternatives
P: [yeah [yeah
D: [don’t you (.) I don’t know much about it [but it’s maybe a thought you [know erm I heard
P: [mm [yeah
D: another patient telling me that erm (.) one of the physios is interested in doing acupuncture for people who are pregnant
P: mmhm
D: for things like this
P: [yeah
D: [for nausea and headache and [things
P: [mmhm
D: might be worth just if you’re interested [maybe speaking at the XXX Centre
P: [yeah
D: cos they’re- (.) you know they’re o- obviously interested in that kind of [stuff
P: [right yeah
D: erm-
(.)
P: cos I’ve done the (.) drink lots of water [to (u.cs.) I’ve done everything sat in a
D: [haha yeah
P: da- dark room so I sort of know a- all the [tricks and-
D: [yeah I know I- you know it’s certainly not for everybody-
P: [mmhm
D: [that but it’s just something that I (.) was interested to see that- that they’re wri- writing [about more in this kind of context (.) I suppose the other thing is
P: [yeah (.) mmhm
D: yeah like you say you know (.) relaxa[tion and all that [kind of stuff so easy for
P: [yeah [yeah
D: me to say isn’t it sitting here (.) yoga that kind of thing are you doing any nice things for being pregnant
P: no I- (.) do you know what I mean it’s time- [it’s- it is really-
D: [mm yeah [(I know)
P: [ti- and
D: [haha don’t worry
P: [then (.) so it’s tight and then finances I-
D: yeah
P: was off work for a week so- well I was off work over a week [so
D: [yes [it’s- it’s
P: [you know
D: [really tricky isn’t it
P: [it’s gonna be a tough month this month so-
D: yeah
P: yeah (.) so (.) not really (.) I was like [oh I’ll go swimming and I’ll do th- but no
D: [mm
P: ha
D: do you think there’s anything else we can be doing to help with all this
P: erm (.) no (.) I- I mean at the moment I think just-
D: mm
P: plod on and-
D: the only other thing that pops to mind is that i- you know short of signing you off work you [can do these fit notes to say (.) you’re fit for work so long as
P: [mm
D: you have (.) different hours or different [duties or whatever now (.) a- of
P: [mm
D: course it’s always a balance and I’m- I’m all- really happy to [write you
P: [yeah
D: something like that saying I think you should be doing shorter hours or- or-
P: mmhm
D: you know less intense work or whatever but (.) people then say to me well actually that just means that I’m gonna be sacked or- or whatever [you know
P: [mmhm
D: so I just wanna know what your feelings are about that kind of thing
P: do you know that could be an idea actually erm even just to break me [back
D: [shall
P: [enough to having-
D: [we do that [yeah
P: [that time off [just
D: [well let’s talk about [what we could put on it
P: [mmhm
D: so (.) when- when did your current sick note run out was it [today (.) yeah
P: [today yeah
D: okay so if we do (.) maybe fit for work- ooh gosh I (u.cs.) there we go (.) right (.) erm (.) so if we do one of these and you see you can tick off these [boxes
P: [mmhm
D: and it says- (.) we’ll say you’re maybe fit for r- for return from today
P: mmhm
D: erm (.) and we- (.) perhaps say shall we do this over the next (.) two weeks
P: yeah [okay
D: [yeah (1.0) erm (.) and if you feel like it’s useful and you need longer (.) tell [us you know (.) erm (.) so we can tick any of these off or just write
P: [yeah
D: something here (.) what do you think would be useful I mean do you feel up to going straight back to the full thing do you want to do different hours or [different-
P: [I think yeah reduced- (.) if you do reduced hours or something [like that
D: [so shall we do a phase [return
P: [mmhm [yeah
D: [yeah (.) erm (.) and do you think long term you need different hours is there-
P: I don’t I- (1.0) I don’t know- I mean I don’t know how- (.) except for being absolutely exhausted and [achey bones and not sleeping cos me hips are
D: [mmhm
P: so bad and everything like that (.) I just don’t know I mean (.) I’m looking back on me last pregnancies and I’m- (.) breezed through them but I was twenty years younger (.) you know so-
D: yeah
P: I don’t know how- (.) and work it- I mean it is hard I don’t finish till eight o clock at night I don’t get in till [nine