So, my next story is really two stories.  The first part happened when I was only a couple of months into my pre-reg and the second part happened very recently.

A lady (A) in her early 40s was booked in for a supplementary.  She was experiencing headaches and double vision.  When A arrived in our practice, she had her children with her but asked for them to wait outside the room while I tested her.  During history and symptoms, I asked all about A’s headaches (using the LOFTSEA approach, no less) and her double vision.  The symptoms didn’t sound eye related and, having only been in practice a short while, I was unhappy that I didn’t have a clue about what was causing her problems.  At the end of the history and symptoms, I told A I was going to do a full eye test just to make sure her symptoms weren’t caused by her eyes.  At that point, A told me that she was very depressed.  She said it bluntly, as if she had been building up courage to say it out loud.

I was caught off guard and didn’t know how to respond.  At that point, do I say “I’m sorry to hear that” and brush it away? Do I chat to her for a bit? What do I do?

I paused for a moment and put my clipboard down.  She was looking at me expectantly and I felt very out of my depth.  I have had experience with mental illness, it has affected family and friends and I understand depression.  I respected how hard it was for A to tell me she was depressed and I understood why she wanted to see me by herself, with her children outside.  I realised that a trip to the opticians isn’t commented on as much as a trip to the GP – her family would ask what was wrong if she went to the GP but not the optician.  I was suddenly very aware that I was a healthcare professional and I had responsibilities that went far beyond getting a prescription right.

I asked if A had been to her GP, already knowing the answer.  She hadn’t and she didn’t feel comfortable telling her family she was going to the doctor.  She didn’t drive so her husband would have to take her and he would ask questions and she didn’t want him to know how she felt.  He was a wonderful man and this was her problem, she said.  He knew she was having headaches so he’d suggested going to the optician and that’s why she was here.

At that point, I just knew I had to address the issue.  She’d opened up to me and I had to make sure that she knew I was listening and that I wanted to help.

I told A that feeling this way was not her fault, that depression is something that can affect any of us and it’s nothing to be ashamed about.  I mentioned my personal experiences with depression and how important it was to seek help.  She wasn’t alone.  Did she want me to write to her GP and ask him to see her? She seemed quite happy with the idea of me telling her GP and she smiled for the first time.

I did the eye test and there were no obvious reason for her symptoms.  I said that I would write to her GP about her symptoms and tell him how she was currently feeling, I also referred her to HES for her diplopia.  She seemed relieved.

When we left the room, A’s husband was there.  He came over and asked if she needed glasses.  I said that her eyes were fine but I wanted her to see the GP about her headaches so would he be able to take her up to the surgery next week? And don’t worry, we ask everyone who is having regular headaches to go to their GP.  My patient hugged me and thanked me, gathered her children and went home.

In uni, we role-played lots of eye related scenarios.  We took turns explaining cataracts and glaucoma and long-sightedness to pretend patients but the hardest part is knowing what to say when someone tells you they have cancer, that they have lost 6 family members in the last year to different illnesses and tragedies, that they are very depressed.  Will a simple “I’m sorry” do?

It’s not the prescription glasses I worry about getting right, it’s the part where the patient feels as if they have made a connection and been seen as a person.