Appointment with my MP - What do we need most to access our healthcare?

Hello lovely community,

Some of you may well be bored of me twittering on about access to health care given the medical/body terrors which result from the sensory processing etc...lol

But it seems I have an appointment with my MP to discuss these frustrations and lack of commissioning for any kind of supports.  Obviously, this is problem is of immediate personal import to me and I do seem to be a bit of an extreme case in finding this barrier, but I hear so many of you expressing at least some or even many of the issues I face too.  Thanks guys, at least I know I am not alone!  But I am also acutely aware that that being the case, I am not just presenting an argument for provisions for me, but for all autistic adults as I go into this. 

I'll copy a precised version of the brief I sent to my MP's office below if anyone wants to be bothered reading through it, but in case there are essential points I have missed to some of you, my question to you is do you have needs I have not covered here?  Do you think I am missing any essential points here?  What would you like me to be saying for us all?

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I approach in desperation as there seems to be nothing commissioned anywhere to offer the necessary support to autistic adults to access health care.  This is a complex topic, which I outline as briefly I am able. 

Among the problems for me and many autistic people are:

  1. Sensory triggers in the medical environment or by medical staff handling my body which can result in shutdown (such that the person has trouble speaking to medical staff or absorbing anything said to them) or else meltdown, which can be misread as aggression or lack of co-operation when in fact it is distress.
  2. Coping with the chaos, unpredictability, constantly changing staff and crowds of other patients in some medical environments
  3. Surprise changes to what is expected (appointments, sudden bad news etc) can spike anxiety sky rocket high
  4. Sensory issues internal to the body such that significant anxiety is created, the individual cannot identify what their physical sensations are (problems in our interoception) or describe them in such a way as a doctor can understand (alexithymia).  Our pain in particular can be experienced as extreme when their should be none or none when it should be significant and we may struggle to rate that on a scale.
  5. Medical staff misreading or not reading our body language/ facial expressions (or lack there of) making incorrect assumptions of our emotional attitudes or physical sensation  
  6. The sensory impact of procedures and their aftermath can likewise cause immense distress and result in the individual not coping
  7. Many autistic people express themselves well in writing but struggle verbally, especially when under pressure, say in a doctor’s appointment, and find the telephone very difficult to use and yet many are still required to ring at 8 am to even make an appointment

…Many reasonable adjustments can be made to mitigate some of the above but this depends on medical staff understanding the situation and the need that they are looking at and most do not because they have not had the training.  Even high IQ autistic adults who can self-advocate in other situations may be deprived of an ability to communicate their need effectively or at all in these situations and are hardly at that point in a position to educate staff, who believe they are just being difficult.  Organising and communicating to achieve adjustment adds significant executive strain on autistic people, who may struggle with this even when not under stress

It should be obvious that what is needed for me and for many other autistic people is significant practical support to make medical appointment where reasonable adjustments are planned for, during them to ensure staff understand that any behaviours of the shutdown/meltdown type or stimming are not a lack of co-operation or aggression aimed at anyone but the product of sever distress, ensure that the needs of the individual are communicated when they cannot do that for themselves and to ensure that the information given is taken down in writing and understood, and sometimes specialist nursing support afterwards to help cope with remaining difficulties due to the impact of procedures may be necessary. 

…. 

These services; … it seems exist ONLY for children and the intellectually impaired.  The rest of us are left to go without any medical care or else continue to experience high levels of distress in medical contexts unsupported with further detriment to the little care we can receive.  Recent research from the University of Brighton has indeed shown that these issues are costing the lives of autistic adults.  Many are just not going to the doctor because they can’t even book an appointment.

In my case the following has been investigated:

  1. My special care dentist has referred to the Learning Disability and Autism Team, who will not help because I do not also have a learning disability
  2. My GP and others have referred several times over to social services, who will not even take the referral and conduct an assessment, even though there is an “essential service” which I cannot access. 
  3. Social services try telling us that mental health are responsible.  They aren’t!  A) Autism per se is not a mental health condition b) sensory and autistic communication issues cannot not be made better by psychological intervention c) mental health services do not provide advocacy or specialist nursing after medical appointments
  4. Voicability - are great.  I have use them over another issue.  But they provide advocacy only and to get that I would need to call, wait two weeks for someone to be available to help and meet with them before a doctor’s appointment could be arranged – not much help if I need to go into A&E or to a GP tomorrow.  They would be unable to help following more extractions of my teeth.
  5. A PIP claim, with the idea that I could develop a relationship with a specialist care agency and buy in the carer support as and when needed.  They rejected that and tell me that they fully accept I cannot access medical care and yet give me 0 points under the category “access to medical care” – but we all know that that agency is in place to stop anybody claiming anything!
  6. I have approached MIND CASS who are commissioned to provide adult autism support, but that is mostly courses for autistic adults and were clueless as to what to do in this case.
  7. Everyone says “go see your autism charity”.  Pardon?  As though I have a personal charity ready to jump to with advocacy and nursing every time I need a doctor?

To date, two social prescribers, my special care dentist and the OH lady from work and me are or have been running around these circles trying to find some avenue for support only to be passed from pillar to post, until we are all dizzy.  The truth is nothing is commissioned to ensure that autistic adults can access healthcare if they do not have intellectual impairment.  This needs a concrete permanent plan of some sort for each individual and none can be made by anyone. 

So, my question to [MPS NAME] about what can be done and what can be commissioned is personal, but also more widely for the many other autistic people who are experiencing some or all of the problems I do in medical situations.  Autistic people all have ‘spikey profiles’, we can experience sever impacts in some areas of life but cope albeit with more difficulty in others.  I am so-called “high functioning”.  The autistic community does not like or buy into functioning labels because they are misleading.  I may have a job, a degree, a home and friends, but put me in a doctor’s surgery or a hospital and I can suddenly become every bit as so-called “low functioning” as those of my autistic siblings who have no oral language at all and/or intellectual difficulties.

  • Goodness!  I'm sorry you've been through so much.  What would like to have seen to make all of that less stressful for you?

  • Good afternoon, 

    My GP appointment was converted into telephone triage during covid and didn't tell me. I went to the surgery and had a word with front of house. Also booking appointments online was disabled. June 2020 prescribed antidepressants (made me feel like a zombie); was supposed to have a follow up call. Found out that the regular GP diagnosed with cancer via text message and newsletter. July 2021 had a text message saying the GP decided to call it a day. My friend said that your go cold turkey if the withdrawal goes wrong. Did have a phone call out of the bloom saying about needing a pill check and didn't have a clue.

    My last appointment last year was told to find a blood pressure machine. Duh! I may ending up telling my GP the wrong result. Very difficult to get an appointment. Now on a higher dose of the pill.

    Also getting a letter about cervical cancer screening, dropped a note through the surgery door, had a phone call saying we don't send out the letters please phone GUM. I did this and explained that didn't want to be involved with the cancer screening and gave me the right number to call. Again wasn't clear on the letter who to phone. *sorry haven't made this clear*

    The local chemist is doing blood pressure checks for anyone over 40 years old. Also can't find my prescription everytime. Always asking my name, address, date of birth and when was requested. Now I get 8 months worth instead of 6 months.

    Now got two long term bone bruise pain which healed up tight. 

  • Yes, written communication forms and recognition of the anxiety we are experiencing is a big theme, isn't it?

    The not the 8 o'clock phone call is super important and yet so many of us are denied that as a reasonable adjustment.

  • OH wow!  And yes, I definitely identify with a lot of that.  

    I have often wondered why it isn't protocol for a GP following a diagnosis to meet with the person and agree a personalised strategy for making and conducting appointments encompassing most of what you said there.  E-mail could help a lot.  I often write to the GP, but it takes hours of work and then you wait for weeks for that to land on their desk...if only there were an agreement that that is how you will approach them and they will read straight away.

  • A very eloquent and well reasoned argument.

    From my personal point of view, it is the provision of being able to make GP appointments in a way that is independent of the 8'o'clock phone scramble, that is really important. Preferably, autistic people should be able to make appointments by email.

    I suspect that I am not the only autistic person who has been misdiagnosed due to high levels of anxiety when in a medical setting. My blood pressure goes sky high when my bp is being taken at the doctor's. After being prescribed various drugs that made me feel unwell, I worked out that I probably was reacting to the situation and that my bp was probably normal, when not in a state of high anxiety. I bought a bp monitor to use at home and I was correct. After some rather difficult self-assertion, I persuaded my GP practice to accept my own readings.

  • I would love to be able to email a description of my symptoms to a doctor, have them send me a follow-up email with questions, respond to that, and then have them prescribe, refer, or ask me to come in for a physical examination on that basis. There is much more chance of the correct information being transmitted that way, compared to me going to the surgery in person. Phone is even worse - trying to figure out what the other person is saying and when it's my turn to talk takes up 100% of my concentration, so there is nothing left over for taking in information or communicating what I need to say.

    For the last few years I've been self-medicating, firstly through an online private prescription service, and now (different medication) by ordering from an overseas pharmacy. It's easier and less stressful for me to read medical studies, work out what medication might work for me, and order it online and give it a try than to figure out how to get access to a GP, persuade them I need help, and accurately communicate my needs. It takes up less time, too, even when you factor in the hours of research and the extra freelance work I have to take on to pay for the medication. A 5-minute conversation with a GP requires about 30 hours of planning and practicing what I'm going to say if I want to leave with anything more than a leaflet.

    I also hate how going to the GP always involves a lecture about standard screening tests that I've opted out of. I must have had the same conversation about cervical screening at least 15 times and every time it leaves me shaking and feeling vulnerable for a few days afterwards. They refuse to make a note in my file that I'm HPV negative and not sexually active, so every time it comes up again, even though I've written to the central administration so I don't get the letters any more.