Building a medical transformation - help me help others

Treatment Agreements - Not Consent Forms

My most important job today was to create forms to allow us to start therapy. These are often Consent Forms which are for legal reasons. They are a sort-of faux protective shield for the therapist.

Surely it could be done differently? Granted having a Medical Licence to Practice allows a greater degree of freedom.

What is their actual purpose? They are Agreements (a form of contract). They aren't a pass to allow me to treat you. We are in this together. I will temporarily join your team!

What are we each agreeing to?

A patient (adult or child) agrees that the description of therapy and the promises of confidentiality mean they feel able to start the treatment. I agree to do my best work to help support them and keep to confidentiality promises. For children, I am happy for any child to sign (whatever their age). Even if they aren't assessed as fully competent, this allows them to feel empowered (and a parent or guardian will also sign an agreement). That contract is between them and me. No-one else is invited to sign the form to highlight that. It is our agreement.

Whatever their age, they don't have to sign the form to start therapy. That choice is up to them.

I have different forms for young and adult patients, though both should read easily.

There is a Parental Agreement Form which focuses on the therapies, my promise of privacy and keeping their child safe. Again the contract is between either Parent and me. Only we will sign it. Both parents are welcome to sign.

These Agreements are the foundation of all of us being engaged and empowered in the process. If there are any questions these should be asked and where relevant answers added to the form.

Here are the first drafts of the forms - let me know what you think. They need to work for you!

If you built it, they will come - there's plenty of debate about that!

If you build it, they will come! Maybe! There's certainly plenty of debate on that!

Austin Kleon describes sharing your work and the creative process. Building this service is a creative process, and I want YOU to be involved!

There are over a hundred Paediatric areas where treatment could be better (in some cases considerably better). It won't be surprising that mental health is one of the commonest by a country mile. Often these areas are where two separate systems ought to deliver a seamless design.

If those in the different systems don't work together (literally rather than metaphorically), how do they make it a seamless experience? So we get delays. We get the frustration. Balls get dropped.

What are the solutions? This isn't easy as many scenarios will overlap different systems. The whole system is complex.

Can individuals make a system for individual situations such as Tourette's? Yes, of course! There are parts of the process that might need to be led by doctors and parts that motivated compassionate people could better lead in various current roles. Evidence shows that online delivered programmes are highly successful.

Brilliant! We can deliver it to anyone who needs it, wherever they are (in the UK at least).

We can scale it with the right people in place, and most importantly, we can share free resources with those who aren't in a position to afford therapy currently. Those people are out there and motivated to be part of this. Those potential patients are searching in vain for a service. Often they search for a diagnosis, believing this to be a Golden Ticket to therapy and cure.

Sadly there is no Golden Ticket. Even if there were, doesn't anyone with distressing tics deserve access to therapy that should help? The therapies are highly effective in managing tics where medications often have severe and variable side effects. They do precisely that, manage the tics. They don't cure Tourette's - nothing does. It can just stop happening as you get older. The therapies are effective most, but not all of the time.

If only we could know who might benefit (and who might not) before we started. For me as a clinician, one of the beauties of this approach is that we cannot predict who might best benefit. The child with the most distressing tics can make astonishing progress.

Meeting a very small number of these very special children led me to devour this training for Tourette's. At this (relatively late) stage of my career, I'm increasingly upset by children suffering because services aren't there for them. Starting the Solution Focused Therapy and later Blast Technique were the first example. When you've done it once (even as an individual), doing it again bigger and better seems natural.

So I'm building it for those who already know they need it.

Subscribe to this newsletter to follow this journey and be first in the queue.

I plan to share an update weekly of what I learned or built this week and what I'm preparing for the next week. I have a full-time Paediatric job, so it may not be a smooth linear process!

You'll get a lot more interesting related info as well. And reach out. What do you need and want? What should it look like? How will you know it was set up right? (Sneaking a Solution Focused question in there!)

Things for many are about to get tough - who is helping?

This graph feels intuitively true just now. Ambulance waits, costs of fuel, and so many others.

Three people who stepped up around the cost of living crisis are Martin Lewis, Jack Monroe, and James Anderson. Both had a presence before the current situation and came from different backgrounds and standpoints. They have in common despair at what is to come, and they want to offer advice to help as many people as possible get through it.

Martin was our money-saving guru in the good (low inflation) times. He helped us save money on various household bills and advised us how to avoid paying too much or when to buy. He earned a lot of money through this (working hard to do so). I believe that he has used some of that in various ways to help and does so under the radar. His voice is being heard, and he is articulate. He sounds increasingly desperate in his recent broadcast appearances, reflecting the fears of those he speaks for. His mental well-being is being affected by this desperation and because he is experiencing online hate.

Here is a link to some of that advocacy.

Jack has been through some of the most challenging times herself and previously faced a lot of hate. The hatred she experiences now is exponentially worse. Her 'crime'? To have developed a cookbook for those with little and few cooking options. To try and relieve the boredom of the same meal every day. Some recipes are controversial (rinsing tomato sauce from tinned pasta - I understand that, so I applaud her). She offers advice on where people are when they have the least. Interestingly, those who are (currently) above that level often spew the hate. I hope that her book is available to all who could benefit.

Here is Jack's book - buy from her own site please.

James Anderson is a plumber up in Bolton (quite close to here). He has also been through some of the worst imaginable bullying and recent health problems. He works tirelessly for those with plumbing issues such as no hot water or heating. Initially, his charity was to help the elderly and now it serves many families too. He presents a bill to those he helps. He doesn't just fix plumbing. He brings hope. He orders food and gives kids presents. He even gets the odd pizza takeaway for those who are in despair.

I and many others support his charity - Hugh Grant is the biggest and most prominent donor.

He has had online hate resulting in police intervention, and he continues to the detriment of his health.

Anyway, here is his JustGiving site - if you can.

So when it all looks black (and it's going to get darker, no question, remember there are folks out there helping. Sleep tight