Thursday, 6 May 2010


Although my career in General Practice is still in its infancy, the majority of my consultations are pretty unsurprising. What I mean by this is that although each consultation is very different, the same sort of conditions appear again and again. Tennis elbow, indigestion, heart disease, coughs and colds, back ache, all the usuals. On the whole, people present with conditions I'm familiar with, and which I can deal with (or at least try to) fairly confidently.

Just once in a while however, someone comes through the door with something completely surprising. Something which I have absolutely no idea how to handle. A 20 year old presenting with aggressive and dangerous behaviour during sleep (he woke once trying to smoother his girlfriend), a hand that suddenly swelled up like a balloon for no reason, a sixteen year old faking an asthma attack.

This week's surprise was a charming elderly Japanese couple, presenting on behalf of their daughter. They entered nervously and told me their story. Their daughter Jasmine, aged 30, was a patient of the practice. She had come over from Japan to study in London and was happy and settled. About a year or so into her studies, she had met an American with whom she travelled to New York. The American was heavily dependent on marijuana, and Jasmine was now using too. The last contact they had had with their daughter was a terrifying phone call during which she shouted and swore at them, spoke of 'the voices', and threatened to harm herself if they came to find her. Some family friends in New York had also reported increasingly strange behaviour from Jasmine when they had attempted to contact her on several occasions. Jasmine's parents were frightened and distressed, and as her doctor, they had come to me for help.

What on earth could I do? I so desperately wanted to help these terrified parents, but how? After talking to them a little more, it became apparent that what they were really hoping for was advice from a psychiatrist about the best way to handle the situation. A perfectly sensible idea - but how to achieve it? They didn't have the money to pay for a private consultation, and the idea of our psychiatric services accepting a referral like this was far fetched. I could see no way of helping them. I gave them a few telephone numbers - Relate, Citizen's Advice Bureau etc, but without any great hope for a solution. They left showering me with gratitude, but I have never felt so inept and frustrated in my life.

She is my patient. She is an adult and has chosen to go to another country where she is now in trouble. She is not seeking my help, but her parents are. Apart from a genuine desire to help, do I have a responsibility to? Is there anything I could or should have done?


  1. Was it not possible to refer the parents to some kind of therapy (the new phone therapy at least?) since they were in an agitated state and could not cope? Maybe they would also get some advice with the daughter problem too

    I am no doctor but I think you are a good one :-)

  2. Perhaps, but actually, although worried for their daughter, they were very level headed and coping pretty well. What they wanted was help for their daughter, not help for themselves. They hoped a psychiatrist could assist them in working out how best to try and help her.

  3. Hello
    Why had her parents come to the UK rather than go to New York? Surely that is where they could help her most.
    I am guessing that they are just visiting the UK. Or has Jasmine returned?
    I'm not sure what is available locally but it is worth asking your drug and alcohol services if they are aware of support services for families, although I don't know how long Jasmine's family will be around. This is our local service:
    Finally, I guess you have had a chance to talk to colleagues in the practice about this case?

  4. I just wonder if telling them about mental health charities (Mind, Rethink) who may be able to offer them information, advice and support would have been of any help. Perhaps not. :(

  5. Thanks Anne Marie and Dr Purple! Yes, some good ideas. Sadly I think exactly as you say, they were just passing through. I believe they are now in New York - perhaps someone will be able to help them there.