Share review of Dr Shyamal Mashru

Dr Shyamal Mashru 2021-05-16 Person 5 5 0

This is long, but all true, and I have tried to express, in words, my feelings of validation - and the life-changing nature of my experience since Dr Mashru took over my care - and the, accessible, reciprocal titration process, during which I felt genuinely valued as a person first, and a patient second; listened to, and *believed* to be the expert on my own feelings and symptoms. (The long version is also included, below!) I was diagnosed with ADHD and prescribed medication via the NHS, at the age of 42. The process took a couple of years, even with a supportive GP who didn't ever attempt to brush me off or dismiss my traits as something "everyone has a bit of" (by no means unusual, unfortunately). The NHS satellite team who diagnosed and prescribed medication were great, and the medication (slow-release Concerta) helped but, even at the maximum dose, did not override some of my more harmful impulses (binge-eating, skin biting/picking); and helped, but didn't remove completely, my tendency to procrastinate low-motivation tasks (late with tax returns, paperwork, etc, leading to fines, missed GP/school appointments for me and my daughters, etc), and I experienced headaches (which were only slightly worse than pre-medication, but still a limiting factor). All of which was MUCH better than life without medication - but did not offer as much help as I had hoped for, and I wanted to investigate whether I could have better results with a different form of medication. My GP was initially skeptical: "Do you think wanting to lose weight is a valid reason to change medication?" but referred me, in the end, because I also hoped the headaches could be helped with a change. It took a while, as I had expected, but I was eventually referred to Dr Mashru via P-UK. (In this case, I am very lucky that NHS Kent has a contract with P-UK, as I know many fellow ADHD sufferers in other parts of the UK struggle terribly to be referred, even for assessment. The whole experience with Dr Mashru, from our initial meeting (virtual-face-to-face) has been life-changing and affirming, rather than a negative experience of being doubted by Drs (and this, then, feeding into the RSD and Impostor-Syndrome-self-doubt which comes along with ADHD for many (especially women)). I was late dialling in to the first appointment (another ADHD failing and, with so much of this experience-history in my life, I was stressed, feeling like a failure (why can't I act like an adult human at the age of 46?) and *certain* I would have missed the slot altogether and would need to be re-referred, with another long wait). However, luckily, I still managed to catch Shaymal, who was just about to leave the call and reschedule - and we had our first conversation via computer (on the PUK version of Teams, I guess!). Having had a couple of these conversations since, as well as my titration service, I believe that, had I not shown at all, I would have received a notification of a rescheduled appointment - with no judgement for missing the first one, and an understanding that Executive Function is one of the limiting things about ADHD, and not deliberate or disrespectful. Dr Mashru was personable and approachable, understanding and validating; accepting and believing that I was the expert on my own symptoms and feelings. Even though I had been late to the call, there was no sense of being rushed. In fact, due to his calm and gentle approach and the fact I felt accepted and validated, I managed to slow my racing brain, calm my stress from being late, and relax enough to communicate what I was experiencing, and what I wanted to achieve by trialling a different medication. Having been put totally at ease, I was able to remember and communicate my points effectively, without written prompts (normally required to help me stick to the point and not forget anything important (but forgotten with the stress of the misremembered appointment): - that I would never want to be without medication (ie, that if a different medication was no better, I would want to go back onto the Concerta, as it had given me many positives) -persisting tendency to binge and bite/pick my skin -tendency towards insomnia -energy crash in the evenings as meds wore off -persisting problems with procrastination around low-motivation tasks Dr Mashru asked questions to draw out the information he needed, without making me feel interrogated, or like a time-waster. The conversation felt natural and unforced; I was immediately put at ease, and even my (frequent) digressions from the direct focus of the conversation seemed valued, as they added to the picture of me as a person and a patient. Having worked in Sales and Account Management for large companies such as The Guardian & The Observer, and BT (despite my condition!) I noticed, and appreciated, the way I, as a "customer", was "handled" - not as a nuisance or time-waster, nor a number in a long list; but as a valued "person", with valuable expertise and insights on my own experience of my condition and symptoms, and with a genuine need for help - specific help, tailored to my unique presentation and experience of ADHD and medication). The decision to trial Elvanse felt genuinely collaborative. After listening to me and confirming he'd understood my symptoms and what I wanted to achieve, Dr Mashru was just as careful to confirm that I was happy, that I had understood the technicalities, and that I wanted to proceed - at every stage in the process. Although he explained that titration would be handled through the nurse prescribing team, he was careful to explain how the system worked and that I was still under his overall care, and would still have access to him throughout the process. On our most recent call, I couldn't access the virtual platform, for some reason, and Dr Mashru took this completely in-stride and suggested we move to a simple call; again, immediately eliminating my feelings of guilt and inadequacy at being unable to perform a simple task (honestly; when I fail, I feel *every single time* I've failed, PLUS the frustration at the current failure). As an Assistant SENCO (Special Educational Needs Co-ordinator) in a primary school (working towards my National SENCO Accreditation - a Masters-Level University course) I know how important it is for people with challenges to feel validated and *heard*, and for barriers to be removed so that they can access what they need - whether it be in the educational or the medical setting. In education, we call this making "reasonable adjustments" to allow everyone to access the system - and they are *expected*, not aspirational. I would not hesitate to recommend Dr Mashru to anyone; whether seeking an assessment of their needs, asking for advice or strategies to help with their condition, or discussing options for medication and long-term care. Although conversations with Drs can be overwhelming or nerve-wracking for some, due to the imbalance in knowledge, experience, expertise and therefore "stature"; I always felt treated as an equal - an equally-valid person, who happened to be asking for help from someone with a much greater expertise and knowledge-base of a particular field. *I* was made to feel the expert on my own symptoms. None of my questions or concerns was glossed over or dismissed, and the whole experience has been extremely positive and affirming for me. I am deeply grateful for this positive experience, in a life with a condition which has made me feel very negative about myself, sometimes. It would be amazing if *anyone* doubting themselves, their diagnosis, or their coping mechanisms (including medication) could have as positive an experience but, sadly, from previous experience, I know that not all Drs are able to involve patients in their own treatment plans; engage with the person behind the patient; or invest the time to be thorough enough to find the relevant issue and jointly decide the best approach for treating it. So, thank you, Dr Mashru, and P-UK. I feel very lucky that I was referred to your care and, as I have said on calls and during titration, it has been life-changing for me and my family. I am very grateful.