to think that I shouldn't have to swallow my principles to save the NHS money?

(252 Posts)
Tollund Wed 12-Dec-12 10:36:50

I was seen by a practice nurse this morning and prescribed antibiotics for my chest infection. When he wrote the prescription I said that if they were capsules with gelatine in them I couldn't take them and would need the medicine instead. He told me that he didn't know if they did or not and didn't have time to research it, and if I really couldn't bring myself to take them I'd have to ask the pharmacist what they would recommend. I've been here before so I said that they wouldn't prescribe anything and I'd end up having to come back to pick up yet another prescription. He said to go and see what they said but he wouldn't prescribe the medicine as it was more expensive. (I'm guessing he doesn't see a lot of Hindus and not sure how far he'd get suggesting that people should take things containing boiled up connective tissue and bones whether they've spent a lifetime avoiding them or not.)

So I went to the pharmacist and exactly what I had said would happen, happened and I've wasted over an hour trying to get them to liaise amongst themselves so I didn't physically need to run between the surgery and chemist to pick up prescriptions myself. (With a chest infection when it's -2!)

AIBU to think that the practice nurse was being a total arse and that I shouldn't be made to run around wasting time because he "was too busy" and clearly thought I was being stupid for not just taking the gelatine?

LeBFG Thu 13-Dec-12 18:11:08

Eh red? Don't get where I implied it would be a good idea to sweep everyone's concerns under the carpet. In fact I said certain categories of people/problem should be taken a whole lot more seriously than someone whining about a milligram of gelatin in her pills (given the non-perfect world we live in).

RedToothbrush Thu 13-Dec-12 15:33:39

So sweeping EVERYONES concerns under the carpet to make the health service better is what you advocate LeBFG?

Thats part of the point in a way though. HCPs thinking they are able to sweep things under the carpet actually makes them do it, rather than solve problems which would actually probably work out cheaper in the long run.

And it ends up being precisely 'survival of the fittest' as it comes down to being pushy rather the HCPs trying to do the best by the patient in every case without exception. We aren't all the same so why try and do things the same way for everyone? You should do it the right way for everyone.


Just as an example, my grandmother has been in hospital recently to have an operation which they didn't know if she would survive. She 87. She complained to my mum about the nurses bullying her to get out of bed and sit in her chair but she didn't want to. She was really upset about it and the attitude of the nurses was adding to her distress. Why?

Because my grandmother is tiny. And the chair she had was giving her pain after her operation.

The nurses refused to listen to why she didn't want to get out of bed. My mum got involved and got the hospital to find a smaller chair. But she had to fight for it. She eventually managed to get hold of a smaller version of the same chair, one of only four in the entire hospital, and bought at the time at some expense.

Thing is though, my grandmother was actually able to sit in this chair without being in pain. So she started getting out of bed. Which probably speeded up her recovery time and meant she freed up the bed quicker.

But she was ignored and left in pain cos they couldn't be arsed to listen to a simple problem. And that chair even though it wasn't cheap probably would be a worthwhile investment if it was used to similar people in similar situations on a regular basis but on paper it looks like a shit investment.

The trouble with trying to standardise everything to fit the average person like the chair is simply that not everyone is as is an average person with the same needs in the first place.

lancaster Thu 13-Dec-12 15:21:45

YANBU. I think you might have got a different reaction if you had seen a GP rather than practice nurse.

nickelbabylyinginamanger Thu 13-Dec-12 15:17:46

I don't agree with your second point though - medicines should be allowed for all requirements, dietary are just as important.

because it goes back to treating each patient as human beings and all things being equal, offering them first class care.

nickelbabylyinginamanger Thu 13-Dec-12 15:15:09

Picturepefect - yes, and that's dangerous too - there are loads of people who have to have a certain brand because of reactions to the fillers in the other brands, including generic.
it's bad form to change the scrip for a cheaper brand without checking it out first (usually by asking the patient or their guardian)

nickelbabylyinginamanger Thu 13-Dec-12 15:10:42

it shouldn't matter whose concerns are swept under the carpet.
all patients should be treated the same.

LeBFG Thu 13-Dec-12 15:08:31

I'd be a hell of a lot more sympathetic to your position red if we were talking about an old biddy whose concerns were swept under the carpet, or an emotional possibly PND women was treated in the same way as OP was. As it is, I think most people, including me, find it hard to sympathise with such trivialities.

Pictureperfect Thu 13-Dec-12 14:48:19

I'm on a lot of medication (thank god for the nhs, I don't know how I could survive in other countries) and the doctors keep trying to change my medication to cheaper ones, I am not alone with having this problem. We can't just be changed if the medication is working well for us, found the perfect dose and moved past all the early side effects. I would be annoyed if I heard people are being given much more expensive medication due to personal preferences rather than need. Have you looked the drug up on the BNF? It will have the price for different forms, sometimes the difference will be penny's and sometimes hundreds. If its just penny's then I would point that out next time you get a prescription

HoratiaLovesBabyJesus Thu 13-Dec-12 14:28:29

Yy, redtoothbrush. Early accurate diagnosis saves lives and money.

Hell, a pair of sympathetic ears are sometimes half the cure.

RedToothbrush Thu 13-Dec-12 14:21:09

I don't suppose the nurse really did know all of OP's hang-ups over meat tbh

Because they didn't spend two minutes to ask. Cited they were too busy, and shoved the problem onto someone else in the health service to deal with. Which doesn't actually solve the problem and doesn't cut the cost. It just takes the problem out of his budget.

Which is just about where the health service is at right now, playing a game of pass the problem until the music stops and someone lands in a particular department who then has to deal with it. Doesn't save money and doesn't solve over-stretching. If anything it has quite the opposite effect.

But everyone is just happy to sit there and justify it by holding their hands up and saying, well we have to prioritise and we have to make cuts.

The best way to solve a problem is to understand it before trying to come up with a solution. Listening and gathering as much information at the start of the process in order to fully understand what the problem really actually is, rather than making it up as you go along and hoping for the best, has always been and will always be the best to solve the problem in the most effective and cheapest way.

I would love to put it on a brick and beat every person who makes decisions about health care with it.

LeBFG Thu 13-Dec-12 14:05:10

I don't suppose the nurse really did know all of OP's hang-ups over meat tbh. She just asked for some awkward information in the name of vegetarianism and her request was given short shrift. Just that really.

We live in society that values people's religious beliefs over animal rights ethics .... and have an overstretched, less-than-perfect health system...and so not many people are sympathetic with OP. Not sure what more can be said really.

ICBINEG Thu 13-Dec-12 12:48:53

no answers to my questions - well i guess this prob isn't the place.

I am absolutely on the fence about the OP BU though.

On the one hand I could develop a strong moral feeling that one shouldn't take medicines that begin with the letter "S". That doesn't mean the NHS need to supply me with a whole different swathe of treatments surely?

If people have allergies to the medicines it is necessary to provide an alternative. If people have moral/religious objections then it is no business of the NHS's surely? They deal in the evidence based treatment of illness! Their responsibility is to provide something that will treat the illness, if you have a problem with the taste, colour, contents of the treatment, the way they found that treatment, tested it, packaged it or packaged the packaging then that is surely your problem to deal with? You always have the option of declining treatment.

The reason I am on the fence is that I believe that mental health is a key part of the NHS's remit. In the case that the OP is psychologically unable to take the medicine because of the contents then I believe a substitution should be made if available. So if you view a pathological level of vegetarianism (it is pathological if the OP would rather die than let animal product (what ever the definition of that actually is) pass her lips) as a mental health issue then yes the NHS should provide an alternative.

nickelbabylyinginamanger Thu 13-Dec-12 12:26:30

Look, I'm a veggie, but I accept the medication I am given because I am very appreciative of the fact I'm being given it at a much lower price than if I were to buy it without the NHS

fuck that - I don't give a shit what my beliefs are - I shouldn't be treated like a problem or a nuisance because I want first class care.
I should expect to receive the best care from the NHS regardless of what my problem is.

RedToothbrush Thu 13-Dec-12 12:16:07

If it took an hour in the pharmacy to liase about a suitable alternative then it would have taken an hour in the surgery too. It was better the OP being put out than everyone else for the whole day surely.

But it just comes back to respect and how its handled sensitivity, rather than the actual end result. You are just making excuses to justify someone to act in a shitty way thats not acceptable on the grounds that one person isn't as important because there are ten other patients. No, actually they are ALL important and ALL deserving of a certain level of respect.

Its a question that can not be that unusual or unexpected and the information should be freely available given the sensitivities of diet/culture. The fact its clearly not, is actually pretty shit especially given there are real inequalities of health along cultural lines in this country and initiatives like this could do a long to help encourage people to use health services more. An hour spent trying to sort out information, for a very commonly used drug, could have far reaching consequences.

And honestly if someone did ask the same question along religious lines like the OP stated in her opening post, I would seriously question whether it would be treated like this. I would would be more surprised if they didn't make that effort to find out because they think the request is 'more legitimate' both legally and morally (and as others have pointed out that is actually questionable).

The attitudes on this thread questioning the depth of her belief is really revealing. It just points to values on what people think is an acceptable request rather that being concerned about how the attitude and professionalism of a HCP, which should be better at all times regardless of judgment. When it isn't, it can more often that not, affect how the patient feels they were treated and easily damages the fragile bond of trust and respect between patients and HCPs.

Lets not loose site of the fact that the NHS is supposed to be equal as much as possible and HCPs are supposed to be at least respectful of ALL beliefs even if they can't fulfil the request (and that includes stuff like when a doctor has beliefs such as being opposed to abortion, they are supposed to simply pass the patient to someone else).

Its ingrained into the system that can not go round judging religious choices but also lifestyle choices no matter what you feel about them. And in cases where one group is likely to have a similar request treated with respect then another group deserves equal respect and attention regardless.

Most things can be googled in seconds, I actually did this the other day for a locum in the middle of an appointment.
Lots of people use too much of nhs resources, I can think of far worse cases.

No the basis of it doesn't matter at all. There were/are other options though, to pay privately for a longer appointment and a medicine to suit her particular preferences or to ask the pharmacist as the nurse suggested (although it seems she did this and left anyway because it took too long confused )

If it was so simple surely the pharmacist would have looked it up and one quick call later it would have been sorted. There was possibly other reasons why the medicine wasn't suitable in this case. If it took an hour in the pharmacy to liase about a suitable alternative then it would have taken an hour in the surgery too. It was better the OP being put out than everyone else for the whole day surely.

WhoWhatWhereWhen Thu 13-Dec-12 10:57:32

Why dont you research the Antibiotics you can take and provide them with a list?

Viviennemary Thu 13-Dec-12 10:54:38

I think this is a tricky situation. If somebody was allergic to gelatine then I think the NHS obviously would have to profide the correct medicine. Or needed an alternative for a health reason. But I think in this situation you should have to have a private prescription and pay for the tablets yourself. Or remove the medicine from the capsule as others have suggested.

Does the basis of her vegetarianism matter?
Why is belief in religion - which is a made up fairy story to some people- more important than if it were an animal welfare issue.

It's nothing to do with it, it's the attitude of the HCP.

She has every right to her emotions about it. I have never denied that. Its not fair to go in making demands on the NHS based on a preference and using up the time of a nurse who would have been rushed out the door at this time of year anyway to look up whether pills were suitable for vegetarians or not. He didn't have time he advised her to go and see someone who would know the answer to her query and said he would write her a prescription based on what he said.

When I had gallstones I didn't go to the doctor and expect him to know everything about them, he sent me to a specialist who would know about it, I didn't sit there telling him to look up all the information I needed to know there and then. She made the choice not to take the medication on offer, why shouldn't she be the one to find an alternative?

What about if someone was going in demanding homeopathic pills because her morals didn't allow her to take convential medication, would the nurse then be expected to go and research that too?

Are you all more than happy to wait 2 or 3 hours for your doctors appointments because the nurses and doctors sit and explain fully every tiny little detail of every medication to every patient? In my surgery the appointments are 5 minutes long, if every patient went in doing what the OP did it would take twice as long.

There are private doctors if you wish to have longer to go through every detail and have particular medicines.

HoratiaLovesBabyJesus Thu 13-Dec-12 10:23:15

Drugs have to be tested on animals to get a licence - but once Phase I trials are over, no more animals need to suffer or die. I don't think it inconsistent to draw a line between strictly limited licensing trials and continuing to kill animals to produce every single dose of the final drug, where an alternative is available.

But for me the important part of the story is the attitude of the nurse. Even if OP's objection had been utterly stupid, it is still his job to look it up in MIMS and give her the information with a smile, even through gritted teeth, and save his exasperation and eye rolling for after her departure.

Get well soon, OP.

RedToothbrush Thu 13-Dec-12 10:04:20

The HCP didn't know the basis of her belief in vegetarism when he was so dismissive. He didn't know why it was so important to her, because he didn't bother to ask or to reassure her.

Her commitment to the cause isn't the key issue here. Its the attitude of the HCP that is.

FelicityWasSanta Thu 13-Dec-12 09:55:54

My point exactly, if its about animal welfare she isn't 100% committed anyway so what difference will an insignificant amount of gelatine make

We don't know exactly what difference it would make to the OP. It's breathtakingly rude to assume that she doesn't have a right to her emotions about it though. Apparently it matters a good deal. And the HCP isn't doing their job if they don't patiently and fully go through everything with her.

ICBINEG Thu 13-Dec-12 09:48:25

Sorry - somewhat off topic...but I wanted to ask the veggie presence at what point the animal products stop being animal enough to cause a problem?

In the OP's case it looks like eating flesh is an major psychological issue..but I don't understand the connection to gelatin capsules. They don't look, smell, taste like flesh and if someone told you you had the veggie version you would never know that they were lying. So how does it trigger the same response?

It's all atoms at the end of the day...and if you aren't bothered about the animal welfare side of it then why should you feel differently about one long chain molecule than another very similar one of synthetic origin?

Animal products are recycled by nature in the form of plants all the time. When do the atoms stop being "animal" and start being "plant" again?

Or not having 100% total coherence between your various beliefs (few of us do, so why should vegetarians be any different?)

My point exactly, if its about animal welfare she isn't 100% committed anyway so what difference will an insignificant amount of gelatine make. As its merely a preference of the OPs anyway then she should just suck it up.

I can't stand tomato sauce (I promise I'm going somewhere with this) I have special rubber gloves that I wash up with when the kids have had some. The smell of it makes me feel sick. Personally I would rather gnaw my own arm off than let it pass my lips.

But if they put it in a tablet that would make me better then, no, I wouldn't like it, but I would take it because my health is worth more than my personal preference.

(loving all the quoting going on throughout this thread grin )

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