To think this GP surgery response was a bit ridiculous?

[lougle]

I have chronic migraine. Treatments over the years have failed, so the next step is anti-epileptic drugs which have quite serious side effects for some patients. I am quite sensitive to drugs and have had to stop several because they gave me severe side effects (e.g. collapse).

I told my GP that I would try the topiramate, but would like to start at a low dose and go up as tolerated. She agreed and said to just keep in touch by phone. I've been on a subtherapeutic dose for 5 days with no serious effects so am happy to try the lowest therapeutic dose.

I telephoned my GP surgery and asked to leave a message for Dr to say that all was well with 15mg and I'm happy to go up to 25mg as planned. 'Ok' said the receptionist, but I won't be able to leave a message until Wednesday.' 'Why?' 'Because that Dr is part time and her telephone appointment slots are full for today'. But I don't need a phone call. It's just a message to confirm what has already been discussed. I suggested that she popped a note on her desk. Can't be done. I told her it seems hopelessly inefficient that a message can't reach a GP who is in the surgery that day until 48 hours later.

Bearing in mind that they've asked me to switch to this drug because the neurologist wants me to reduce another drug I'm on. Given that the prescription then needs to be written, printed, signed and delivered to the pharmacy, who then need to order the drug in and check it, it would be next week before it was ready.

In the end the receptionist decided that she'd add a slot.

AIBU? I know the GP would have to open my record, refresh her memory of our appointment 5 days ago and write the prescription, but that will take a lot less time than phoning me or have me take an appointment slot.

[Mrsmorton]

When would you like her to do it if not in an appointment slot? I don't really understand the system but if the GP is fully booked on a day then there's no time for her to open your record and do the paperwork.

Does the receptionist mean you'd have to phone back on weds or that the GP wouldn't action your message til then?

[FlyingElbows]

I'm on the fence here. I don't think you are being unreasonable but I do think it would be preferable that the gp spoke to you directly.

[kali110]

I don't think you are, my gp does this for me all the time. My gp tells me too keep in touch for certain drugs all the time, ive left messages on her desk before.
When i was on thatdose i noticed that my mind was groggy, taste changed, i struggled to remember things and stammered, but it does get better.
Incase your neurologist didn't mention it as mine didn't, it can affect anxiety. I tried to go up higher but had to stay on 25mg twice a day as i had crippling anxiety.
It also affects your limit if you drink.
I only had a few and it completely fucked me up( google alcohol and topirimate some rather funny results! Apparently it is safe to drink with it but i don't believe that neither do a lot of people.

[PurpleDaisies]

It's a problem with not having enough doctors. It's highly unlikely you're the only person who's phoned with a small job to be added on to the regular workload for the GP for that day. If there weren't some system for managing it the doctors would never leave the surgery. To be fair, you did get what you wanted in the end.

I can understand why you're frustrated, but I think you are being a bit unreasonable.

[catonlap]

It could be that the receptionist is not willing to take responsibility for passing on clinical information. We have had receptionists get the wrong end of the stick over the phone as they are not familiar with the drugs being discussed etc. They are therefore discouraged from taking verbal requests for medication and are asked to take written requests.

Could you write a note/prescription request for your GP and put FAO your GP's name on it? Or email it in to the surgery? It avoids the confusion of the message going via a third person and works fairly efficiently in my experience.

[shovetheholly]

I think this is probably one of those things about time - obviously, it's faster for the GP to 'just do it' - but when? They are working such long hours now. It would be so easy for a note on the desk to get lost, or forgotten, and then you wouldn't get the drugs you need. At least this way, it is scheduled and you can answer any reminder questions the GP might have.

I'm so sorry about your neurological problems - it sounds awful

[AugustaFinkNottle]

When would you like her to do it if not in an appointment slot? I don't really understand the system but if the GP is fully booked on a day then there's no time for her to open your record and do the paperwork.

Surely the answer is for the GP to have an hour or so written in for paperwork?

[EarthboundMisfit]

At my surgery, that message would go into an inbox for the GP who is signing repeat prescriptions that day. They would refer to and add to your notes, speaking to the original GP if necessary. Different surgeries have different systems, and at most practices GPs do have time each day for paperwork but not enough to deal with, perhaps, 20 similar queries over the course of a day.
A good receptionist can work within the surgeries systems to get the most efficient result possible for patient and doctor alike. At our surgery, in these days of very heavy workload, leaving a message for Wednesday wouldn't be best for doctor or patient.

[PresidentCJCregg]

When I was a receptionist we had to refuse to pass on clinical info such as this; the potential for error is too high and often we had no understanding of the context which makes it harder to know if the information you're given is right or wrong.

Totally agree that the GP should speak to you first.

[lougle]

I'd be fine with any of those explanations. But 'we don't have a slot available' is barmy.

[PurpleDaisies]

But 'we don't have a slot available' is barmy.
But they didn't have a spot available. They've done you a favour by adding one on.

[Mrsmorton]

Surely the answer is for the GP to have an hour or so written in for paperwork they can't just magic one of them though! It would be lovely but when I worked in MHS dental practice, that's what we did after work. There's no money or time to do it in the normal day.

[CraziestOfCatLadies]

The thing is that you are requiring a slot because the GP has to issue you a prediction, bring up your notes and update them etc. Just imagine if all the patients on that day insisted on the same thing. I can understand where you are coming from and the crux of the problem is our NHS shortfall but YABU for thinking you take priority over everyone else and your doctor has to spend longer at work or rush other patients because of it.

[Newmanwannabe]

Why can't she email the information to your GP?

[lougle]

"YABU for thinking you take priority over everyone else and your doctor has to spend longer at work or rush other patients because of it."

I don't think I take priority. If the note was passed to the doctor and she put it on her 'to do' list and didn't get to it until Thursday or Friday, no problem. My issue is with the notion that my note wouldn't even be passed to the doctor until Wednesday. I think 48 hours for a message to travel from the front desk at the surgery to the clinic room 10 yards away, is very inefficient. If I were considering myself a priority over others I would have insisted on an appointment I don't need or a phone appointment I don't need. As it is, I know that my GP told me just to phone up to tell her how it's going and adjust the dose, which is what I've done.

Added to that, we have no idea how urgent my case is, really. Since the aim of getting me established on the new drug is to reduce the intake of the other drug, because there is a risk of stroke with the other drug and I'm currently having to take far too much of it, it could be considered urgent.

I have no idea, Newmanwannabe.

[NotQuiteJustYet]

Iougle - Just a quick note about topiramate, I've been on it for 4 or 5 months now and I haven't had a single migraine! I've gone from having several a week, to maybe a couple of headaches a month but no migraines.
In terms of side effects I was pretty nauseated for the first two weeks but it's completely gone now, my hands and feet go tingly quite a lot and I've had to give up drinking but it's a small price to pay to have my life back (and as a bonus I've even lost some weight too!)

[SistersOfPercy]

I don't think yabu either actually.

I use the patient access app. A few weeks ago I managed to take two of my 10mg nortryiptolene tablets instead of one. The result was the best nights sleep I've had in a long time.
I emailed my gp through the app, told hey what I'd done and asked if I could up my dose. Within a few hours i got a message back saying "yes of course, I've sent a new prescription to x pharmacy for you"

I can't complain at all about my surgery. It just all works smoothly.
I do hope you manage to sort it lougle, I only have the odd migraine but I know how debilitating they can be

[lougle]

That's really encouraging! I'm teetotal (don't like the taste) so alcohol is no issue. I was worried about brain fuzziness because I'm an intensive care nurse, which is why I wanted to take it slowly. Although tbh, I get a lot of fuzziness from the migraines in the days after the acute phase.

What dose are you on? I'm on 15mg now, then will go 25, 50, 75, 100 as long as tolerated and until symptoms go. I'm currently having to take frovatriptan daily which is why they're trying to get my prevention better established.

[arethereanyleftatall]

Augusta -' an hour or so for paperwork' - at the expense of what? Seeing 6 extra people for a ten min appt? Thus pushing back waiting times further.

[NotQuiteJustYet]

I titrated up to 100mg over about 6 weeks I think, starting at 25mg and adding an additional 25mg every 2 weeks. I'd been on so many other drugs before this that honestly I was expecting these to be useless too, triptans never worked at all, pizotifen near comatosed me and I was sleeping 14 hours a day then zombified when awake, and betablockers gave me horrendous chest pain.

I've not had too much trouble with being foggy headed and found that taking the whole dose in one go before bed rather than split across the day helps a lot, as I sleep through the brain fog now. I occasionally can't recall a word instantly but no one else seems to notice this (though DH had a good laugh the other day when I forgot the word compromise, he swears it was deliberate...) but as you said, the brain fog from migraines is awful.

[GlitterNails]

I agree with you. My doctor often says to update her on certain things. It seems such a waste to book an entire slot when the info is often very brief.

My surgery takes messages for doctors, and has a system where they send the GP a message that they need to action. It remains on their 'to action' list until it's done. Which means if they get a second between patients or whatever they can read/do it and probably prioritise which are important, without taking an appointment slot from someone who needs it.

The OP isn't being unreasonable at all, and probably the receptionist isn't either. Her surgery as a whole should have a system in place to resolve the issue.

[LadyStoicIsBack]

OP How bad and how frequent are your migraines? And are you under a specialist headache clinic (yes, I do know migs are NOT 'headaches' but for some reason that's what the clinics are called!) - IE led by a Professor Goadsby or Dr Mark Weatherall et al?

Asking as my experience on topimerate was the polar opposite to pp, did nothing for migs but loss of cognitive functioning truly horrific. However, as daily migraneuer I qualify under the NICE guidelines for the (pretty new) PRE-empt Botox protocol - is injected into scalp, across top of shoulders, down back of neck and works by somehow interferring with onset process. Has quite literally given me my life back so I'd give that a shot (no pun intended...!!!) before Topimerate. For me it was so bad that I had to stop it even though was then out of ALL options - the daily migraines were better than the side effects of that med for me (doesn't mean will be for you, but just keen to ensure you aware of the PRE-empt option which may not be if not under care of specialist clinic)

HTH

[kali110]

Op one thing have blood disorders been ruled out? My neurologist and doc never tested me for them and it was only after getting a clot and actually learning about my condition did i realise that headaches and migraines are a huge side effect of them ( however for some reason they are never tested for. A blood test to check your clotting level can rule out hughes syndrome and sps. I never thought i would have one as i have suffered with headaches and migraines since i were a child).

I started at 10mg 2 i think then went to 25mg 2 then up to 50*2 but dropped back down to 25mg as neurologist failed to mention that anxiety is a major side effect.
I still do get side effects and i've been on them for around 2 years.
I struggle with my memory and i find it hard to get the right words out. For Around a year though my migraines had improved.

[kali110]

Sorry that should say hughes syndrome and APS.

[Daenerys2]

Ludicrous situation! YANBU! Why aren't we addressing the issue that we don't have enough GPs in this country? Pupils should be actively encouraged and enticed into this field of work.