One appointment, one issue

I am a GP.. really happy to see your list as I can scan though and see what’s most important and likely related ..and make a plan to tackle over several appointments .. I will tell you if too much for 1 appointment and make a plan.
i once had someone go berserk though because she wanted to talk about a whole lot things and the one thing I wanted to talk about was her chest pain.. I couldn’t make her see that chest pain was the most Important thing.
My record for a 15 minute appointment was 29 things !

It’s crazy and currently I’m filled with rage about this situation as I have spent 2.5 years telling my doctor there is something seriously wrong with me but he wouldn’t look at all the connecting issues and would get me to choose a couple of symptoms to discuss. And a week ago I finally discover I have MS. Just how much more permanent damage has been done because he took 2 years to refer me to neurology and then wrote such a shit referral in Jan I was triaged as non urgent by neurology so didn’t have MRI’s done until mid sept?

The policy one appointment, one issue should only be for those who quite happily say "I've got a list". On that list would be a range of things totally unconnected eg, painful toe, itchy head, occasional nausea, waiting too long for their hospital appointment for example but never mentioning all of these in their initial call. The GP allocates time for what is on their triage list not "oh by the way Doctor, whilst I'm here ...".

That's very true - I remember reading, I think it was, in the British Medical Journal that
'The knee bone's connected to the thigh bone. The thigh bone's connected to the hip bone. The hip bone's connected to the back bone.'

What… the…

I wouldn’t put up with that, honestly. I’ve told doctors on a number of occasions that I come to them because I value their training and experience, not just because I can’t write my own prescriptions. I guess I am behind the times!

I do Google everything but Google is not a doctor!

It might be done differently elsewhere, but when I’ve gone for flu jabs for example, they do everyone in a couple of days. It’s more efficient for them I guess to deal with them all at once. So mentioning another health issue really would be inconvenient at that time.

I agree with the rest though!

Not what you're asking, but vitamin B1 (thiamine) deficiency can cause all those symptoms. Your doctor is unlikely to know anything about that though as doctors aren't trained in nutrition.

EO Nutrition on YouTube has lots of videos about it if you want to find out more.

The worst one I’ve had was when I attended my appointment and the GP asked me if I’d googled my issue and the treatments for it. I said no so he told me to book another appointment when I’d done that.

Given I’d had 30 seconds so far I asked if I could ask him about a lump on my hand instead and he said no.

It's not totally separate, though. In the last couple of weeks, I've seen the nurse for annual bloods, for a smear and I will be having a covid jab next week. It would be far more efficient for both the practice and me if they could take my history, take the bloods, do the smear and then do the jab in a single appointment, or two adjacent appointments, rather than me considering just changing my address to the surgery, as I'm there so often just now. But the system can't cope with that at all, especially as the smear is unconnected to the bloods and jab.

Comorbidites can make treatment trickier, because treating one thing can have a knock-on effect on the other. And sometimes unrelated symptoms are actually linked - only it might not get mentioned.

I haven't seen my GP for a couple of years (whereas all the nurses...) But I've nearly always been asked, "is there anything else?" at the end. Although I think my answer has slways been no.

I always thought the rule was for things like "I have been having bad headaches. Right that's dealt with and I have a prescription/tests have been ordered. By the way I also have a weird mark on my leg." Both are clearly different issues and the patient should book a double appointment. It shouldn't be used to discourage a GP from discussing related symptoms. For example, I went to the GP because I'd been sleeping badly. He asked for details on sleep habits, then asked about a few other potential symptoms i hadn't thought to link to sleep issues. Completely different situation.

Sounds like you came across someone who was being rude / was stressed about workload & timekeeping and that translated into poor service provision.

I had to decide neck or elbow. Elbow won. Refused the injection offered as I really don't like needles. Asked for physio. Physio assessed me and discovered on her last question that it was my neck causing the elbow pain.
These days I'd self refer to physio as they're usually brilliant.

If I'd said neck maybe we'd have got to the same result but I suspect it would have took longer.
I'm glad I don't like needles.

YANBU. I just rock up now with a list and say this is what’s happening so in ops case I would list all symptoms as she did plus migraines

if they treat each symptom separately they could just miss stuff

We are lucky with our gp too.

I have read others moan about getting appointments etc, but they have tried a few different ways of doing things, and the current way appears to be working. They have always been good at emergency appointments for children.

I have read terrible reports of some practices where a timer is set when you walk in and the consultation ends whether you have finished or not. I am not saying people should waste appointment time when there, but you also want to feel that the person you are seeing is listening and not clock watching or rushing you out of the door. Luckily we have some lovely doctors that do listen to what is being said.

I agree- means gp may not get the full picture.

I was diagnosed with underactive thyroid nearly 20 years ago. Things that would have seemed unrelated to me, or not relevant (dry skin during colder months) were all as a result of my thyroid.

Was diagnosed with anemia about 4 months later - had put the tiredness, hair issues etc down to my thyroid. I actually went to the GP for something totally unrelated. GP noticed I looked very pale, and so asked a variety of questions and did bloods - which showed my iron levels were very low ( and causing both the symptoms ).

More recently I was diagnosed as celiac. I hadn't gone to the go for anything linked to my stomach. Thought my thyroxine or iron levels would be the cause, but due to the symptoms I had given, GP did a selection of bloods, including a celiac antibody test. Results meant I was referred for an endoscopy for diagnosis. Gp didn't just determine iron levels were low, but found the cause.

All examples of how one issue can cause multiple symptoms, that to a non medival person may seen unrelated. I have found that by giving the symptoms that are concerning me, it leads to questions about other symptoms, that give the gp a better picture of what is going on.

I had a call from the gp today to discuss test results - we discussed my iron levels, thyroid levels, celiac antibody results and menopause in one call. Four different conditions but all have overlapping symptoms, and can impact each other, so can't be considered in isolation.

Exactly. I totally agree. You're a whole person not just a separate series of symptoms. Things are often connected. 😬

Goodness we are so lucky with our local surgery. They regularly send out information on their FB page and are a huge part of our community. I went 2 weeks ago and my GP actually asked about my life and family and encouraged a conversation. Nothing is too much trouble they are amazing

The system is crazy. Some conditions have a multitude of otherwise minor-looking symptoms. Look at them in conjunction though...

It seems we are just very lucky here! Really good GP provision and never a problem getting an appointment. South East and near a major teaching hospital.

Atrocious that provision is clearly so patchy.

I agree op. A GP who listened to my complaint about something connected, by not the appointment issue caught my cancer and meant I had the treatment needed in time.

At a follow (post op) appointment, I took her some flowers as a thank you. She said she had never received flowers from a patient before … she saved my life, why would I not thank her?

I went to the surgery as I had the most horrendous flooding the night before (embarrassingly I’d never come across it) and she explained it was the start of menopause. As I got re dressed I said that I thought the menopause was supposed to stop the bleeding and I thought it annoying that I not only had to deal with spotting mid month, but now flooding too. “Tell me about the spotting” she immediately said. I was at the hospital being scanned that afternoon.

i can’t see that a layman would be able to tell which connected issues are important, if they are interrupted and shut down.

Yes, I agree the paramedic was unreasonable.

I understand that someone coming in for an ingrowing toe nail also wanting to discuss contraception would need two separate appointments but there will be plenty of cases where things are inter-related.

Yep have had this happen to me, it makes you feel like you don’t matter at all. Without building a profile of what’s going on how is anyone supposed to work out a plan forward? What if you want to request various medications? Won’t this just end up with people having to take up multiple appointments for each separate question? Don’t get me wrong I know they don’t want to run over and fit every appointment in but when you can be sat talking about what’s stealing you’re quality of life from you and you are being timed to the minute (literally sat looking at the watch saying you have two minutes left) it don’t give you much hope :(

Well if you need to discuss 6 issues then it would take 60 minutes. If a GP clinic is 3 hours, they would then be able to see 3 patients per clinic. In a practice with e.g 8 GPs, for 10000 patients.

Which means you will wait 6 months to be seen. Like for an e.g. Orthopaedics appointment, where they get longer to see patients.

If you want to sit and talk to a GP for half an hour, why don't you pay for a private GP? It will cost you hundreds of pounds of course.

All this 'waste of money' - waste of whose money? It's free! And GPs are often dealing with 50+ patients a day, so they are hardly fleecing the NHS by refusing to discuss your 5 things.

The general public don't deserve the NHS, especially GPs, and I will be glad when people have to pay and realise what they have lost.

I went to a doctor’s appt yesterday; it is a six-week wait here. I could have been Princess Diana risen from the dead sitting there, because the GP did not look at me once. Just muttered “How can I help you?” whilst tapping at the computer (obviously not about me as I had not yet said anything). My appointment lasted no longer than five minutes. It could have been dealt with on the phone, but you are not allowed to request a phone appointment - the receptionist is the judge of that.

The other thing is if you look at my GP practice’s website, you think Gosh, they have 20 GPs - great! But oh no - they may have 20 GPs, but all except one are part-time. In fact, a lot are extremely part-time - one day or even half a day a week. Setting aside any continuity (impossible) - how do these GPs develop professionally? You’re not coming across a lot of medical issues if you’re only working one morning a week.

It takes me on average 6-8 weeks from booking to see a GP, a double appointment can double that wait. I started seeing them for an issue in June, I had to wait 8 weeks for an appointment then 2 weeks for bloods then another 6 weeks for a follow up. They found concerns in both my bloods and urine tests and follow up is still a 1 month wait. So from initial contact in June im waiting until November until my next point of contact whilst having multiple concerns.

I cant often get a double appointment but if there is a chance of one popping up, thats months of waiting. Years ago I would absolutely say the same but in the last 2 years our GP appointments have become like gold dust.

I can’t book a double appointment

I’d have to get past the receptionist and then they would run it past the doctor and they would decide whether it was worth a double appointment or not.

I actually don’t have a problem with that. I’m just surprised to hear that you can get one easily.