One appointment, one issue

I agree about ANPs. The ones at my GP are my go to for most issues initially. And 90% of the time they can deal with it.

I can book a double appointment without the need for an interpreter.

If I am going in with an issue, I will bring a list of any symptoms, and if they want to bring me back for another appointment, I’m happy to do that. It seems the problem isn’t with the system, it’s with one or two rude doctors. Mine are fine with it.

It must be more efficient to discuss several issues at one sitting than to have multiple appointments. Many things will only require a minute's attention or a note making for a referral, rather than an in-depth discussion.

100% agree with you @monkeymamma How are we to know if our symptoms are linked without speaking about all of them. Then having to decide which issue is the first one you make an appointment for?

I really hate this policy as I think so often it misses key things that as a patient we dont necessarily link together but if we had time to discuss our health as a whole there may be things that we see as unrelated, that actually paint a bigger picture.

Ive had exactly that happen and it took a year for me to realise a couple separate issues were related but because its 1 issue per appointment and appointments are so hard to get, I just focus on the most important thing at the moment. Its the wrong way to do things I think especially when complex health issues are going on.

The paramedic at my surgery is a bit incompetent. I mentioned dealing with her twice, once was actually earlier this morning where she prescribed an antibiotic for a UTI. Despite me telling her that the one she mentioned is not suitable for me due to other health issues, that is what she had prescribed when I went to pick it up earlier. The dispenser at the surgery went to get her and she came out and told me that that specific antibiotic is the “only one we would ever prescribe for a UTI”. Which is so obviously nonsense I wonder about her ability to function at all. I insisted she speak to a dr, and surprise surprise, it turns out there isn’t literally one antibiotic for UTIs (which is something I think every single person on this thread would know, regardless of medical training), and he confirmed I couldn’t take the one she’d given me and gave a different prescription.

I appreciate one person is not representative. But she isn’t a great advert for the training paramedics in GO surgeries must have.

@justaquickquestionifyouplease I think we would all agree that if you’ve got an appointment for a specific thing like a vaccination or smear test or a blood test… that is not the time to raise any other issues.

But if you’ve got your 10 minutes with your GP, it’s entirely logical to want to bring up more than one thing. The 10 minutes isn’t particularly realistic.

But I have long given up puzzling over GPs are set up the way they are. The whole NHS model is hugely problematic and needs changing.

One of my former GPs, now retired (this poor lady had the misfortune of seeing me a lot when I was constantly ill in my 20s) ..she used to talk about the bureaucracy as taking more time than actually seeing patients and we have got to find a way to undo that.

she was always running late to see patients often by about an hour. No one complained because you got looked after properly when you saw her. she was the most in demand doctor at the practice. I dropped in to see her on her final day - after her surgery had finished that morning, she did say to her patients to come and say hello - and I was probably the first one there because I popped in at lunch. You could not move for flowers in her office.

That was more than 20 years ago and it shows how much patients value a good doctor.

She may not be allowed to work the way she did now, though.

Perhaps my choice of using the vaccines as an example wasn’t the best. Another example would be I am given 15 minutes to do a smear. This includes all history taking etc. Quite often women will want to talk about contraception or HRT within the same appt. It’s not always possible due to time and it’s classed as a seperate appt.

I also think those who are knocking the skills of a paramedic practitioner should look into their scope of practice more fully. They are a lot more skilled than you may realise. The same for ANPs.

My mother was harmed by exactly this policy. I’m still furious about it now, ten years later.

Yes we had this with my daughter. She is a coeliac. The diagnosis took longer as she was first assessed for stomach issues and then separately for skin inflammation (eczema). Turned out the eczema was from the stomach issue. She was given gaviscon and steroid cream for a while separately until one GP finally looked at both. Really silly and potentially dangerous approach.

It's bonkers. A friend was telling me a similar story the other day. A range of symptoms and issues she thinks are all tied up with peri-menopause so was keen to get bloods and hormones looked at. But because she's also got an ongoing issue which is part of the mix she was told off and told they couldn't discuss that as it's only 1 issue per appointment. Even though there's a chance it's all connected.

It's so dangerous for other conditions or symptoms too. Like, some cancers have a range of impacts on your body and if you're only honing in on one at a time you miss the bigger picture. One symptom on its own might seem minor but if you're also losing weight, feeling exhausted, other stuff it could indicate other investigations.

Yanbu a lot of stuff is interlinked, my cancer kept getting dismissed as anxiety and I basically wasn’t allowed to list off all the things I was having issues with as “you need another appt”, I ended up having a private drs appt, it wasn’t even particularly long appt, but I was just like please let me list everything and listen to me and that was basically what got the ball rolling on someone taking me seriously, was for someone to listen to me and to all the symptoms not in isolation.

I agree OP it's madness.
Things are obviously interlinked i.e throughout the mind and body.
Who tf came up with this?
Wasteful, inefficient and dangerous.

Our GP lets you book a double appointment for more complex issues?

HCP is doing vaccinations is different though. And actually not really relevant to this…

Every health expert, interviewed on telly or radio etc will applaud a holistic approach to medicine. In practice, this does not exist in the NHS (though I am very much a 'fan' of the NHS).
You are a knee, a hip, a low mood, a migraine, but nobody ever considers anything remotely approaching holistic health care.

As a HCP in general practice I have to put my point across from the other side.
I am given 5 minutes for eg a vaccination appointment. 50 people have appointments in a row. If even one person starts the ‘while I’m here….’ then is that fair on everyone else having to wait? Aside from genuine emergencies.
I absolutely am not saying there are not problems in general practice but I also think sometimes common sense must prevail.

My GP has wholeheartedly embraced AI and online triage.
The won't even book an appointment any more unless you go online. If you are elderly or have additional needs, the reception now fill in the online form for you instead and you hope they call you.

It is horrendous. I've not seen an actual GP in several years.

I end up putting through many more triage requests than I ever would have when we used to actually have access to humans as they keep getting closed without resolution.

Reception staff seem to triage now, I've been given dangerous advice, and actually had a pharmacist call them to have a go.

I'm due an hrt review and a smear, the same team do both, excellent chance to get 2 things sorted quickly with 1 appointment. System won't allow it. It's ridiculous.

The whole system needs overhaul. It's a huge money pit.

I also wondered this for a different reason

A paramedic is usually very good.

I wouldn’t put it past physician associate to use the term “paramedic” because of the backlash against physicians associates.

IANAD but surely it's all linked to the endocrine system, OP @monkeymamma so all the issues could well be part of a hormone imbalance one way or another. Little things like the adrenal gland and ovaries can cause a lot of problems.

https://my.clevelandclinic.org/health/body/21201-endocrine-system

It's not a separate appointment unless you have a separate body.

Not like you asked about a stomach issue and an ingrowing toenail.

I was talking to a retired GP who said he was totally disillusioned with the current system. He explained that diagnosis of some quite serious and complex conditions needed him to actually see the patient.
Some tell tale signs might not have been noticed by the patient, but would emerge with a proper hands on examination by a doctor.
He worries that these signs could be ( and probably are) missed by telephone consultations or less qualified medical staff.
Although he agrees with triage over the phone, for very basic obvious things he thinks that anyone with significant unexplained symptoms, particularly over longer than a couple of days, should be seem by a registered GP who has had full training and experience in diagnostics over a wide range of fields.

Pretty much everyone I know who has a complex/immune issue started with "weird" disconnected symptoms. Back in the days GPs knew their patients, one diagnosed my gran because her hand "looked different"-she'd never had put that on a form.
When I had pregnancy issues, I could have gone just saying my stomach hurt, but it was mentioning the pain in my back/shoulder that alerted the doctor to the real problem.
Plus, it is so hard to get an appointment-the hospital referred someone back to their GP in August, and they won't get to see them until mid November (not joking, they've been cancelled on 3 times), it's very likely you will have more things to talk about, particularly as you get older, but of course many young patients have multiple issues.

Back in April the University Medical Centre at the Radboud in Nijmegen (the Netherlands) organised a 48 hour diagnosis hackathon for exactly this reason. They took the files of 33 patients with long term undiagnosed conditions and put them together with specialists from different departments to actually talk to each other. They made breakthroughs in multiple cases because they were able to join the dots.

That makes sense

I wonder if we could have a future with fewer doctors e.g.

Triage by paramedics
AI enabled Physician Associates to refer you to a specialist as required
Everything else / chronic conditions handled by pharmacy or specialist nurses

A few GPs left to supervise / pocket the money