One appointment, one issue

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

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

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

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.

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.

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

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.

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.

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.

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.

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.

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!

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!

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.'

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 ...".

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?

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 !

@PumpkinSeasonIsHere I thought he was joking at first! He’s one of the 2 partners - I saw the other one once and had to do a breathing test and he told me I was ‘shit at breathing’ 😕.
I’ve tried leaving reviews online but they get removed and I got a warning email about leaving negative reviews on care.

I’ve moved house now so it’s a larger surgery and getting an appointment is very difficult!

I have steroid injections for arthritis, around two a year so far.

For these appointments, I have to ring the surgery, they make a note of my details and where the injection is sited, then I wait for someone to ring me and give me an actual appointment after running it past the doctor to decide whether or not I can have the injection. As I only seem to have two a year, I am within the criteria for having them.

My GP surgery seems to be one of the better ones locally and I am pleased that I can make these appointments by actually phoning and speaking to someone directly (even if I am on hold for a while) rather than struggling with an e-consult form online.

If I get a different health issue though, that might be a lot trickier to get an appointment. 🤔

I had a good one: I had an issue and the GP started banging out a prescription. I tried to expand on the issue and the GP snapped that my appointment included her writing prescription so my time was up. (I had had far less than 10 minutes.)

For anyone with a physical-type problem I would advise going straight to a good physiotherapist. They spend time actually identifying the problem, there is no wait for treatment and they can usually cure it! Hang the expense, it’s worth every penny for a shoulder/knee/foot etc.

I agree, OP. My policy says it has this practice but in reality, the doctors never seem to enforce it and are always happy to address concerns more holistically. I am mindful that they only have 15 mins per slot and try to keep it as succinct as I can, but it depends on the issue really doesn't it?

They’d be playing a dangerous game if they did as paramedic is a protected title.

Unlike nurse, which currently isn’t. Which a PA at our surgery definitely happily allowed people to think he was…

Our GP has moved to filling in an online form to get an appointment (with good things in place for those who can’t) and it has actually helped with the multiple issues thing.

I don’t think they’d have picked up my long term knee issue being the cause of my neck pain (I was walking funny to compensate) had I not been able to put everything down in detail for them to read.

That's amazing!

I agree that is it a very dangerous practice. How would i know which symptoms are relevant? I'm not a doctor, with 5 years of medical training, am I?