I'm a GP AMA

[DrBubble]

I'm a GP. Any questions about my job?
(Please refrain from asking for specific medical advice)

Some of the women who haven't been referred. May I just ask, do you ever say "no I am sorry I wish to be referred because this isn't acceptable" And if there's a refusal, do you ask why and politely say you aren't happy with that decision?

@RosesAndHellebores

Some of the women who haven't been referred. May I just ask, do you ever say "no I am sorry I wish to be referred because this isn't acceptable" And if there's a refusal, do you ask why and politely say you aren't happy with that decision?

Yes. What happens is that you get ignored, and ignored, and ignored, and then any subsequent stuff you go to the doctor for is seen as That Woman Making A Fuss Again and so unimportant.

Middle-aged women are so often automatically seen as fussing, over-anxious, attention-seeking, and all the rest if it, when 99% of us would gladly never bother our doctors ever again, if only we could get listened to, diagnosed, and treated, and return home well at some point.

@RosesAndHellebores

Some of the women who haven't been referred. May I just ask, do you ever say "no I am sorry I wish to be referred because this isn't acceptable" And if there's a refusal, do you ask why and politely say you aren't happy with that decision?

I’ve stopped asking, as I’ve had absolutely horrendous ‘treatment’ from gynaecology at times - having been seeing them since age 15, now 30 - and am too scared to seek their help now . I ask the GP for pain medication when I’m in agony but the rest I just try to put up with now .

@RosesAndHellebores I first asked my GP for a gynae referral in my late teens, I was having 1-2 periods a year lasting nearly a fortnight and so heavy and painful I couldn't leave the house. The answer was always "We only refer when you've been TTC for a year, come back then". I was 24 before a (young, female) GP even sent me for an ultrasound and prescribed Dianette, previous GP had refused the pill due to chronic migraines.

I have diagnosed health anxiety.
Have you seen an increase in this type of anxiety and do people like me piss you off?
I can imagine the doctor being like "ffs 🙄" when they see my name on their screen.

I had a GP once tell me I had vulval eczema because I DIDN’T wash with femfresh every day .

I ended up needing major surgery at 20 as skin was so knackered they were concerned about VIN .

Even now when I go for a smear they haul the GP in who has a gape and asks why I ‘wanted’ to have surgery ! As if I made an active choice .

GPs can be horrendously dismissive of women’s health (but so can the bloody specialists), I’m still relieved I was lucky enough to find one who was determined to fight my corner as she did .

If you were working in a multi gp surgery..
A patient came in with one leg the size of a tree, the other leg normal. Patient is autistic and doesn't have a phone.
Patient asks at reception to see a gp, having been to pharmacy first.
Receptionist says they dont have any appointments and goes to fetch a gp.
Gp says "phone or nothing. Go away"
By 6 pm the same day, patient is in majors in a&e with a DVT .
What would you say yo the gp who sent patient away without even looking at their obvious tree leg as they walked past?

If there is a complaint made against a receptionist for a dangerous level of incompetence does anything actually happen discipline wise? Or are receptionists allowed to keep making mistakes with people's details without any comeback? (As seems to be the case at my local surgery).

In at least two cases one at my local surgery has made mistakes with me, one that could have been really dangerous, and judging by online reviews, I'm far from the only one. Both times the fault was with the same receptionist, and we recently complained but I have a feeling nothing will be done about it.

RosesAndHellebores Mon 01-Mar-21 14:18:18
Some of the women who haven't been referred. May I just ask, do you ever say "no I am sorry I wish to be referred because this isn't acceptable" And if there's a refusal, do you ask why and politely say you aren't happy with that decision?

Stopped asking. The older I was getting the less they were interested as you know menopause soon. If I had known it was going to go on for 12 years then I might have been more insistent at the start. In the end you just feel defeated and ignored and like you're a nuisance for asking. If I could have afforded private I would have. Its pretty much affected my life for 12 years, ruined outings and holidays and has just been shit.

It's interesting @ArcheryAnnie I saw a female GP probably in her early 40s about 8 years ago for an HRT repeat prescription and she actually said to me "well if you were to give up work, you might cope better with the menopause and not need HRT". I am afraid my response was "as I have a director level role and am probably as professionally qualified as you, that won't be happening and are you suggesting that non working women should not enjoy the best possible care to have the best possible quality of life." She went bright red but at least apologised.

TBF dd has had all number of gynaecologist issues (she's) 22 and the GP has been proactive arranging scans etc so no concerns there. Although I do wonder what is up with CCG commissioning vis a vis CAMHS which was horrific and dd only recovered because we could afford private care into the several thousands. Sadly nobody looked at whether there were comorbidities such as ADHD/ASD which there were and diagnosis ages 17 was the absolute turning point but no care was available on the NHS in time for A'Levels so dd would have dropped out and probably never have recovered had we not been able to pay. The funding structure is a real issue.

@reesewithoutaspoon

Why do womens health issues not get taken seriously. At 42 I went to my GP with heavy periods. I,m talking soaking through an ultra plus tampon and an always night pad in an hour and this continuing for the first 2 to 3 days of my period. I,m literally house bound for those 2 to 3 days. I couldnt see this being acceptable for men. My GP's answer was "well some women get heavy periods and you will be getting your menopause soon anyway". I,m 54 now and still haven't menopaused. This has affected my life and job for the last 12 years . Why wasn't ablation offered or even a gynae referral? After going back 4 to 5 times and getting no help I gave up.

I honestly think GP's need a women's health nurse specialist like they have with asthma and diabetes. There are so many issues around periods, contraception, endometriosis, thyroid and polycystic ovary disease which are poorly diagnosed, managed and treated that would have a huge impact on women's health and wellbeing but are totally overlooked.

YY

When I started getting peri-menopausal symptoms (at around 45), my GP looked me up and down and told me I didn't look old enough to be in peri menopause, and refused to do anything to help or advise. Even the private GP I ended up consulting didn't know anything other than basic symptoms. I was having all sorts of issues, and getting more information from the internet than from paid professionals in this country.

Gynae health in this country is absolutely hopeless. The real help and info I got for post partum issues all came from US based experts. Same with the menopause stuff, although there are a couple of good, but very over subscribed, private clinics in the UK. A woman I know suffered miscarriage after miscarriage in this country. Close to 20 of them, and she was desperate for children. Her marriage broke up because of it, and she moved to a Australia. Under the Australian insurance system, she was diagnosed pretty quickly as being a coeliac, and once she had that under control, she went on to have children without any problems. I am convinced that there are many women out there struggling with weight and other issues dismissed as "women's issues", who would benefit from a proper holistic assessment of diet, allergies etc. No chance of any of that in a 10 minute consultation run by someone hostile and dismissive of your concerns, and refusing to listen to anything other than the 1 or 2 symptoms they are prepared to entertain at any one time.

I think I have been to an NHS GP less than 20 times in my adult life, and only about pre and post natal and gynaecological related issues. I honestly can't say I came away from one of those visits feeling heard and helped. By contrast, specialist nurse practitioners I have seen have been, on the whole, really great and pleasant people to deal with.

My experience is that the more ehem mature you are, the better the care. I've never had better care since I became peri then menopausal. That said I do insist on seeing the female GP who I know listens. She admits too that having seen so many meno patients she's actually dreading it herself. Maybe that's also because I'm more confident and bossy than ever.
Contrast with my DD's experience and young women and their menstrual or fertility problems - she's had rubbish treatment. Completely brushed aside by receptionists and GPs

@Sevensilverrings

I’m not sure how to frame this, but I’ll try! My experience of both NHS and private is the attitude and even language used by private health care towards clients is so much more polite and professional. I understand thats partly because it’s a bought service. What I don’t understand is why (some) NHS staff feel they can be so rude to patients and other staff at times, and it’s so culturally unacceptable to challenge this. I’ve got up and left a consultants appointment before because of the way he spoke to me, being very clear I’d not be spoken to in that way, and the nurse in the room followed me out and said well done, she wished more people stood up to him. (It was after a MC and he was awful). Many more examples over years of using various services. (Tons of examples of amazing care too, obviously). I wouldn’t put up with bad service in other areas of my life, but because the NHS is nationalised somehow the standards shift, and patients are seen as owing or something, rather than receiving a service that should be professional and polite, and is after all also paid for by taxes. I’m not NHS bashing, not at all, I just don’t understand why internally this sort of practice or culture is allowed. It’s obviously endemic throughout the NHS, more so in hospitals than GPs I’d guess. I don’t know if it’s also reflected in the way levels of the organisation treat each other? I have trained in organisational dynamics as a therapist, and the nhs fascinates me in this way. Such entangled historic dynamics and hierarchies. I think it must be a confusing organisation to be part of.

Have experienced a few situations where private care was poor and at least three occasions where they were seeking to make money out of me for unnecessary surgery, unnecessary psychiatric help, unnecessary cancer screening checks...I don't trust the motives of private healthcare - they care very much - about making your wallet lighter. Not saying the NHS isn't perfect either but both have their weaknesses.

Hi OP.

Is there a reason why someone would be called in for a face to face appointment in this current climate for anxiety/depression? I have been having telephone appointments but have recently been put on new meds so when the GP I spoke to nearly two weeks ago made me another appointment for this coming Thursday to see how I am getting on I didn't think too much of it. It wasn't until I checked online that I realised I had been booked in for a face to face appointment and I also confirmed with the surgery that they wanted me to come in. I am just a bit confused by why I need to go in person.

Also I am not sure if this has been asked already but how much training do you get on nutrition?

What is the ideal patient?

@DrBubble

I'm a GP. Any questions about my job? (Please refrain from asking for specific medical advice)

Great thread, thanks.

Sorry if that’s already been asked.

@NameChangedForThisFeb21 they can but shouldn’t. There is an audit trail so, if you do have concerns, it can be looked into. There are systems in place to show who has logged into a patient record. If it is found that someone has looked on your record who hasn’t had reason to there could be serious consequences.

Thank you @Disressingtimes

@DrBubble do you tell patients with chronic illness to measure their activity by thinking about their days in spoons? Do you think this is a good solution ?

What do you think of the CAMHS system re ADHD? You need the school, who aren't qualified, to score your child highly enough before a diagnosis (provisionally made by a psychiatrist) can be accepted.
As an adult, I wouldn't need to contact work regarding this issue. Just as well as I used to work with someone who had bipolar and I had no idea until she was sectioned

[quote DrBubble]@RhubarbTea
The training was indescribably difficult. I think myself, and a number of others, have some PTSD from the experiences we've had during training. I think Adam Kay highlights this well. The stories I could tell...

Yes I will very regularly Google things. Google is a gateway to a plethora of medical resources, often books turned into websites for ease. Not just an article by Joe blogs who thinks turmeric will cure all his problems. Google done the right way is my friend :)[/quote]
Do you have an Athens account?!

I'm a medical librarian and am constantly reminding our students not to just use Google. But I'm not sure how much access GPs have to online resources?

If I wanted to attempt to discuss my mental health with my GP, is it possible at the moment to request to do so face to face? If so, how can I request that? Any conversation about it would be extremely difficult, I don’t know how to explain it or where to start, and I hate talking on the phone even to people I know about normal everyday topics of conversation. Last time I tried was before Covid and my problems were not nearly as bad, but I ran into an issue when the receptionist asked what the appointment was for and I couldn’t work out how to answer.

I totally understand why face to face appointments are not generally happening at the moment and don’t want to increase the risk to the GP (although I have had one vaccine dose and do twice weekly lateral flow tests), but it might be possible that phone/ online appointments remain the norm and that would prevent me from accessing them.

This would have been easier to read if the questions were quoted and answered. I'm sure it is a really interesting thread. Just can't face all the constant scrolling back to see what the question was.