Questions for GP's on medical sexism generally & certain conditions in particular being so hard to get dx & treatment for

[Graphista]

Inspired by several discussions on mn in the last few months as well as mine & dds own health issues.

I want to TRY and keep this discussion as calm as possible hence in chat not Aibu.

Basically I have endo, possibly a thyroid problem, possibly a nutrient absorption issue, problems with a variety of medications (either completely ineffective, allergic or major side effects problems depending on the meds)

Dd has eds, possibly endo, possibly anaemia (but diet is more than fine)

Mum & sis have similar probs with meds, mum also has had gall bladder & thyroid problems

Both grans had thyroid issues

ALL of us it took years to get the conditions dx.

I know there's a lot of pressure on gp's, that surgeries are understaffed and overwhelmed and that patients sometimes don't help by attending unnecessarily for minor ailments, insisting on seeing dr when nurse or even physio or podiatrist or similar would be better.

What I'm noticing more & more on here & in real life though is that it's taking particularly female patients longer than it would seem is necessary before they even get taken seriously let alone dx & treatment.

But the big question is - for the benefit of Drs (because it would reduce numbers of appointments overall, patients needing meds to merely treat symptoms when treating the cause would be more effective) and patients...

...how do we change this?

The main "culprits" in terms of conditions seem to be thyroid disease, gall bladder disease, nutrient deficiencies, gynae conditions.

So do female patients present very differently to male patients and Drs are still being trained on the male patient model?

Are tests ineffective? Are guidelines on parameters outdated? Are results being interpreted or communicated wrongly?

Are treatments ineffective? Or outdated?

Are patients not communicating the "right" information? And if so what DO you want us to tell you? Are we too stoic and not effectively communicating levels of pain or other negative impact? Are there things a patient should try first to rule out other possible causes of their symptoms? That's something I certainly try to do but I'm aware not all will and its not something that should prevent patients seeking help when very ill.

Is GP training generally ineffective? Are there elements missing that shouldn't be? Elements included that are no longer necessary? I'm thinking particularly of gynae and especially endo as a lot of gp's (and even gynaes which is even more shocking) STILL seem to think that an US scan will definitely show if endo is present.

I genuinely want to try and find a possible solution to this.

It would alleviate pressure on gp's and the nhs generally, reduce costs, reduce losses to the economy in terms of sick days and even people being unable to work at all.

I don't believe all gp's are just plain disinterested, some may be stressed, jaded etc but I do think certainly at the start when they first train to be Drs at all it's because they want to help people, so what happens that so many patients have so many experiences of struggling to get a dx?

There has to be a solution to this.

Bumping

Hope you get some useful suggestions OP.

I find that the NHS is only good for dire emergency situations and most other things get a cursory test and if the results seem reasonable they don't want to know. This means that conditions that don't present in a textbook way are missed.

I have a problem with my gallbladder with very definite symptoms, but no gallstones are seen on ultrasound, so nobody's interested. The problem is still bad enough to have caused pancreatitis in the past, but nobody seems to think it needs further investigation.

I think that doctors are overworked and that, if they fob people off, then a third will get better by themselves, a third will die of the problem or something else and the remaining third will need treating so will return eventually with worsening symptoms that can't be ignored so something will have to be done. If an overworked person can effectively dump two thirds of their workload they're not going to avoid doing it are they?

The only other option is to go private for niggling, but significant problems and try to get the NHS to deal with the problem once you have the private results. Obviously, not everyone has the resources to do this.

The NHS should be properly funded, efficiently run and able to serve everyone (even women), but that's never going to happen as it has too many issues and too large a population with too few doctors.

According to my friend who’s a retired prof of medicine, training for doctors has changed massively since her days. Her son is a junior doctor and she was appalled at how poorly diagnostic skills were taught. Even in retirement my friend has diagnosed conditions in family and friends that their own doctors and consultants had persistently missed.

She thinks far more attention to how to take a decent history, how to carry out a proper examination, think ‘outside the box’ when it comes to seemingly random symptoms and importantly give doctors more time with patients which is a huge and probably impossible to achieve ask.

I finally got a diagnosis at 56 for a genetic condition and am seeing a consultant privately for a chronic bladder infection that has got worse and worse over 5 years and which NHS would not accept existed and treated me for a condition I didn’t have because they couldn’t diagnose what I DID have. I have been hugely let down over the years. Something - well, many things, seem to need changing

And heaven help you if you have a pre existing condition
I have hypothyroidism- had it 20+years treated with thyroxine all good and I have normal levels
When ever I turned up with another condition the thyroid issue gets the blame
So annoying

Painful heavy periods?- it’s your thyroid
My fingers are swollen and painful - that’s your thyroid
5! Different Gp’s later I got referred to a rheumatologist who was horrified that I’dbeen fobbed off while the arthritis was untreated and getting worse

MouseUtopia BUT if they DX and treated properly from the outset patients wouldn't be needing multiple appointments - adding to the workload - because they're worried about continuing symptoms and/or to get treatment for symptoms.

I've asked before and never had an answer to:

How much did it cost the nhs:

NOT To refer me to a gynaecologist when I presented with TEXTBOOK endo symptoms (gynaecologists description not mine) but INSTEAD for 14 YEARS-

having me on the pill and frequently having to change brands when that brand was no longer suppressing symptoms

An average of 6-10 appointments a year JUST for symptoms treatment (at current prices min £30 per appointment)

Prescriptions for the resulting anaemia, to reduce blood loss, treat the pain, treat the low bp, migraines, back pain and vomiting.

Unnecessary treatment (including many prescriptions) for "ibs" which it turns out I don't have - what I do have is endo on the Bowel which is what caused the worst symptoms and since it was surgically mostly removed has much improved symptom wise

5 admissions to a&e when the pain was severe or I'd passed out and the person that found me didn't know what was wrong with me

Ovarian torsion a few months before the 2nd mc

2 mc inc one being twins with one extopic meaning 3 surgeries and finally getting a DX and treatment. Gynae saying I wouldn't have needed such extensive treatment had I been referred years earlier.

Versus how much it would have cost if I'd been referred to a gynaecologist the first time a GP was made aware of the full nature of my symptoms INSTEAD of blithely putting me on the pill as a cure all.

SURELY it's cheaper overall/long term to DX and treat PROPERLY than to mask/ignore symptoms?

"Her son is a junior doctor and she was appalled at how poorly diagnostic skills were taught" doesn't surprise me in the least - and if they can't DX accurately which is the very first step then they could even be giving HARMFUL treatments. At best NOT treating something and it worsening.

"And heaven help you if you have a pre existing condition" yes this is also true.

My mum had one condition that was being treated (cancer) and while that was happening also developed gall bladder disease (completely unrelated to the type of cancer not even crossover symptoms) for months she kept getting told it was either the cancer or side effects from treatment. It wasn't until treatment was finished and she had a particularly bad night and dad called ambulance that via a&e she was DX with the gall bladder issues and they were treated, narrowly avoiding pancreatitis. Completely unacceptable.

Plus from my other thread and numerous other posts I have seen on mn and elsewhere, in the uk/on nhs the levels relating to thyroid tests that are considered "normal" and "ok" are WAY out of range as per guidelines in other countries and by experts in the field.

Again NOT treating patients meaning more GP appointments, long term treating symptoms but not cause PLUS days off work etc CANNOT actually be saving the country money!