HRT prescribed but then cancelled for random blood test--can I complain?

[Coffeetree]

After several years struggling I finally got a consultation with a prescribing pharmacist two weeks ago, and she prescribed HRT.

Went to collect the prescription and was told there was a note to call GP.

Phoned all day (whilst trying to work) and got called back by GP who quizzed me again about my symptoms. Really degrading to have to step into the supply closet at work and discuss my symptoms again.

GP insisted that blood test necessary because it might be thyroid problems or various other things. I objected because I'm a 50 year old woman who hasn't had a period in 13 months. She said I could just pop in for a blood test the same day and get the results in 48 hours so I stupidly agreed.

No appts for a blood test for two fucking weeks. Got blood test on Wednesday and was told two days for turnaround.

Wrote the GP just now and said since they now have blood test results please release prescription for HRT.

Do I have a basis to complain?

1. Blood tests not needed to diagnose menopause in someone of my age and symptoms according to NICE guidance.
2. Appalling clinical practice to just ring someone and launch into quizzing on symptoms. I even said to GP, "Okay I can't really add to what I told your colleagues. Do you have my chart?" She insisted and so I said, "Okay I'm at work, let me try to find some privacy". There was even a follow up call so I had to do it twice.

If still no prescription today what are my options?

I also had to have blood tests before they gave me anything. I’m also 50.
I’ve been back and forward to the GP with a varying range of symptoms for many years and been fobbed off every time so I understand your frustration.

At least I'm not begging for a prescription anymore but telling them to reinstate the prescription which was already made.

@Redcrayons

I also had to have blood tests before they gave me anything. I’m also 50. I’ve been back and forward to the GP with a varying range of symptoms for many years and been fobbed off every time so I understand your frustration.

Yes. And two weeks ago when I finally got a prescription I was like, "Okay really? I'm going to walk over to X pharmacy now and the prescription will be there?"

They can still do blood tests while your starting in hrt

Blood tests should be done prior to stating HRT for accuracy.

And just prescribing HRT isn't the best approach - you need to weigh up the wider medical context, as was required in my case, for example (I'm on HT).

• starting

Blood tests should be done prior to stating HRT for accuracy.

That's not what the guidelines state. If you're going to claim to know better, best to check your facts first.

@CorrBlimeyGG

Blood tests should be done prior to stating HRT for accuracy.

That's not what the guidelines state. If you're going to claim to know better, best to check your facts first.

Sorry I wasn't clear. I meant for accuracy overall, ie in relation to wider endocrine issues or other markers.

It is recommended that bloods are done before HT is started. I'm not in the UK, but that's the case in Ireland.

Equally, once HT is started, of course hormone markers will be affected. In one sense, that doesn't matter (as HT isn't based on bloods / hormone levels), in another it does, as it helps having a wider perspective as you try to manage the products prescribed, for example. I've changed my progesterone twice, for example.

It's about having a bigger picture of overall health, that can be used as a marker

Hope that reassured you that I do 'know what I'm talking about' 😐

When did you do your medical degree, OP? Just trust the doctor is trying to do the best thing for you. Why would they not be? I've just picked up m first HRT prescription yesterday. It's taken a few months and three blood tests but I'm trusting my doctor has my best interests at heart. Just be patient.

The NICE guidelines say the OP doesn't have to have blood tests to be prescribed HRT.

I can understand your frustrations.

You’re right in that bloods aren’t needed for women 45+ to diagnose menopause. However many vague symptoms ought to have further investigations, to clarify whether menopause alone is responsible for those symptoms.

Vaginal atrophy is actually best treated with topical vaginal oestrogen rather than oral or transdermal HRT for example, so if that were your only symptom then patches or tablets may not be a primary consideration. Hot flushes and night sweats are often readily resolved with HRT whereas vaguer symptoms such as aches and pains, brain fog, mood swings and fatigue could be due to issues with the thyroid, ferritin levels, B12 levels and suchlike.

It sounds like your GP is trying to achieve a holistic evaluation and not just issue HRT with no assessment.

Part of the problem actually is at the start - "prescribing pharmacist". The response to not enough doctors has been, well lots of prescribing is straightforward and simple, we can train others to do some of that to take some of the work off doctors.

But, prescribing is only straightforward and simple AFTER a proper diagnostic process has been carried out. And it is that, that is why medical training takes time. (btw by diagnostic process I mean, history and examination and tests if needed)

I would really like to trust that the GP is acting in my best interests. Genuinely. What makes it hard is:

1. I don't have "a GP". I get luck of the draw.
2. I've been fobbed off for months. Told to drink more water and reduce stress.
3. I get random phone calls to be grilled about intimate symptoms which they should already have on record.
4. They went against NICE guidance and I had to push push push to get treatment.

Again, blood tests not recommended to diagnose menopause for 50+ woman with no periods and straightforward classic menopause symptoms.

I wouldn't have objected 5 months ago when I first brought up symptoms.

@BatshitCrazyWoman

The NICE guidelines say the OP doesn't have to have blood tests to be prescribed HRT.

She doesn't - it's about wider health checks for which bloods are recommended.

@Pythonesque

Part of the problem actually is at the start - "prescribing pharmacist". The response to not enough doctors has been, well lots of prescribing is straightforward and simple, we can train others to do some of that to take some of the work off doctors.

But, prescribing is only straightforward and simple AFTER a proper diagnostic process has been carried out. And it is that, that is why medical training takes time. (btw by diagnostic process I mean, history and examination and tests if needed)

Exactly this.

Well, I did have my treatment delayed for a last-minute blood test. Could they not have done the blood tests months ago?

I really would like to just trust the medical professionals and respect their expertise but the system is set up so that you only get help if you're pushy.

I’ve started the HRT ball rolling and I’m another on the fence I’ve had to wait 6 months (not the wait for the test, it’s to give my body time) for a third blood test to check the results from the first two.
It’s just to double check it’s not anything else.

But your right. It should all be quicker and simpler and I truly understand your desperation

I completely understand your anger OP. I managed to speak to a GP at the end of Sept about my peri menopausal symptoms. She was happy to prescribe 3 months of HRT and requested I have blood tests as well to rule out anything else going on. I'm 49 and still have fairly regular periods. Running blood tests in a woman your age with your symptoms absolutely is against NICE guidelines for prescribing HRT. I hope you get your script today.

@Coffeetree

Well, I did have my treatment delayed for a last-minute blood test. Could they not have done the blood tests months ago?

I really would like to just trust the medical professionals and respect their expertise but the system is set up so that you only get help if you're pushy.

That's a fair point. Hope you got sorted today.

@Coffeetree

Well, I did have my treatment delayed for a last-minute blood test. Could they not have done the blood tests months ago?

I really would like to just trust the medical professionals and respect their expertise but the system is set up so that you only get help if you're pushy.

You're absolutely right OP. The whole system is frustrating.

I have recently had a private blood tests which identified I was folate deficient. Very simple you would have thought.

I sent the results to the practice by email and it was confirmed by their admin teams they'd been uploaded.

Spoke to a GP who wasted most of the time interrogating me as to why I'd had private blood tests (1. None of your business 2. I see a private endocrinologist 3. Thank god I have private blood tests or my Graves' disease would never have been diagnosed (a previous issue missed by two doctors over 3 months) and god knows how long it would have taken for a simple folate deficiency to be identified - I didn't go into all this with the doctor for obvious reasons but it was what I was fucking thinking ie if you all did your fucking jobs properly I wouldn't need private endocrinologists and private blood tests!). Anyway I digress!

So she then said she couldn't see the results. I confirmed I had an email saying the results had definitely been uploaded. I read them out to her with ranges. Not good enough, can't give you fucking folic acid without actually the results because obviously I can't be trusted to read out some numbers. I tell doctor I feel absolutely horrendous and am struggling to cope at work. No dice. She says she will prescribe when the results appear in writing. Bear in mind I'm asking for folic acid not a controlled substance!

The following week arrives and no contact from doctors. Spoke to another doctor. He still can't see the results. He says for ME to contact the admin team again and ask them to check again that the results are uploaded. I do this.

He calls again next day. Still no results (and no response to my email). I tell him the results. He now wants to repeat the test and test for other things (I've already been tested for B12 which is fine (but not anaemia tbf)). He said something about ranges being different between different labs - yes they are but that's no reason to retest ffs it's like he didn't understand why ranges differ between labs!! What a waste of NHS resources especially when we have a shortage of blood tubes.

Anyway, I obviously just bought my own high dose methylfolate to take after the first appointment and am already starting to feel better. But am so pissed off at continually having to go private and pay additional costs for treatment because its exhausting trying to get adequate care from the NHS (something I am very aware is not an option for many people). I also wanted the folate deficiency noted on my records as otherwise doctors act as if it's never happened which is why I persisted.

Anyway, telling you all that (and that's just one story off a huge list over the last 4/5 years I've had chronic illness) because I empathise completely. The whole system is massively frustrating with many many dismissive, rude or incompetent doctors. Not all I hasten to add just most ime.

Rant over.

How did you get on today @Coffeetree ?

I did get it. I'm a bit embarrassed at how wound up I got.

I really do want to trust the professionals and rely on their expertise. What makes it hard is that instead of having a real professional trusting relationship with 9ne or two doctors I just have these random voices on the telephone asking me different questions and forgetting details. I know that's not their fault and they'd prefer to work differently. It's just so alienating.

@Coffeetree

I did get it. I'm a bit embarrassed at how wound up I got.

I really do want to trust the professionals and rely on their expertise. What makes it hard is that instead of having a real professional trusting relationship with 9ne or two doctors I just have these random voices on the telephone asking me different questions and forgetting details. I know that's not their fault and they'd prefer to work differently. It's just so alienating.

Don't be embarrassed I'm sure you were just super anxious of the outcome. I'm so glad you got your prescription and I hope it makes a swift difference for you

@Coffeetree

I did get it. I'm a bit embarrassed at how wound up I got.

I really do want to trust the professionals and rely on their expertise. What makes it hard is that instead of having a real professional trusting relationship with 9ne or two doctors I just have these random voices on the telephone asking me different questions and forgetting details. I know that's not their fault and they'd prefer to work differently. It's just so alienating.

Meh. Don't be embarrassed. Put it down to menopausal RAGE . I hope it works for you.

I can completely see you point of view, and I'm glad for you that it was resolved in the end.
I've been told I need blood tests for loss of sensation in the back of one leg, my chin and tingling in my arm. I have to wait two weeks for them (whereas before covid we had a 'sit and wait' blood clinic).
The NHS has gone to absolute shit. This is not just my experience, but also that of family members (I've just been diagnosed with having a life-changing condition and have now been unable to work for seven weeks, my family members (who have life-threatening conditions) and I have struggled to even get an appointment, in any form, with a GP, or even then, get prescribed the appropriate treatment).
I guess I'm just trying to say you are not alone, and that the state of healthcare in this country has gone far past unacceptable.