Was this a bit unethical for my GP to suggest this?

[TheWholeShackShimmies]

Last month I went to see a GP as I am totally and utterly worn down with everything in my life.

I am 51 and in the depths of perimenopause, I have some decades long health issues (including poor mental health) which have gone crazy over the last few years, I care my my mum who suffers from Alzheimer's and cancer, I work part time as a carer and on top of that I have the normal life stuff such as helping my teens navigate the world, trying to train our previously abused and very anxious rescue dog and finding time to enjoy some fragments of my life with dh. I am frazzled, feel awful every day and have had enough.

Wasn't expecting much from the consultation, we all know we can only get so much across in a 10 min GP consultation and our surgery does have a "one consultation, one problem" policy.

Anyhow, I ended up seeing a new GP and I can honestly say that I thought she was fantastic. She gave me 45 mins of her time which was unbelievable. I got upset whilst explaining everything and she was so kind and gentle and started explaining that in her opinion the NHS is pretty poor at seeing the whole picture when it comes to health issues and as a result she is very much into a holistic approach. This all sounded great until she started telling me all about a natural health clinic in our local city which she is working at and suggested to me that I go to them, she gave me the details of one of the practitioners and said I really should go see her as she will be able to help with all my health issues). I was so bamboozled by it all tbh, it was left it at that and no other help via the NHS was offered.

In my naivety (and desperation) I believed this place was somehow connected to the NHS because she was involved in it but upon further investigations it is an 'alternative' health clinic, the lady she recommended is a nutritionist and not a state register dietician. She also charges £300 for an initial consultation. Tbh, I have spent a small fortune over the years going to see people like this and am still struggling with the same chronic health problems so can't say they have been much help.

I can't help but feel this is wrong. I feel bad saying this because, as I say, this GP was absolutely lovely but I am kind of back to square one now and will have to make another appointment with a gp which will be a least 4 weeks wait.

I get that a doctor may suggested other avenues when someone is looking to treat various conditions but should NHS doctors really be actively promoting places outside of the NHS especially if they have a vested interested in the place they are apparently promoting.

I am not sure what to think tbh but I no that I am in the same position with my physical and mental health right now and nothing has changed so back to square one.

100% she should not have suggested a specific place she is working at. She could suggest other therapies/approaches but not a specific business. For example I work in the bereavement office at a hospital and we cannot recommend individual funeral directors, we can just suggest ways in which to find one that suits needs (websites that list local ones etc.) I would definitely be reprimanded for suggesting one I worked at!
I wouldn’t report her to the manager as you say she is nice and trying to be helpful…. But she is trying to drum up business so actually I’m not sure. Her motives could well be mercenary rather than helpful.

I worked for the NHS for many years and our practitioners were never supposed to suggest anywhere outside of the NHS so it did raise alarm bells a bit but I won't say anything because, as I say, she was so kind and understanding.

I don’t think suggesting to try something else is an issue. Nor being specific on what sort of practitioner (eg not all nutritionist are trained the same way, many have specialities etc… it can be a bit of minefield so good advice can be helpful there)
It used to be that GP wouldn’t direct you towards anything but NHS services. It’s less and less the case simply because 1- the system can’t cope and 2- some guidance like acupuncture for persistent back pain is extremely hard to get on the NHS (it’s in the NICE guidelines) 3- the ‘I can’t propose that to people because it costs money’ has gone out of the window with sending people to see specialist privately.

I think suggesting a SPECIFIC place and practitioner isn’t ok. Esp because it clearly was very self serving. I’d have much less issues with something local she had no affiliation with (but let’s say feedback from her patients said it was very good)

Things have changed a lot in the last 5 years re referring people ….

This will go against any policies for conflict of interest. Whilst your GP is working for the NHS, she should not be promoting or advertising her own business interests.

I would be delighted if a Dr gave me several options, including alternative healthcare, and even more impressed if they suggested how they could work in tandem with more accepted methods of western medicine. However I wouldn't be happy if they just plugged their own private side gig. It's an obvious conflict of interest and I'd wonder whether this alternative approach was appropriate or they were just trying to scam money out of me.

Did you go to her with a specific problem you needed to be resolved? I know you've detailed a lot of issues you are currently facing, but what did you want to get out of the GP visit? Please don't feel you have to answer here, I am just wondering whether you went with a specific medical issue (like wanting blood tests to see if you're feeling run down because you're low in iron or something like that) and, because she was so kind, you ended up being able to talk about all your issues, which may have meant she didn't understand what the specific issue was that you were seeking help with. You therefore left without the resolution you were hoping for.

@ComingBackHome it's hard isn't it I would rather go somewhere the staff are working at least part time in the NHS as it means they must be reaching minimum standards. The conflict of interest and potential to be throwing money away worries me less than the potential people aren't practicing properly as they are escaping regulation.

I think it's good that the days of not recommending top up care are coming to a close, as someone with a condition that isn't severe enough for the NHS to do anything my quality of life is much better topping up with private care. If I could have the same GP for acute and chronic it would be amazing.

OP would you be open to using this centre or do you have an idea of what you want from your GP.

Oooh no that's bad! Sounds as if she may have a financial interest in the natural health company. I'd report her to the practice manager at your surgery. You can still follow this lead if you want to of course, that's up to you.
General advice is OK, BTW, several times my GP has suggested trying an osteopath or private physio. It's specifying a particular, very expensive place that is not OK.

This is not okay at all. Please complain. Lots of people will assume that anything suggested by an NHS doctor is evidence-based and spend money they can't afford with these quacks.

definitely complain - they shouldn't be doing this

are you sure this person was a GP and not a physician-associate?

Might be unethical but I totally agree with her that the NHS does not treat patients holistically and if you can afford it do it. Where do you live to get a gp to listen for 45 mins wow ?

It does seem pretty unethical, but it also sounds like there was nothing she as a representative of the NHS had to offer you.

Take a look into a high fat diet and the menopause. Eating more dietary fat can really help with symptoms, as women make their hormones from the dietary fat they eat. There is quite a lot of interesting stuff on youtube on the topic, but Ben Bikman is a good place to start. Mindy Pelz, and Dr Boz also discuss it, but can be a bit OTT.
Best of luck!

@TheWholeShackShimmies , just checking I have this right. You had a 45 minute consultation with your GP and she openly told you that she works somewhere else and suggested that you could try getting in touch with that place. She didn't tell you to go there, it was a suggestion. You looked into it and it is too expensive for you, so you won't be going. What is it that you think is wrong? Is it the suggestion of the private place or the lack of help from the NHS - I'm not clear?

Did the GP say anything else at all in the 45 minute consultation? That is a long time for that to be the only suggestion.

I think it’s highly unethical. Yes, the NHS has its issues and it’s lovely to be given more time, but the time wasn’t given to finding NHS solutions.
It was to signal the OP to a clinic where she would have to spend £300 minimum. So if any patient can’t afford that, while they have had some time, they’ve gone away with zero solutions.
Yes, it’s great to treat the whole person and in the real world wouldn’t it be lovely to have it all for free? But it’s not going to happen and this doctor hasn’t helped at all.
Go back and see another GP.

Really bad form op, she absolutely shouldn’t have done this and actually the 45minutes was unprofessional of her too, because it was only ever going to allow you the time to digress and get upset. Hope things get easier op x

She's basically saying I'm not treating you here, but I will treat you privately for hundreds of pounds?!
Bang out of order. And 'nutritionist' could mean anything. It's not medically trained or even an official title.
I used to have a GP that got struck off for treating kids with cancer with Reiki and crystal therapy. She gave me homeopathic (fake) antidepressants when my dad died. But she was doing it out of her NHS practice, free of charge. I don't know whether that's better or worse than what yours is doing but I'd refuse to see that GP in future. It could even warrent a complaint.

The GP did listen though and sometimes that is what a patient needs. It is impossible to get counselling at the moment at my GP practice. Dr Chatterjee does a great podcast about treating health holistically.

The GP didn't have any help she
Could give you on the NHS because it's fallen over. She didn't want to leave you with nothing so suggested an alternative. 🤷🏻‍♀️

Would you have been happy to take antidepressants OP as this will probably what the next dr will offer ? You probably aren’t depressed but anti depressants or HRT could help with stress in your life. I have been a carer for Mum with dementia so know how hard it is especially around midlife.

Complain if you wish. She will spend 8 minutes with patients in the future and move on.

Patients often ask about private care/alternative health but are then shocked by the cost. That’s the true cost of healthcare.

I assume that she spoke about alternative options, you seemed interested and wires crossed with you thinking it was nhs linked. Unfortunate to have your hopes up that it would be helpful but I don’t think anything wrong, unless she said ‘come see me privately - I’ll fix you’ which is different to ‘this is an option that I have experience of’

I would be pissed off at being directed to a private nutritionist (anyone can call themselves that) with no options for actual investigation or suggestions for treatment or therapy etc - even if they said there's not really anything the NHS can offer, you'd know where you are.

She recommended a clinic that she has a financial interest in. That's not ok..

I would 100% report her, she could kill people recommending woo nonsense. What happens when it's someone who is suicidal and she recommends they go there and pay £300 to drink magical flower juice and it does nothing and they kill themselves?

The whole point of the NHS is that it's free, unless you're specifically going with the intention of a private referral, you're not sitting there for a 45 minute sales pitch for expensive alternative treatments provided by god knows who with god only knows what intentions.

GP's are not NHS employees, they are contractors. That doesn't mean that they shouldn't be operating under similar ethical standards but it isn't quite the same. i think that this situation is not something that they should be doing for a patient who is registered with the practice and I would suggest that a good place to start to find out if she is allowed to do this would be the BMA. https://www.bma.org.uk/advice-and-support/gp-practices/gp-service-provision/what-services-gp-practices-can-and-cannot-charge-for

I wouldn't approach the prac tice manager until you know what is and is not allowed!!

I initially asked her if I could be referred to the menopause clinic at our local hospital as due to my gynae complications and the fact that my mum has just been diagnosed with breast cancer and the fact that she wasn't keen on recommending a specific hrt due to this reason but somehow we ended up going off on this tangent with her talking about how she likes to look at someone in a holistic way and then started telling me all about this new natural health centre and suggesting I try this place even though I could not afford to see anyone privately.

You are correct in what you have said, I think I was just so glad someone was listening to me eventually (some of my health issues have been stretching on for years) that I went along with it but it hasn't been until now and I realise I am no further forward with controlling my issues and will need to start from scratch again.