Diagnosed with pneumonia and pleurisy over the phone.

[Imfat]

I've had a terrible cough lasting nearly 7 weeks and having flu.
Started with sharp pain at the bottom of my right side of the rib cage.
Absolute agony so I got a telephone appointment for this morning
thinking that the GP would call me in to listen to my chest.
No she diagnosed me pneumonia and pleurisy over the phone.
She has prescribed antibiotics and told to call her back if no better on Friday.
I asked if she needed to listen to my chest and was told no need she knows what
is wrong with me.
I just hope she is right and I do start to get better.

whatever her diagnosis the main thing is the antibiotics
rest op and take plenty of fluids

What treatment were you expecting had she listened to you your chest?

I’m not trying to be shitty, I think she definitely should have had you go in and been examined, but, if the overall outcome is the same I would probably just be pleased she didn’t rob me off with the usual ‘viral, will run its course’ / we have a spectacularly awful surgery though so anything that results in treatment is a bonus!

I was sent for a chest xray with suspected pneumonia so I am surprised you were diagnosed without being seen. Treatment was just antibiotics though.

I work as an ANP and find it awful that this has been diagnosed without a full face to face assessment including a set of obs to look at you O2 sats, resp rate, heart rate, BP and temperature plus a listen to your chest. Are you coughing up any phlegm? If symptoms deteriorate get yourself back there - you should be having a chest x-ray after a persistent cough lasting 7 weeks.

When you have the really experienced specialists up front, you can sometimes get this - (probably) effective diagnosis and treatment with absolutely minimal contact. This is the point of medical and GP training. And the national information systems, national training levels etc. Your GP will be looking at information bulletins describing current presentation of infections etc. Maybe they did a long medical rotation in a respiratory speciality and they’re really good at this.

Trouble is, people often don’t feel seen or heard by this system. But this is why the NHS at least used to be one of the most financially efficient systems in the world - making your first contact with experts is much much faster and better than putting in layers of extra non-doctors, all of whom require far more time and inputs to achieve the same outcome. The numbers look cheaper up front but they’re actually not - non-doctors end up referring far more patients to secondary care - they need to because they can’t do what GPs do.

What this system does require though is that if you’re not seeing improvement by day X of the antibiotics, you take responsibility and go back. Also of course there will always be issues - eg are you sure that actually was a GP you were talking to?

Tbh you can hear a lot of what’s going on with someone’s breathing over the phone, if you’re a doctor.

Crock of shit. I listen to chests all day every day. As I’ve said a chest exam is only one part of a clinical picture which cannot be built up by a telephone consultation - resp rate, temp, sats etc. we’ve got so used to sub standard care we think it’s ok. It’s not.

I’m shocked that some people on this thread think it’s perfectly ok not to have a face to face appointment with the OPs symptoms.

You need to have your oxygen, BP etc checked.

Twice in my life I’ve had what I thought was just a minor chest infection. Both times after the GP checked my stats an ambulance was called to the practice and I was admitted straight to hospital for over a week each time for IV antibiotics and oxygen. I had no idea how unwell I was both times, but my oxygen levels were an emergency.

I dread to think what would’ve happened if I had to suffer some shitty GP that didn’t check my stats.

I'm in hospital. I'm on a iv drip. Plus oxygen mask.Hospital was very good and got me seen straight away.
The doctor couldn't believe I wasn't seen by the GP.
Took our dog out into the garden and when coming back in felt disoriented, struggled to breathe.
Our DD was visiting and called an ambulance. Didn't have time to take more than one tablet.
My oxygen levels were very low and BP was too.
All since 5pm thank goodness for the NHS.

I second a crock of shit and see OP is in hospital now. I'm a retired GP. I worked through the pandemic and we gave up telephone consultations in November 2021 as we felt it was substandard care. My partners are 15 years younger than me and the relief when we stopped the 12 telephone consultations which invariably led to 11 face to face consultations and a lot more time was palpable

I've often taken a history from a younger patient, thought they looked and sounded ok then done their observations and thought "shit, they're ill" young people mask severe illness until they crash.

I once read that depending on the type of phone you have, not a mobile but the old landline style 2 piece, you can actually take an accurate heart rate.

You can take a heart rate with a mobile. Supposedly not accurate, but I've tested it a few times against the hospital monitors and it's never far out.
Edited to add, just seen you (op) are in hospital, wishing you a speedy recovery.

The nice guidance would be an xray if you’ve had a cough for more than 3 weeks. I’m shocked how many posters think this is all acceptable care.

I'm glad you're now getting the treatment you need. I had pleurisy as a teenager and it was hideous, so you have my complete sympathy.

Incidentally, the GP who diagnosed my pleurisy listened to my chest for a clicking sound when I breathed. Apparently it's because the chest wall was sticking rather than running smoothly as it were. I'm not sure how that could be diagnosed over the phone.

MN has such low expectations of the NHS, if your arm isn't hanging by a sinew, then A&E is not for you. The usual argument being the alternative is US style healthcare, overlooking the fact that much of the world works well on mixed insurance/social healthcare.
The NHS isn't working when this is the care a lot of the country is receiving, there needs to be honest discussions about this.

The thing is, it does work in pockets. Last Friday I called my gp at 12pm asking for advice following a virus which has seen me peak a high temp twice over 3.5 weeks with ongoing cough. I was put on the assessment list. 5 minutes later I get a call asking me to get to the gp surgery for a nurse assessment/blood test/xray form to use at hospital walk in. During the appointment my peak flow was low so the gp came in and assessed me, upped my inhaler and gave me steroids. I then went for the xray and by 4.30pm I was cleared of pneumonia and confirmed it was an asthma flare up.

My gp is aging and I worry what’ll happen when he retires.

What's incredible Richard is that with the vintage "candle stick' rotary phones you can actually carry out a prostate exam providing the person on other end is qualified

I was very poorly with a cough that wouldn't go in 2020 (just before COVID). Late 30s age but history of 'dusty' work.

X-ray, blood tests, chest CT, precautionary blood thinners....and finally diagnosed with pleurisy. I almost felt they were taking it too seriously! The ANP who looked after me was amazing. That was following a same-day GP referral to A&E.

Sorry you didn't get the same treatment from your GP.

Pockets aren't good enough though. My Dad has had unbelievably good paramedic and community nursing care, he couldn't have had better care if he was Bill Gates himself. But the nurses work hard at keeping him out of hospital as our local hospital is so poor, they've nearly killed him on two occasions. The hospital is near bottom of Starmer's new league table, the ambulance service is at the top. A health service can't function with that much disparity.

I agree. The hospital I work in has a terrible culture and bullying from the top but apparently we’re doing okay compared on the league tables. My parents’ experience was very hit and miss.

...and this is exactly one of the reasons why antibiotic resistance occurs. She should be ashamed of herself for prescribing something without even looking at the patient. She could have heart failure and drop down dead tomorrow, and then what?!
Stupid, stupid "doctor". This has me furious.

To one of the other posters: of course a listen to a chest is only part of an assessment. You wouldn't just listen to someone's chest and then ignore the visual signs of say blue lips, low sats, high heart rate and BP, would you?
This patient could have run in from the garden and have been panting breathlessly.
There is no definitive way of detecting a feint wheeze without a stethoscope or indeed if the bronchioles have been infected without an MRI. A phonecall?? Disgusting.

I at seen your update. Glad you're getting the help you so obviously need.
Please, please make a formal complaint against this "GP".

This is madness!

I saw a GP in an emergency out of hours appointment when I had pleurisy. He sent me straight to hospital thinking I was having a heart attack. I had loads of tests before a diagnosis.

Hope you feel better soon op

dd couldnt get a GP appointment for a week when she called, an ambulance was called for her whilst out shopping, also admitted with pneumonia - GP services are absolutely struggling