To leave the doctors in tears? (GP's opinions gratefully received...)

[AuntieMaggie]

Ok, so I went to the doctors today for a bad shoulder/neck. I didn't see my usual doctor as they weren't available, so even though I've got a complicated and long medical history I thought this would be ok.

However, the locum doctor decided after we had discussed my shoulder/neck that we would talk about my being overweight and being on the pill, despite the fact that I had already had this discussion with my usual doctor before xmas (which he knew as he kept saying 'I know you discussed this with X when you saw them...') and insisted on showing me the criteria for whether or not someone is prescribed the pill and that I'm in the last category which shouldn't be prescribed it.

I tried to explain to him that I am on the pill because I have polycyctic ovaries, and that the decision for me to go on it was made between myself, my gynae, another specialist, and my normal doctor to manage the fact that when I ovulate the cysts on my ovaries grow to 5cm and I cannot walk because of the pain, which can last upto 2 weeks. However he kept saying 'I'm telling you this because I sometimes work in family planning' and 'if you walk out the door and something happens to you it will be my responsibility'.

I regularly see the nurse at the surgery for weightloss and have lost over 2 stone, albeit slowly, and am seeing her again tomorrow (which I told him and he still carried on and weighed me so I was also upset that I'd put on half a stone over xmas despite hardly any indulgence).

So he carried on this vein, making me feel like an idiot, with me getting more tearful and when I left I burst into tears in the waiting room and the receptionist was so worried that she whisked me off into a side room.

I should probably mention that I am also on ADs for anxiety mainly concerning my health.

So what do you think? Did I overreact?

Because I'm torn between thinking he was only doing his job and thinking he should have picked up on how I was reacting to what he was saying and actually listened to me.

yes and i cant see why she is upset when a doctor is doing what they should be doing. He hasn't said anything she doesn't already know and is trying to help her.

Do you have to take a week off?

No narky - unfortunately!

Though I did have to take an extended lunch when I saw the state of my make up in the car so I could go home and tidy myself up!

She's already losing weight and being monitored by the nurse. She was due to be weighed the next day. It was in her notes. As was the fact that she is being treated for health anxiety.

Broad prescription guidelines have exceptions, where the benefit outweighs the risk, and the opinion of a gynae trumps a gp on birth control pills.

Hang in there OP. Lots of "red" days on slimming world too - stick with slimming world but make it as "low carb" a version of the plan as you can.

Whilst you probably are at increased risk by being on the pill, GP's/Consultants will weigh up the benefits against the risks, and in your case, the pain you suffer probably makes it worth sticking with the pill at this point as long as you are tackling your weight to try and minimise the risk overall. I dont see why the locum couldn't accept this, and if he couldn't, why he couldn't discuss it with the OP's regular GP and consultant, rather than hounding the OP.

I was surprised that given that he 'sometimes works in family planning' that he didn't know my gynae, as he's very well known in Bristol and I'm very lucky to be under that care of someone like him, although it's because if I ever do get pregnant then I'll need extra care and monitoring to check the effect on one of my organs due to an unusual condition.

Glad you've had the chance to make yourself feel tidy and together. It must have been very stressful.

It might be worth asking your consultant if you could take the pill for your full cycle without a break. There may be reasons why they'd rather you didn't, but if you could even do it for 3 months or so it would give you a block of uninterrupted weight loss that might help your Pcos.

I know about the red days Tatty, but have you been to a class and mentioned them lately?

It's all about extra easy now... and if you don't lose weight on that then you must be stuffing your face with take away every night...

My SW consultant is also rubbish - another reason I'm seeing my nurse tomorrow to see which group she goes to as she's lost loads!

Hadn't thought about that Narky - will ask thanks :)

I had to come off the pill 3 years ago for major surgery which is when I put all this weight on, and the pill I'm on now isn't as strong so I still get some hormonal symptoms and period pains but I don't mind that as it makes me feel normal.

Anyway, thank you all for taking the time to reply :) you've all made me feel much better.

Not sure why its such a big issue. If anything he was wasting his own time as not telling you anything you did not know. Try to be more assertive, and well done on the weightloss

have you tried xenical? i too have PCOS and this was a real help.
Lots of people dont like it as the side effects are awful if you eat fatty food but i would after just one epsode of overdoing the fat intact it sure did help concerntrate the mind on avoiding the fatty foods.

You probably know this, but most PCOS can be helped by following a special diet, low GI but - see Colette Harris's pcos diet book for full details (rather than slimming world.)

If you are high risk on the the pill, well its high risk whether you have pcos or not -so he was right to say what he said. Its your choice though whether you want to take he risk of the pill, but its important that you fully understand what the risks are, and don't think the risks disappear as you have PCOS.

IMO as a fellow sufferer weight loss and the plan that Colette sets out in her book is much better for you than the pill.

I hope you feel better.

Notice you're in the south west and I am too and I was pondering the other day if gp's have been told to cut-down on giving the combined pill - is that what you're on?

I went to get new pill a couple of weeks ago as currently on cerazette which just doesn't suit me and was told because of my advanced age 38 - I can't have the combined pill but have to take the mini-pill. I'm not terribly keen on that as its not that reliable if not taken at same time each day (different one to cerazette) and I am worried I'll forget. But Dr was adamant that despite not being in any other risk groups that I couldn't have the combined pill.

Now I'm perfectly prepared to defer to the Dr but was quite odd as my sister who lives in a different region has no issue getting combined pill from her GP - strange.

So sorry for ramble but I do wonder if there's just a general clampdown on pill prescriptions at the moment.

A similar thing happened to my mother when her regular GP (who'd been treating our family for over 20 years) was on holiday, and she had an appointment with the new one in the practice. He started poking his nose into things that weren't what she'd come to see him about, giving conflicting advice to what she'd previously been told, despite having no knowledge of the whole inter-relation between her diabetes, depression and arthritis. To make matters worse, the reason for her appointment (earache) was dealt with by syringing her ears, and he did such a poor job that she ended up with crippling pain that took her regular GP months to fix.

Since then (about 10 years ago) she's always very pointed about requesting not to see him, when she makes an appointment and the regular GP's not available.

As a result of her experience I have no patience for unfamiliar medical professionals stepping on the toes of my usual contacts in whom I trust (my GP, midwife, health visitor, practice nurse, etc). I would recommend that anyone in the OP's position say as soon as they feel uncomfortable that they're very happy with the other medical advice they've received and would the current person mind sticking to the problem at hand.

"I know that's no help, but people so often end up going along with things in GP surgeries that they really dont have to do".

So true TattyDevine. It's hard when faced with an overbearing, I-know-more-than-you HCP but the truth is, it is your right to stop the discussion, not get on the scales, and not do anything you're uncomfortable with. Yes, it takes some guts, but you will walk out of there more empowered for it. Have confidence in your regular GP and specialists, your plan of attack with your health problems (which appear to be working) and that fact that you are actively improving your situation. This one-off GP might have mistaken you for someone who needed a lecture, but frankly once you told him it wasn't his concern, he should have shut up.

Next time just say thanks, but bye.

YANBU. Sounds like he didn't listen to you. You've made the decision to go on the pill under the guidance of other medics and you're aware of the potential problems. He must have seen you were getting upset and should have been a bit more sensitive.

I have PCOS so know how tough it is - well done on the weight loss and keep it up.

Actually, walking out is not feasible if you have anything that shades into mental health even remotely. There's a very real chance it will be deemed you "refusing treatment" and used against you. The more you struggle, the tighter the coils.

There's a thread here, at the moment, and tho my own experiences are nothing like as bad I'm now very, very wary of interactions with Health Professionals.

Thank you MumNWLondon - the main issue that I'm on the pill for is the pain - I literally can't walk as the pain is so bad when I ovulate due to the cysts becoming so large. So I had to make a decision about what was more important and rightly or wrongly I choose to go onthe pill albeit a lighter dose one to previously. My sister is very 'in the know' with PCOS and she lost loads of weight by becoming a pescetarian and taking certain supplements but she doesn't suffer the same symptoms as me. That's how I know about the carb thing and carbs definitely do not fill me up. I have been crying in hunger determined not to eat anymore because there was no way I should be hungry when I've been doing green days on SW in the past before my sister told me about them. I'll ask if she has that book.

cantspel - I tried xenical in the past and think I may try it again although I've been avoiding it because I found that it reacted with some odd foods that had very little fat in them at all and sometimes spicy food. Maybe it was just me...

Tracybath - was it a young doctor? I'm in Bristol and the locum I saw today came across as very formal and by the book so thought perhaps he's still reasonably new. Yes it was the combined pill and he showed me a formal document about the guidelines to prescribe it so perhaps they've had a reminder or somethign about the criteria!

Auntie - new-to-the-profession HCPs can be a bit rigid - they sometimes are more concerned about what they have to do than about going with the flow and listening to the patient

I've just read the thread, although I have no experience or advice to offer - but I can't help wondering what the doctor's reaction would have been if you had turned up with a long list of ailments you wanted to talk about? I can imagine mutterings of double appointments, etc etc. And yet, when you go in with one issue, the doctor saw fit to waste spend his time giving a whole load of unnecessary advice.

Saw the nurse today - feeling fairly positive about losing weight now but I cried when telling her about yesterday.

While I was there I saw the reception manager I spoke to yesterday and she had spoken to the doctor who felt perhaps he was a bit hard on me but he is really worried about me being on the pill.

So I have to go back and see my doctor to talk about it so they can keep an eye on it.

Nurse said not to worry about it too much in light that we are working on my weight and if the worst came to it they would send me back to my gynae to sort it out.

However I now can't stop thinking about it and feel really tearful.

I've also found the document he showed me with the criteria, and I am in the last one which shouldn't be given the pill. Interestingly enough though it was written in 2006 and so I expect the people involved in the decision for me to go back on the pill at the end of 2007 would have been aware that I shouldn't be given it at my weight, and I was 2 and a half stone heavier at the time!

So part of me thinks that they recommended me to go on the pill because it really was the best option for me even in light of my weight, but part of me is really worried. :(

Its not like I'm planning to be on it forever - just until we decide to have children in the next year or so...

So confused all over again.... and I really felt before all this that my health was now under control and my life was back on track and this was going to be a good year....

Oh and DP has just said he can't afford to take me out for my birthday :(

You're losing weight which lowers the risk. The doctors who agreed to prescribe the pill are aware of the guidelines, but obviously felt there was more benefit to you taking it than not. The guidelines may have tightened in that year but it wasn't a new idea- the risks have been acknowledged for a long time. They will have fully considered them.

If you are concerned, when you talk to your own GP ask about taking a daily low dose aspirin- this has been shown to lower the risk of clotting. I have no experience of PCOS so you'll need to check it's the right thing for you. Also avoiding long periods of constant sitting- get up and wander about a bit every hour or two. And, whenever you see the nurse/doctor get them to check your blood pressure.

For now, why don't you think about what you'd like to do for your birthday? Even if you can't go out you could rent a DVD you like and have a relaxing couple night or get some wine in and invite friends round- if you have any supermarket vouchers or points this would be a good time to use them. If you check online a lot of restaurants have vouchers that would bring the cost down. You could make plans for the day after your DP's pay comes in. You could have two birthdays.

You've had a lousy few days so be kind to yourself