Our Doctor was shitty with me this morning. Was IBU, or was he?

[AgentZigzag]

My DD1 (10) had asthma diagnosed when she was about 4, until 2 years ago when she was prescribed Piriton she had 3 or 4 chest infections a year, after taking Piriton it's now about 1 or 2 a year.

This involves her being so out of breath she can't walk up the stairs/talk, really listless, pale, coughing all day/night.

It's awful to see your normally energetic DC regularly in such a state.

I've estimated that she's probably had 20 odd chest infections so far, so I know the symptoms very well because they're the same every time.

I took her to the Doctors this morning and when he asked me what he could do for us I said 'I think she has another chest infection', and he said 'Don't tell me she has a chest infection, I'll tell you what's wrong with her', and to say he was annoyed would be an understatement.

The reason this phrase made me angry (and I'm paraphrasing what I said to him) was because sometimes when I've taken her along saying the same thing (not sure how many times), they've said 'It's just a cold making her asthma worse, antibiotics won't help'.

So we've gone away, the asthma has got worse and we go back two days later (after watching her suffer), they give us antibios and it starts clearing up after another couple of days.

I know it's not just a cold and the antibios aren't just coincidently working, and I understand Doctors don't like people googling symptoms and telling them their job, but I don't see this as the same thing.

I just see it as easier for me to say 'I think she has a chest infection' than go through the same thing every single time, he can confirm she has or that he thinks she doesn't.

The Doctor we saw was one of two we see, we've been going for 8 years, I trust him because he's always so caring and doesn't rush you.

I was angry at the time but didn't raise my voice or let it creep into my tone. I'm sure of this. By the end of the appointment he was talking really kindly to us as per normal.

But now I'm upset at the way he was, perhaps he was having a bad day or is generally pissed off at me saying she has a chest infection and not phrasing it as 'Her asthma is bad'. Perhaps he just had some bad news or something? I don't know

DD1 was at him, and says she's glad I spoke up and said something, she also believes he was shitty straight off (and not because I've spun it that way to her).

So was IBU to say 'I think she has a chest infection'? Given that I know DD1's asthma like the back of my hand, and if I go away without antibios DD1 has another at least 4 days of agonising breathing.

Was I right to answer the Doctor back and explain why I said it? He didn't take it very well, but I thought he was out of order at the time.

I'm dreading her being ill again with it, I don't really want to change doctors after all this time, and as I've said I really trust and like the practice, how can I deal with it?

I'm totally open to being told I was unreasonable, and I would appreciate objective views.

Sorry it's long, I'm trying not to drip feed.

AgentZigZag, she needs to be on a nebuliser. 5 puffs every 20 minutes is far to much for you to manage at home. She needs to go to A & E. Take her over now, I'll bet they keep her overnight.

sorry x-post there, wow they told you 10 puffs every 20 minutes, haven't heard that before, usual rule is more than 10 puffs every 3/4 hours, then A&E is needed.

But you've obviously been given different advice.

I'm sorry I really have to say again, I know you've been told differently, but I really don't think that advice is correct, 5 puffs every 20 minute is an awful lot, I really really would take her to A&E, I would imagine you will be kept in.

I hope she is ok.

I think your Dr was unreasonable.

I pretty much always self-diagnose - in fact worse than that I talk to either my sil or friend who are both GPs and get their opinion too

But means I get dealt with super-swiftly at the Drs and am very aware they do not have much time to spend with each patient.

Yes perhaps he was having a bad day but it is his job to be polite to patients.

The hospital said she could have 10 puffs every 20 minutes? That's a whole inhaler in less than 7 hours! Did they say how long you could keep that up for? Assuming it's ventolin she's on then I can't imagine it's safe to do that for more than a couple of hours (the stuff really makes your heart race if you take a lot of it). If I was needing to take 20 puffs of my inhaler an hour for more than a couple of hours with no sign of improvement then I'd drag my arse down to A&E. By the sounds of it she needs a nebuliser or three and maybe some IV antibiotics.

agent Did the GP check your DD's oxygen satuations? If she is needing that much ventolin ?

Sadly I agree she may need to see a consultant and may need medical support/ nebuliser tonight. I really do hope she improves soon.

I was pretty surprised at the amount we were told was OK to give her, but it's definately what the nurses said to give her, and were giving her.

I actually made her a little booklet when it was really bad because it's so hard to keep track of 10 when it's that regular.

Coldtits, I believe the nebuliser just gives the same meds as the blue inhaler, or that's what she's had in hospital and at the doctors before.

That's one reason they said to give her that much ventolin, it's instead of the nebuliser as she uses a face mask to diffuse it.

I just monitor her breath and as it starts to control it I start stretching out the time between the ventolin.

Anyway, to answer the original question. I really don't think it's unreasonable to tell the doctor that you think you or your DC has something that has been diagnosed that many times before. I've had at least a hundred chest infections in my life and I tell the doctors that I have a chest infection (I dispense with the "I think" bit). I've only been refused antibiotics once and that time I ended up in hospital a day or two later. The last couple of times I've had a chest infection they've written a prescription for my housemate to pick up for me after a phone consult.

They will give her that much ventolin and more in hospital, but that is rather dangerous advice to give that much ventolin at home. How long are you to continue that much before going to hospital?

10 puffs of ventolin is supposedly the same as a nebuliser.

But she may well need back to back nebulisers, oxygen, IV antibiotics, fluids and very careful monitoring.

Sorry to go on, hope you are both ok, you must be worried, and all on top of grumpy doctor this morning.

agent I am not a dr or nurse so please take this advice as parent to parent. DS allergies cause wheezing/ breathlessness and I work wth children with nuerological respitory conditions so this is where I have this information from.

Can you record how many breaths/minute your DD is taking. (that is in and out counting as 1 breath) Although she is needing a lot of ventolin if her breathing isn't rapid/ laboured then I agree with you that it is working as a nebuliser would - I have been told the same thing as you btw re the amount that can be given. If however her breathing is still rapid/laboured despite the ventolin I would suggest hospital for advice if nothing else. (could you ring OOH GP?)

Please, again, this is just information I have re when to seek help with DS/ pupils. You know your own DD better than anyone and from your posts on MN you seem to have your head screwed on

Again I hope you DD is better soon.

If a doctor spoke to me like that I'd make quite sure I never saw them again. I detest the patronising attitude (which I spied in the gp who posted earlier in the thread) that assumes that patients are essentially ignoramuses who need enlightening by the doctor. I am in a similar situation in that dd is under a paediatric consultant as she gets a serious bacterial chest infection approx once every 3 weeks in winter (may start as viral but always ends up a bacterial too). If my regular doctor asked 'what makes you think that' when I said 'I think dd has a chest infection' I'd assume she'd taken leave of her senses. we've gone through the exact same scenario upwards of 20 times in her short life; I know as well as any gp the signs that indicate she needs antibiotics. Luckily my gp knows this too and we discuss whether dd needs antibs and come to a joint decision based on them listening to her chest and me assessing how that matches her overall condition. I know pretty accurately whether we need immediate antibs and when we can hold off, and the doctor takes my view very seriously. Patients with chronic conditions (or their parents) build up a fund of expertise that only a bad doctor does not take seriously. I would find a new gp!

AgentZigzag if you can, get rid of her bedroom carpet and lay laminate or wood flooring. Trust me it was life changing for me. Does she have a spacer, plastic thing you spray the ventolin into (helps you get all the goodness), if not ask your GP to prescribe one. Is she on either becotide or seretide as well as the ventolin, if not they may not be managing her asthma very well.

Oh and one more thing, if you haven't already... Remove every single teddy bear away from her bed.

BTW my experience is identical to Kepler... moving to London strangely helped me too, because I am highly allergic to rape seed, which they grow in abundance where I grew up.

YANBU I take DD in to see doctor fairly regularly with suspected ear infections and usually say what I think problem is no one's got shirty with me yet and I'd get pretty pissed off if they did.

Hi, I'm a GP, YANBU, perfectly reasonable to say what you think and then (as prev said) you can discuss and make a plan together. However, if he's usually great I would just put it down to an off day and forget about it - I am sure I have been unreasonably grumpy with patients at times for reasons that have absolutely nothing to do with that patient - it's wrong, but it is human.
I'm also concerned about the 10 puffs every 20 minutes advice, how long have you been doing that for? that's the equivalent of just over 1 nebulised dose salbutamol hourly, which is a lot. If she's still needing that / getting tired, please think about getting her reviewed tonight - either A+E or OOH GP. I know I can't see her and I may be being a bit over-anxious, but sounds like she may need a wee bit more input, even if it's just overnight obs.
Take care and hope she's better soon.

I don't think you should be phrasing things in order not to upset the doctor. He/she is the professional in the relationship and should act accordingly.

YANBU. If you suspect xxxx then whether or not you actually have xxxx it is perfectly reasonable to start off by saying "I think it might be xxxx" It is a good opening to the consultation and then you can go into the details of the situation, examination etc and the decision about diagnosis can then be made.

I think the response the GP gave was rude. He could have asked why do you think that?/can you explain a bit more about what has been happening?/can you describe the symptoms? Anything really to give you the chance to expand on the details of the situation rather than snap like that.

Saying that if you say he is normally kind and this seemed a one off out of character event then I'd probably let it go now. Hopefully he would have realised it was a stupid thing to say as soon as he said it/as soon as you spoke up. We all say stupid spur of the moment things without thinking sometime in our life. If this was a general standard attitude I would be inclined to make a formal complaint.

I have asthma and got given the same advice, 10 puffs every 20 minutes is the same as a nebuliser. It does work. BUT if she is grey-looking and tired, you do need to take her to hospital. I know from experience, struggling to breathe is absolutely exhausting. If they can get her on oxygen her sats will go up and she will be much more comfortable.

If she's been taking the ventolin for over 2 hours like that you DO need to get her seen.

Hope she feels better soon.

Thanks again for your posts, they really are appreciated

In a comparison with how she was this morning she is a bit better.

She's coughing a lot less, getting up and moving about a bit, eating, got more colour in her cheeks, and the best indicator of all (although I'm not telling her ) she's started talking!

I've got a stopwatch on when she needs her inhaler (about half an hour at the min), it's all about objectively measuring and controlling it, and it has improved over the day.

DD said that as the Dr was on the computer, she could see him typing something like 'can only be cured with amoxcillin' and I'm wondering whether he was putting it as 'advice' to whoever sees us next, or was he making a record that we'd had words.

DH suggested having a look through the freedom of info act thingy, it costs a quid and we can perhaps see why they are resistant to prescribing the antibios.

Why can't they see the pattern in it?

And I'll tell you what, this will be a thread I'll cite if I see posters slagging MN off.

This morning I was very upset and confused (as was DD1 even though I tried to play it down) as to whether it was me or not, and I feel much more in control of the situation now.

I'll go back to the doctors if I need to and just act totally normal, it's possible the patient before us made him feel stressed (although I don't want to say why I think that) and if she has another chest infection, I'll say the same thing.

I'm actually a bit worried about the Dr as it was so out of character, but to ask would mean I have to say we had words to someone else, which wouldn't be good.

Regardless of what the GP said, I'm concerned at the management of her respiratory symptoms.

Is she on anything apart from the salbutamol?

Salbutamol should be helping her for about 3-4 hours - if she's needing it every 30 minutes then it isn't working or isn't what's needed in the first place.

It may well not be a chest infection - an exacerbation of asthma can cause similar symptoms, without the infection. Did he listen to her chest, check her oxygen saturations, check her respiratory rate?

As nice as your GP may usually be, the requirement for antibiotics once or twice a year every year, accompanied by the need for Piriton, along with profound breathlessness and possible infection is screaming uncontrolled asthma at me. You really need to be seeing a specialist nurse, or someone in a paediatric respiratory team.

They do hate being told and they're probably sick and tired of patients walking in with something they printed off the internet and they've convinced themsleves that they have it or need a prescription for something.

He could just have had one of those patients I guess. But then you're not one of those patients and you didn't tell him what was wrong with her as you said "I think" you didn't say "I know".

I've done it when I've gone in and said I have cystitis. It isn't rocket science.

He was a bit shitty but he was fine by the end. He's only human. I'd try not to let it bother you.

How is she this morning agent? I just popped on to see, I bet she must be shattered.

I was thinking more about this as I have started appointments in the same way as you many a time. I in fact went to the OOH a few years back with one of mine I went in and said 'I think he might have croup again', doctor said 'ok then what's been happening', I explained, he examined DS, then he said that 'actually he didn't think it was croup', I said 'right, ok then', DS was admitted to hospital with his first asthma attack, doctor wasn't grumpy or rude at all and as it turned what I thought DS had was totally wrong.

Sounds like your suspicion about the patient before you is correct, the way he spoke to you wasn't called for at all.

She's still improving thanks sky, very kind of you to ask

I've even had a bit of back chattig this afternoon, so all's well

DD has Qvar preventer and ventolin, I think the weather affects it too, wet/warm and the damp air makes it worse.

They have an asthma clinic at the practice, but they've never asked to review her meds, perhaps I'll ask, because you're right sidge it's not right.

We've been looking at it as an improvement on how she was, so not really questioned that she shouldn't be having them at all.

We just thought it was one of those things that you treated as they came up.

Just presumed if there was anything they could do, they'd have done it by now. Stoopid us.

I agree wholeheartedly with the person who recommended Symbicort. I was a two inhaler a month sort of asthmatic (when I was doing well) and now that I'm on symbicort I'll go weeks without using my ventolin inhaler. Even when I'm having a bad patch I won't necessarily need my ventolin inhaler every day. Over a period of less than a year I was asking for a prescription for ventolin at the same time as the symbicort until I realised I had half a dozen unopened ventolin inhalers in my drawer. I never noticed the difference when I was on just a steroid inhaler but I do notice the difference on this. It's a mixture of budenoside (a steroid) and formeterol (a longer lasting version of salbutamol) in one of the powder inhalers which should make it ideal for a child. Best of all it doesn't taste rank like the steroid aerosol inhalers do :)