To Be Unhappy with GP Surgery

[ruby29]

My 9 year old DD is just home from hospital recovering from a nasty appendicitis.

She developed the symptoms overnight and I phoned the GP surgery as soon as they opened at 8.30am and explained that I belived my daughter had appendicitis and would like an appt as soon as poss.

I was told that the only appt was 4pm as the Drs do not offer morning emergency appts and that there was no possibility to speak to anyone prior to that. I emphasised again that I was worried about her but the receptionist wan't budging.

In hindsight I should have gone straight to A&E at this point but waited it out for the appt. This was a mistake as the GP was of the opnion that there wasn't anything to worry about and sent us on our way.

Fortunately at this point. I trusted my instincts and took her to A&E and she went to theatre later that night.

I am upset with the Dr as I don't feel she took it seriously enough but in addition feel that the system of not seeing anyone in the morning is totally unreasonable. How many people must be worrying about a sick child overnight and phoning in at 8.30 only to be told they have to wait an additional 7 hours?

Surely they should at least have a triage system in place. Am I unreasonable in thinking this is totally
unsafe practice or is it the norm?

Am obviously in a bit of a minority then !

Clearly had she been in unmanageable pain or very unwell I wouldn't have bothered phoning the GPs.

ALthough she had absolutely text book symptoms she wasn't acutely unwell. (I do actuallly have medical training but can be very difficult to be objective with your own children. Hence wanting a 2nd opnion!)

Appendicitis was nasty as in very severely inflammed.

I do realise the diagnosis isn't always straightforward although all Drs we saw in the hospital were in agreement.

ANyway, She is recovering so Onwards and upwards. Will maybe have to find something else to be unreasonably disgruntled about!

As a GP I have been heartened to read how many of you have stuck up for the GP and practice!

Actually I do think if you told the receptionist your concerns you should have been referred to A and E or at the very least had a triage appt over the phone. Where I work if no appointment were available the nurse practitioner would speak with you and then decide how soon your Dd needed to be seen. At the practice where I am a patient they have an emergency clinic every morning just for children. I have never had an issue getting an appt when needed (adults are another story though).

It's impossible for me to comment on you GP missing the diagnosis without being here and hearing the history and examining your daughter. Appendicitis is rarely textbook though, especially in children.

Acute medical conditions are certainly something we see plenty of as GP's. I do find it odd hoe many people turn up with obviously hospital problems though. Deformed wrists that are obviously fractured, or last week a disocated thumb for example. Strange.

Poor BIL had pain and vomiting for seven whole days, GP was adamant it was not appendicitis - he went to A &e several times and they sent him away. He finally got rushed in with peritonitis and nearly died. I don't know what the moral of the story is, other than appendicitis must be really hard to diagnose, so even if you'd seen doc early, you might not have got the correct diagnosis. Hope DD is better soon.

I would complain for sure. Not about the appointment, GPs cannot be expected to be A&E but about the GP misdiagnosing.

You will be doing the GP a favour so that they are more vigilant in the future. Imagine if you had had more trust in the GP and taken them at their word that it was nothing - could have been fatal if the appendix burst.

What led you to think it was appendicitis by the way?

We had a GP misdiagnosing and then a doctor at children's A&E misdiagnosed. It happens.

I don't think you're being unreasonable. My surgery would've sorted something out for you, whether it be a telephone appointment or asking you to come in and squeezing you in somewhere. They've always been really accommodating with me and other people I know in the area. That's what I'm accustomed to, so I'm surprised to hear that others wouldn't expect emergency treatment of some type from their gp.

So it goes that if I had a scheduled appointment and they were running late, it would be fair enough because someone like you and your child should take priority over me despite short notice.

People don't always know when they're gonna get sick! Isn't that just common sense? The receptionists need to work around that.

I think you should write and flag up concerns about misinformation (or lack thereof) from receptionist and fact that GP doesn't have some form of phonecall system for worried parents, even if it's after AM surgery at 11ish? Maybe not complain perse but flag worries. You tend to get further doing this than complaining anyway!

Also, A&E - esp the paeds side - will NEVER tell you you're wasting their time if you are worried about your child. If you take child in with what is obviously a slight clean graze on knee, then they may be a little but for appendix / bump on head / flu-like symptoms - to rule out meningitis - never. They would rather see 100 kids who they can say 'nothing wrong' to the parents, than 1 dead child who had parens who were worried about time wasting.

My surgery would have arranged for a practice nurse to triage - usually within half an hour - and depending on the outcome of that would have either offered an immediate emergency appointment or told you to go to A&E - I think the latter should have been done regardless. Not the GP's fault though, the receptionist acting as gatekeeper handled this badly and would benefit from training.

YANBU - they should have a system in place to triage any urgent calls. You should complain so that they can improve the system.

Hope she's fully well soon.

Getting an appointment the same day is hardly something to complain about really!!

As for the misdiagnosis that is completely impossible to comment on without knowing what symptoms she was showing at the time of the visit. It also needs to be remembered that GPs aren't expects in everything so of course they wont see the same things as a specialist will.

DS has asthma, when he was 12 months i took him to the GP as he was ill, GP said all was fine 4 hours later he was in A and E on oxygen and spent a week in hospital. Although I was miffed with the GP (he wouldn't prescribe the steroids I knew he needed!) I also know how quick he deteriorates and how things change quickly. We have now been told to skip the GP altogether for anything to do with his chest!

YABU

If you took the view that your DD had appendicitis then you should not have bothered with the GP at all and taken her straight to A&E and not even waited until the morning.

You are blaming GP you delayed matters yourself for several hours by waiting for the GP surgery to open. What on earth for? What did you expect the GP to do with appendicitis she'd have to be reffered to hospital in any event and it's pointless to delay the inevitable.

There are several things you could have done: telephone NHS Direct, telephone an out of hours GP or go to A&E in the middle of the night.
Why didn't you?

Actually I don't think YAB that U. Agree you maybe should have gone straight to A&E with suspected appendicitis.... BUT a GP can get you referred straight to surgical assessment unit or peads SAU if they suspect you may need surgery instead of you potentionally waiting up to 7 hours in A&E. Sometimes A&E through to surgery is not the quickest route - and quickest route is best for the patient.

Hope your DD is better soon (not the best way to spend the school holidays)

Clearly I wasn't sure she had appendicitis (How could I have been?) But I was worried she might have. My judgement as a mum of 4 and with training myself was that she wasn't sick enough at that point to need emergency treatment.

I took her to the GP to get an opnion +/- referral to the surgeons.

Given that when I did see the Gp she didn't think it was it obviously wasn't that clear cut.

My main concern really was the thought of people phoning the surgery concerned about their child/elderly husband etc and being offered no other advice rather than come in in 7 hours.

If other surgeries can manage to offer a phone triage system etc I don't see that I am really so unreasonable!

But as others have said if something is that urgent you can't wait 7 hours to see a gp there are other options available - nhs direct/walk in centre/a and e.

What do you want them to do cancel other people's appointments to see you? There is a limit on how many people a gp can see in a day and often more people wanting appointments than available appointments.

I took her to the GP to get an opnion +/- referral to the surgeons.

An out of hours GP service could have advised you and triaged over the phone. If they took the view she needed admission, they could have fast tracked you through and told the hosptial to expect you. You could have done this rather than waiting until the morning.

Out of interest, is there any Continuing Professional Development value in informing GPs when they do get something important wrong? Not as a complaint but just as feedback?

Otherwise I can imagine a practitioner coming to believe they can reliably spot X, when in fact they can't. (I know it's lurking in the notes somewhere, but in our practice the doctor who makes the decision might never see you again).

What do you want them to do cancel other people's appointments to see you? There is a limit on how many people a gp can see in a day and often more people wanting appointments than available appointments.

That is a very good point. There must be countless mothers telephoning first thing in the morning about sick children, they can't see them all. The whole routine appt system would shut down if every mother with a sick child was given an urgent appt in the morning. I would be complaining if I got a phone call from the surgery cancelling my routine appt I've probably waited two weeks for to fit someone else in.

IMO if your DD was too sick to wait any later than first thing that morngin, you ought to have looking elsewhere than your GP surgery for advice, as they can't drop everything for her.

Your OP also says that she was in surgery that night. So in other words she could actually have waited an additional 7 hours to see the GP at 4pm as surgery wasn't scheduled as an emergency as soon as she got to hospital.

Of course I wouldn't expect someone else's appt to be cancelled!!

As I said above many surgeries have a nurse triage/ dedicated duty Dr solely dealing with urgent calls/appts.

Again my worry really was the safety of their system. Not particulary with respect to myself necessarily but as to how they respond to the "countless" other sick children.

I am amazed at how many people actually stick-up for the GP practice.
Free maybe, but compared to elsewhere in Europe, the service is actually quite poor if you consider GPs hours / wages.

It might be my anecdotal evidence from having been registered with a handful of crappy practices, though. Somehow, I do hope so.

If you thought it was an emergency why did you go to your GP? A+E would have been appropriate for an emergency, and you would have been triaged on arrival.
The was that I think about it is that if I feel that the problem requires an immediate hospital solution then I go to hospital.

Some GPs aren't great, but appendicitis is pretty difficult to diagnose. Did the GP ask you to come back or go to A+E if things worsened or did they just say 'there is nothing to worry about' and send you on your way?

Our surgery is impossible to work out. Sometimes you ring and ask for an appointment and straight away get told to come at X time. Other times you will be asked "is it urgent for today?" and other times you will be told what is the problem and the nurse will ring you back. It is frustrating not knowing what the response is going to be.

my doctors have morning and afternoon emergency appts, if they are fully booked if you push hard enough on the bitch receptionist a doctor will give you a call back within the hour and if you phone in the am will usually be seen between 12/1.

YANBU. appendicitis is one of the first cases you study as a doctor in general surgery and if some1 calls themselves a dr they should be able to diagnose without any problems unless its a baby or a very elderly person or an obese person in those cases its a bit tricky. in a child of 9 yrs it would be very easy plus there r some scores now which have really simplified diagnosing appendicitis. i have been in uk for a few mnths now and the doctors have dissapointed me greatly.

appendicitis is always very serious and you need to observe the patient in hospital start them on antibiotics if need be so the fact that surgery was done later on dsnt excuse the gp. if the OP has listened to her gp and waited it would have meant very serious problems for her child