To wish the doctor wouldn't ask my opinion?

[MomsNatter]

I know we're all customers rather than patients these days, but please, i have not had 6 years of medical training - don't ask me what I think my son's treatment should be!

Basically my son has had a cough/cold for about 6 weeks. He's fine in himself, but he just can't shift it. So the doctor asks me what I want to do - give him antibiotics or not. I don't know. Take the lead please!

The problem here is we all think with a bit of google knowledge or basic nursing skills are opinions are as equally valid as the doctor's.

I have a huge bug about this new approach in the NHS. My mum was diagnosed with breast cancer. She isn't educated at all and finds it hard to follow any simple logical argument.

She was duly presented with all the 'facts' about breast cancer, risk factors and probabilities of the different treatment options. She had a take home pack inches thick she couldn't/didn't have patience to read. She decided she didn't want to lose a boob and chose a small operation. If lump was larger than estimated, she would need chemo, which she definately didn't want. I don't think she understood the real consequences of her desicion. In the end, the lump was bigger, she had chemo, lost hair, had DVT etc. I'm sure being presented with all the 'facts' was a total waste of time and had the consultant said, 'we'll take the boob off' she would have gone along with it and this would have been safer and carried less long term trauma and worry.

Why couldn't they just say 'here are the options, but I recommend x'? That way, if you feel strongly about AB or losing a boob, whatever, the discussion has been opened. But you are still getting an expert pronoucing his/her opinion.

So what is basically being said by some is the patient should get no say in their care? We should just assume that doctors know what is best for each individual in each individual case?

If someone doesn't understand something then it is up to them to ask, that shouldn't be a case of not giving people the choice because some people don't ask enough questions.

everyone should feel as if they are in control of their treatment not that decisions are being forced upon them.

But what if the problem, various treatments and consequences are not understood by the patient? That's my real concern.

When we take our car to a mechanic, he doesn't say 'what do you think I should do?'. We pay him to make the right decisions - he has the full training and experience which is why he's doing it not us. A good mechanic will say 'this is the problem, these are the things we can do but I suggest doing x'. Doesn't this involve the patient if they so wish in the decision making process but at the same time offers his professional, expert advice?

You can't compare cars and people. All cars are pretty much the same (within makes and models anyway) but every person is different.

If a patient doesn't understand they need to ask questions. We need to move away from this culture of "the doctor is always right" and people need to start taking more responsibility for themselves. Doctors should let the patient know the options give the patient time to consider and ask questions and then more forward with the patient happy with choices made. They shouldn't just be told "this is what is going to happen"

YANBU. Some doctors really do presume their patients have more knowledge than they may have. The doctor should recommend a course of action, and be open to questions or concerns from the patient.

Er? Aren't we all plumbed the same, our immune systems work the same, joints and brains work in the same way? If we were all built uniquely, how would a doctor know how to treat us?

My question again, what if the patient just doesn't understand, even after being explained?

In our last practice the doctors (and there were about 7 different doctors) obviously did some sort of patient management course because they all started asking "What would YOU like me to do to?". It drove me mad. In the end I started saying "Give me your expert opinion and we'll take it from there"- in a lovely smiley way of course.

I've had to attend Gynae clinic for the last two years on and off for...well gynae ishoos.

For the last three appointments, I've seen different members of the team but when I've sat down they have all asked me the same thing; 'why are you here?' with this blank enquiring expression on their faces.

I would love to say 'well, it's your clinic, you're the Dr and you've hopefully read my file in front of you, bloody well tell me why I've been recalled'.

I don't say that , I just say 'to discuss my further treatment'.

We are far from the same when it comes to medical problems. There as a whole host of variables and one diagnosis can mean different things for different people.

You seem to be almost advocating treating people without them or a carer actually understanding the treatment simply because that's what the doctor says.

YANBU. There is a big difference between having an ongoing condition and having acquired a lot of knowledge about it that informs you opinion, and basically being asked to guess whether your son's infection is viral or bacterial! Lots of people want or don't want antibiotics but a viral cold won't be cured by any amount of antibiotics, and a bacterial infection might need them.

An ear infection is an ear infection. A cancerous growth is a cancerous growth. Different people have different problems. Not all cars that go to the mechanic have the same problem.

If people react so wildly different to diseases/conditions, what makes you think the patient is just as qualified to know what's going on in their own body than a doctor?

I've not said anything about whether or not treatments should be explained to patients. I just think it is unreasonable to expect the average to answer 'what shall we do then?'. As I've said previously, give the options x, y, z and then say 'I recommend y for these reasons'. Seems a reasonable middle ground to me in many situations.

because the patient is the only person who knows exactly how they feel and exactly how the symptoms are effecting them. 2 people won't necessarily react in the same way to the same condition, peoples bodies do respond differently to different things. For some a chest infection will always be severe for others they can easily fight it themselves.

Unless it is a case of only one course of treatment being suitable (for example in the case of a severe infection) then patients should always be presented with options and the pros and cons of them and allowed to make there own choice. Only if they ask "what would you recommend" should that come into it. By automatically recommending something you are making it harder for someone to make their own choice and the doctor won't always be right.

I rarely get an appt. with my GP, anymore, and recently have been given an appt with the nurse. She told me she knows as much if not more than the GP, but when I explained my bad reactions I have had over the last 8 years with antibiotics, and told her the name of the one I last took, which was fine for me, and asked for it, she told me the GP on her pc had said I can't have that one as decades ago, I was supposed to be allergic to it. But was fine last time I took it. I did understand, the GPs stance, but I was given a different AB that I had never taken before, and took the first one sitting in my bed, just incase I konked out - which I didn't, thankfully.

I was asked after going to the drs a few times with a sore leg hip do you want me to refer you for physio do you think that would help ? well I don't know do I she referred me, you are the gp you decide

I think it needs to be done with judgement, my mum would be sent into a spin of panic by a gp asking her what she thinks. However I think one of the reasons why our gp is so great is because she discusses things with me and asks my opinion, she will admit when she doesn't know something and has sat and googled something with me.

I think the thing is that medical issues are not black and white and sometimes there aren't any clear answers, it would be great if there were. In these circumstances, and as long as the patient or carer understands, then it is important that they are involved in discussion about treatment.

Our gps ask my opinion too... For example when dd cut her forehead I was told it would scar either way but stitching would minimise the scar and asked if I wanted to proceed. I said go for it as dd is very calm about that stuff, if it had been one of the boys I would have left it as with their sensory issues stitching would have required them being pinned down screaming... Unnecessary in terms of the benefit.

Again when ds2 was withholding poo I was consulted as to whether I wanted to put him on movicol.

I take it as a sign they consider my opinion valid and like the fact they ask me. They don't ask for anything that's completely necessary, so I would take the fact that you were asked to mean the abs aren't strictly necessary but may or may not be of benefit

I do remember a time in 2005, when I had an ECG at the local clinic, and heard the girl on the phone asking if she should call an ambulance ??!!
She told me I had an appt with GP later that afternoon, and I was to go with the ECG printout and stay there until I was seen - very scary.
My Gp just asked me if I would like to go to A&E right now, or would I like him to refer me which would take about 3 months. I asked if it was urgent, but he didn't know. So, as I just couldn't face 4 hours waiting at A&E, I said refer me then, as I didn't feel as if I was having a heart attack. He didn't even listen to my heart, which was not long afterwards privately diagnosed as a heart murmer - Aortic valve leakage/moderate.

The patient is to communicate symptoms, a doctor's job is to diagnose and treat. I expect an expert to always recommend a treatment course. If I have a chest infection, I have no idea about whether it will become serious or if I'll be able to fight it off. Doctors are not always right. But on average, I expect them to be right a lot more often than a lay person, even if that person happens to be the patient.

I actually understand the other side, so to speak. I'm not in the UK and here doctors are revered and rarely questioned. They are paternalistic. It's part of the tradition. They frequently don't explain what they are going to do or why. When I ask questions, they are either not answered (plain rude) or are pooh-poohed. I've gone through three GPs to find one which says 'I'm not sure, I'll phone the paediatrician to ask'. However, I find the NHS system has swayed too far in the other extreme.

Actually I'd rather have the Dr discuss options with me than what happened with my son when he was six months old.

On a pre birth scan they had decided he may have problem with one of his kidneys (but that's a topic for a whole new thread!!). He was put on antibiotics from birth but didn't give any explanation as to why (and in my post birth haze I didn't really ask the full details). DP demanded a full break down of the whys and wherefores as he was really unhappy with a tiny baby being given ABs. We did get a full discussion which ended with the fact that the risks of taking ABs from birth were much less than the chances he could get infected and lose a kidney without the treatment. After that we were happy that it had been explained clearly and were happy to agree to the ABs.

Less impressed on going back six months later after a battery of tests with the consultant looking puzzled at the results and stating he wasn't sure what to do next as it wasn't his area of expertise and didn't understand what the results meant. He then asked his junior to go and google to find out if he could find anything on the subject!!!!

Well, the thing is with antibiotics for a prolonged cough/cold it is a bit of a grey area. (For a deep tissue infection like an ear one or mastitis, not so much.) Your son's cough is viral. So ABs won't touch it. He may, however, have developed a bacterial infection on top (which might be why it's gone on for so long). So yes, it is kind of up to you. Admittedly your GP should have explained this to you, though.

(And also it is easy for me to pontificate on as I write about this stuff, and pick the brains of specialists precisely to know what ABs work for and what they don't .)

sugariceAndScary I so agree.

I got very frustrated with other medical professionals coming along and asking me why my son was receiving particular treat and so on and so forth. When I would try and explain my understanding of what had gone on I would be pooh poohed or told I couldn't possibly be right in what I was saying whilst all the time they were holding the actual notes about my son's health issues. I would then have to politely ask them to read those notes if they weren't clear after my explanations. I understand they may have not had time to read those notes but I'd rather we sat there for a few minutes whilst they read the notes to get a clear picture of what was needed or required.

Now I am intelligent and articulate but I am not a medical person and I would be very concerned if that medical professional had then carried out treatment based on my interpretation of what had gone on.

I have to agree that I have ,frankly,felt very concerned when Gp or other professional asks me to recap what is going on,rather than reading the notes.

That's different to consulting and asking my opinion on treatment.

Surely the whole point of notes is to record the important stuff,so as you're not relying simply on anyone's powers of recall.

I would basically just like the option of,for example,saying 'yes' to antibiotics and being given a choice to do that rather being told they will not prescribe them.

I usually give time for a virus to start to improve,or for the body to fight the bacteria off itself,if that's going to happen.
I consult the gp at the point that it becomes clear to me that if you cannot tell whether a problem is bacterial or viral,I would like the antibiotics tried as I have already tried without IYSWIM.
Whereas I find that my gp always insists that give it a couple of days and if it doesn't improve,come back. I explain that I've already done that.I say it does my child no good to spend longer off school than they need to (or for me to spend longer off work).But all to no avail.Couple of days later,9 times out of 10,I'm back,antibiotics are prescribed and problem is sorted.

What do I do? See the gp sooner - and keep bothering them with things that'll clear up by themselves given a couple of days? Such a waste of resources!

I wish my gp would listen to my opinion more,I really do.

Change GP VerSmallSqueak.

LeBFG I would if it wasn't the only surgery geographically feasible for me.

Anyhow's - rant over.Made me feel much better.