for being really fecked off with GPs

[banana87]

I understand that antibiotics do not work when you have a viral infection.

However, last week DD2 (15m) was clearly not right. I called GP and told them her symptoms (sleeping 17+ hours, bad cough, high fever, not eating). They told me (over the phone) that it was a virus. Wait it out. I waited 2 days and took her to see a private GP who immediately diagnosed her with a chest infection and prescribed antibiotics.

My SIL has been sick since end of last week. She is getting progressively worse (same symptoms as above other than sleeping!). She phoned GP Monday. He told her (over the phone) it was a virus, take paracetemol and wait it out. It got to the point that she felt her chest tightening and heavy so went in the next day (yesterday). He acknowledged that she was quite ill, but gave her an inhaler and said it wasn't an infection. She's worse today than she was yesterday and is now going to see a private GP.

Last winter my DD1 had persistent high fevers that did not respond to calpol or neurofen. We were in A&E twice and dr twice. Every time, "it's just a virus". After 6 weeks I had enough and took her in and said I wanted her to have blood tests as I was convinced she had cancer. Funnily, they gave me antibiotics even though "there is no sign of infection" and within 3 days the fevers were gone and have never returned.

Also last winter my then 5 week old baby had a high temp. I took her to the GP. "Just a virus". Next day, same thing and on call dr had us go straight to A&E where I was told "it's just a virus". Luckily a very good consultant was on call and thought it would be wise to do a chest x-ray "just in case". She had PNEUMONIA.

I understand that there are worries about antibiotic resistance. But what is the point in withholding antibiotics until one is so sick that there is no other option? In all of the above examples, antibiotics were or are currently being withheld needlessly. Why?

[Sirzy]

I have to say my GP is awful with children at time simply because he doesn't listen to parents and is too "by the book" even refusing to do a repeat prescription for an inhaler because DS is too young even though it was prescribed by a respiratory consultant. Other times he has given antibiotics when I have said I felt it was his asthma not an infection so he needed steroids - he has done that 3 times and each time we ended up in A and E within 12 hours needing steroids, nebs and oxygen by that point.

I do agree there is only so much they can do with the time and resources they have but in my experience that isn't always used effectively (surely GPs should be able to check sats at least yet they have never checked DS)

There again, its better than OOH who now won't see DS and just send us straight to peads A and E even if its not serious enough to warrant A and E.

[thebitchdoctor]

I know the OPs experience does happens and it's a disgrace that it does but don't generalise against GPs please, I'm astonished you would do that as a hospital doctor.

And yes I think I am a good dr. I'm not perfect though, no doctor is. I know my limitations and work on them daily. Having a child has made me a better doctor, I know the true terror of being a parent to an ill child. I lose all logic and reason when my DD is ill and understand that panic in my patients and their parents when they present to me.

[banana87]

Zavi- my surgery won't give you an emergency appointment until you've spoken to the GP. Also, I wasn't overly concerned at that stage, but mummy instinct told me to ring the dr in case.

Landrover- I am so sorry to hear your story.

[silverstaresatnight]

Not generalising, just said a lot of GPs under treat children ime. Also the onus to come back lies mainly with the patient, or with the parent in the case of children, but I don't think it's often clear to them when they should worry / go back or whether they should at all if the GP hasn't asked them to.
With adults I find there is a lot more caution.
As I say I am sure a lot of GP practices are excellent but this is definitely something that happens.
Same as for eg hospital drs often don't tell patients their diagnosis and send them home too early with no information to the GP!

[dikkertjedap]

Maybe there are many good GPs, who knows? I just didn't have the luck to come across them.

In the end, whilst still in the UK, I either took my dc if we had any (major) concerns to a private paediatrician or to A&E, thus bypassing GPs altogether. I know quite a few parents who do this after some near disastrous experiences with either incompetent or uncaring (or maybe both) GPs.

We have found the hospital doctors far more thorough (eg checking temperature - several GPs we saw over the years never bothered to do this, checking SATS (again our GPs didn't do this), checking heart rate, respiratory rate, eg things you would expect, but many GPs don't do whereas hospital doctors always seem to do them. That is maybe why hospital doctors are more able to identify the issues and address them.

The ten minute slot is a red herring, if a GP is not able to do his job as a result from sticking to the allocated time, then why should we patients take the risk bothering with GPs?

[thebitchdoctor]

The ten minute slot isn't a red herring at all. Mind you that is the reason why most doctors tend to run late, because they take longer to deal with problems because they deserve longer than 10 mins.

And yes there a good GPs. I'm sorry some people on here haven't found any yet.

GPs do those examinations definitely.

And silverstaresatnight you are generalising by saying that and that may be your experience but its not everyone's. Good GPs should be are cautious with every patient. I'm surprised at your attitude towards your medical colleagues, being a hospital dr and all. (Speciality?)

[NightFallsFast]

The OP is expecting a private service on he NHS. The NHS has insufficient funding to provide appointments with a chosen GP at a time of your choosing. NHS appointments are 10mins long and GPs often see 40 patients a day while a private GP sees 10-15. Are the Great British public prepared to pay more for more doctor time?

A GP gets paid about £70 to look after one patient for a year, no matter how many appointments that person has. Private GPs can charge this for a single consultation.

And for those advocating x-rays before antibiotic prescribing - x-rays do not come without radiation risks and not all bacterial infections show on x-ray. There is no perfect solution.

[banana87]

Night: no, I'm not expecting private service. I'm expecting decent service. I pay for it, so I should get it!!

[silverstaresatnight]

thebitchdoctor
Don't make it personal, I think this does happen . It's not about you personally you sound quite thorough.
I agree with the posters who just don't understand why not do more examining and basic obs like sats? I really don't get why this doesn't happen as routine.

I think some GPs don't recognise sick children or make it clear what should happen if the child does not improve.

[landrover]

I think you are right silver, parents are often left not knowing how long to leave things. In my experience the doctors made it obvious they didnt believe me and that i was over reacting.
One thing i kept going on about was the fact that she had been on calpol 24 hours a day for five days, on the package i think it says treat child no longer than three (or something similar). The doctors seem to think she could stay on it as long as i wanted!
Truly heart breaking that we weren't listened to. The whole story actually is horrific, ending with us being sent to a major hospital by ambulance from our local hospital and then being sent home with the doctor saying he was perfectly happy with her, she died 24 hours later.
Thankyou for your thoughts you lot anyway!! dont know what id do without this site!!! I do a lot of laughing at "Am i unreasonable" xxx

[FasterStronger]

banana87 Thu 14-Mar-13 20:40:30

your reference does not say go to A&E - which is what you said - it advises, under specific conditions, to contact your health provider which is very different....

[crashdoll]

lisa The trouble is that some people are naturally very intuitive and know when something is wrong but many people are not. That's not a criticism. I've had lots of health problems and I tend to know when something is not right.

[dikkertjedap]

crash - I think that unfortunately for many of us with no medical training we are learning the hard way.

I now have a pretty good idea what to look out for. I have learned this the very hard way through watching paediatricians assessing very ill dc in A&E. I have watched nurses checking sick child during the many days and nights on the ward. All these little things together give me an idea what to check for.

However, I think that it is utterly unreasonable if doctors expect all parents to know these things, because this is why we are supposed to have doctors.

I think the way forward for the NHS is far fewer GPs and better local hospitals (basically the opposite of what the current NHS reform is doing). In a hospital setting there are more experts, I think we need more experts and fewer generalists. My experience with GPs is that they either don't care or just don't know enough (they may know lots of things superficially but we all know that a little knowledge is sometimes more dangerous than no knowledge). I also think that GP training needs to be massively improved. GPs need to learn their own limits.

So far, I am very impressed with the Dutch system. The few times we have used it, we were swiftly referred to local hospital for tests (literally send to hospital straight after seeing the GP). GPs here seem more the first point of entrance and then refer you to the appropriate place rather than trying to do it all themselves. Hospitals are geared up for this, so if you are send for an X-ray, you can literally go straight away and are seen quickly plus the dialogue between hospital and GP seems to be very swift. So a treatment plan is very quickly being put in place. Admittedly, it is easier in the Netherlands as distances are short, there are lots and lots of hospitals (where I live there are 5 of which 3 are very major in a 30 minute drive radius) and there is a lot more capacity in the system, so it is possible to see a GP/hospital doctor at short notice. Clearly this comes at a cost, it is one of the most expensive systems in the Western world. And mistakes are still being made as well, it is definitely not perfect.

[dikkertjedap]

Silver I have always had the impression that when you arrive either by ambulance or own transport with a seriously ill child in hospital the A&E doctors follow a very strict protocol, like a check list to tick things off, because they all seem to be doing the same things. Sometimes they were done one after they others, sometimes there were around 8 doctors or other medical staff all doing things at the same time it seems.

That is what I think GPs need - some kind of check list of all the things they should basically always do. I don't know precisely what should be on the list as I am not medically trained, but expect things like temperature, sats, heart rate, ear check.

I am not to sure about listening to the chest. In my experience GPs don't seem to be able to diagnose pneumonia no matter how often they listen to the chest. They just seem to go through the motions so they can tell you that your child's chest is clear even if the child has life threatening double pneumonia.

I also found that many GPs cannot use ear thermometers. I have the same one as many doctors and nowadays take it with me, they take the temperature and it is fine, I take it or let my child take it and it indicated high fever, then GP tells me my thermometer is unreliable so ask to use theirs and get exactly the very same high reading - many GPs don't seem to insert the thermometer properly, I didn't have this problem with hospital doctors and nurses. Again this was not a one off but time and time again and it makes you totally loose all trust in GPs.

Also, I contracted whooping cough (positive swab), correctly identified by OOH GP. I was concerned about my dd, given her medical history and wanted antibiotics prophylactically for her. Regular GP refused and said that there was no whooping cough in the UK but only on the continent. I said 'actually there are several outbreaks at present and I have been positively diagnosed as visible in my records which you have on your computer'. She refused to treat dd prophylactically as she was fully vaccinated and there was no need as there was no whooping cough and she also said that she really doubted that I had whooping cough myself as I was much too well and didn't even whoop. Dd ended up hospitalised for weeks.

I don't have it in for GPs BTW, but I do think they need clearer guidelines, better back up/supervision/inspection (basically performance assessments like for hospitals) and much better training initially and ongoing.

[Sirzy]

Apparently listening to a child's chest is actually quite hard and it's easy to miss things. DS has a patch of permenant damage on his right lung and it is always quite interesting watching doctors listen to his chest and fills me with confidence when they notice this without me having to tell them.

I think it would help if each GP practise had a peads specialist GP as I think that would greatly improve the treatment for children. To many GPs seem to ignore the fact that what is "just a cold" in an adult has the potential to kill a young child. Our local A and E is a peads A and E which I think is part of the reason why they are so good as it means not only do they have the medical knowledge needed for treating children but also they have the bedside manner needed to treat children!

[dikkertjedap]

Sirzy - I fully accept that it may be very very difficult to diagnose pneumonia through listening to child's chest. However, then GPs should also not be so damned sure that a child's chest is clear and hence no risk of pneumonia and labelling parents as over anxious. You can't have your cake and eat it and that is what many GPs are trying IME.

[thebitchdoctor]

Silver I'm not making it personal at all. And don't patronisingly tell me I seem 'quite thorough'. I'm starting to doubt you are a doctor actually.

I'm hiding this thread anyway, I'm sorry people have had bad experiences I really am but stop generalising about how bad all GPs are and dismiss our supposed 'lack of knowledge' because we are generalists. GP training is intense and tough. We spend a long time in hospital in different specialities (such as paeds) before we ever go to the community and we have to pass postgraduate exams just like hallowed hospital specialists have to do. It is very hard to be a good GP, it's a very difficult job but one that is much maligned which pisses me off when I and the majority of my colleagues work bloody hard for our patients.

If you all actually spoke to your GPs and practices instead of bitching about it on here that'd probably be more helpful. Like any job, feedback is important and good GPs do take notice of patient comments and complaints. For example we changed the wording of a letter we sent out to patients recently after one patient complained to me and I brought it up to the practice, a small thing but we took notice of that feedback and did something about it. Write to the practice managers and do something about it!!!!!

[Sirzy]

I fully agree dikker, if they are in any doubt they should seek a second opinion

[dikkertjedap]

Bitchdoctor I have tried to speak to GPs about my concerns, I have discussed them with the practice manager, but I have found that it is all an utter waste of time and that it is best to bypass GPs altogether. If there is sufficient time and if you can afford it, my advice is to go private, if urgent go to A&E.

And this is based on my (and my dc and my dh) experiences with a number of GPs who happy blunder their way through life with patients having to deal with the consequences . Not saying that there are no good GPs, I am sure there are, unfortunately I haven't come across them whilst in the UK.

[quickdowntonson]

Silver - How dare you be so unprofessional as to criticise GP's? It is because of secondary care doctors like you (who have no idea what we do every day, seeing 50 + patients at times) that we get get so many unfounded and unnecessary complaints. Get your facts right before making some casual throwaway remark to patients. So unprofessional.

[quickdowntonson]

I obviously agree with Thebitchdoctors comments above.
Don't criticise people who are doing a very demanding and high risk job.

[quickdowntonson]

I obviously agree with Thebitchdoctors comments above.
Don't criticise people who are doing a very demanding and high risk job.

[Sirzy]

So we can't criticise people when they make mistakes just because they do a demanding job?

So I should just accept a GP refusing to prescribe medication for my 3 year old because he is too young dispite this having been done by a pediatrician? I should just accept that it took me, the consultant and his secretary 3 days to finally get the medication issued?

Sorry if someone is doing something wrong then people should speak up about it. That should certainly be done if you feel colleagues are doing things wrong aswell.

[firesidechat]

I must be very fortunate with my GPs (we have moved around quite a bit) because I have never had these substandard experiences. I've always had the level of service that I would expect. Perhaps my expectations aren't as high as some.

Our GP diagnosed my husbands cancer very quickly, for which I am very thankful. I had a possible infection just before Christmas and the doctor gave me a prescription for antibiotics "just in case". I never had to get them because I waited and waited and it got better all by itself. I've had to take antibiotics in the past for serious infections ie dangerous chest infection and kidney infection, so only have them if I absolutely have to.

Personally I hate going to the surgery, but just felt the need to stand up for doctors who do a job that must be very difficult and stressful sometimes.