To complain about this GP? Long, don't want to drip feed.

[OriginalGreenGiant]

Ds1 (6) has had a minor sore throat for a few days but yesterday had woken up crying in pain, couldn't swallow, yawn or talk. I had a look and his tonsils were huge, felt his glands in his neck and they were like hard round marbles and he went 'ow' when I touched them. Felt a bit warm but no actual temperature at that point. So I managed to get a morning appointment in open surgery time and took him to see GP.

We waited over an hour for an appointment, in which time I could feel and see ds's temperature going up. He was tired and a bit lethargic and you could feel the heat radiating off him. So I stripped his top off and put him next to the window.

Anyway...in we went. The GP didn't look at ds at all when we entered, just maintained eye contact with me and asked his symptoms, then picked up the thing (light...magnifier?) and looked in ds's ears and throat. It's hard to explain how 'off' this seemed in words, but IMO you can tell quite a bit from how a child looks, so it seemed very odd that she didn't even look at him, let alone ask him anything.

So, she pronounced his throat red and ears fine. She then ran her hands lightly over his neck and said 'glands are normal' and took his temperature (in the ear) and declared it 36.8 and fine. Then asked me what treatment i was hoping for from then on .

At this point I could feel the warmth still radiating from ds so asked if she could test his temperature again. She gave me an indulgent smile and did...looked surprised and a bit shamefaced and went 'Oh it's actually 39! Sorry!'

I asked her about his glands and said to me they seemed very pronounced and painful. She felt them again a bit more firmly, ds1 visibly winced but she again said they were completely normal.

She then said that she understood I was probably hoping for antibiotics, but...and gave me a two minute lecture about the differences between viral and bacterial. I tried to politely interrupt (I'm not an idiot, I know the difference and had given no indication I was 'looking for' anti b's) but she was on a roll with her speech so on she went.

She then turned to her computer and brought up google, saying she would check if antibiotics were needed. She googled 'fever pain score', clicked on the first result and filled in a form. She said to me 'You can actually do this from home, to see if anti b's are necessary but obviously I don't mind completing it for you'. Well gee, thanks

She turned to ds (and just to point out, this was the first time in over 5 minutes in the room that she had looked ds in the face or spoken to him) and asked him 'So, would you say your throat pain is moderate or severe?'. Ds is a bright 6 year old but fgs, he's 6. He stared at her, obviously not understanding so she repeated it to him word for word. So I answered that it had seemed severe.

Anyway, this form came up with the result that antib's were recommended. So she completed a prescription after poring through some text book for a full two minutes to check dosage. And out we went.

It all just seemed so wrong. Other than the moderate/severe question, she didn't actually look at ds or speak to him/question him at ALL. I'm not a Doctor, but considering the painful marbles that are protruding from ds1's neck, I'm pretty certain they wouldn't be described as 'normal'. Plus add in the temperature mistake, and google telling her whether to prescribe or not.

I said to dh I feel like complaining. I know that Doctors are probably sick of people traipsing in kids with a sniffle at the moment, but ds clearly had more than that and I don't feel that she really examined or diagnosed him at all.

Dh thinks I'm overreacting. He is of the 'Aw come on, she's probably newly qualified or having a bad day' opinion...tbh I couldn't give a fuck and neither of those warrant not doing your job properly IMO.

AIBU?

[Coyoacan]

Well said Alpacacino

This idea that money can be used as a filter to avoid time-wasters is totally daft, especially in a society where ten pounds could be a week's food shopping for one person or an hour at Starbuck's for another.

[Sirzy]

You start charging for gp appointments then you will cause two things to happens - a and e departments will be even busier than they already are and too many people will put off going to the gp when they really need to leading to a delay In diagnosing serious conditions

[Springheeled]

Hats off to the GPs on the thread. Generally nicer attitudes to most public servants would be nice. Everyone is just trying their best!

[Alpacacino]

Theoratician, may I make you aware of macdoodle's post on p.2 of the thread, where she describes her daily tasks (amongst others) thus:

(1) see anything up to 30 patients every 10minutes in the morning, work out which ones are self limiting minor illnesses (the majority), and explain to them why, how, that there is no treatment, and how they can self manage - all the time make sure you remain calm, polite, considerate and perfect (after all someone might complain about your attitude)
(2) in between those, make quite sure you do NOT miss those with serious pathology, the weight loss that might be lung cancer, the tears that might be a serious depression, the bloated lady who might have ovarian cancer, the anxious man who might be thyrotoxic
(3) make sure you spend enough time with the complex, elderly, multi co-morbids, you need to make sure their meds dont interact or cause side effects, or falls. You dont want to miss an early dementia because the government says we are crap at that too

How then can you possibly make a round statement that most GP visits are unnecessary?

How on earth can you expect patients to know whether their condition is in fact serious or not?

It would just be a case of "Oh no, I'm sure I'm fine, I don't want to pay for a GP to tell me that, I'll just carry on", and then being diagnosed with a condition that would have been manageable if it had only been picked up earlier, and possibly dying as a consequence.

Detecting nasty illnesses such as cancer early, and hopefully being able to clear people of their cancer through just an operation - would that not be important, worthwhile and also economical in your book?

And why on earth would you describe people going to see the doctor as a "waste of resources"? Which resources?!? This is taxpayer's money if I'm not entirely mistaken?
and you don't want people on benefits to see the doctor, possibly so they can get better and find a job again?

This is such a corrosive and misanthropic post, I couldn't let this be the last word on the thread.

[Theoretician]

Since apparently the majority of appointments are patients who doctors think they don't need to see, I do think we need to bring in charging for GP appointments.

TBH I don't think a GP appointment is something that should be covered by insurance, social or private. It is a routine part of the cost of living. To use an analogy, it is more like a plumber's bill than the cost of rebuilding a house that has burnt down. (The latter is something that should be insured against.) People on benefits can have some or all of the cost refunded by the taxpayer, though I'd prefer not all, I think even they should be left with some incentive not to waste resources.

[mumbanator]

"I also feel there seems to be a lot of misunderstanding between the medical profession and the people they serve about what constitutes a minor ailment that does not need GP attention. I may be obvious to the doctor but it is not always obvious to an anxious parent."
Exactly. The taxpayer has trained me to be able to assess patients and that's why they come. A car mechanic might think I am an idiot for not knowing what to do with my car but how am I supposed to know? This is why I do not get too upset when people want their coughs and colds checking out to make sure it's not a chest infection, especially young children. I have seen an awful lot of minor ailments this week, I don't mind seeing them, it's more that it can be at the expense of those who actually are unwell.
TheHorse - I always discuss antibiotics use with patients and parents, discussion is welcome. "I was wondering, how do you decide whether antibiotics are needed or not" ie just ask politely, any way should be fine. If you're polite I don't see that it matters how you ask.

[OneWaySystemBlues]

Actually antibiotics are not ALWAYS the correct treatment for tonsillitis. From the link that PacificDogwood posted - which I was about to post too - it says:

"Do I need an antibiotic medicine?
Usually not. Most throat and tonsil infections are caused by germs called viruses, although some are caused by germs called bacteria. Without tests, it is usually not possible to tell if it is a viral or bacterial infection. Antibiotics kill bacteria, but do not kill viruses.

Even if a bacterium is the cause of a tonsil or throat infection, an antibiotic does not make much difference in most cases. Your body defences (immune system) usually clear these infections within a few days whether caused by a virus or a bacterium. Also, antibiotics can sometimes cause side-effects such as diarrhoea, rash, and stomach upsets.

So, most doctors do not prescribe antibiotics for most cases of tonsillitis or sore throat.

An antibiotic may be advised in certain situations. For example:

If the infection is severe.
If it is not easing after a few days.
If your immune system is not working properly (for example, if you have had your spleen removed, if you are taking chemotherapy, etc)."

[TheHorseHasBolted]

I am sorry the OP felt unsatisfied with the consultation. I don't know who's right about the antibiotics (more about that in a moment) but I know from experience it can seem very frustrating when a doctor won't acknowledge your child but just talks to you as if they weren't there.

On a slight tangent, this story has reminded me of a question I've often wanted to ask. I wonder if one of the doctors who have commented could help me with this one.

When my own children were younger, doctors prescribed them antibiotics several times when I never quite understood how they could be so sure the illnesses were bacterial. I was always a bit concerned that they might be over-prescribing them, but I didn't know how to query it without the doctor thinking I was "telling them how to do their job".

Is there any polite way of asking a doctor why they think antibiotics are appropriate when they haven't actually tested for a bacterial infection? Those of you who are doctors, if someone was genuinely curious about how you determine whether something is bacterial or viral, would you want them to ask, and if so what wording would be least likely to make you feel attacked?

[PacificDogwood]

FYI EndAusterity

[EndAusterity]

Sorry but this is a simple matter. I could tell straight-off that it was probably tonsilitis. Antibiotics is the correct treatment for this. In any case Ab's won't do any harm. Plus tonsilitis can develop into Qinsy which is a medical emergency. The GP should have made a bit more effort to engage with you in my view.

[PacificDogwood]

One wonders, ModernToss

[ModernToss]

some massive hidden (or not so much) agendas

Indeed. Makes me wonder about astroturfing, tbh. I don't think the doctors on the thread have been remotely abusive or dismissive, but there's been a lot of shit thrown at them.

[Pishedorf]

This is actually getting quite funny now the chandler I've not demeaned anyone and that fact you can't see that would be concerning for someone as supposedly intelligent as you state you are. I would have been happy to appreciate your opinion/debate if it wasn't littered with personal insults on my character and ability to do my job which you seemed to have confirmed from some comments I have made on this thread.

It's often the case on MN that if you go against someone's opinion regarding a professional job that automatically invites comments that you are an incompetent/arrogant/suspicious practitioner. That's seems to be the default position for those who cannot handle debate. As I say if you had not consistently attacked me personally (commenting on my 'ego') and professionally (commenting that is was suspicious that I apparently cannot tolerate scrutiny from
my peers when I said absolutely no such thing) then we could have had a reasonable discussion.

However that did not happen, so I do not wish to engage with you anymore as it is a waste of my valuable MN time. I stand by what I've said on this thread, I've not been rude, nasty, offensive or incorrect in any of what I have said and I'm sure you will take from that what you will, twist it and paint me as the modern Dr Shipman.

However as this seems to be something you deem acceptable I would like to pass comment that from the comments you have made on this thread you must be an awful solicitor because you can twist words and misinterpret phrases so wilfully that all logic is lost from your argument. I'm sure you feel sorry for my patients and I feel very sorry for your clients, especially as they probably pay through the nose for your incompetence. At least my incompetent, arrogant, egotistical practice is free at the point of access until Jezza Cunt has his way

I'm hiding this thread so feel free to pontificate some more.

OP, I hope you son is feeling better and whatever you decide to do re: the complaint there is a positive outcome for you in that you will feel better for have brought it to the attention of the practice and that the GP trainee, I will put money on her being one will learn from this.

There is always room to learn IMO in any job, as I have stated before this thread has helped me to reflect and hopefully improve my practice even though I apparently think I'm perfect. Best of luck to everyone and a merry Christmas.

[TheChandler]

The chandler thank you for that rude response which shows your true colours and that you have completely misinterpreted what I have said.

I'm not sure what you think my "true colours" are (perhaps you would like to inform me)? I replied because I found the scenario interesting. I would have welcomed some informed comment on the issue that stood out - the failure to take the temperature by the doctor correctly, and the subsequent failure to notice it.

Unfortunately everyone in almost any field, is now under so much scrutiny, workplace review, subject to detailed complaints procedures, user questionnaires and surveys, feedback scores, internet comment, etc. that cultivating a "customer/client/patient" friendly attitude and demeanour will protect you against a lot of flack. Or what used to be called "bedside manner" - its just basic common sense. And that's what I discuss quite often with the doctors I know professionally, but they are usually at the expert witness level (other than friends from university) and perhaps a bit more aware.

If I spoke about my clients the way some of the doctors on here have done, it would rightly be seen as rude and demeaning. Even amongst colleagues, we only talk about clients in a professional sense, or not at all, or in very broad general concepts, such as clients who don't have valid cases.

I'm left wondering if there is anyone else you are going to demean - you've done the OP, me, the media, patients...maybe pathology would have been a more fulfilling career path?

[Pishedorf]

And I do not dislike people responding. However I will object when people deliberately misread or misinterpret what I have said.

[Pishedorf]

The chandler thank you for that rude response which shows your true colours and that you have completely misinterpreted what I have said. If you think I have been condescending I'm sorry you have interpreted it that way as that was not my intention. However on that note I think you need to realise you too have come across as highly condescending.

I have not commented anywhere at all that I do not like being under scrutiny by my peers. At all. I've no idea why you think I object to scrutiny by my peers and TPTB. I object to scrutiny by other people who have an alternative agenda (such as the media) just as other professionals object to it (teachers etc).That scrutiny is not to improve our practice, Which is what scrutiny should be resulting in surely. Instead it reduced morale and is causing a recruitment crisis which at the end of it all impacts patients negatively.

Yes I am a good doctor and have stated so. So what? I don't think that makes me better/more intelligent/more educated as you have implied. I'm allowed to think I'm good at my job as it is true and has been proven in the scrutiny I am under at work. That's not ego at all. I have no ego for you to make platitudes to soothe (although I've not seen any platitudes, just condescension). I've just made a comment that I've reflected on this thread and learnt from it. Hardly the act of an egotistical, arrogant GP now!

I have respect for other professions. I've not said otherwise here. I've not made disparaging remarks about other professionals' abilities just as you have made about me from a few remarks on an internet thread. Nor have I tried to exhibit knowledge about something I know very little about (just like your tetracycline/macrolide comment).

[TheChandler]

Pishedorf Give me strength the chandler yes we are under scrutiny from our colleagues and TPTB and rightly so.

Do you have an issue with people pointing out these things? I work as a solicitor, I haven't encountered many doctors with the sort of attitude as you have towards having a professional attention to detail - I'm guessing that's because some of you and your colleagues are simply using the internet to spout off about your frustrations. If you don't like people responding, maybe don't post on the internet, or start your own thread. I think we get the idea you are a great and wonderful doctor, but other people are also intelligent and professionally qualified.

Before you start another condescending rant against me attacking doctors, I've only done defence work in medical negligence, and as I've said repeatedly, and various other platitudes to soothe your ego this isn't negligence here, but that is because no harm occurred. I'm afraid the need to be prompted, by the patient's mother, to take a temperature for a second time, properly, does jump out. Taking a temperature and looking for indications of signs of infection is so basic, its really suspicious to try and muddle and deny it so much.

Whether you like it or not.

I actually sympathise with you, I have a number of friends who are doctors, and one who has several stupid and unfounded complaints made against her (upthread I said that if it were me I would not even make a complaint), and I think everyone in the UK must read about the pressures doctors are under nearly as frequently as danger of over-prescribing antibiotics, but I was simply being objective, and trying to comment on the facts presented by the OP, not engage in a PR exercise for disaffected GPs.

[Pishedorf]

Give me strength the chandler yes we are under scrutiny from our colleagues and TPTB and rightly so. However what I was clearly talking about was the scrutiny we are under From the media which seeps into the general public. If it was done objectively then fine but it's becoming a bit of a witch hunt. I'm sure you will disagree with me there but it's true. That is what is happening. If people are too blind to see that then it'll be interesting when the NHS in general gets completely destroyed and they'll wake up and wonder what the Jeffin' Hell happened.

Great post by idiot and by coyocan. I've been thinking about this all day because despite what people may think, GPs are constantly reflecting on their practice and this serves as an excellent reminder that even though I may think a consult has gone well, it mightn't have felt that way for me patient so thankyou for this thread.

[UptheChimney]

gave her what was a totally unnecessary and condescending lecture in her case

I understood that it was a Government directive that all GPs had to give this information about over- and mis-use of antibiotics to patients?

[Coyoacan]

I also feel there seems to be a lot of misunderstanding between the medical profession and the people they serve about what constitutes a minor ailment that does not need GP attention. I may be obvious to the doctor but it is not always obvious to an anxious parent.

[Coyoacan]

plummyjam now you are the kind of doctor I find so rare but always love to find. You explain so well and treat people as adults.

The doctor in the case of the OP just automatically assumed that the OP was a time-waster who had only gone to get antibiotics and gave her what was a totally unnecessary and condescending lecture in her case.

As for the mistake about the temperature, if the OP could feel and see he had a temperature, it is very telling that not only did her thermometer or temperature taking technique not work, but that she wasn't able to realise this herself by look and feel.

[Idiotdh]

Too many pseudo doctors and outraged s from the Daily Mail school of thought on this thread.

The GPs on the thread are sticking up for themselves under attack and threat of complaint. Give them their due. They are entitled to reply to all of the ( slightly underhand ) accusations against them. It would be nice if the accusers replied to these Drs in a fair way instead of just condemning them generalistically as if they are not fit to do their job..that is completely unfair.

No one has been unkind to the OP..an argument between the doctors and those who want to tell them off/ think they know better has taken over the thread.

It's a good example of why they are fed up...it's not about workload, Drs have always had a heavy workload, it's about 'telling' the dr the facts ..teaching your grandmother to suck eggs. It's been done to death that the GP from the OP didn't do anything wrong, just OP didn't like her manner...maybe she was talking to herself, maybe she was mentally ticking off the score ('glands are normal') who knows? But does OP have to make a complaint, and do people on the thread have to go on about it as if they could do better and telling the GPs their job? It's ridiculous. OP can mention to the Practice Manager( as suggested by one of the GPs) that she found the consultation unclear and off putting.

It's annoying if you have a bad consultation and no one wants that but this particular Dr sounds inexperienced rather than anything else. When just out of Hospital Drs deal with sore throats etc, its not a common problem in the hospital setting so for a GP Registrar it could be a new thing...but not worrying enough to ask the GP about.

With children, it's always good to have a plan...that's all a parent wants. So the usual plan with children is if things deteriorate , or fail to improve within the expected time, to seek more medical attention or advice.

I have been in the position of not knowing whether or not to take my own child to the Dr...and I am a Doctor but know nothing about Paeds!!! It's normal to feel like that. All you can do is ask the GP for guidance...what do I do now, do I need to come back for any reason etc.

Peace and love and happy consultations to all on the thread.

[TheChandler]

Pishedorf The chandler yes we are professionals and maintain professional standards and as such are under scrutiny from the government and others. But there is a fine line between monitoring and being used as the NHS' whipping boy. GPs are sick of that and rightly so. It's utterly demoralising

You are under scrutiny from your own colleagues and your professional association in the first instance, so its not really a question of being anyone's "whipping boy" - I'm a bit surprised at the lack of distancing and objective comment from some commentators.

[bruffin]

If he was 6 when he had one then he should really be referred to a paediatrician. DS was referred for having one the day before his 6th birthday. He was eventually diagnosed with GEFS+ at 13 but that was because it was only a recently discovered syndrome. We have generations of this going back to at least my grandmother, mum and sister.

[UptheChimney]

I do realise that. It was just indicative that if it had been yellow, banana flavoured amoxicillin I probably still would have given it with no checking. I'm familiar with it iyswim, even if it did no good, I know it does no harm

This is a really odd way of thinking. Yes, the "wrong" medicine can do harm: if not to your PFB (and I'm sorry, but you do sound very PFB in your recent posts) then to the community at lrge: have you not heard the news reports about antibiotic resistance now threatening the possibility in the future of standard procedures such as hip replacements?

You are criticising your GP's medical knowledge and procedures, and yet you complain about the colour of the medicine? Give me strength!!!