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?

I still need to know what to do in such a case! I would still want a doctor's certificate, in case the school/college refused to confirm that my dc was ill.
How can the school know the child is ill without seeing them?

So would I get that from a private GP?

I get anxiety I have 2 DC, what I dont get is why this becomes the GP's problem.
Fact 1 - children with minor self limiting illnesses do not need to see a dr
Fact 2 - sick notes for schools are not a NHS service, if your GP does them, they are not a priority and are chargeable
Fact 3 - there is clear guidance on this and exam sickness for schools
Fact 4 - this actually has nothing whatsoever to do with your GP, and taking an urgent appt just for a sick note for school IS an abuse of the NHS
Fact 5 - parents and schools need to take some responsibility and not involve 3rd parties. GP's are drowning in requests for just do a note for this that and everything, we cant manage the workload of those actually in need, never mind all this non medical non neccssary stuff. There is clear national guidance on this dating back more than 10 years webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4003147

What I find staggering, is even when this is clearly explained, patients /parents still persist and argue, that thread you linked being a perfect example really, threatening and harassing until they get their way.

There are a lot of replies which I've mostly read but can't respond to them all.

The one thing that's cropped up over and over again is how so many state they 'wouldn't have bothered the GP for these symptoms' and that they could be easily managed at home.

Just to point out that google the GP decided that anti b's were necessary and prescribed them. Not something I had available at home, obviously. Unless she was wrong and people on here obviously know better?

Thank you to those that have given sensible answers to my op and not either attacked me or jumped onto their defensive high horse. It has helped me to make my decision.

You may want a sick note, the school may feel you need one, it is still neither a medical problem, your GP's problem, nor a NHS service.
If your child needs to be seen fine, taking an appt just for a sick note, not fine, some GP's will do them and charge, some may even do them for free, some may not at all. That is still not a GP problem and the emotional blackmail of saying why should my child suffer, is pretty disgusting IMO.

But that is the problem, macdoodle - that you find it disgusting!

Obviously difficult to say without being there or examining the child, but IME antibiotics are very rarely of benefit, with the risk of side effects being higher than any benefit in most cases.
"NICE Guidance on Antibiotics for RTIs (2008)
Antibiotics provide no discernible benefits for most patients
with: AOM; acute sore throat/acute pharyngitis/acute
tonsilitis; common cold; acute rhinosinusitis or acute
cough/acute bronchitis."

Just because you got antibiotics doesnt mean you were right, it may mean the GP couldnt be bothered to argue/explain any further.

I think the attitude taken by the OP's GP was one of "teaching her a lesson" for asking for an urgent appointment. I think the GP was dead set on demonstrating to the OP that her child was perfectly OK. I think that's why the GP got the temperature wrong, overlooked the swollen glands, and was determined not to see the 6-year-old child for what he was - a very sick child in need of urgent treatment.

All that - because she was on a mission to teach patients not to ask for urgent appointments.

You think emotional blackmail to get what you want is ok?? Really?
Just because I am a doctor, I dont have to accept abuse in any way, and I find that kind of emotional blackmail unpleasant in the extreme.
Imagine 60 patient contacts a day, a lot of those will be genuinely unwell, some will need assessing and reassuring that they are not that unwell, some wont be unwell at all, and maybe 10% will want something that isnt medical at all (like a sick note for a minor self limiting illness). If all of those 10% complain and shout till they get what they want, you think thats ok?? Why??
There is another thread on how unacceptable it is to treat a call handler or customer relations person like that, why is it ok to treat your dr like that??

I think your emotions are making you react in an irrational way.

Really? You see a child with a sore throat and a temp as someone in need of urgent care? That is why the NHS is buggered, because to me someone in need of urgent care, is the COPD patient who cant breathe, the asthmatic with a tight chest, the 50yr old with chest pain, the 6 week old with bronchiolitis, the young man hearing voices, the old man who is so distressed by his dementia he is a danger to himself and his family, the dying patient in pain, the housebound lady who is so confused by her UTI.
I am sorry if you dont like it, I am sorry it makes you feel bad or guilty or cross, but the NHS IS NOT A bottomless pit. And on the front line we have to decide every minute who can wait and who cant. And strangely enough those is most need are the ones who shout the least. Someone needs to shout for them. Not the 20 patients every day with RTI's.

Surely it is a GP's responsibility to give health information - so they should say: I will not issue a sick note, but google for a private GP locally and you can get one that way.

I am probably the most rational person I know.
However, I trained in a country that has no NHS. I was one of the privileged upper class. I sent patients home to die every day. It just about broke me.
The NHS is something to be valued and treasured, and be proud of, not abused and disdained and broken. So yes I feel very strongly about this but not irrational at all.Rational and well informed. More than most on this thread I would think.

Indeed Dazzle, as we do, I would probably tell them where the closest is, I am actually very kind to my patients IRL, firm but kind. It is still a wasted 10 minute appt, and at the moment they are becoming a very scarce resource.

The main problem seems to be that GPs are the gateway to all health care, and they don't want to be, and are refusing to be.

But the state still dictates that they are.

So what on earth should patients do?

We've moved a way off the OP, but yes thats a good point.
GP's have always been the "gatekeepers", to medical care that is fine, to every other ill in society, not so much. And that is the problem, the GP has become the dr, the social worker and the priest. And not really something most of us relish, nor have the time for.

It would help if private GPs could be recommended. IME some of them are drunkards!

I think a big part of the problem is that we're in a transitional state in health care, and no-one knows what's going to happen. So you can see a private GP, but they seem to be unregulated, so it's not entirely safe to do that.

Private GP's are variable, they cant refer or prescribe on the NHS, and most folk wont pay for a service they can get for free. Its not a big market in the UK. We have only one locally who I would be happy to recommend.

They are regulated, you cannot practice as GP, without being on the GMC register as a GP with a license to practice. I think you also need to be on the local health boards performers list, and undergo annual appraisal and 5 yearly revalidation. But they are mostly dealing with the worried well.

Just because you got antibiotics doesnt mean you were right, it may mean the GP couldnt be bothered to argue/explain any further

Have you read my op macdoodle?

What arguement? I didn't argue, I didn't ask for antibiotics. I had a 6 year old in extreme pain who I wanted checked. And I don't mean 'a little sore' by that. I mean a child who seemed in quite severe PAIN. As in the hyperventilating, bordering on panic sort of pain that you get with a sudden injury iyswim. Which, forgive me, I did want to get checked.

In terms of taking him to the GP I'd do the same tomorrow.

I apologise if that's an inconvenience to the GP's out there, as it's been made clear that there are obviously much more important things to be doing - but I would.

OriginalGreenGiant I have not read the whole thread but some of it. I just wanted to say I think you would be right to complain about the doctor. If GPs are all run off their feet in such a way then they are certainly not all behaving in this way. The three GPs at my local surgery are brilliant. One has said on many occasions that parents know their kids and if they are worried then it is good to check it out.

Ultimately, you must do what you feel is right. I have felt very frustrated recently as a friend whose child is ill has not really had their problem sorted out or been referred on. It just seems to be wait and see.

Hope your son is better soon.

I would hope most GPs would examine a sick child, and give a child priority. It looks like even that priority is no longer a given, however.

the inability of the population to self manage simple illnesses or even any concerns, has become staggering

Oh I'm sorry, I got this from page 6 and just have to comment.

I am getting on in life now. My brother's life was saved by penicillin when it was still quite new on the market. But many years later when I had my dd, I was forever changing doctors to try to find one that wouldn't prescribe antibiotics for any minor illness she had. And I soo remember asking the GP how I could look after my dd if I didn't give her the antibiotics he had prescribed her and answer came there none.

I cannot opine about the quality of NHS doctors as I live elsewhere, but some of the doctors giving opinions on this thread hold patients in such low regard it is staggering. When my mother was dying of cancer in an NHS hospital I was amazed and delighted at how kind and tolerant the nurses were under very difficult conditions, but I was also impressed by how an unkind word would reduce my poor mother to tears. Sick people and the concerned parents of sick children need to be treated with consideration and kindness. If a doctor does not realise that they are in the wrong profession.

and macdoodle this comment You see a child with a sore throat and a temp as someone in need of urgent care? That is why the NHS is buggered, because to me someone in need of urgent care, is the COPD patient who cant breathe, the asthmatic with a tight chest, the 50yr old with chest pain, the 6 week old with bronchiolitis, the young man hearing voices, the old man who is so distressed by his dementia he is a danger to himself and his family, the dying patient in pain, the housebound lady who is so confused by her UTI is all well and fine, you are not responsible for the state of the NHS, but in my young day, doctors made home visits to children with a fever and we did not have to have hallucinations to justify attention in a GPs surgery.

The amount of anti GP rhetoric, passive aggressive abuse and entitlement on this thread is astounding.

I used to be a UK GP, I now work in the antipodes where I work significantly shorter hours, have a managable workload, don't do home visits (except palliative care, home visit for a child with a fever is never clinically appropriate), and have patients who welcome and appreciate my time and expertise for which they actually pay (kids and pensioners are exempt).

I do at time also use the Internet, but again sites like medcalc, gp notebook, patient.co.uk, wedMD and paperback mims to ensure that I'm giving the most up to date information and correct prescribing information.

The biggest difference is the day to day interaction with patients, they understand we are human, aren't constantly on and defensive and don't have such massive passive aggressive behaviour wth constant threats re GMC etc if they don't get their way.

FWIW I have been qualified 10 years and never had a formal complaint despite having a very low rate of antibiotic prescribing.

And before anyone even thinks about posting bullshit about how I owe the NHS my training costs, don't even think about it. The oft quoted £250,000 includes such thinks as food and accomodation which the UK government most definitely didn't pay for, let alone take into account the significant amount of non paid overtime over the years.

For those of you whining, you are soon going to get the NHS you and the daily mail are responsible for. A few very good GPs amongst the burnt out ones just counting to the end of the day, with senior GPs retiring and young GPs leaving for overseas. Both Cons and Labour have promised more GPs but there is there is little chance of this actually coming to fruition. GP training post are being left unfilled, doctors aren't idiots why would they want this bullshit, the retirement and emigration exodus continues.

I can honestly say the quality of my care has improved with my working environment just a shame I had to leave the UK for that to happen.