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?

Excellent summary of just how utterly awful the OP's GP was, alpacasosoftsnowgentlyfalling

OP, YABU

Round of applause to alpaca

I was at the walk in last Sunday, a week ago, as my chest infection had got to the point where I couldn't sleep effectively and felt I was drowning in my own mucus and the fever was such that I was taking paracetamol on a 4 hour rota just to be able to get out of bed - it was becoming impossible to function.

So I went to the walk in and saw a lovely nurse practitioner who diagnosed a bacterial infection and gave me Amoxycillin, which kicked in after a couple of days and now a week later, I feel a lot better, though I am still coughing, it is manageable, the fever is gone and I am able to rest effectively which is allowing my body to do what it will eventually do which is recover.

I was amazed at the sheer volume of people who didn't look terribly ill who were in the walk-in. I know I am in no way qualified to judge anyone for being there, but the amount of children running around squealing and playing, and reasonably well looking (compared to me) adults seemed excessive. Who knows, they may have all been pissing razorblades or god knows what. I even saw a lass from school who's mother had been saying on Facebook the night before she was going to take her in to have "chickenpox confirmed". There are about 30 children off in the school at the moment with chickenpox. Did she really need to take her in on a Sunday morning to what was basically an emergency only service (no appointments, walk in if you simply can't wait till Monday morning) to have this confirmed? Seriously I could have done that! I know I'm being a bitch but I felt so unwell I couldn't sit on the chair, I had to lie down on a piece of floor waiting for my appointment as I couldn't even sit upright, so I was not in the best most "I'm sure they have their reasons" type of mood.

A week later, feeling better, and I would still hazard a guess that less than 50% needed to be there. You could say I didn't, I suppose - would I have died? No, of course not.

Thanks

alpaca while I agree a specific ground of complaint is hard to pin down and probably pointless, I find the overall lack of professionalism worrying.

Is it NHS management driven, to try and avoid possible compensation claims, to ask the patient what treatment they expect? And to deliver the usual lecture on antibiotic viral inefficiency?

I'm concerned about the googling, in the presence of the patient, when faced with a common complaint, and the time it took to come up with an answer. To me, that's not professional. Even if you must google, don't tell the patient you are doing it!

The bit about filling in forms about fever pain scores from home is odd, because it seems to imply you can order antibiotics from home, which you can't - which begs the question, why bother saying it?

Taking the temperature of an obviously feverish patient wrongly the first time and having to be encouraged to retake it correctly is mildly concerning.

Probably not negligence, probably not worth complaining, but a pretty near useless appointment?

Certainly not negligence!
The GP listened to the Mother, asked about her concerns and responded appropriately.
Sorry she didn't go " ohhhh little one are you poorly,oh dear,ooooooh dear ,poor little one !( SO WHAT )
The temp thing- its not her fault if the temp didn't record correctly- she listened and rechecked so she responded appropriately .
How is it useless when the child got the correct treatment???

No it is not NHS management driven. I've mentioned above we are trying to move from the patriarchal doctor-patient relationship to a mutual one.

Asking a patient what they think/want is BEST PRACTICE. Patients come in with hidden agendas that they are too scared to reveal, or don't want to bother us with. So then after they leave they have not had their Ideas, Concerns and Expectations address and will leave dissatisfied and more importantly, their illness/whatever has not been dealt with.

I said earlier, doctors aren't mind readers. We need to know what the patients wants/or is worried about.

In this case, if the OP had wanted antibiotics and didn't get them she may have left the consult upset/dissatisfied and her trust in the practice may diminish.

I always say to patients that they are as much part of the team as a doctor/nurse is. I WANT to know what they want. I want everyone to leave my room feeling that they have been listening to and that I care about their concerns and that I've tried my best either to sort them out or give them reassurance or a plan.

I'm not saying it happens in every single consultation. Some consults do go badly. And trust me right now, if a patient leaves a consult unhappy or whatever it's a horrible, awful feeling for the doctor. But it's something we can learn from. That's why in one way, complaining may help this GP. If she is a trainee it will absolutely obliterate her confidence but it would provide a learning point for her to improve on her 'it's a virus, no antibiotics' speech all GPs need and also to make sure the Centor Criteria is embedded into her brain.

And one last point on this post. Doctors are human and infallible. We can't know everything. A doctor who thinks they know everything is a dangerous one. When I was training, my trainer once told me that he will happily admit to patients that he didn't know the answer to their question. And patients appreciated his honesty. I've adopted that and patients appreciate it because I say that I don't know but I will endeavour to find out.

I forgot to put. No it isn't management driven to give the viral/antibiotic speech. It's clinically best practice. And good patient education too.

Pishedorf I'm an unreconstructed old style guardian reader and find this all quite shocking. So far am biting my tongue, changing the subject and leaving the room to avoid engaging.

Fascinating.

Now I see why my friends who are doctors say what they do about GP.

Please excuse misquote. I'm sure as part of the team of which we are all part on mumsnet, you've seen it for the constructive learning experience that it was!

In response to my first post on this thread (a looooong time ago it seems!) I would be willing to bet a good amount of money that the OP saw a trainee, possibly even an FY2 doctor or maybe a new registrar. FY2s are only in their second year out of med school and are not GPs, have not got same experience and whilst they might have read the textbooks on communication, haven't got the experience of putting it into practice.

It sounds predominantly to me like communication was the problem in this case. For example, GPs are trained to try and ascertain what the patient is expecting you to do. However that doesn't always mean you need to ask them, usually you can listen or pick up on the visual cues they give. Clunkily asking the patient what they were expecting you to do, if said in the wrong way or at the wrong time can sound either facetious or like you don't know what to do yourself!

Differentiating viral from bacterial tonsillitis is bog standard every day GP stuff, no googling of scores should be required really. Checking doses is fair enough though.

The standard of consultation has improved massively over the years. I think patients have come to expect a lot more than previously - its just as much about how you explain what you're doing as what you actually do.

I might be wrong though, it could well have been a fully qualified GP. Either way I'm not sure a complaint is really justified as the outcome sounds appropriate and in no way negligent.

OP do you think your perception of things would be different if it had definitely been a trainee you had seen and you had known this?

My ire?
What ire?

NHS Constitution - plenty of rights for patients (as it should be). I don't think that Zero Tolerance wrt violence at my place of work is too much to ask in return.

Show me anybody working in any job who does not have frustrations, bad days and difficult situations to deal with. It's the same for HCP.

I love my job, where I work and live and have constructive relationships with most of my patients.

I have also written to my MP (several over the years, or rather MSPs as I'm in Scotland) about changes needed locally and nationally. I thank my lucky stars that I am not in England, I have to be honest.

We are all in this together - don't make this about individuals.

Sorry I'm confused. the chandler what part of what I have said is shocking? And what does it mean you understand what your doctor friends say

About GPs?

About GPs?

There's a whole other thread there: IMO every single hospital doctor should spend spend one year in primary care.
I am saying this as somebody who spent 10 years as a hospital doctor including A+E and being married to a hospital doctor .

Absolutely pacific I respect my hospital colleagues so damn much. It's a shame we don't always receive the same respect back.

Plummy - no, I don't think it would have.

Put it this way - I left with ds, looking at the prescription and feeling a bit...I don't know...incredulous and confused. Despite the prescription, like I'd wasted my time as ds hadn't actually been examined.

I went and got the prescription filled and only looked at it when i got home. It was [checks] Phenoxymethylpenicillin. Not a name that I recognised...the only one I or my dc have had before is amoxicillin (sp). It's also different from the thick banana-flavoured antibiotics that I've seen kids have before, it's red and runny and needs to be given with a syringe.

There was no leaflet with it like there usually is (not sure why). My confidence was such that I had to do my own bit of google research on the medicine and it's usage and dosage before I felt comfortable giving it to ds.

I'm not a helicopter, paranoid, pfb moaner. Really, I'm not. I've never checked up on any medicines in the past, or had any particular issue with medical care before - GPs/consultants/nurses/whatever. I don't have impossibly high standards or expect GPs to be some super-human perfect entity at all times.

But if I felt the need to do that (google), surely that shows something was not quite right. Maybe she was a trainee. Or just poor at communicating. Or maybe she's well out of her depth and floundering.

I know that I wouldn't ever want to take the dc (or me) to see her again.

I do also find alpaca's 'summary' a nice bit of writing but not remotely accurate.

She prescribed the correct thing OP.

You said she did examine him. She checked his temp ( ok twice), looked at his throat and felt his neck glands. What else did you expect her to examine?

Phenoxymethylpenicillin is the correct antibiotic for bacterial tonsillitis.
Amoxicillin is used for bacterial lower respiratory tract infection and can (sometimes) cause problems if used for tonsillitis.

What flavour/colour/consistency a liquid antibiotic has has nothing to do with the prescription and depends entirely on supplier an individual pharmacy uses. Equally whatever leaflet or not was in there, will depend on the pharmacy - the instructions how to take should be on a named, printed label with your DS's details on it.

I agree that you should not go back to see a doctor you don't trust.

Have you decided whether to take it further?

And she looked in his ears too.

To summarise my concerns...

1. She didn't speak to (except 1 q) or look at (facially) her patient at all. Ds is 6, not 6 months, and perfectly able to answer questions about how he feels.

1. The incorrect temperature. Not that the thermometer gave an incorrect reading...obviously not her fault. But that a child, red in the face and lethargic but radiating heat, and apparantley only giving a temp of 36.8 didn't give her any indication that it may be best to recheck.

1. The glands described as 'normal' and 'fine'. They are huge and painful, which seemed to me like she was unable to tell this.

1. The fact that she launched into her viral vs bacterial speech, assuming I was aiming for anti b's (indication was that she did not think them necessary). Then accessed google, which apparantly proved her wrong and made her decide to give antibiotics (I will add that this whole time I was silent, I did or said nothing to influence this).

1. The text book. I get that things need to be checked. But she didn't do a quick check for reference, she poured over it for a couple of minutes. Like you do with a newspaper, or any other new reading material, not something you're (hopefully) familiar with and just need to check.

The inappropriate question to ds was just very poorly thought out, not something that hugely bothers me, just made me a bit

So she didn't examine your DS?- you stated she did- she felt his glands and your DS said "ow" and looked in his ears and throat with a torch.
It is normal to have enlarged glands in a child with a sore throat- its the natural response of a healthy immune system.
She maintained eye contact with you and listened to your opinion as the childs mother.
.You asked her to recheck the temp - she did.
She used current guidance and checked it to ensure that your DS got the right treatment.
Really confused OP - what on earth did she do that was so wrong

Pacific, 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.

But after that experience I just didn't have enough confidence in her to give ds a medicine that was completely unknown to me.

I don't think I can just leave it. I haven't decided which way to go about raising it though.

Pishedorf She prescribed the correct thing OP

Actually, that's an excellent point. Would she have prescribed the "correct thing", as you put it, without prompting by the OP?

Possibly not, the OP had to prompt the doctor to take the temperature correctly, for a second time. The googling which resulted in the treatment (prescription) was based on "fever pain score".

You would have to say that probably does fail the Hunter v Hanley (and subsequent) test(s), in that the reasonable doctor etc would probably have done things better.

Anyway, the OP has only raised it on an internet forum. Personally, I wouldn't complain, as no harm has resulted (therefore its not negligence), it wasn't that bad. But no-one could seriously claim this was a very professional way to examine a patient, or one which would fill them with confidence. I would hope that it was a trainee, and personally, I would gently ask the surgery if indeed this was a trainee (or whatever trainee GPs are called, FY1 or 2 I think).