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?

Why don't you speak to the practice manager?
Get more information about who she was?
If she was indeed a trainee it may be an idea to voice your concerns to her trainer - all of this can be done informally or down a formal complaints procedure which usually involves putting things in writing and then having a meeting with whoever deal with complaints in your practice (we have our complaints procedure on our website - maybe your surgery does too? And our senior partner is the 'complaints' partner so meets with anybody who has issues to raise).

This thread has become slightly bonkers now, so I'm hiding it and off for an early night in preparation for the absolute deluge of sore throats and coughs tomorrow.
I will make sure to be cheerful and upbeat and not at all despairing of the rude, demanding, entitled behaviour of a large proportion of my patients, with minor illnesses.
I'll make quite sure if I need to look anything up (because of course I am capable of remembering every single thing perfectly), I will ensure the patient cant see.
I will be happy to serve, because I couldnt possibly be overdrawn and worried how to pay my bills this month. I might just fit in a round of golf at lunchtime.
Toodles.

OP can you clarify you've said she didn't examine but in your OP you said she did examine.

The pouring over the book I don't see a problem. The BNF is a pain in the backside to find the correct thing you're looking for and the writing is tiny so it can be hard to find the passage you need. I bet she was nervous, so took a bit longer. It takes me a while to find the dose sometimes. That's not because I'm incompetent.

The doctors in here have told you it's best practice to check the dosage yet people remain convinced this is a sign of incompetence. It's ridiculous.

You're complaining she didn't look/speak to your child but she did as a question to him but that wasn't good enough.

By all means complain if you think her attitude was wrong or her communication was wrong but as far as practically/clinically she didn't do anything wrong as alpaca has demonstrated above.

Yes she would have prescribed the correct thing without prompting by the OP the chandler. The GP decided in the end that the child needed antibiotics and was checking the dose in the BNF because doses in children are difficult to remember. She clearly knew what to prescribe.

Trainee GPs are called ST Registrars, either ST1,2 or 3.

FY1 and FY2 are the years below speciality training posts.

I thought GP trainees are GPVTS.

Nowadays Foundation Drs can do four months GP as one of their rotations, under supervision.
GP registrars have already completed the two Foundation years and are in their GP Training, 18 mos hospital, 18 mos GP)

I would rather a GP gave the right dose after checking than give the wrong dose.
I know plenty of GPs and pharmacists who use a BNF often online (used to be the old fashioned paper copy)
Its good practice to check but the OP thinks its wrong

It's a bit of a storm in a teacup.

OP, I wonder if you regret posting on here now. I hope not as I hope it has clarified the situation for you. And I hope your son is now well and truly on the mend. I can quite see that you innocently thought 'I'll ask MN' and did not expect all this discussion. Sitting on the side-lines as I am, I find it all fascinating and though-provoking but I can see if I'd been the OP I might at times have felt rather upset by some posters' contributions. As I say, I hope you and your son are okay.

Quite frankly, I am astounded at the vitriol and ignorance (on both 'sides' - I hate using that word as it should not be about sides) on this thread. And in some cases, downright arrogance from certain posters who are GPs. I hope you are all unidentifiable as I would hate to find some of you work at the practice where I am registered - and attend regularly for very legitimate reasons.

The GP who included a link to an actual practice - I hope that's not where you work. If it is, I assume you aren't the pillock with the bow tie (I've always mistrusted doctors who wear bow-ties at work - probably unreasonably, I know, but some of them were pretentious idiots).
I hope too you aren't the one with a HUGE syringe instead of a pretty picture. This is a serious point as I don't think an image of a syringe on a practice website is actually appropriate.

Very many patients - and perhaps especially parents of young children - can be unsure whether to bother the doctor. Despite being an experienced ex-HCP (that's right, MrsMorton, not a doctor or a dentist , in fact a nurse in acute care, but a HCP nonetheless) I have sometimes been unsure whether the symptoms I or my family displayed merited a medical consultation. Sometimes I was right, sometimes I was wrong. I was nearly always, as the patient or the parent, treated with politeness and respect. It costs nothing really to leave any supercilious and patronising attitude at the door. I do know this cuts both ways - my practice certainly has a big notice warning of the need for politeness towards staff - it's beside the other notice listing prices for non-essential letters. I have no gripe with this. Buses likewise have notices stating bus staff should be treated with respect and not assaulted. Everyone should expect that at work, whatever they do for a living.I once, years ago, walked out on a GP when she was very rude to me. She was often very off-hand in her manner but only once did I walk out. I'd like to see my notes - I doubt that she wrote 'I was very rude and I unpleasant to Topaz. Quite rightly she walked out of the room'.

I think some of the confusion - over bothering the GP unnecessarily - does come from internet sites. Often they will tell me I should see a doctor, often urgently, when I know I am unwell but okay-ish, can wait another day, can 'sit on it' and see what happens. Relatively few lay people (I am now a patient more than a HCP) have that knowledge or experience.

Although no longer practising for health reasons (I am your ultimate heart -sink patient, docs!), I am with Pacific on being glad to be in Scotland, not England. I also find myself hoping I will die of my numerous chronic problems before the NHS comes to an end. The system works not badly here at present, I find, but I dread it getting any worse. It's a very scary prospect. Recently I cancelled an appointment made for me by the practice nurse while at a blood-letting appt. The appt (with the GP) was at 5 PM on a Friday. Despite knowing one of my chronic conditions is not as well-managed as it could be, I knew I could not see a GP with a whole heap of nondescript complaints at 5PM on a Friday. I made this decision and gave the practice at least a day's notice (so someone else would get the slot) after much deliberation. So, all you GPs, for every patient you think is wasting your time there will be another who has decided not to waste your time. Even when they possibly should.

If I have come across as arrogant I certainly wasn't intending to be. However you can't expect GPs to take some of the bashing they get on MN. I normally don't get involved in these threads as they are demoralising. Particularly if you are ex health care topaz you must know what it is like when you are trying your best day after day but are vilified for it.

If the daily fail are reading this thread they will be rubbing their hands together in glee to know their propaganda is working quite nicely.

Yes she would have prescribed the correct thing without prompting by the OP the chandler. The GP decided in the end that the child needed antibiotics and was checking the dose in the BNF because doses in children are difficult to remember. She clearly knew what to prescribe.

No, I don't think she would pishedorf. You are muddling what was initially missed with checking the dosage. What the OP says is:

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 hmm. 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!

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.

Anyway, this form came up with the result that antib's were recommended.*

Now of course the OP's impression could be incorrect and she could have been going to prescribe antibiotics despite a temperature of 36.8, but it seems unlikely.

I'm a bit surprised by those who are GPs claiming to be all upset at the scrutinising of this. You are professionals and as such, expected to maintain professional standards. None of this should be a surprise to you, nor a cause for consternation. Its not a big issue, neither is it something that should not be mentioned. The danger is that something more serious is missed. You hardly need that pointing out.

It seems a bit...flippant on the GP's part. As I said, I wouldn't complain, but I would be asking for a different GP the next time. What if it were something more serious which needed, say a macrolide or tetracycline - could you be confident that this GP would have the knowledge or interest to bother finding out?

Pishedorf - I 'felt' as though ds hadn't been examined. My op was correct in what she did though, but it was quick and perfunctory (IMO).

It's hard to put into words - what the pp said is right, I'm regretting putting it on mn because with hindsight it's not black and white enough for a lot of people to 'get', as clearly shown by the huge number of contradictory posts.

It felt as though I just as well have been stood at reception, talking to the receptionist. No medical knowledge needed. It was dismissive, cold, and came across as a box-ticking exercise, with no actual diagnostic skills, common sense or knowledge applied.

I keep coming back to the temperature. Yes, not her fault that the thermometer was dodgy. But she'd not bothered to glance at my ds's face, so didn't see his flushed cheeks, and clearly didn't notice the (fairly obvious) heat coming from him...how could you not notice?

What if he'd had a dangerously high temperature and a dippy parent that hadn't noticed? And the GP sent them on their way?

What if it were something more serious which needed, say a macrolide or tetracycline

This sentence is utter nonsense.

Um, the most recent national guidance at this age (different for babies) is that height of the temperature is no indication of severity of illness.

www.nice.org.uk/guidance/cg160/resources/cg160-feverish-illness-in-children-support-for-education-and-learning-educational-resource-traffic-light-table2

(I think the traffic light system, especially for HCPs who aren't specifically paeds trained, is one of the more useful things NICE has brought out)

A temperature can be 'dangerous' in itself if you consider convulsions dangerous.

Ds1 has had two in the past so maybe I'm more sensitive to it. But it is a consideration.

Public Servant? Public slave more like. Roll on independent health care. This is not sustainable.

No, Pishedorf (I do like your user name, BTW!) I don't think you were one of the posters to which the epithet' arrogant' applies. But I haven't looked back at all posts and this thread has taken enough of my time already. Indeed 'arrogant' applies IMO to only a couple of the posters on here. I have intentionally not named names as I may well misquote and cause another stooshie. and I can't keep all the user names in my wee inadequate brain these days.

However, I feel sorry that the OP asked a perfectly legitimate question and in return received a huge backlash from a bunch of off duty professionals who clearly are disenchanted with some aspects of their work. And, yes indeed, as an ex-HCP I do get a lot of this. Part of me is glad to no longer be working in the NHS; part of me grieves for the only career I have ever really liked and found fulfilling - in spite of the bad bits. But at times some of you were just unkind and unpleasant to the OP.

But what astounds me most is that some of the GPs on this thread (again, not naming names) appear not to have the awareness and common-sense to realise when their vitriolic responses are simply not appropriate to this thread. In amongst the anger and nastiness, there are some useful comments and answers to the original question. But they can be hard to see. Some of you have not cast yourselves or your profession in a good light at all. This is a shame as we all need to believe in the medical profession, and to be frank the medical profession needs the public on their side more than ever in the present political climate. This thread was not the place for such a discussion, in most part, and I don't think some of you achieved anything positive by being so damned unpleasant.

Now off to bed. Somewhat later than intended. Thank Christ for the employment scrap-heap so I can sleep late. And I hope you all have a good day tomorrow, today.

Thank goodness I never tried to be a surgeon - I've just sewn two pieces of knitting the wrong way round. Really off to bed now .....

I haven't trawled through the whole post but I have to say I am in support of the GPs who have posted. People really fail to use any common sense and take any responsibility for anything these days-health or otherwise. Everyone is an expert on everything as they read about it on the internet. Sore throats are now "Strep throat", a cough is a chest infection, throwing up is gastritis, diarrhoea is enteritis. Everyone is so down with the lingo and therefore know that they have to rush to the doctor for treatment for their horrendous condition. And of course random strangers online give the best advice for people-without even seeing the individual, without years of medical training, they can tell that the individual (or their child) without a doubt has a condition that is seen in 1 in 500,000 people and they must insist on being seen that day with their condition.

Things also take time to heal and resolve. Coughs and colds need to run their course, strains and muscle tweaks need to be rested, ice and anti-inflammatories help along the way. People now seem to expect to be able to turn up at the doctors for a miracle panacea that is going to resolve everything immediately.

Common things are common. The amount of cases of the same thing GPs are going to see day after day, week after week would astound us. Just because something is new to you or your child, the chances are your GP will have seen tens or hundreds of them before. Yes, people have obscure things going on, but the frequency of these is so low-it's just people who have had a condition misdiagnosed or diagnosed after one revisit or more will be the people who shout the loudest and everybody hears.

People just seem to have the attitude that they can demand attention and treatment for something right now. Posters have actually stated that a child with a sore throat and temperature is not a mild condition..... Really?! Something that makes the child a bit miserable for a few days but will resolve with no more than some TLC and mummy nursing is serious? If the child has an underlying serious health condition, or is on chemotherapy maybe then you can call it serious but for a normal healthy child-think of it as a bit of training for the immune system.

Last week on Monday there were 210 children absent from my son's secondary school-total pupils 850. What if all of these kids were dragged to their local GP's surgery all displaying the same symptoms? They were all sharing the same bugs, which gave the same symptoms and guess what-by the end of the week numbers at school were back up again.

The best case of time wasting at a GP I personally have heard of was a lady with a child my son's class who insisted on an emergency appointment....to have the spots that had erupted on her son confirmed as chicken pox so that she knew whether to cancel going in to work. Chicken pox was spreading like wildfire through the school, her child had been mixing with other children who had chicken pox and other mums who had experienced it before with older children had confirmed that it looked exactly like chicken pox. But she had to have the doctor confirm it and it had to be there and then.

And people wonder why GPs get so hacked off with it all......

But what astounds me most is that some of the GPs on this thread (again, not naming names) appear not to have the awareness and common-sense to realise when their vitriolic responses are simply not appropriate to this thread.

Right, so some of the replies are rabidly anti-GP, contain significant untruths and some massive hidden (or not so much) agendas, but we (GPs) shouldn't have the right of reply in case we offend someone?

And while I'm ranting-could we talk about lymph nodes rather than glands since we all know so much....

Right of reply: - fine;
Being rude, presumptuous , unpleasant, at times nasty, arrogant: - bad.

Right of reply, if communicated politely, is of course fine. The vast majority did this. Some of you just looked like you wanted a fight rather than to get your points across. Some of you just shot yourselves in the foot. OP asked for guidance, she didn't need a bun fight breaking out.

IME MN can be rabidly anti-everything. It isn't just GPs that get it. I should know - I used to run classes for the NCT. Though I've always thought homeopathy was bollocks and I had 2 caesareans. It could be argued NCT teachers are more maligned on MN than GPs, non? That is a digression, I know. I'd have been asleep by now if it hadn't been for those bastard terrorists in Sydney.

Why? WaroftheRoses. I'll call them what I like, some days they are glands, some days they are lymph nodes. Not that I have much cause to talk about them really, but largely it depends who I'm talking to.

It is curious how a complaint about one GP, or trainee GP, has caused such a storm of defense of said GP and a lot of people feeling personally affronted. They must really inculcate you all with a collegiate spirit at medical school.

I haven't specifically defended the GP in question, rather replied to the general points and behaviours shown by other posters.

IMHO many GPs may have been more sympathetic to the OP and other posters if she hadn't contradicted herself or fail to take on that some things e.g. Checking doseages in children and asking about specific patient/parental concerns are actually considered good practice.

I'm now off to make mince pies although 26c and sunny kitchen isn't helping my pastry.