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?

[Pishedorf]

Well we would have to disagree the chandler especially with that tosh you write about tetracyclines and macrolides. Pen V is used to for other things too - scarlet fever for example.

And she didn't miss anything apart from the temp which is not her fault given the thermometer was dodgy. As a PP said temp is actually not a part of the traffic light system now.

And OP I'm sorry to hear your son has had 2 febrile convulsions in the past. It makes sense now the depth of your concern. This is a good example of stuff a GP needs to know. The GP may not have know about that (it's not always clear on a quick check at a patients medical records before calling in or may not have been coded properly).

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.

[YesIDidMeanToBeSoRudeActually]

OP you're making yourself sound like a bit of a nightmare tbh. Complaining about the colour of the medicine. The fact the pharmacist didn't enclose a leaflet, how can you blame that on the GP?! The dramatic temperature description - wouldn't you just give calpol normally or would you go to the doc every time LO has a temperature. My DCs have had febrile convulsions too which is why we keep calpol in the house, I certainly wouldn't be worried about a temp which by your own admission had only developed in the last hour. I would only worry if it couldn't be brought down. No wonder GPs are so snowed under if people can't self manage minor illnesses like this.

I have sympathy with all the GPs and HCPs posting here, particularly if you might be their patient.

[YesIDidMeanToBeSoRudeActually]

Some people don't seem to understand that minor illnesses actually do make you feel ILL. They can't necessarily be cured by going to the GP straightaway, you have to give your body a chance to try and get better first. GPs should, IMO, be used as a last line of defence after a "wait and see" attitude, not a "just in case" and "well it might get worse". Well, if it does get worse, then is the time to see your GP.

I posed before about my lovely GP paying me a none requested home visit, I think the reason I get such a good level of care is that she is fabulous, but she also trusts me to self manage and that I would only see her when something is serious.

Maybe I feel this way as I have a long term condition though. Maybe those of us with serious permanent ill health, have different ideas of where the "serious enough to need medical attention" line is drawn?

[bruffin]

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

Your ds is now 6, the chances of him having another febrile convulsion is extremely rare, unless your family are genetically disposed to having abnormal febrile convulsions.
Most gps will not have heard of fc in a 6 year old, it is rare.
Also febrile convulsions tend to be caused by a very rapid rise in temperature, not a high temperature. My dcs would fit at 39 and would be the first sign they were ill. DS had FC until he was 13 and had over 20 of them.

[OriginalGreenGiant]

Bruffin - ds is very nearly 7 and his convulsions were at age 2, and most recently 8 months ago.

yesididmeantobesorude - can you tell me what thread you're reading? Because it's clearly not this one as your post is nonsense.

[OriginalGreenGiant]

Coyoacan - I agree. It does nothing to install faith in the profession IMO.

[plummyjam]

Greengiant tbh I think some of the points you raised as concerns are relevant and I can understand where you're coming from, looking at it from a patients perspective. Not looking at your son - seems a bit odd, most 6 year olds will give a bit of history, and even if they aren't forthcoming, I would expect a doctor to look at them. I think the temperature issue is unfortunate, although it's more often the history of fever which is more relevant - kids are often dosed up with calpol by the time they get to the doctors which will bring their temp down. I don't think looking up the dose is an issue really, kids doses are difficult to remember - 6 years is often a cut-off age at which dosages change.

To try and put things in perspective, the usual thought process behind a GP seeing a patient with a sore throat is this:

Does the patient have tonsillitis which needs antibiotics or is it viral?

That decision is usual based on 3 out of 4 criteria (the Centor criteria) being met:

1. Pus on the tonsils
   
2. Tender glands in the neck
   
3. No cough (cough is usually viral)
   
4. History of a fever (not just a temperature when you examine them)
   

Other considerations are whether the patient is dehydrated, if their tonsils are so massive they can't swallow for example. Penicillin is the antibiotic to use, because although amoxicillin will work for tonsillitis, if you give amoxicillin to a patient with glandular fever (same symptoms, caused by a virus though), they will come out in a nasty rash.

So after a GP has made the decision whether to give antibiotics or not, it's really a case of explaining that rationale to the patient (I even bore them with the criteria). In my experience, the vast majority of patients are happy with the explanation, and are given advice about signs to watch out for that would mean they need to come back.

Sore throat consultations really are bread and butter everyday GP stuff. I still don't think your doctor was negligent and I'm not sure a complaint would really achieve anything for either party. Although if it was a trainee you saw, perhaps some constructive feedback on the points you made given to their trainer might be useful.

(And tetracyclines are avoided in kids under the age of 12 btw - makes their teeth go brown )

[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!!!

[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.

[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.

[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.

[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.

[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.

[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?

[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.

[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]

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).

[Pishedorf]

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

[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]

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.

[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.

[PacificDogwood]

One wonders, ModernToss

[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]

FYI EndAusterity

[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?