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?

And there is an almost instant test that can be done on a swab to test if the throat problem is bacterial or viral. Do NHS GPs not offer it?

Well, in all honesty, i think it would depend on the child - whether there is a history etc.

I'm pregnant with DC1, so I don't honestly know how I'd react.

However I was a very, very unwell child (multiple hospital admissions per year with tonsillitis and asthma, ENT problems, all sorts) so in the case of suspected tonsillitis I'd err on the side of caution (tonsillitis set off my asthma and breathing was very difficult every year from September to May). So I'm probably a bit more over-invested than I should be in this thread.

op doesn't say whether she tried calpol / ibuprofen before taking him, but to an extent I think you need to put faith in parents that they will do what they think is best for their child. Of course there are people who don't take responsibility as they perhaps should, and patient education is the way forward for this. But personally, if I thought there was a risk of their condition worsening and I'd already tried everything I could, then yes I would err on the side of caution.

Sorry, that was to YesIDid (not snippy in the slightest btw - you're not living up to your username! )

Which test is that, Wobbly? I've not heard of it but it sounds fab (genuine question - like YesIDid I don't mean it to sound snippy!)

What exactly is that instant test and why has no UK doctor ever heard of it?

Did you by any chance read about it in the Daily Fail?

it's a strep throat swab they do them all the time in the US (make of that what you will), not only in Daily Fail Land e.g. kidshealth.org/parent/system/medical/test_rapid_strep.html

Topaz, having worked a 13 hr night shift last night (admittedly not as a gp but as an icu doctor) where I only went for a wee once, 11 hrs into my shift and mainly because I thought I'd better take the opportunity as I was about to spend over an hour in the back of an ambulance, most doctors manage to not pee for that long because they don't actually need to due to not having time to drink enough (and not being allowed to drink anything in a clinical area), I frequently get home after a 12 or 13 hr shift realising that not only have I not peed all day, I still don't need to go. Not relevent to this thread, just wanted to point out that if you're going to be impressed by our anatomy, be impressed by our poor hardworking kidneys rather than our pelvic floors!!

No we don't swab throats routinely. It's a waste of money. Evidence shows it does not make a difference to the management of a sore throat/tonsillitis.

To me (GP), the computer thing the doctor in the OP was doing was demonstrating the Centor Criteria for prescribing antibiotics for tonsillitis. I think this GP was possibly a registrar and hasn't got that down pat yet in memory so was demonstrating it physically to the OP. Sometimes that can benefit when patients are demanding antibiotics when they aren't indicated clinically. However in this case it has come across as the GP didn't know what she was doing and I don't think that was the case, she just didn't know her audience/didn't explain it simply enough. I don't think this is cause for complaint.

As for the examination, I think it was appropriate. Thermometers can be a PITA. I always bring my own in work because I don't trust the ones in work.

And as far as looking up doses in the BNF, that's excellent practice. Dosing of meds in children are based in age/weight. It's impossible to remember the different age-related/weight related doses for kids. I ALWAYS check. And explain why to the parent because I have seen plenty of them raise their eyebrow.

Macdoodle's example of a typical GP day was so accurate and commonplace . A PP commented about the lack of wee. It's true. On Thursday I genuinely had my first wee of the day at 6pm when I got home (I was meant to finish at 4pm so it wasn't a bad time getting home 2 hours later). Medics do develop exemplary bladder control. Because something always comes up just when you think you have the chance to have a wee.

I love Macdoodle's posts on GP bashing threads because she tells be plain truth and I think sometimes people dislike it because it's difficult to read about these people who are meant to be in positions of authority etc are mere mortals, can make mistakes but by God are most of trying our best for out patients.

Te general public are being manipulated into toeing the line of the government's plan to completely destroy the NHS from the inside out and making GPs the whipping boys. And the constant amount of GP bashing threads here show how successful the government and the Daily Fail have been.

I'm not saying there aren't shit GPs, or crap NHS services. But in this example, complaining is ridiculous. There is nothing to complain about.

Haven't read whole thread.

Dismissive GPs can be dangerous. I once went to see a Dr, and after a horribly long wait the only thing I could manage to say was that my mouth hurt. If they'd bothered to even look they'd have noticed I'd been cutting chunks out of my gums, tongue etc with a razor blade, and needed help.

After being practically and humiliatingly bundled, near thrown, out of the office, my faith in receiving help had been shot down. Had the first Dr looked I might not have ended up in a and e not much later.

If a Dr is fed up of listening to patients' complaints, perhaps it's time for them to take a break?

Imo OP should complain.

Read the full thread?

I really think it's time the public started to lean how to do some home nursing for these types of ailments. It's not difficult, and it's also possible to learn how to identify signs that mean routine illnesses need to be seen by a medic as well.

The relatives that visit the care home shout for the doctor for the least thing and it's wasting valuable time and resources (a sniffly nose and a slightly bumped ankle in the last two weeks).

I also witness first hand how antibiotic resistance is leading to deaths.

Yes, sallysparrow, I've done these long shifts too in the past. Ended up with pyelonephritis in 1st pregnancy due to not drinking and not peeing all night. It was ghastly. Ironically it was a theatre night in surgical urology! I wasn't being entirely serious and I do know what it can be like.

Decaff. It sounds like you've had a rough ride and I'm not saying this to be horrible but there had to be more to it surely? I can't believe you sat down and said 'my mouth hurt' and the GP immediately manhandled you out of the room without further ado?

This in general brings up a very important issue which has been touched on earlier. The issue of doctors asking what the patient was hoping for. It was taken badly by the OP but it's actually a really good thing to do. I don't know how many times I've seen a patient for a seemingly minor thing and I've managed to wheedle the real agenda out of them.

Be honest with the doctor. Write it down if you can't speak it. We are not mind readers. We can't do our job without the correct and complete information about the issue.

Ooooh yes don't slag off the NHS. We could end up with a system like in America!!! Oh wait no we might get a system that works like in Germany

Some very true words written above, esp Macdoodle. I think it was perfectly reasonable for the OP to take her son to the GP, I wouldn't be dismissive if I saw him. Antibiotics may or may not make any difference. Presume she was googling to check the Centor criteria or a similar scoring system for sore throat. Fine to raise concerns, would be interesting to know if she was a trainee. I have some sympathy with the view that one wouldn't want to leave an incompetent doctor whose next mistake might be serious. Being rude to patients is unacceptable although (and this doesn't excuse it) GPs do get pushed to the limit. Out of the patients that are seen every 10 minutes, a large proportion of them will come with more than one problem. Fine if it's "could you have a listen to my chest I think my asthma's flared up with this cold and oh can I also have a repeat script" etc but you would not believe the issues some patients come with (the 'list') i.e. back pain (still need to check through proper history and examination that it's not serious), depression, headaches and then as they walk out of the door "shall I come back another time about my breast lump?". No of course you cannot leave this possible cancer and we run late! HCPs in the NHS are a resource and it is up to us to ensure we are used appropriately... so patients are asked to make another appt to deal with list of problems... more complaints! Yes it is possible not to wee for hours, queries and phone calls coming through from reception staff during the surgery, then GP has to wait because patients' phones that haven't been switched off are ringing and they just need to quickly answer that they are in the doctors, before sending a few texts because they can't resist in the 5 seconds that you've turned to the screen! Also, some patients turn up very unwell - the older man whose wife nagged him to get his indigestion seen to who's having a heart attack in the surgery, the psychotic patient, the asthma attack, the baby with severe croup, the young woman that hasn't realised she's pregnant and turns up with a 'late period' and severe abdominal pain who's suffering an ectopic pregnancy... I feel kind of obliged to hang around while I wait for the 999 ambulance to arrive. Meanwhile, the waiting room patients who have no idea what is going on are fed up! I love being a doctor, don't think I've ever been rude to a patient (and would like to know if I could do better) but all of this crammed in to the day Macdoodle describes above. Let's see if I am still smiling in 10 years' time!

As Pishe has just said, asking the parent their concerns is now considered best practice. If a trainee doctor does not ask the patient or parent their ICE (Ideas - what do they perceive the problem to be, Concerns and Expectations - what do they want to happen next?) then they would fail their exams. It's supposed to be more patient-centred care to avoid the paternalistic approach of old (but yes, there are ways of asking this that sound a bit slicker than maybe the OP experienced).

I do find this confusing , I have the most fabulous GP who frequently go the extra mile, I always make sure I thank them and last time I went I had to wait over an hour after my appointment and the young doctor apologised profusely , and of course I made a point of saying that it was fine. It happens.There others making a fuss it has to be said , not the young lady with the coughing baby, or the man with blood pouring from a horrid looking bandage but all the old people who were about to miss "lunch with friends" or whose cars were in the car park.

The bit I find confusing is that I tend to go in with several things , I thought I was saving the DR time because otherwise I would be needing more appointments , so for non urgent things , I have an ongoing hip problem for example I will wait until I need something else and then deal with it .Am I wrong ?

OMG, I see this thread has developed in the usual manner.

It is very upsetting to see again and again this attitude of 'us' (the patients' vs 'them' (the doctors) when it should and can be a 'we' which leads to satisfactory outcomes for everybody.
The Daily Mail and its ilk have a lot to answer for with skewed and untrue reporting of GP incomes, workload, appointments etc etc and yes, I do think its part of a bigger plan to get rid of Primary Care and maybe the NHS in total.

I am a dr, and I am a patient.
I have encountered unreasonable patients and rubbish doctors.
We all know that people in pain/in fear/feeling out of control can react in ways that they would not do if they were calm and happy, but that does not justify swearing/threatening ("I know where you live you cunt and I will get you with battery acid") or physical assault.
I do not think that 'doctor knows best' is the attitude to have, but equally I understand that doctors come in all shapes and sizes and personalities - some more suited to life at the coal face and some maybe better hidden away in a lab looking at microscopy slides .

There is no way that any of us can express whether the OP should/should not have seen her GP with her DS, whether the dr in question did the right thing or not, but was is clear is that the OP was not happy with the outcome and that was down to communication.

I agree that complaints are not a bad thing: I like getting thank you cards more, no doubt, but complaints are a great opportunity to look at ones own practice and that of the surgery and how to improve things so it all works better. For ALL our patients. Which means that sometimes a complaint will not lead to any changes because much as that particular person was unhappy about some aspect of their care it actually was in the greater interest of the practice population to not make any changes.
It really is true, you cannot please everybody all of the time.

In order for me to do my job I need people to tell me what it wrong (please say "I've got a chest infection" but say "I've had a cough for a week and am spitting up green gunk" and then we can check you out), be honest (it's really helpful if people come right out and tell me their 'agenda' i.e. what is really at the bottom of why they attended "I just want to have it checked out" vs "I am worried it may be lung cancer" will lead to quite different consultations). And then be prepared to listen to what I might have to say: I am not suggesting no antibiotics because I am mean or stingy (why would I stand between you and 80p worth of penicillin?!), but because there are very sound reasons to stop prescribing antibiotics like we do (your and my children are at real risk of not being able to have hip replacements or heart surgery because we won't be having antibiotics that work for mulit-resitant bugs).

And to whoever said it cannot be that difficult to remain pleasant for a few hours: no, normally it isn't. But sometimes it is very hard to be concentration all the time, while chatting away, trying to get prescriptions right, thinking on your feet when the consultation takes an unexpected turn AND keep a smile on your face.

Training schemes for GPs all over the country cannot fill their training posts. Practices cannot recruit but the government promised 5.000 more GPs - I am not sure where they are to come from. It takes approx 8 years to train a GP…

Anyhoo, I love my job, I cannot think of a better one, but the adversarial nature of debate is another part of grinding GP down. GP in their mid to late 50s are leaving in their droves because our pension was unilaterally reduced and working longer would not have increased their pension pot, drs are burning out left right and centre, patient demands are rising and rising (both because of unrealistic expectations and due to ever more complex multi-morbidity and longevity) and there is less and less of us.

But do lets all carry on with the outrage rather than engage in dialogue.
It's not 'us' and 'them', it's 'we'.

Good grief, apologies for the epic post.
A subject close to my heart, I get carried away…

outtolunch, you have ONE appointment time (typically 10 minutes these days) - personally, I try to deal with as many things as I can in that time, but sometimes need to prioritise.
You are better making more frequent appointments that saving it all up for one epic consultation: neither you nor the doctor is likely to be satisfied with trying to deal with several things in 10 min.
Think about what can be achieved in 10 minutes.

Good point pacific , however I don't think I have ever been in there for 10 mins except when they decided to send me to hospital I an ambulance ! Always speak really quickly have often given the receptionist the details of the non embarrassing non urgent items so the GP often has them on screen already .

The thing that's annoying as I said are the people who just go to " update the doctor" this is my MIL or many elderly in my small town .She is not lonely , but she values the drs opinion and so just goes for a chat .Consequently I can't get an appointment for my ds2 who has an ongoing condition needing regular appointments .I have no idea how we stop this , I have tried to explain to her but she just thinks that it is polite to update the dr on her life eg she will go to see him if she has an argument with FIL just to get his opinion !!!

great post, PacificDogwood.

It might have been better to have just explained the sore throat could be viral and bacterial, we don't do swabs but are guided by clinical features..and to add in the caveat that if ds deteriorated to come back for review etc

I think the problem with Macdoodles post was that it sounded like we should all be understanding when a GP is blunt/rude with us because they may have seen our complaint 20 times that day already and he/she has had enough. Well, no. I understand that they are rushed off their feet and the working conditions sound awful but I won't accept a bad attitude from a gp and pass it off as them being stressed or bored of seeing my symptoms for the 20th time that day. Plenty of people in their jobs have enough... I am sure police officers have enough of dealing with certain people and surgeons get bored if they have to do the same operation all day long and supermarket workers get bored of being asked where the stuffing is.

I am probably a gp's worst nightmare with health anxiety. I am sure people would class me as a time waster, but you know, if there were better mental health care provisions in my area maybe that would help, but as it stands I get offered a 4 week course of CBT which isn't enough for me. I work as hard as I can to overcome it and not rush to the gp all the time but I know if I had proper mental health care and could talk through my fears with a mental health professional it would no doubt cut my visits down by more than half. I have an appointment next week to discuss my increased health anxiety but what can a gp do? nothing much, it is not really their area. They can look at what I worry over but that will only help for all of a day or two.

Same for my husband with bi-polar. He now has to see his gp if he wants his meds adjusting, that should be a psychiatrist's job but they don't have enough so his care was transferred to a gp who is well out of his depth and it not trained enough to spot psychosis coming on or anything. So gps seem to be doing other people's jobs as well now.

I must say that I have mostly been treated with kindness and patience. I do however go in and tell them I am anxious and don't demand any tests unless they say I do and I am always polite and show my gratefulnesses and apologise for being the way I am.

I very rarely take my children, I deal with colds, coughs etc at home and take them to the pharmacist for advice before to see if a gp visit is warranted, unless of course there is no doubt that there is. Pharmacists are underused and I have found them amazing at dealing with the every day minor complaints.

unless they say I need them *