To be angry that my doctor won't prescribe the drug I want

[DazeyandConfused]

I went to the doctors today to try and get a prescription for diannett. It is a 'skin friendly' contraceptive pill. In other words it nukes spots and considering I'm long past the age when spots are appropriate, it is a god send. I've been on and off it for 9 years. There is a slight increase in the risk of blood clots/stroke/heart attack after two but that has never been a problem. I'm fit, healthy and every time I try another pill/acne combination, it doesn't work/I feel ill. Today the doctor put his foot down and wouldn't prescribe it. AIBU to get really angry over this? Is there anything I can do?

I am really shocked by the number of people suggesting you see a doctor privately, who will basically be less scrupulous or less informed and prescribe it anyway! They must have a very low opinion of private doctors.

The suggestion of seeing a dermatologist for alternative treatment seems much better advice. Hope you find something else that works op.

Derma referral is the stuff on my dreams

Over the years I have tried about 5/6 different treatments and ever expensive and credible brand, especially dermalogica, none of which have worked. Acne is severe enough that random people on the street stop to give me advice ( as if I've not thought about using just soap and water or making sure to take make up off before)

My gp won't do a referral until I give another pill at least 6 months to see if that works :(

How old are you? Are you overweight? Smoker? All these are relevant but I'm a GP and I would usually insiste on a trial of something else after several years on dianette. Blood clot risk much higher than the others and there are other skin friendly pills around, Cilest being a good one.

'GP's nowadays (unlike GP's of old) seem to be scared to use their own judgement and tend to rigidly follow 'Current Guidelines', even though often 'Current Guidelines' are fond of stating that, even if there is a 'slight' risk involved with a medication, it shouldn't be prescribed

As a GP, can I just say piss off?

I sign hundreds of prescriptions a day. Every single one of the drugs has potential side-effects, some of them fatal. At each signature, I am balancing the risks of those side-effects with the potential benefit to the patient - if I get it wrong, a patient could die and (clearly less important but still a big deal to me) my career could be over. You have absolutely no idea what my job involves. And, FYI, developments in case law mean that all doctors are obliged to consider current guidelines - we can be struck off and sued if we don't.'

What Turps said above.

The OP is really naive and some of the responses v foolish e.g. seeing a private GP/ Gynaecologist. I'm not a private GP but I hope you wouldn't find one who just does as you tell them because you are paying them directly. That isn't good medicine nor is it ethical.

The OP is really naive and some of the responses v foolish e.g. seeing a private GP/ Gynaecologist

It was an NHS Gynaecologist who perscribed it to me and recommended that I carry on with it, hence my GP being happy to carry on giving it to me.

Cillest sp? I was under the impression was dianette but just generic form?
I Was prescribed it dianette for my skin and it worked wonders..
Then i went back on to it at 28 to sort my periods and i ended up getting a blood clot. I nearly died.
Sounds like your gp was worried about your health.
I'v suffered with severe acne for over a decade and i tell you now id take that again even though it depresses me than go through the hell i'v gone through with the blood clot.

Generic dianette is co-cyprindiol. Cilest is a different contraceptive pill that is ofte good for skin.

Really, three?there's some people on another forum who are uninformed then!
I had no problem being diagnosed dianette twice, mind you i suffer severely with headaches so when it was found i was ok on dianette my doc didn't have a problem prescribing it again.
Im just very unlucky! My dp mother friend daughter just died from a clot from being on it.
She only told me recently, she didn't want to scare me!!

Well the two active ingredients in Dianette are cyproterone acetate and ethinylestradiol, co-cyprindiol is the combination of those ingredients. So there's also Cicafem and Clairette available.

Yes kali110 Cilest and dianette have different ingredients. The genetic name for diabetes is co-cyprindiol and there are various brands around as per graysanalogy above.

there's some people on another forum who are uninformed then

Uninformed people on the Internet? Surely not

Everyone should own a BNF, in healthcare or not

I wouldn't go near Yasmin. A woman I know had a brain haemorrhage while taking it, and was told by her neurologist that there was mounting evidence against it. I think there are a couple of lawsuits pending in the US.

Yasmin has a higher risk of blood clots than other pills and is very expensive for no good reason. I rarely prescribe it.

I get annoyed too as I know my health and what works for me, I have chronic conditions and I take what I need, no more, if I go in and ask for something stronger than my day to day medication, like morphine for example (had both oramorph and tablet form in the past), it's because I can't cope without it. Passing kidney stones is fecking awful, passing them on top of living with chronic pain is a nightmare, but I prefer not to go to hospital to be medicated, so if I ask for pain medication, it's because I need it, not because I want to get high or am addicted.

Same goes if I ask for something to help with sleep, as I will only go when I've tried everything else already. Being in pain and losing sleep is the worst combination ever, sleep loss is a known trigger for my mental health issues, and if I can't manage those issues, I'd rather take a sleeping tablet than have a psychotic break.

I had a great doctor when I moved away from this area for a year, she sat with me and we discussed my needs and what we could do to manage pain, and when I needed more help, she was happy to prescribe me with antibiotics to take on holiday in case I needed them, and some painkillers stronger than my usual to take for the flight and travelling, and for the bouts of renal spasms which I thought might indicate a stone coming through. I am on long term pain medication, but that only manages the day to day pain, when I get infections or a flare I get masses of breakthrough pain. I use other methods, like heat pad, TENS, warm water in bath/hot tub/pool to try and manage, and if nothing works, then I will go to see GP. I don't think I am being unreasonable, knowing what works and what doesn't is just part of day to day living with chronic conditions.

I have access to a BNF even, so I know contraindications and side effects of most medications, so I can make an informed choice.

YABVU OP.

Also, what turps said.

Not everyone is like you though FanFuckinTastic and whilst you sound like you know what you're talking about and more importantly know what you need, there's still a lot of things that goes into making the decision of what to give patients whether they ask for it or not.

There's lines between autonomy and beneficence. Like I could give someone all the autonomy they want and given them what they ask for but at some point for beneficence sake I may have to draw the line. This includes even when patients know things work for them, if I think the risk factors are too high I've got to say no sorry we need a different plan lets find something else.

Not only that but there's people who will royally take the piss.

Out of curiosity, did oramorph work well for you? My patients have it for breakthrough pain and it seems to do the job. I had it last week when I was in hospital myself and I was waiting for the relief and... nope. I was shocked.

Oramorph isn't amazing no, with kidney stones everything still hurts, but it might make enough of a difference that I could sleep. With the joint problems it definitely is an improvement on the slow release tramadol, but not enough that I would want to switch onto it as the side effects are worse.

The tablets were okay, things still hurt, but the connection to my brain made it feel like it didn't matter so much, making it easier to cope with. They make me nauseous though, so have to get an antiemetic too. Used to take antiemetics daily because the kidney problems make me feel sick, but I've managed without for over a year, although some days I wish I hadn't.

Morphine is probably best intravenously, I have had it in hospital and despite being in awful pain, the whole world felt fluffy and wonderful. I wouldn't want to take that unless I really needed it though, as I can see why it might be addictive, especially when you are in constant pain.

Dianette is a horrid drug. I took in my late teens/twenties. Cleared my acne but it sent me quite loopy

Yeah I know what you mean. I ended up having IV moprhine and it felt wonderful. The pain was still there, but I just wasn't bothered by it anymore IYSWIM. I can see why people get addicted to it because the feeling is nice and it helps a lot.

This is what I struggle with as a HCP. This flow chart of pain medication. Start them on paracetamol which will do ball all I know but oh try it anyway. And when I know things haven't worked for myself I question whether it's going to work for the person in front of me screaming in pain. Obviously we're all different and it effects us differently but I still struggle with it. It's like when midwives tell you to take paracetamol for contractions at first. REALLY?

I've found paracetamol makes a bit of a difference if I take it along with the tramadol, but not remarkably. I can't take anti inflammatories for any prolonged period because it makes my stomach bleed and isn't good for a struggling kidney, or I'd be happy with diclofenac alongside the tramadol. Reducing inflammation helps a lot with the pain, so I do get general steroid injections occasionally, diclofenac was the only one that really impacted on kidney pain too.

Co-codamol helps a bit, but the constipation is an issue because of previous history of bowel blockage, I will occasionally get some to take alongside the tramadol.

Tried Acupan which also helped, but doesn't seem to be used much here, helped the co-codamol work better, not tried it with tramadol and not sure of contraindications, especially with being on sertraline, amitriptyline and mirtazapine.

Am on an antispasmodic for my bladder right now, and have been on another in the past for my renal system in general, that helped too, but I rattle when I walk, and prefer to take as little as possible so I have options for flares and infections.

My pain is widespread and caused by different things, some of it is nerve pain, some is acute kidney stone type pain, and then there's inflammatory pain in my poorly joints. It's hard to find one thing that does them all or combinations that don't have side effects that aren't good in my health. I live on my heat pad, as that really helps with stiffness and pain. But my body isn't my friend.

Bloody hell fan it sounds like a nightmare for you. Must have been tricky getting the right combination. I'm glad that you had a good doctor before who worked well with you, hows the one you have now? I think people like you who have chronic conditions should have a lot more say in their treatment, in fact this has been talked about quite a lot on the whole anyway, because you are the experts in your care.

The one I am with now is pretty good, he's getting to know me still as I recently switched due to the doctor I liked being so busy it was hard to see him fortnightly, so we're a ways to go, but he listened and whilst he didn't do everything I asked for, he said that he would focus on one issue first so prescribed the mirtazapine as I was finding the insomnia worse than breakthrough pain. His reasoning was sound, he didn't want to start me on a bunch of new medications because I am already on a fair amount.

I am due back to see him as the mirtazapine trial hasn't been pleasant, I had to stop taking it because the side effects were making me feel disconnected from myself. So back to square one, it's a pretty serious depression caused by numerous factors, but our CMHT has "no room at the inn", so unless I am psychotic or going to kill myself, they won't have me right now.

So next time it's either antipsychotics, which we have discussed, or it's pain. Not sure what to focus on this time.

Ah that's absolutely crap. You're in a catch 22 aren't you. The fact that you've got these multiple problems means CMHT should make room for you. It's disgusting it really is :(

I hope you find something that works for you I really do.

They've gone from a team of two psychiatrists and a psychologist, to one psychiatrist, I was really unhappy with their choice to sign me off for IAPT because I knew IAPT would just refuse to see me because of the suicidal thinking - passive, but still! I'm stuck in no mans land because it's really too much for primary care to manage, but not bad enough to call crisis. Seeing CMHT took nine months from referral this time, so I don't rate my chances of seeing them any time soon. I am hoping to find a medication that helps at least, I've recovered before, so I know what to do, just it's a lot easier when you have proper support.

I totally respect the people who work with me, because I know I am complicated and hard work for them, but I am definitely disappointed not to find the support I've had in the past when I finally admitted I needed help.