To ask for investigation into GP?

[parmalilac]

Long story - sorry ! Had private knee replacement op last year. Am allergic to Codeine, this was duly noted in hospital. Came home 4 days later with lots of painkillers, blood thinners etc. GP visited me at home to see how I was, and I told him I wasn't sleeping due to pain. He looked at the meds and told me I could double the dose of 2 of the painkillers. Also gave presc. for sleeping pills, which I did not ask for and did not take. I doubled the dose of one painkiller that night and had severe anyaphylactic response, was rushed to hospital. They looked at all the meds and said it was probably the double dose I'd taken which 'tipped the balance' as that particular med was related to Codeine and I should not have been taking it in the first place. They looked at what I’d eaten and discounted food as a trigger, with 3 doctors saying it was probably the meds. Came home, continued to have anaphylactic reaction after adrenaline had worn off, was back in hospital twice more even though I'd stopped all meds by then. During this 10 days or so I was unable to do the physio which is vital after joint replacement. As a result I have not recovered properly (despite 6 months of physio) and am actually disabled now as I cannot walk without crutches.
Asked the private hospital to investigate why I was given those particular meds - they replied that basically as I had no reaction while I was actually there, they do not take any responsibility. Called a legal firm for some free advice about that, but they said the person responsible is the GP who advised me to double the dose. On researching this medication I also learned that it should NOT be taken with sleeping pills ... so now I am very concerned that the GP's actions were wrong. He did not ask me at any time if I had any allergies, but it is on my medical records.
Now I don’t know what to do and I wonder if it will negatively affect my future dealings with the Health Centre (it’s the only place in town). On the other hand, I think this GP has made a serious error, and it should be dealt with so it doesn’t happen to others. What would you do? I can't get my old life back but I think he should have to answer for this.

What are you seeking to achieve here?

Compensation?
A review of practice?
Having someone you can name to blame?
Getting this GP struck off?

The private hospital have refused to accept responsibility, and you seem to have accepted this rather easily and instead seem keen to pursue the GP. I'm curious as to what you think this will achieve and what you hope to achieve.

It seems to me that there probably are a number of factors at play here. It sounds very much like it is a series of events.

I would say the GP had reasonable grounds to assume that you had no issue with the drug and therefore could tell you to double the dose. Even though its on your notes, you were taking it without issue so far.

It sounds like an error in giving you this in the first place which triggered a series of events.

I don't know why you are trying to hold the one at the end of the chain of events responsible for it all. Which is why I really do question your motivation and what you are seeking to achieve.

I have no problem with complaints, in fact I encourage them rather a lot on MN, but you do need to a) be realistic about what you want to get out it and b) be honest about your motivation and how this actually is going to benefit you or anyone else.

I suspect the legal firm which you called gave you poor advice. I presume this was a initial, exploratory call so they will have only touched on the surface of the issue. Medical negligence is very difficult to prove and if you are determined to pursue this you will need to use a reputable firm with expertise in that area, not a no-win, no fee outfit. You will need to be prepared for a very long battle and for the legal and medical arguments to drag on for years. Just on the basis of what you have said, your case doesn't sound straightforward. If you have three doctors who say it was "probably" the meds which caused the reaction, you can be sure that insurers will line up three more who say that a single, double dose couldn't have caused the reaction. The GPs insurers will try to redirect the claim to the hospital's insurers as they prescribed the meds first, they will bring in experts to provide evidence that not every knee replacement is a success and that you are unfortunately one of the 0.5% (or whatever) who unfortunately do not make a good recovery. And that's just a couple of the lines of rebuttal which will be used! Meanwhile, this is all taking time and effort on your part to pursue.

Can I also point out that medication prescribed by a GP should come with a patient information leaflet. If not, these are available online or from the pharmacist. A patient should always double-check medication before taking it. We have to accept some responsibility for our own actions.

I'm allergic to codeine. I can take tramadol. Knowing your allergies to codeine would not necessarily stop someone from prescribing tramadol/inc the dose. Your GP did nothing wrong. Sleeping tablets are often issued to people on opiates too.

Aspirin and ibuprofen shouldn't be take together so you shouldn't have been discharged on that.

Discharging someone on oxycodone and tramadol not great; they should have calculated your pain requirements into one dose of oxycodone and not give you 2 separate opiates.

Your GP did nothing wrong. Allergies happen. If you've never had anaphylaxis before to anything how can anyone predict you're going to have one ever? Nope they can't.

Stop looking for someone to blame.

As a patient I dont just take medicines dished out to me.
I check the medicine - as you should have if you are allergic to codeine. And then don't take anything with codeine in - or related opiates.
This was very unfortunate but sometimes these things happen.
Your story is very muddled so you won't have a good case anyway - if that is what you want.

i doubt it was to to do the codiene allergy and was probably a new reaction.

My mom took ibuprofen for YEARS without any bother, then suddenly developed an allergy to that had immediate anaphylactic reaction, she can't touch it or any other NSAIDs now.

DownInFraggleRock -
thanks for the info re oxycontin. It was also mentioned in A&E that I should not have been given this, but I had not taken it for about 4-5 days since a few days post-op. When I asked the private hospital to explain why I'd beeen given these, they came back saying they had talked to the surgeon and anaesthetist, and said that synthetic opiods had a very low risk to those allergic to opiates, and that they stand by their choice. They ended by saying as I had no reaction while I was in there, they took no responsibility.

Stillunexpected-
I realise that it is not feasible to pursue the matter with the private hospital as there is no concrete evidence.

RedToothBrush -
It’s not that I am keen to pursue the GP, I certainly don’t want anyone to be ‘struck off’, and neither am I looking for compensation. I looked on the whole horrendous past year as ‘bad luck’, and realising that I could not do any more re the private hospital, was prepared to let it go. However when I received their reply about synthetic opiods etc being very unlikely to cause the problem etc, I read up a bit more on Tramadol and saw that sleeping pills should not be taken with this. The GP prescribed them for me on his visit, having just advised me to double the dose of Tramadol. Thus I think he did something wrong. I did not take the sleeping pills thank goodness but nevertheless this WAS his responsibility as he prescribed them. I certainly do not trust this GP now, as nice as he is, and will not see him again. I realise that having an investigation like this would be a serious thing for him, and that's why I'm hesitant to do anything. But what if it happens again to someone else and I didn't say anything?

AliceInUnderpants -
I accept your point, and I know that medication comes with information. However I was already taking this, having trusted the hospital to prescribe suitable meds. With hindsight I should have asked for all the information to be given to me prior to the op, so I could do my own research and reject meds I thought may be problematic, but shouldn't a patient be able to trust that allergies will be taken into account? I was wearing a bracelet with the allergy stated on it for the duration of my stay.

I've gone 30 years without having a reaction to nuts. Now at 32 I have a bloody nut allergy. So Its possible you were reacting to something else.

You seem very determined to blame your GP and very accepting of your private hospital not being to blame which, from my reading, seems somewhat to be the wrong way round. Were you treated at the private hospital for your reaction, if you were this may account for some of the rather bizarre conclusions they seem to have drawn as to the causes and reasons for your reaction.

Why not ask your GP why he recommended a double dose and what, if any, risks he took into account when making this recommendation. Also, why not ask him to explain why he prescribed sleeping tablets and what, if any, dangers there was to this given the other medication you were taking.

Perhaps those answers will reassure you that the GP was only trying to help, or they might prove the GP made a mistake. Once you know which you can decide how to proceed.

With hindsight I should have asked for all the information to be given to me prior to the op, so I could do my own research and reject meds I thought may be problematic, but shouldn't a patient be able to trust that allergies will be taken into account? I was wearing a bracelet with the allergy stated on it for the duration of my stay.

But what does the GP have to do with the treatment in hospital? He visited you at home afterwards, yes?

The main thing that stands out here as a bit is that you say you went home after the adrenaline and then went back twice more as the reaction continued at home.

You simply wouldn't have been discharged if you needed adrenaline, without a period of observation longer than it takes the adrenaline to wear off (which is within hours.......)

OP, I think you are getting an unnecessarily hard time here, possibly because you worded your initial post badly. 'Investigated' is quite a strong word to use. However, you are unhappy with an aspect of your care and patients have a right to feedback on that and to have any concerns looked into, addressed and explained.

Write to your GPs surgery with your concerns. Keep it unemotional in tone and ask them to look into it and explain the processes involved in the prescriptions you're concerned about.

I'm really quite shocked by some of the aggressive responses on here and I sincerely hope they don't come from NHS workers. That way lies another mid-Staffs...

Fortunately OP in my experience working in this field most NHS/GP surgeries are a lot more helpful and professional regarding patient feedback. As long as you are reasonable and non-aggressive in your dealings with them I see no reason why it should damage your relationship with the centre.

Tramadol is a synthetic opiate.

I can take opiates but I have severe respiratory issues on Tramadol.

Op you have my sympathies

So are you saying that actually what you wish investigated is only why the GP prescribed sleeping pills with Tramadol? As you have discounted pursuing the hospital who were the ones who prescribed the medicines in the first place? Therefore you seem to be accepting that the GP was only following what had already been prescribed? Why did you consult a solicitor then? Surely the first step would be to write to your GP asking why you had been prescribed the combination of the two meds together.

Asked the private hospital to investigate why I was given those particular meds - they replied that basically as I had no reaction while I was actually there, they do not take any responsibility

This is the problem with going privately. So now the good old NHS will have to sort you out. No wonder GPs and hospitals are on their knees.

I would say it was probably joint liability. Are you trying to bring a claim?

But there is nothing wrong with being prescribed tramadol and sleeping tablets, I myself receive a regular prescription for tramadol and zopiclone.

OP I'm sorry but there is no one to blame for this, it was just one of those things. Please don't be one of those people who try to sue the NHS, it's absolutely unnecessary.

A pic of my prescription

Typical of private medical care. They make a fuck up which ends up getting sorted by the NHS who takes the blame for it.

Madness.

"Aspirin and ibuprofen shouldn't be take together so you shouldn't have been discharged on that."

Not necessarily. Aspirin isn't used for its painkilling properties any more (when the dose is 600mg) but to prevent blood clots/heart attacks etc at a dose of 75-150mg when co-administration is perfectly acceptable.

Aspirin and ibuprofen can be taken together (indeed 900mg aspirin and ibuprofen as dissolvable tablets in a soft drink is a brilliant migraine abortive) however prolonged use will cause serious GI problems as I have found out...

Asked the private hospital to investigate why I was given those particular meds - they replied that basically as I had no reaction while I was actually there, they do not take any responsibility

That is such obvious bollocks. If a doctor sees that you have an allergy to particular medication, his one and only choice is to avoid prescribing that medication or anything related to it. There is no way it can possibly be appropriate for him to say "You know what, I'm going to prescribe it anyway, if nothing happens that's fine and if the patient drops dead, too bad."

The prescription of sleeping pills with Tramadol, as you admit, had nothing whatsoever to do with the problems you had. You don't know whether it would have caused a reaction if you had taken them; you're relying on something you've read on the internet which is not necessarily accurate, complete and up to date. I really think it would look a bit mad complaining about the GP when it is the hospital that ignored your allergy.

Did you have a red/red edged wrist label thing stating your allergies whilst an inpatient? I always have them and they state tramadol plus an antibiotic that makes me violently sick so I never get prescribed them. If you'd had that on then yes you have recourse against the hospital.

But they didn't ignore the allergy Augusta, the OP has a history of allergic reaction to codeine, so was prescribed Tramadol instead. They are not the same at all, so it's sheer coincidence that it caused a reaction, if it was indeed anaphylaxis and actually caused by the tramadol.