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.

confucious aspirin and ibuprofen shouldn't be taken together at high doses as the risk of a GI bleed is 6 times higher when combined.

I'm surprised that you were released from hospital before being stabilised parmalilac. I'm also surprised that the hospital are so confident that the tramadol is responsible for your anaphylaxis.

You are clearly out for blame or claim, and have decided your poor GP is an easy target. Not the hospital who was paid mega bucks.
Nothing wrong with tramadol and zopiclone together, not that you even took them, so no negligence there.
So go ahead try and get something from crucifying and stressing your GP.
I wouldn't be happy to see you again if that's your attitude, I'd be terrified you'd 've looking to sue me for something.
GP's are human too. Your whole case is frankly absurd.

Tramadol isn't codeine, zopiclone (tiny dose) is fine short term with tramadol, the tramadol didn't cause the knee complications, doubling the dose of tramadol didn't cause your disability or "sensitisation"
What exactly do you want from your GP?

I feel sorry for your GP as you seem to be wanting to blame both the failure of your surgery on him and also the allergic reaction.
You need to face factsit's NOT his faultany of it.

No wonder GPs are leaving the profession in fecking droves

Where have you been advised that tramadol and sleeping tablets can't be prescribed together?

There are some increased risks taking multiple medications that can have sedative side effects, but there isn't a 'rule' that they can't be prescribed together.

If you have concerns about this I would book an appt with the GP to discuss it face to face, rather than a complaint, which will take them hours to respond to.

As you didn't actually take any of the sleeping tablets, you haven't suffered any harm from the prescription, so there are no grounds for legal action with regard to the sleeping pills.

With regard to your anaphylactic reaction, you don't know what you had the reaction to. It would be very unusual to have anaphylaxis after taking a medication for four days. It may well have been to something else. A&E doctors saying it was probably tramadol doesn't mean it is tramadol. I would ask your GP if you can be referred for allergy testing as it is important to find out what provoked this to avoid further risk.

How do you know you are allergic to codeine? Was this confirmed on allergy testing (a blood or skin test)? If not, you may be allergic to one of the additives in the tablet rather than codeine itself, and perhaps that additive was in one of your other medications?

I really don't think your GP has done anything wrong.

I would focus on finding out what you are allergic to.

The private hospital have been v quick to say it isn't their fault. I think it is odd to go home on a collection of different opiates, it is more typical to have one for safer and easier dosing, but I don't think you suffered harm from having several different medications so I don't think there is grounds for legal action. However people certainly can complain about things that occurred after they went home, otherwise patients would have to linger in the car park for days in case they suffered a complication!

I think you would be better off seeking another opinion about your knee as a way forward from all of this.

Anaphylaxis isn't related to the dosage of a drug - it's an 'all or nothing' thing, so if you are going to react to a substance, even a tiny amount of it can be enough. Taking a double dose of anything doesn't make it any more likely to cause a reaction.
There are circumstances e.g. when someone is in very severe pain, when it is actually OK to prescribe painkillers and sleeping tablets together.

Hello AF long time no see (macdoodle here, changed my name and some fucker pinched it)!

It's scary that a lot of GPs are leaving, mine is lovely so hope he doesn't go. I think our surgery only do home visits in emergencies as the Drs have too many patients and too many boxes to tick.

Zopiclone and tramadol can be taken together. They both cause drowsiness so you have to be very careful if a patient is going to be driving/operating machinery the next day but, as you were laid up in bed, this didn't apply to you.

Nothing you describe sounds like poor practice by the GP or the private hospital and I agree with everyone saying it is unlikely the anaphylaxis was to Tramadol anyway.

hey there, mac. Here we are again sticking up for the NHS (someone has to...) but have you seen that thread with the little girl with the massively backed up constipation ? That one is a real shocker.

I'm really quite shocked by some of the aggressive responses on here and I sincerely hope they don't come from NHS workers.

I think this GP has made a serious error, and it should be dealt with

The frustration HCPs are having here is that there is no evidence that the GP has made an error, serious or otherwise.
Obviously misunderstandings occur, and the OP could book an appt with this GP to discuss this, or write an informal letter to the GP asking for clarification.
What seems more likely is that she may make a complaint to the GP surgery. This will take hours to respond to, probably in the GP's own time. The GP May have to declare this at their next appraisal, or if applying for a new job when the complaint is still open. If the GP seeks advice from their indemnity insurer before replying, their insurance cost may go up. If the OP takes it further, the Gp May have months of stress before the gmc (or other body) agrees that there is no grounds for complaint. A friend had an eight month long GMC investigation, which he had to declare on job applications, before the GMC agreed that there was zero grounds for complaint. This was in a barn-door faultless case. Sadly these stresses cause doctors to reconsider their career.

The OP has clearly had a difficult and stressful time and been given conflicting information. However I would really urge her to speak informally with her GP/ practice before taking it further.

I also think you're getting an unnecessarily hard time on here. Whether or not anyone was at fault, you had a traumatic medical experience which has left you struggling, possibly permanently, and during which decisions were taken by the medical staff that you don't understand. I've seen plenty of maternity threads along these lines with people getting loads of sympathy.

I think what you need is a medical debrief - I know you can get this after giving birth, but I'm not sure how it works for other procedures. You need someone to talk you through why you were given the medicines you were and what went wrong. I suspect it will turn out that the decisions were all fine and you were just unlucky to have a bad reaction to something other than codeine, which no one could have predicted. But I think it's understandable that you want to know.

I would write to the practice manager along those lines, not demanding an investigation but registering your concern and see what they say.

I still can't see what your GP did that you consider so wrong it requires "investigation".

You told him you weren't sleeping due to pain. He finds out what painkillers you are taking (up till now with no issues) and doubles the dose - presumably you were not already taking the maximum 600mg per day. He also writes a script for half dose zopiclone (which is fine with opioids short term) to help with sleeping.

That you had a reaction to something subsequently could not have been foreseen by him given that you had been taking the meds without any issues until then. You do need referral to a specialist allergy unit for skin testing to what you can and can't take for future reference however.

Sorry if this is coming across as muddled - I've tried to include everything while not making it pages long!

Let me repeat a couple of things- I AM NOT INTERESTED IN SUING ANYONE - insulting to be called an ambulance chaser when I am looking to get answers/apology.

The anaphylactic reaction occurred an hour or so after doubling the dose of Tramadol, taken around midnight. Was rushed to A&E, given adrenalin, and was discharged within 24 hours. Reaction came back the next day, rushed to A&E again, discharged after 2 days. It came back again, stayed in 5 days as I begged them to keep me there until it was completely gone.

JustAnotherSod
I am not 'just accepting' that the private hospital has no blame. I see their point that as I did not have any reaction while I was there, it would be almost impossible to prove that they were at fault. They have teams of lawyers, and I do not, so I don't think I can do anything else. I am not determined to blame the GP, but EVERY doctor I saw at the A&E over 10 days shook their heads and said I should not have had Tramadol/Oxycontin/Oxycodone and said that it was 'probable' that the double dose of Tramadol 'tipped the balance'. I am not a doctor or pharmacist but I assume that they know what they are talking about.

I know the GP was trying to help, and let me repeat, I accepted that it was just bad luck/whatever, but when I read that sleeping pills should not be taken with Tramadol then I did start to question that. He did not mention any possible problems with taking both, but thankfully I did not take the sleeping pills.

AliceInUnderpants
The GP has nothing to do with my treatment in hospital, and yes I understand that he naturally assumed the meds I was on were all perfectly suitable, as I thought too.

BillSykesDog
Thanks, I think I should write to the surgery, as I am not happy and do not wish to see that GP any longer. He's a nice guy but I would not trust him now. Unreasonable? Maybe but that's how I feel.

Re the aggressive responses - re those whinging about going private - DH's job gives us private insurance - why should I have to justify using it? Ditto NHS - they are not 'sorting me out' - there's nothing to be done so you can be happy about that at least.

hopeless you've added a line to that quote that I didn't say! What I and the other posters who aren't lining up just to give the OP a kicking are suggesting is that she writes to her surgery and asks them to clarify the exact procedures involved and what exactly happened.

I wouldn't put that in your letter OP, about not wanting to see him. Just deal with that with the receptionists when you book appointments. Tell them your concerns and ask them to address them. If you're not happy with the response then you can think about your options and one is to say you would prefer to see a different GP. But for now address your concerns and the facts rather than rushing into that.

"I understand that he naturally assumed the meds I was on were all perfectly suitable, as I thought too."

That's because they were all perfectly suitable. As others have tried to explain to you, an allergic reaction (and it doesn't sound like a typical allergic reaction at that and hasn't been proven) to tramadol is not necessarily related to an apparent allergic reaction to codeine.

"I am not happy and do not wish to see that GP any longer. He's a nice guy but I would not trust him now. Unreasonable? Maybe but that's how I feel."

You are being unreasonable and are scapegoating the GP for some reason. His course of action appears to have been perfectly reasonable. You appear to have suffered from some odd reaction that could not have been predicted.

I'd really second and third Simon and Seemslot's suggestions to see your GP to go through what does sound like a very turbulent time. If you have lost confidence (however much he doesn't appear to be responsible) in your GP, it might be best to find another surgery as your health centre is not going to be able to guarantee that you never see this GP again.

I think this GP has made a serious error, and it should be dealt with

This is why the hard time. Clearly fixated and blaming the GP, harping on and on about the miniscule dose of zopiclone as a massive error (that she luckily didn't take, yes we got that). Who adviced that or was it just Dr Google?
The oxycontin/oxynorm/tramadol combo is odd and not standard, mixing opiate types is odd and makes it hard to judge total doses. Typical of poor private care IME. But that was the hospital not your GP.

My indemnity payment was 7000/ year last year for 3 days as a GP partner, largely because of vindictive,money chasing complaints on the profession (despite the fact that I have never had to use them in almost 20 years). Fear and stress and the blame game ( Nothing can ever just happen anymore, it must be someone's fault) makes the job of a GP very unpleasant nowadays.
Never mind not wanting to see your GP, if he knew this was your mind set can guarantee he would be very wary of seeing you.
I ask again OP what exactly do you want from your GP. I can't see anyone did anything wrong but if you feel the need to blame anyone then surely the hospital and consultant who discharged you is to blame.

"Was rushed to A&E, given adrenalin, and was discharged within 24 hours. Reaction came back the next day, rushed to A&E again, discharged after 2 days. It came back again, stayed in 5 days as I begged them to keep me there until it was completely gone."

This suggests something ongoing that you were exposed to. The tramadol dose on day 1 could not be responsible for new reactions on day 1, 2 and 4.

Tramadol has a half-life of 6 hours and is gone within 36 hours. It couldn't be responsible for the reaction on day 4 as it wasn't present.

I think it is actually quite dangerous that you've been told it's the tramadol - if it isn't then you'll be vulnerable to whatever it is but think you're safe because you aren't taking tramadol.

I agree with other pp you need to see the gp who prescribed this to discuss what happened and your anxieties related to this. Your gp acted in good faith and I cannot see from what you have said that he behaved in a negligent manner.

I would also be asking for a referral with an allergy specialist.

I don't think you have been given a hard time I think many posters are trying to be very balanced about the events that have clearly left you disabled and traumatised.

Despite the legal back up and denial the private hospital should be the focus of you attention. Not having a reaction whilst in their care does not mean that they were not at fault.

Fwiiw I have had reactions to both codiene and tramadol and ibuprofen in a hospital environment that have resulted in respiratory problems, nausea/vomiting and dangerously low blood pressure. I was unlucky, these drugs are very different in make up and this was not a predictable event.

I think you have been through a very frightening experience and would also be aware of the possibility of post traumatic stress problems.

Thanks, everyone. I agree that there seems to be no concrete evidence, or at least none that is admitted, but I have only repeated what NHS doctors said about probable cause, and right or wrong I believed them.

ConfuciousSayWhat
Yes, I had the red wristband stating allergy while I was in for the op. Had pre-op checkup etc a couple of weeks before so no doubt they knew about it. However for the reasons given previously I don't think I would get anywhere in pursuing them further and could not afford the legal advice to match theirs.
I think it will put my mind at rest to write to the GP personally. I would not tell him/them that I don't want to see him (ever again), but I do just tell the receptionist it's not suitable if offered an appointment with him. He's a nice chap, but this whole thing has made me feel a bit weird about seeing him now. I think a letter to him rather than the practice manager would be best. I will also ask for referral to allergy testing.

memorial
I don't think it's 'harping on', it's repeating something which appears to have been missed by some of those replying. The combination of drugs I have stated did not mention anything called 'Oxynorm', which has no connection with this topic.

Oxynorm = oxycodone.

hth