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AIBU?

Share your dilemmas and get honest opinions from other Mumsnetters.

To ask for investigation into GP?

117 replies

parmalilac · 06/04/2016 13:01

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.

OP posts:
parallax80 · 06/04/2016 19:18

Oxynorm is a brand name for fast release oxycodone.

NewtoCornland · 06/04/2016 20:39

but EVERY doctor I saw at the A&E over 10 days shook their heads and said I should not have had

Shock fuck me that's a breach and a half!! Grin

shinynewusername · 06/04/2016 20:59

LOL NewtoCornland

And most A&E doctors know fuck all about anaphylaxis except how to treat it. I say that as a proud member of the Royal College of Emergency Medicine Smile

Onepot · 06/04/2016 21:02

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
could you not have done your phsyio exercises whilst bed blocking?

livewyre · 06/04/2016 21:18

Did they check your triptase?

Describe exactly your 'allergic' reaction to codeine in the past, and the reaction you had this time?

Why is everyone 'rushed' to A&E, always? No one ever says 'and the ambulance drove me safely and sensibly to A&E', they're always rushed.

ConfuciousSayWhat · 06/04/2016 21:23

With the traffic round here even a blue light job is more of a slow meander

lljkk · 06/04/2016 21:24

You really need to find out exactly what caused your anaphylactic reaction right after the joint replacement. Whether it was a new drug or an old one. What caused it seems to be very unclear.... and could get you again.

Some posters are being horrible, but it's probably a gentle ride compared to what could happen if you took this to court case or any kind of formal complaint procedure.

SilentlyScreamingAgain · 06/04/2016 22:08

I really do feel for you, Op. As someone who developed seemingly utterly random allergies, I understand how awful it is to be treated for anaphylaxis. I think it would be reasonable to ask the GP who treated you, to explain what happened to you. However, I think you need to see him understanding he probably didn't do anything wrong. Allergic reactions can be sudden and to things you've been exposed to countless times in the past.

Go and see him with an open mind. Lots of medicin is about weighing up risk and making judgements based on the person in front of you. There might have been a mistake but there probably wasn't, you were probably just very unlucky.

TheRealBarenziah · 06/04/2016 22:26

parmalilac I agree with previous posters that it doesn't sound like your GP has done anything wrong.

But I'm interested: what blood pressure meds were you on? Were they a type of medication called an "ACE inhibitor" by any chance? Sometimes patients develop anaphylaxis to ACE inhibitors completely out of the blue, having been fine on them for years. Obviously you need further investigation in allergy clinic, but I really wouldn't be surprised if it was your blood pressure meds, if you were on an ACE inhibitor.

EffieIsATrinket · 06/04/2016 22:50

Good point barenziah.

If I stopped the sleepers or tramadol in the many many patients I have seen who are prescribed both I'd be able to paper my living room with the complaints I'd receive.

The human body is unpredictable, medicine an inexact science and there will always be gray areas and differences of opinion in terms of diagnosis and management of illness as well as prescribing.

Deciding you couldn't have any form of opiate/opioid medication would have effectively meant you couldn't have undergone major surgery without facing significant pain.

Hope your condition improves over the course of time.

Muddledupme · 06/04/2016 23:38

I have peanut allergy and carry epi pens as anaphylaxis comes instantly on contact very severely. My body does not differentiate between smelling the peanuts that someone else is eating or me eating them myself, the result is identical and instantaneous. My friend cannot take co codamol ( her reaction is not anaphylactic yet but she gets hives blotches etc) however. She is fine with tramadol.

DecaffCoffeeAndRollupsPlease · 06/04/2016 23:43

I think you need to find out exactly what you are now allergic to.

Can't see that your GP did anything wrong tbh, not sure why you don't trust him. Do you expect him to have predicted your anaphylaxis, which no one even knows was caused after the event? The prescribing of Tramadol and a sleeper at the same time sounds... normal, not something I would distrust a GP for.

What outcome would make you feel better about what has happened?

CinderellaRockefeller · 06/04/2016 23:45

I'm interested to know what county you are in OP. Because somewhere where GPs have the capacity to do home visits to check up on people and see how they're doing after a routine op (and you weren't phoning them up begging for a home visit or going through out of hours) is certainly not feeling pressures which the rest of the system is under.

Normal procedure in most places would be to see the nurse for dressings/wound care and then back to the consultant.

RedToothBrush · 06/04/2016 23:53

I think the problem I have with the OP is the fact that she doesn't appear to be asking the right questions and to the right people.

Its the fact that she's sought legal help BEFORE perusing a complaint within the system and seemingly even giving the doctor she has a problem with the right to reply.

Step one is asking the relevant parties what they think happened. She seems to have done this with the private hospital and got brushed off (when I don't believe she has had a satisfactory response from them anyway) and taken this at face value without too much question. The fact she didn't with the other medical party leaves me bewildered.

Hence my question about what she is seeking to achieve.

If making a complain about a GP, the first port of call is to discuss with them first to establish if there is any misunderstanding or explanation you might not have been aware of. If someone isn't comfortable with that, then that's what PALS are for. That's the point of investigation - before external involvement.

Its not a call to some legal firm who want to make money from your misfortune. That does not improve health care nor does it deal with failings in procedures. All it does is put extra pressure on all doctors, not just those bad ones. It just encourages defensive medicine rather than good or appropriate medicine whilst is fundamentally different in nature. The trouble is that early and unnecessary legal involvement discourages transparency rather than encouraging a climate of openness because of the implications.

If you want to change things and improve procedure and prevent similar mistakes in future then working WITH doctors rather than against them is more productive. This is the way you should approach complaints with the NHS - in the most constructive matter possible, This means engaging with them and having a two way discussion over the case. This can also have psychological beneficial affects for someone who has suffered a medical error or mistake as it gives you back the control and makes you feel something good has been achieved despite the problem.

Legal redress should be the last resort when all other avenues have failed simply because their remit very different in nature to complaining via other channels.

Legal action DOES have its place and its use within malpractice, but it needs to be used appropriately otherwise it has the effect of being part of the problem rather than the solution.

As I say, this is why I raise my eye brows to the OP, especially when I read what she's said and find the advice she seems to have been given by a law firm as somewhat dubious in nature.

What she wants to achieve here is important. Thinking that a legal investigation is the best way forward, at this point, is something that I do not think she has fully thought through. As others have said, the burden of proof is different, as is the stress it puts on everyone involved as agendas are different.

Finding out what went wrong, is about being able to ask the right questions to the right people, in the right way. Stopping and thinking about your end goal is a crucial part of that.

CinderellaRockefeller · 06/04/2016 23:56

WRT blaming a gp in this situation, imagine you had always been allergic to kiwi fruit. In a cafe one day you have a small slice of strawberry pie. But it doesn't fill you up, so the waitress suggests that you go for a whole pie all to yourself. You do it and have an immediate allergic reaction and end up in ED.

Do you blame the waitress who sold you the pie as she should have predicted it would happen? Because she has as much chance of understanding what might happen as the gp in this case as you had been fine on a smaller dose.

CantChoose · 07/04/2016 00:41

I'm a doctor and would prescribe tramadol to someone who previously hadn't tolerated codeine. Especially if they had been taking other opiates with no ill effect.
I would also advise you to increase a dose of a medication you were already taking if it was indicated and without suspicion you would suddenly react to it.
I would prescribe tramadol and zopiclone together.
If you saw me in a&e with that history I would also pick out the tramadol as the most likely culprit in the absence of any other obvious trigger. But it would be an educated guess.
I would not expect your anaphylactic reaction to recur as late as you had described.
I don't think anyone is particularly at fault, though I can see why you have found the information you've been given confusing and frustrating.
This is a very atypical history and I would suggest in the first instance that you request allergy testing before reaching any conclusions about blame.
Hope you feel much better soon.

gotellitonthemountain · 07/04/2016 00:58

My experience of knee replacements is that most people are not happy afterwards. The success is nowhere near as good as with hip replacements. I doubt much of the problem now was caused by lack of physio post-op.

TeatimeForTheSoul · 07/04/2016 01:07

parmalilac sorry you've had such a hard time after your surgery (and on this thread).
Any errors in healthcare should be investigated as its one of the fastest ways to improve services (see articles by our illustrious leader Mr J Hunt on following incremental change principles). So any hospital or surgery 'should' welcome constructive feedback on what's gone wrong. Sorry if thus hasn't happened in practice.
Bringing this up with your GP may also raise opportunity for allergy testing to clarify what's going on.
Good luck and I hope things get a bit better for you.

NewtoCornland · 07/04/2016 07:45

yesterday 18.17

They have teams of lawyers, and I do not, so I don't think I can do anything else.

I think this goes some way to explaining why OP isn't interested in going 'after' the private hospital for their failings. Much easier to pick on a lonely GP who, imo, has actually provided the better care and support (he came to see you at home while most people can't get a flipping call back!).

I hope you have had a change of heart OP and come to the right conclusion that the GP has no case to answer.

shinynewusername · 07/04/2016 08:44

They have teams of lawyers, and I do not, so I don't think I can do anything else

For anyone asking why the OP has been given a hard time, that is your answer. GPs are leaving the profession in droves and a key reason is medical indemnity insurance, which costs a full-time GP £7000 a year, more for out of hours work. And why is indemnity so expensive? Because chancers like the OP think the way to resolve a concern about a GP is to approach a dodgy 'Where there's blame, there's a claim' lawyer before even giving the doctor a chance to explain his actions.

Fretfulparent · 07/04/2016 08:56

Rather than looking to complain It might be better if you could tell the GP what you want him to do in the future for similar patients. In other words - What do you think the GP should have done when he visited you?

lem73 · 07/04/2016 08:58

I don't understand why the Op didn't just contact her Gp the next day and tell him what had happened. She could also have made an appointment to discuss it? My dh had an operation in a private hospital and was sent home with tramadol. He took it when the pain was very bad and suffered palpitations as a result (opinion of the out of hours gp, he certainly wasn't 'rushed' to A and E). The next day he called up the private hospital and told them what had happened. He wasn't looking for anything from them, he just wanted it recorded in his notes. From the way the Op has handled this, it seems she is looking for some compensation.

EffieIsATrinket · 07/04/2016 09:12

My experience of knee replacements is that most people are not happy afterwards. The success is nowhere near as good as with hip replacements. I doubt much of the problem now was caused by lack of physio post-op.

Completely agree gotell. I think expectation has to be carefully managed when patients are thinking of having one done.

HazelBite · 07/04/2016 09:17

Gotellit, knee replacement surgery is not as successful as hip replacement as it is a far more complicated joint and you cannot replicate what Mother Nature made.
It is not something you go into lightly because your new knee will never function as well as what you originally had, but you will have a new knee that will be far less painful and will never "give out" on you as you are walking along.

As I mentioned upthread I had both knees replaced last year the first one in May, the second in October, and I made sure beforehand by speaking to other patients and the Surgeon what exactly I was in for.
All the people I spoke to who had, had the op previously said it is better to suffer pain post op when home by relying solely on paracetamol than be out of it by taking stronger medication and running the risk of being dizzy/being out of it and not being able/aware to keep moving the affected knee.
The rehab is really down to you and how much effort you put in within your limitations, but post op for the first 6 weeks you cannot spend any length of time static.

I can sympathise with the OP as I have never experienced pain like I had (especially with the second op) and I could not fall asleep without an ice pack on the knee, but the pain lessened a little every day. Within 8 weeks I was able to push a trolley around the Supermarket and at 13 weeks back at work (full time and commuting) it hasn't been easy but I had a terrific surgeon good physio and I kept moving my leg(s). There are lots of things I can't do like kneel down, but I could never do that previously because my arthritis was so bad. On the whole I am pleased with the outcome but I did not have any unrealistic expectations.
Incidentally I had my op done in a local private hospital paid for by the NHS, I cannot fault the care I got.

I think when the OP is ready she should perhaps get a further opinion on her knee (under her husbands insurance) and seek out a recommended surgeon who specialises in "sorting out" surgery that has gone wrong, and before embarking on any further surgery find out exactly what pain relief she can cope with.

An unfortunate set of circumstances but I don't think anyone particularly is to blame and perhaps the Op wasn't aware enough of the necessity to "keep moving" post op.

blaeberry · 07/04/2016 10:21

Why, when she had pain after the operation, did she not contact the hospital? Surely the surgeon should have been responsible for ensuring post op care?

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