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.

There is a sad story in media about a lad who had private spinal surgery & now the NHS won't give him the physiotherapy he needs to get better... because the surgery itself was private. Does OP have a not-NHS GP? Else seems odd that NHS GP would provide painkillers after private procedure.

I don't think I would get anywhere in pursuing them further and could not afford the legal advice to match theirs.

But why do you need legal advice if you are not looking for a payout?

Let's go back to the start? You had a medical alert bracelet on stating your allergy - which was what exactly?

CinderellaRockefeller
I'm in Scotland, and I was as surprised as anyone to have the GP visit me at home - out of the blue I might add, not at my request (before one of you puts the boot in for wasting NHS time blah blah). He said the NHS was different in Scotland, and this was normal for the referring GP at this health centre. I agree that it does seem they are not under the same pressure as other parts of the country.

RedToothBrush
I did pursue a complaint with the private hospital, as per my previous posts, and when they basically told me to bog off, I got rather annoyed and did seek legal advice as to whether they could dismiss my queries so easily without a full investigation/contacting relevant A&E for information etc. As I also stated previously, ad sodding nauseam, although I do think the private hosp. should have probably given more attention to choice of meds given my stated allergy, I realise I don't have a hope in hell of getting any more information/apology etc from them without having legal backup. If anyone can advise to the contrary I would be grateful to know about it. I've stated more than once that I am not going down any legal route about any of this. Would I do so if I had unlimited cash? Probably.

CantChoose
Interesting that you say would would have also picked Tramadol as the possible trigger - exactly what happened in A&E during my 3 admittances there, hence the whole point of my original post re doubling dose.

lem73
'I don't understand why the Op didn't just contact her Gp the next day and tell him what had happened.' - because I was in hospital connected to heart monitors etc and at that time completely out of it????(and for the next 10 days)

Thanks to most of you for your time, your good wishes and advice. Definitely going to ask for allergy testing. Re the GP - I won't do anything now, I do realise that he does not deserve the aggro but I genuinely thought he had made an error. Now I'm not sure, so thanks for answering my question.

To answer some of your points - Yes I was fully aware of what knee surgery entails, and the need for physio etc. My knee is now a thousand times worse than it was pre-op so pardon me for not being very happy about it. Yes, it is normal to have pain after the op, hence the painkillers. Operating surgeon was seen at 6 and 12 weeks post op and told me the joint was perfectly fine and I just had to 'work at it'. I do not see any point in seeing this person again.

To those who come on here to criticise and attack - that's just sad.

lljkk
NHS GP at no time provided painkillers. See previous posts.

AliceInUnderpants
If you want to go back to the start, please go ahead. I have explained everything and answered all questions. If you know the secret of getting a large private company to do an investigation into something (for which you, the patient/client signed all the usual disclaimers), which will possibly mean them admitting they did something wrong, and all without any legal advice or backup, then please share.

But it was an NHS GP who advised you about what painkillers to take and when? and it's the NHS GP you're cross with now?

Does sound a bit like a classic problem of miscommunication between the private sector & NHS health professionals, then. Maybe they're like hamsters & can't really coexist in same space...

parma I suggested going back to the start to help you make more sense of your disjointed complaint. However, I've now seen you've come to your senses and are planning no further action, so that's good.

As a wider point; this sort of thing is why I always think twice about receiving private healthcare in the uk despite having BUPA. We basically don't have private healthcare in the uk, only private procedures with backup provided by the NHS who are not in the loop. At times it can be useful but if anything is likely to go wrong I think you are much better being under the NHS from the start.

Op you must be lucky with the part of Scotland you are in. In my area the NHS is under just as much stress - not helped by the fact the SNP passed on only 1.5% of the 7% rise the NHS in England got.

OP, I'm pleased you are leaving it re the GP. I'm in year 4 of a medico legal case and frankly, you need to be very sure of your case to bother. You've come across as muddled as to what you have hoped for. The private hospital have done an excellent job at discouraging you to ask further questions but they are the ones who prescribed an odd selection of drugs.

Your GP acted in good faith and did exactly what many other posters on here have said they would do. This is crucial because in legal cases that matters...did the doctor do what other doctors do? Yes. Could he reasonably have predicted the outcome? Absolutely not. Does any of this have any bearing on the fact that your knee is not as you wish? Probably not and even if it's a yes it would be very hard indeed to prove causation. If you were to peruse a case for the anaphylaxis alone the compensation would be very small as it was of short duration and you presumably suffered no financial losses.

I think all reasonable doctors and hcps accept there is a place for litigation for medical negligence but the other side is that not all events can be predicted and not all surgery has a good outcome. By all means continue to complain to the hospital if you feel they have not fully answered your questions, just because they snubbed you don't feel intimidated. They are unlikely to apologise, though because to do so could leave them open to litigation.

Finally, sorry it's so long, I haven't had to pay a penny to my excellent lawyers, there are systems available when the case is deemed likely to win.

Get some further advice on your knee, that would be a better use of your time.

"Does sound a bit like a classic problem of miscommunication between the private sector & NHS health professionals, then. Maybe they're like hamsters & can't really coexist in same space..."

What "miscommunication" has taken place, lljkk?!

The OP said she was allergic to codeine.
She wasn't prescribed codeine.
She was prescribed different drugs.
During her admission, she had no adverse reaction to those drugs.
When her GP visited, the OP was in pain.
The GP saw which drugs she had been sent home with.
The GP advised that she could double the dose of one of the painkillers.
The OP then had an idiosyncratic reaction to something, potentially but not necessarily tramadol.

Where is the "miscommunication"?!

Equally, I am not sure why the private hospital need to "have probably given more attention to choice of meds given my stated allergy, I realise I don't have a hope in hell of getting any more information/apology etc from them without having legal backup."

As a number of HCPs have stated here, the choice of painkillers were fine given an apparent codeine reaction. What more attention do you feel they should have given?

Again, I'd really advise going to your GP (asking for a double/triple appointment and explaining so you are not rushed) to go through from the beginning all that has happened so that you are get your head round things. And, again, seeing an NHS allergy clinic would be a very, very good idea so I hope a referral can come through soon for you there and that you have no further reactions in the meantime.

If anyone is interested in medical negligence, you need to prove all 3 things:

1. duty of care - that's easy to show that a doctor treating you had a duty of care towards you

1. negligence - was it a reasonable course of action (and there might be a number of different reasonable actions that could have been taken) or was it something that other competent doctors wouldn't do?

1. the negligence caused the patient harm - this can be hard as the harm that a patient perceives or experiences may be due to a number of things/treatment etc.

No decent HCP can deny that things go wrong sometimes and that there is an appropriate place for litigation to compensate people and to prevent things happening again.

Indeed, in the last fortnight, I've written to PALS in my local hospital as a patient because I was given some dangerous advice by an individual MW and don't want others to be falsely reassured. I don't want money or an apology, just for the MWs to be reminded (was going to write "re-educated" but that sounds a bit Orwellian!).

However, there is increasingly a feeling of people threatening a "formal complaint" when sitting down and explaining what had happened and why, or why treatment X isn't suitable, or why a doctor did something that the Daily Mail claims causes cancer etc, would have sorted things out for the real and significant benefit of the patient (and indeed the doctor).

I'm in Scotland, and I was as surprised as anyone to have the GP visit me at home - out of the blue I might add, not at my request... He said the NHS was different in Scotland, and this was normal for the referring GP at this health centre. I agree that it does seem they are not under the same pressure as other parts of the country.
Was he a genuine Dr. OP? As it is most unusual, GPs make a lot of referrals,

So the gp came, unannounced and unrequested? Just to see how you were a few days after surgery?

I'm not sure things are THAT different in Scotland.

That's not typical of Scotland IME, but hasn't the OP said this was a private GP?

cinderella, while it would be unusual, the practice that I did one GP placement in as a medical student (albeit 10-15 years ago) had a similar policy of popping in following discharges after major admissions/surgery/new babies/deaths.

It sounds like you've really been through the mill and I suspect you'd feel a lot better if anyone involved with the different stages contributing to your bad time had had a sensible and informed discussion with you.

It's scary being so ill, not knowing why, and being left with half truths and incomplete care where the key 'experts' are too busy proclaiming the op a success to look at the patient who isn't ok still.

My sister had a 'perfect' op on her scoliosis, which let her terribly ill, with endless life threatening problems... Yet the surgeon ignored the reality as he was too invested in proclaiming his own amazing skill. My sister would have died within weeks of she hadn't had the op, so there wasn't an option of just getting by and being in a better state before the op than after, but still. The fear of knowing your body isn't doing what the docs pretend it is. Not ever ok.

So I do have some sense of where you might be coming from .

I hope some of the info on this thread has helped you form a better pitcher of what happened, and I hope it's enough to put some of what's happened to bed, and focus on what needs to happen now for your health.

Btw, I too have taken tramadol & zopiclone together, without life threatening effect, also then combined with fentanyl & oral morphine, plus a few other drugs thrown in! And the combo wasn't the problem (there were other issues with my 'care'), this combo is quite usual, though needs monitoring and careful prescription.

The reason the leaflets & the internet say to be very careful taking these type of medicines together is that each one works as a depressant on your system. So when used together, there needs to be checks in place, and careful prescribing, as there is a risk that in some people, in some situations the combination might depress the bodies systems too much.

However, your body gets used to these medicines and if you've been taking strong opiates, and being fine on them, adding a low dose of zopiclone would be fine. And as you'd already been on strong opiates, and are actually reducing the combinations and strengths of opiates following discharge from hospital (where you would have been monitored closely as part of being in hospital, nurses checks etc), it would have been pretty sensible / low risk to prescribe them both.

You were tolerating Oxycodone well, which is stronger than tramadol and more closely related to codeine. So the increase in tramadol would have seemed a sensible thing to do as well under the circumstances.

Just rotten luck to have had this reaction to something. Also really rotten to have had the story in knee rehabilitation. You don't say, when you were in hospital with the allergic reaction, didn't a Physio or a knee surgeon visit you? If not, I wonder if this is the crappy bit of combining private & nhs care? If your knee was being cared for you on the ward, you would have been given rehab exercises to do, or even being told the consequences of not following the original discharge plan whilst in hospital again, so you could have been more alert to continuing movement even what poorly with the allergy. To me, this is the gap in care that has left you with problems. And I can't see who is then to blame? And who would benefit to you trying to get a legal answer? Not you, I'd say.

So, from this thread it sounds like you need to:

1. Get referral for allergy testing. You need to know for sure what caused it, and if tramadol why the reactivation for so long after the original reaction - what caused that continuation, it doesn't sound like a normal allergic reaction?

1. See a specialist Physio to work on your knee. Throw everything you can into doing what will help you moving forwards, rather than dwelling on the past and what might have been. You can't change what's already happened (& legal action will just tie you to the past, and anger, blame etc, rather than focusing on helping you NOW).

1. And see if you can find a specialist in failed / problematic knee surgery?

As a previous poster said, you need to find a specialist at helping people in similar situations to you. Don't accept the 'it's fine go away' verdict of the private surgeon, but also don't assume that's the only person who can help! He's shown he's not got the right attitude or motivation to help you get some mobility back, so go find someone who has!

Good luck OP, so crappy this has happened, and I hope you can get to the right place emotionally to focus on moving forwards. You deserve a better future, not to stick in the hurt and sadness of what's happened.

OP, you don't seem to have the facts-you say all doctors in A&E kept saying it was tramadol-yet you were "totally out of it"-do you have the A&E reports, and hospital discharge summary, actually documenting this? why haven't you gone for allergy testing, through your private insurance, to confirm what has happened, before attacking your poor GP? I feel really sorry for the poor man

parma I don't think you answered my question (unless I've missed something) - which blood pressure tablet were you on? The more I think about this thread, the more I am making a bet with myself that this will turn out to be due to an ACE inhibitor. I saw a chap once who'd been completely well on his ACE inhibitor for 9 years before one day, out of the blue, developing full-blown anaphylaxis.

I'm also a bit about this spontaneous home visit. In most parts of the UK, General Practice is at breaking point. We barely have the funding to deliver our core contracted services, let alone provide an unsolicited home visit for a previously healthy patient who's had private surgery.