To think I shouldn't have to come to A&E

[QueenNefertitty]

im ranting because I'm exhausted and worried about DS. Again. And because I love the NHS and it pains me to see such poor standards for the second time in a matter of weeks

To get proper care that could be administered in a community setting for my baby?

For the second time in two months, my GP practice have told me DS has a "cold", despite my insistence it isn't (temps of 40 with rigors, not eating, listless, working hard with breathing, high heart rate). For the second time in two months, the very same day I've seen my GP, DS has deteriorated to such a point, I've sat in A&E for 4 hours, before being admitted to Paeds CDU because DS has bacterial tonsillitis, plus a chest infection and needs antibiotics.

Bacterial Tonsillitis is a really really common illness. The exudate was very obvious to the paeds reg- it hadn't just appeared in the last couple of hours. It must have been there when I saw my GP.

So why on earth can't practice GPs at my surgery see - using the same equipment, same techniques, same diagnostic criteria- when DS is unwell- and why not listen to a mother who has a strong sense of illness being more than "just a cold"?

A&E in my city is absolutely on its knees. I shouldnt be here with Ds- this should have been picked up and dealt with in the community care setting. If community care were of a higher standard, there wouldn't be such an influx of people to a&e departments, with problems that wouldn't be an emergency, if they were just bloody picked up when they were presented at a GP surgery!

rant over. And this isn't a criticism of the NHS. It's a criticism of my gp writ large because I've had no sleep for two days.

YANBU I'm angry too on your behalf! How could a GP miss the signs for that none of those syptoms especially a fever that high arent even associated with the common cold of course something else was at play it's disgraceful that the GP tried to fob you and your son like that. I'd be putting in a formal complaint about that GP and never see them again! I understand that GP's are overworked and stressed out beyond belief but they put the health of your baby boy at risk and that's unacceptable.

How old is your DS and does he have focal consolidation on a chest X-ray? If he's young and doesn't have a confirmed pneumonia, the likelihood is he does have a viral infection. Most tonsillitis in pre-school children (with pus seen on tonsils) is viral. Most chest infections particularly if the paediatric registrar listened and heard widespread crackles and/or wheeze are viral. Unless he has a positive throat swab for group A strep or an X-ray and blood test combo that looks bacterial, he's probably being over-treated to make you and the Paediatric team feel better. So you're probably BU. Your GP is likely to be correct.

I changed GP practice for this exact reason. My DD was 4 rather than a baby but I was heavily pregnant and it floored me.

This has happened to me with small baby more than once. My 5 week old was seen by a gp for lethargy and vomiting. Got the “it’s just a virus”. No. It was pneumonia and we were nearly admitted the next day when I took her to A&E for a fever. To be fair, the dr in A&E also said it was a virus BUT the pead wanted to do a chest X-ray since she was so young to rule out other stuff. That’s how pneumonia was diagnosed.

Second time it was same thing but slightly older baby. Ended up in A&E told it was a virus, I INSISTED on a chest X-ray and low and behold....pneumonia.

I do think the key thing in your post is “ds has deteriorated”

GPs can only treat what is in front of them at the time, they can’t predict what js going to happen in the future. Add to that the fact that most illnesses are viral and will self limit then although I can understand your frustrations yabu.

I am changing GP practices- we moved house yesterday - thank God DM could help out with DS, as he really was very poorly.

I do understand that doctors aren't psychics, and I do know that ABs are overprescribed- I was really conflicted about DS having them last time, and tempted to "wait it out", but when his temp hit 40.5, and he started to pass large amount of mucusy blood in his poo, I sort of decided that they were worth a punt. And they worked very very fast. As they did when I picked it bacterial tonsillitis from him that same week...

I don't know... i think our healthcare system does the best it can, and I think we receive good care the majority of the time. I just feel a bit perturbed that such a common, but potentially serious illness, can be missed not once, but twice by the same gp. Even if she'd said "yes there tonsillitis, but no, you cant have ABs"- I would have at least had some reassurance as to her diagnostic capabilities!

I do also see where I'm being a bit unreadable, but Jesus wept I'm tired...

Unreasonable**

Hope your son gets well soon.
It's difficult when you know there is no improvement etc and you just want the doc to take it onboard.

OP,
How old is your DS? Hope he recovers soon.

Huha:
I INSISTED on a chest X-ray and low and behold....pneumonia

Viruses cause pneumonia. For example 32% of children with RSV infection have pneumonia on a chest X-ray. That's why it's better to not do the X-ray in the first place.

Glad you are changing GP.

It really is GPs who can be very different where your problem lies not with the whole NHS.

Have to say I agree with what NotBadConsidering has said

Annoyed me too. I note the people asking the clinical questions haven't been answered.

It is very difficult getting a GP appointment these days never mind getting them to diagnose all and every illness correctly which is a mammoth task.
I have been at A&E a lot with my elderly father who keeps getting very confused, is falling, urinating randomly in his bedroom, blood pressure dropping and feeling very unwell etc. He has had about 5 quite severe water infections in the past year and my mum can’t get doctors appointments for him so they get worse and he ends up in A & E.
I was feeling really tired and run down. I went back to the doctors several times for blood tests and was fobbed off and it was suggested I may have depression but didn’t know it. A few weeks later was undergoing tests for cancer and was diagnosed with blood cancer.
However bad the NHS is at the minute I still feel very lucky we have it especially when I hear about American health care schemes where many people don’t have access to treatment etc.

brighteyes27 I really hope you don't mind me suggesting this for your dad, but have you tried probiotics for his water infections? I spent years having chronic water infections which made my life a misery and which completely went when I started taking probiotics and haven't returned since. The ones I take are optibac (it does make a difference the brand and in the reviews others have found the same!)... just a thought x

I think you are being a bit unreasonable,you say yourself that ds has deteriorated and the GP wasn't to know this was going to happen. They act on what they see at the time.
As for the temperature indicating more than a cold well for my dc they have had some impressive temperatures when they have had viruses so can't see that it follows that a temperature means it's not a virus.
As for A&E don't you have an out of hours service? We would phone and see a GP in out of hours rather than sitting in A&E,for a baby they may well come to the house rather than having to venture out as well.

NotBad what's an RSV infection? Can you explain about why it's better not to do the X-ray in the first place?

Not challenging you BTW, just interested as I can't think of why you wouldn't want to know about pneumonia -or is it because you can't do anything as it's a virus and just get more worried?

I know how you feel. Newborn baby with a cough, they didn't even listen to his chest at the doctors, next day he was in a&e with bronchiolitis struggling to breathe. Then temp of 40 and unwell a few months later. Gp checked ears and throat, all fine apparently. A few hours later baby was hard to rouse and in a&e again, a&e doctors checked and severe tonsillitis. It's like they don't look properly in gp surgery.
Doctors in a&e gave baby proper mot, checked glands, weight, reflexes, temperature, ears and throat properly etc.

RSV is a cold.

When one of mine was a very small baby she caught a viral cold that became bronchiolitis. If they'd done an X-ray her lungs would have been full of fluid, because they were. She was very ill and needed to be on a ventilator in hospital for a week, but she didn't need or get given any antibiotics.

However, the GP were great, they diagnosed then told us to call back if she got worse than referred us to hospital, skipping A&E.

A good GP is really valuable.

Respiratory Syncytial Virus. The commonest cause of bronchiolitis. 32% of babies with this virus will have a pneumonia on chest X-ray. But it's a viral pneumonia; antibiotics won't help. But by doing an X-ray and seeing the pneumonia it's hard for doctors to not give antibiotics, even though they won't do a thing. It's a concept called overdiagnosis. The diagnosis of pneumonia is correct but finding it won't help the patient and may lead to harm (over-treatment for example). Overdiagnosis is worth googling. Also worth looking at the Choosing Wisely campaign. It's about avoiding tests or investigations that don't improve the outcome for the patient.

@flesh - I called 111 for advice- they could offer me an OOH appointment at a hospital 23 miles away, at 4am, or suggested local a&e. I don't have a car at the moment, so getting DS to the ooh was nigh on impossible. Believe me, I don't see a&e as a place to go for shits and giggles.

And DS is 14 months

Yes my baby had rsvits a virus. . No she didn't need antibiotics. The only reason she was admitted us that her low flow oxygen wasn't enough at home and needed a higher rate.

I wouldn't want my baby having a chest x ray when wouldn't alter the treatment
We have to be very careful with antibiotics. There are some infections now that are resistant to all antibiotics.

Small children can change their condition very quickly. Hour to hour.
Your GP can only treat what is in front of them.
Remember they can have up to 100
Patient contacts a day be that face to face, telephone advice and visits. I really respect what they do in very hard circumstances and we have to also accept that just occasionally they might not meet your expectations.

I do think a lot of people, especially when children are involved (and I am not talking about any specific cases in this thread just in general) want to be seen to be doing something and antibiotics are that something so often we still view them as a miracle cure when actually increasingly the evidence is pointing to the fact that in most cases these illnesses are viral and even when bacterial for a lot of illnesses in most cases it is self limiting.

The illest ds has been was with a virus (RSV as already mentioned in this thread) he was at the point where we didn’t know if he would survive the night - but giving antibtiocis wouldn’t have changed a thing. It’s horrible having to just provide “support” (ventilation etc in this case) and wait for the body to do what it needs to but sometimes that is the only option.