To not understand why I have to talk to a nurse before I can book an appointment for implant removal?

[Alarae]

Considering I want it out to start to TTC?

Rang up my local GP today to book an appointment for removal, only to be told my the receptionist that I need to speak to the nurse first, and then she might schedule an appointment for me.

I don't see why I should need a conversation considering my reasons? Understandable if someone wanted it out for other reasons such as concerns on side effects, recent implantation etc but even then if someone wants something out why should someone be trying to convince me otherwise?

Just a bit annoyed as the earliest telephone appointment is in 10 days, and then who knows how long it will take to actually get an appointment considering only one person holds the clinic!

I can't even go to a walk in clinic as I need a GP referral for that in my area because I am not 25...

@Graphista

Wow! Your primary focus shouldn't be on not getting sued! (Which is rare in this country

I don't know what country you live in, but in the UK medical litigation is spiralling out of control. I have been sued by the family of a patient that I saw once, five years before she died. It took several years to get it dropped, even though I had done nothing wrong and I keep copious notes. Litigation is so common that until the govt stepped in last month, my litigation insurance was over 20% of my pay. So, with respect, to say that litigation is uncommon in the UK is rubbish.

I'm certainly not buying it incurs a loss!

You can buy it or not, but I've seen the figures and in some areas it does. Do you know how much a surgery is funded for coils or implants? Do you know the cost of providing them? Happy to hear your figures.

DietCokeMegaFan - I find it VERY interesting that with the number of very valid comments and queries on this thread that show Gp's AREN'T acting ethical or in the best interest of the patients you choose to use the ONE POSSIBLE example of where you were "right

I actually gave four examples, and in the one you are talking about I later clarified that the woman was actually very happy with the implant. She thanked me afterwards for stopping her having the hassle of an unnecessary removal and refit.

But obviously you know best and all GPs are evil controlling witches, so I'm not really sure why I'm bothering.....

This happened at my surgery. I had the implant for a year during which it made me feel awful. I rang to book a removal appointment. Oh no you must have an appointment with the GP first. I managed to get them to agree to a phone appointment that went:

How can I help?
I'd like my implant removed please.
Ok is there any reason for this?
It's not agreeing with me so I'd like something else.
Ok that's fine I'll put you through to reception, just ask for a removal appointment.

I'm so glad I didn't follow their procedure which was to wait weeks for an appointment, drive across town, battle to find somewhere to park in the tiny surgery car park, and wait the usual 30+ minutes to be seen just for that.

I'm in Scotland now but I've lived all over the uk except Northern Ireland. I know several currently practicing hcps who've never once been sued, I also know victims of serious medical negligence who've found it extremely difficult to sue, were eventually successful but their cases took decades because who they were suing were obstructive in many ways, which the courts presiding over these cases criticised.

"Do you know the cost of providing them? Happy to hear your figures." Interesting that you haven't given any figures of your own when you have far greater access to this knowledge than I or other non hcps, why the figures are so difficult to access I'd like to know too.

You used only one example of a patient that you believe was happy with how you handled matters, but on this thread alone there are numerous examples of patients who were prevented from getting a LARC removed who I'm fairly sure at leafy some of those hcps THINK they persuaded those patients to change their minds and those patients were happy with that outcome, yet the patients ended up going to another hcp in the practice or to sexual health clinics BECAUSE their main hcp didn't do as asked.

My opinion on this and other issues regarding primary care hcps is based not only my own long experience of being dismissed and ignored by many of them, but of hearing similar and worse experiences from friends and family and the experiences of other patients on mn and other forums.

To make out I or anyone else stating their negative experience of such matters are exaggerating or name calling is at best disingenuous and at worst yet another attempt to silence us and shut us down! It's unacceptable, but far from unusual or surprising I've been dealing with that since I was 14!

https://www.telegraph.co.uk/women/womens-health/11678916/IUS-hormonal-coil-The-troubling-truth.html

"All us health professionals would like to see more women on long acting form of contraception because they are more reliable in the long term and cost less for the NHS.”

"The coil costs £90 over five years, including insertion and removal. The Pill, however, requires multiple appointments and costs £3 to £6 pounds a month, on average, for the NHS." So even at the cheaper end of the pill it's DOUBLE what the coil costs IF a patient keeps it in for 5 years.

Condoms are cheapest as they cost the NHS zero monies, and stop stis (which do cost the NHS much monies, and horrible complications which cost the NHS huge monies)

Where's the health campaigns and pressure to get men to take responsibility instead of all the sterilising of the female population?

but the high discontinuation rate does point to there being problem. And it seems that no one is listening.
Adds Murphy: “It’s really important that women know they can get a device removed if it’s not working out for them. Doctors should reassure women that this will be the case

This seems particularly pertinent to our discussion here. That in fact GP s are regurgitating marketing speak, and women are trying to tell them this is not the case,that symptoms can be horrendous, and they're not happy. Very not happy about removal is with GP 'agreement'. Well fuck that shit.

GPs service is a service to the patient, we don't need their 'agreement' to remove a device from our bodies,they have to just do it if that's what a patient wants. They can't have it all ways, as in control patients but also blame them for not being autonomous in their own health care, which does seem to happen a lot.

I'm sure there have been cases of contraception being stopped and HCPs being held responsible for subsequent pregnancies.

Seriously? Has any health trust, in the history of the NHS, ever been successfully sued by a woman who stopped contraception then got pregnant? And if so how does the cost of that stack up against the cost of lawsuits for failure to remove implants/coils?

I understand that GP time is valuable and- as a small animal vet- I know how infuriating it is when double appointments are wasted. Still though, I don't know why a receptionist can't have the

• Want coil out
• Are you TTC in near future?
• Yes
• OK stop smoking, start taking folic acid and here's your appointment time for coil out

(Any other reason given for coil out- here's your nurse counselling appt time) conversation which would take about 15 seconds and save a nurse appointment in all the soon- TTC cases.

I know the NHS works on a population cost/benefit system but I believe the sums take into account wasting doctor time, but not wasting patient time. Most of us have to take anything from an hour to a morning off our tax-paying- and therefore NHS funding- work to attend appointments and making that proportion of women with an implant or coil (rather than those relying on condoms/the pill/etc as well)come in for an extra appointment to be told to take folic acid - which the majority of them know already- seems like an inefficient waste of nurse and patient time.

I can understand that GPs reading this may be dismayed by some of the views. What I don't understand, however, is why this is being taken so personally by them.

Providing that you are happy that you are personally behaving properly, why are you being so defensive about the conduct of other GPs? I am surprised that there is an automatic reflex to defend, rather than say something like 'on the face of it, that sounds like bad practice'? If you think about it from the perspective of the patient, do you not think that a willingness to explore whether practice could be improved, and an acknowledgment that sometimes (other) GPs get it wrong, might be a better approach to reassure women that these examples of bad practice are not the norm?

It may help to remember that, although strides have been taken in recent times to improve patient autonomy, it is not so very long ago that a 'dr knows best' approach held sway. Even today, many women report having their autonomy violated during, for example, childbirth, where it seems often preferences and views are not respected, consent is not always sought, and it is not always well communicated why this has been the case.

I don't expect GPs to be perfect, or even that all of them will be good. We have to accept bad apples will be in the profession, in the same way they are in all professions. What I would hope, though, is that rather than leap to the defensive, HCPs would be willing to listen to constructive criticism from patients, with the aim of improving the service they offer, and their rapport with their own patients. A GP's job is a tough one, I know, but never forget that patients can be traumatised by bad - or even careless - treatment.

Tolleshunt you’re right of course. Much of what is being described is not ideal practice, and we should certainly challenge that when we see it.

But you have to appreciate that since I qualified as a GP - now 13years ago - I have been told repeatedly by the media and others that I am lazy, ignorant and just in it for the money. To read threads like this therefore does feel personal. For all that I try not to be defensive I actually do find many of these comments hurtful. Honestly comments such as those from Graphista and Smother are hugely generalising and, actually harmful not only to GPs (and God knows there’s not enough of us - hence a lot of the shortages, long waits and rationing that people complain about) but also to women in general. Women (or men) should not be booking GP appts and thinking “oh here we go I’m going to have to fight against a Govt conspiracy to get even semi-decent care”.

However offensive people find it to be advised to take folic acid, or asked whether there are side-effects that we might be able to resolve I can guarantee that the suggestion that well-motivated, highly-educated GPs qualify and immediately become puppets of a money-making maniac in Westminster is significantly more offensive. Especially to those of us who turn up to work every day doing our best for the patient in front of us.

Do you know what? After 8 years of training and 13 years of experience as a GP I think I probably do know more about medicine than you (the patient) do. I see doctor colleagues who are not GPs and they readily admit that they aren’t up to speed with the evidence around our day-to-day practice. Obviously each patient is the expert on their own experience. But it is possible to have a constructive relationship where I bring my knowledge and experience and you bring your experience (symptoms, past history etc) and hopes or fears and we work out a solution together.

I accept fully that the NHS isn’t perfect: I witness that every day. But conspiracy theories and randomly throwing insults around don’t help any of us.

Just want to chip in to say that every single time I go to the GP for a pill prescription they give me the hard sell for an implant. The infantilising, patronising attitude “but how do you know you prefer the pill when you haven’t tried an implant” infuriates me, wastes my time, and exactly echoes the outlook of the HCPs on this thread.
And then I get a patronising lecture about not running packs together. I actually hate the nurse at my surgery because she makes it so hard for me to get my damned pills.

However offensive people find it to be advised to take folic acid, or asked whether there are side-effects that we might be able to resolve I can guarantee that the suggestion that well-motivated, highly-educated GPs qualify and immediately become puppets of a money-making maniac in Westminster is significantly more offensive. Especially to those of us who turn up to work every day doing our best for the patient in front of us

The problem is women are asking for a device to be removed not whether you can resolve side effects of said device or offer other advice. Meanwhile women are suffering as we have heard.

@Graphista I know if several practices, with GPs who are passionate about women's health who have reluctantly stopped fitting coils and implants as they weighed uo the ever shrinking funding available and worked out that they were losing money with each fitting. TBH I don't really care if you believe me because clearly GPs are all part of a massive conspiracy in your eyes. But I have direct experience of this and you don't.

Do you know what? After 8 years of training and 13 years of experience as a GP I think I probably do know more about medicine than you (the patient) do
I would hope you do, and of course when I want to discuss my birth control options, you will tell me all options (the patch seems to be ignored a lot despite users rarely gaining weight, but that's a general thing) and I will choose the pill, then in a year I just stop getting prescriptions for the pill. No one asks for me to come in to discuss this. It seems to only be the coil or implant that have this effect. Yet coming off the pill is equally likely to result in pregnancy and a folic acid talk.

Hmm hurt feelings of GPs who are on a damn good wage and in a position of relative power and certainly are more able to ensure good service for themselves and their families

Vs

Over 30 years of:

Being dismissed, ignored, ridiculed to the point of literally being laughed at (and not on one occasion or even a few but at least once every few months at one point), misdiagnosed to the point of having lost 3 babies, twice almost losing an ovary and/or Fallopian tube, being given the wrong treatments that caused further harm and masked symptoms for DECADES, suffering with symptoms including extreme pain, fainting, vomiting, migralne, very long heavy periods, pain at ovulation time, nerve pain for years before getting a DX, having Drs remove access to mh meds that were working or making it difficult it to access them (and I'm not talking anything addictive/known to be harmful just the antidepressants I had at that point been taking for years but if I moved and had to move Gp surgery or when I got a new GP to deal with, this happened on several occasions and as far as I and the mh specialists I discussed it with can tell was purely down to the gps personally having a preference for a different antidepressant or not liking the one I was on), having the fact I have DX mental health issues used to dismiss physical ailments...

Dd - 18 years of my health issues being used as a way to discuss my valid concerns about her health issues particularly the mh ones, the symptoms of her disability being dismissed and ignored until she was in high school even though they were clear from baby/toddlerhood, Gp's refusing to accept treatment plans from her consultant, refusing to prescribe recommended medication or items necessary at the time due to ailments occurring as a result of her disability (one of these is jaw/dental issues which means she sometimes needs fortisips or similar as she physically cannot chew), she's currently trying to find a contraceptive that works for her, she's 18, slim, never been pregnant, her disability means she has to be careful what items she uses, she's had some difficulties using hormonal contraception and guess what GP is trying to push on her?

Sodding mirena coil!!!!

Nah, if you want patients not to criticise, which is all myself and others have done and politely if assertively so, then as a group, you need to stop infantilising, dismissing, ridiculing and ignoring us!

No conspiracy theories FACTS there ARE incentives that mean it benefits Gp's financially to promote larcs, to give "advice" that was neither needed nor asked for and that have led sometimes to people having inaccurate notes made on their official medical records - that's a damn sight more harmful than anything I or anyone else has said on this thread.

"who have reluctantly stopped fitting coils and implants as they weighed uo the ever shrinking funding available and worked out that they were losing money with each fitting" IF they were NOT being recommended pushed because there were financial incentives to do so but because they were better for patients then WHY would they STOP promoting them because they're now losing money? That really just confirms that the decision either way revolves around money and NOT what is the best option for the patient.

Money shouldn't come into the decision making process at this level at all! That's why I think Gp's should never have been allowed to be "self employed" but within the Nhs

At the point where a GP is deciding what is the best care/treatment plan for patients that should be informed by evidence based best practice.

Something that's extremely difficult to achieve (evidence collecting) if side effects are not being reported accurately, if patients are using a treatment for X length of time NOT because they want to and they found it useful BUT because they had no choice because primary care hcps wouldn't remove devices when requested. It skews the results of how a treatment is working "in the field".

I don't think it's a conspiracy, I think there's poor practice from the top down, poor training, poor guidelines provided to clinicians and a lot of complacency particularly with record keeping and collation of stats.

Should be : 18 years of my health issues being used as a way to dismiss my valid concerns about her health issues

My dr is trying to push contraceptives on to me trying to get me to use the coil or implant I refuse why? A, Because I haven't had sex for years B, im unsuited to hormonal contraceptives C, I have frigging graves disease and its contra indicated when it's out of whack (which it is right now) why bully me? My body my choice

Go to a drop in sexual health clinic. No need to see GP.

I had this as well op. I was having some major physical and mental health complications due to the implant and the clinic tried to make me keep it in. It was only because I threatened to remove it myself that the Dr was called, took one look at it and made me an appointment for emergency removal that afternoon.
It hurt like hell having it removed due to infection and swelling but I'm glad I put my foot down

I personally have not had a massive issue getting my implant removed but only because I moved and subsequently lied to the GUM about when it was due to expire as I had already been told very sternly that it had to be in for at least 2 years.

As a note to everyone who has had contraception and had side effects of any description, please report them to the yellow card scheme, link below. And/or the Pharma company that makes them as without people reporting them, they only go on the clinical trial data and more data is useful always.
yellowcard.mhra.gov.uk/

How aggravating. I just stormtroopered my gp and said either take this out now or I'll cut it out myself. He did.

thatsnotmytoddler, GPs obviously have a difficult job and most are no doubt trying their best. However, that doesn't make it okay for a number of GPs to routinely ignore patients wish to have a medical device removed. I (and many others) have had difficulty getting an implant removed and have felt pressured in to keeping it in. Surely that goes against best practice for pretty much any medical treatment? Good GPs should be leading the way in fighting for improvement in this.

Gp refused to remove mine at 23, it was painful and also we were wanting to ttc. I must have been back and forth to him a few times and gave up with him, went straight to family planning and they took it out straight away. Thought this had just happened to me but it seems like GP really don’t like taking them out 🤔

If I had know how much a pain in the arse getting the implant taken out would be i wouldn't have had one. Requested it through my GP nurse that could do it was in long term sick. Went to the family planning clinic and had it removed. Couple of months later GP finally called to discuss having it removed.

Haven't RTFT yes but just wanted to add my experience. I had my son at 16 and the day after I came out of hospital my 'family nurse' (young parents health visitor) brought a nurse to my house and put the implant in my arm. I imagine I did consent but I was on drugs and I had just had a baby so was very tired and not really sure what was going on. About 8 months later after side effects not going away (was told it could be due to giving birth, they'd wear off, body getting used to it etc) I went to the doctor. I had the nurse consultation. They flat out REFUSED to remove it. The local sexual health clinic wouldn't do it as it was a nurse from my GP practice who put it in, not them. I ended up cutting it out of my arm myself. It actually wasn't too bad as it's not that far under the skin, but obviously you shouldn't have to do that! It's disgusting how they won't let you just have it taken out because you say you want it doing - no matter why you've decided you don't want it. I can't believe you have to jump through so many hoops to exert your own bodily autonomy.