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...

I had this and was confused, I wanted mine out for having hormone problems on it and have a long term partner but I still had to tell them what I was going to use instead and was told that condoms are unreliable

Apparently though Graphista we don't have personal experience and she does.

I am so sorry for all your awful experiences

I could sue my GP for nearly killing one of mine, had to be hospitalised in intensive care, but there you are no personal experience.

I am not by any means negating the whole if the profession, but I am not happy to accept arrogance of always knowing best whilst blaming patients for their lack of autonomy

I'm sick of hearing how we have to be the experts when it comes to making critical decisions about calling 999 or 111 or waiting and making a GP appt. I've been blamed for all three. No,not because I called 999 when I shouldn't have,but because I should be calling 999.

I had to talk to the family planning nurse when I wanted my iud out. She very helpfully gave me permission once I explained that we were planning a baby.

We're treated like children aren't we?

It's so wrong.

What is the matter with taking ownership of our own bodies, answer, we're too stupid to be trusted, and need permission.

I've had issues with contraceptives too.

Firstly I started off on Micrygynon at 16 which I got from a family planning clinic which I had for a number of years. My mood swings and headaches were really bad so I went to the clinic and they changed me to Marvelon.

I lasted a few months on that as I had constant thrush needing treated, I went back to the clinic for a change of pill and the female nurse actually said "this is your third type of pill, what are you planning on doing if this doesn't work, how many visits will you need?" in such an awful tone. I just stared at her for ages and replied with "ill keep coming back as often as I have too because I'm absolutely not staying on a pill that doesn't agree with me because it makes your job easier."

I'm a nurse and was then too!!! Since then I've had a few implants, didn't like them, back to the pill which I stopped when TTC and now I have the coil which was my choice and I had to actually fight to get an appt for fitting.

(once they found out id had twins 12 weeks before they reshuffled some meetings and had me in the next week )

Thanks for your response Thatsnotmytoddler. I do appreciate GPs get a lot of unfair bashing in the media, and it is a difficult job with a lot of responsibility, especially when the government does not provide enough resources.

I agree with much of your post, and from your posts, I wouldn't have thought you were the type of GP that is being complained of on here.

The one thing I might take issue with, is the notion that you would always have a better view of treatments than patients. If I think of my own experience, I would say this is true when I am consulting a GP about a new issue for me. I certainly wouldn't know which antibiotic would be best for my sinus infection, for example.

This can change, though, if you have a long-standing medical condition, especially if it manifests in ways that deviate from the 'textbook' definition. In those cases, it certainly can be the case that the patient may know more about latest treatment options than the GP. I certainly find this with my Ehlers Danlos. Far from being up to date with this, it actually took 10 years from onset of obvious symptoms (though more subtle ones date back to childhood) to diagnosis. Even after 10 years I only finally got a diagnosis after working out myself what it was, and pushing for a referral.

While a 10 year delay in diagnosis is obviously not good, I appreciate it is relatively uncommon (though much less rare than has been thought), and I wouldn't expect a GP, as a generalist, to know as much as I do, given the amount of interest I have in it, and the length of time I have spent poring over articles on research into the condition, and the treatments for it (such as they are).

My experience with my own GP practice is that, with the exception of one GP, who is rather old-school and generally not popular with patients, since diagnosis, the GPs usually are willing to listen, and often freely admit I will likely know more about it than them. I find this works well.

My sister has a similar experience with her type 1 diabetes, which presents slightly differently to the norm/what is expected, in terms of how she responds to various forms of insulin. She has managed to establish a good, collaborative relationship with her GP, much as you describe. They work out between them how her treatment needs to be tweaked. This seems like a win-win to me.

Some of the treatment described on this thread, however, and Graphista's previous thread, really does stand out as being far from acceptable. There are times where autonomy is being denied. I would agree with Graphista that GPs need to be careful to ensure that, when discussing concerns, that they don't dismiss women's worries, or railroad them into keeping a LARC when they wish to have it removed. Given the power imbalance inherent in the relationship, it can be difficult for some patients to be as assured and assertive as is sometimes necessary, it would seem. Some practices described here are downright coercive, and need to be stopped.

I mean really, I don’t know what to say. Many of these examples are awful. I would never behave like this to my patients and I really don’t know anyone that I work with who would.

Clearly autonomy is vital but a precursor of that is being informed. What I would say is that just as not all GPs are as terrible as the examples you give, not all patients are as informed as you might think either. I would reiterate that I try to work in partnership with my patients to achieve a solution that works for them. I have never refused point blank to remove anything for anyone. The only time I would encourage people to persevere is with irregular bleeding in the first few weeks or months of an implant: this often settles or can be helped to settle with medication so it is worth keeping going if that is the only problem. I do counsel women about this before fotI say, I enjoy my family planning clinics for all sorts of reasons.

Can’t remember who but pp who mentioned reporting side effects via yellow cards is right - the only way we build this knowledge is through ‘real world’ use. And I would also advise complaining about many of these conversations. There are ways of raising things in consultations without it feeling as though you are harassing the patient and if nurses or drs are making people feel bullied then there is a learning need for them.

But honestly. Stop with the financial accusations. Current GPs have no influence over the deal reached when the NHS was set up. Primary care finances have been on a knife edge with falling pay (certainly for partners in practice) ever since I qualified in 2005. We are not fitting or removing or refusing to remove anything for financial incentive. We just aren’t.

Hi again Tolles yes you’re right - with long-standing or unusual conditions patients become experts in their own right. And often do know more than we do. Great - again, it is an inter-personal relationship and one that changes over time (if you’re lucky enough to have continuity between patient and a dr you trust) and certainly a patient’s knowledge and opinions are not less valid than their dr’s.

There is so much I could say in all of this but obviously there are limits! I think I’ve made my points anyway so off to bed now

Just realised the end of my second paragraph at 22.27 makes no sense. I mean I counsel women before fitting that they may have irregular bleeding and this will often improve with time. Fitting and removing these things are not without risks (the procedures themselves I mean) and so it’s generally not good practice to immediately remove something when time often solves the problem. I do remove things sooner if the issue is something other than bleeding though - such as mental health issues as some have mentioned.

Some of the stories on here are awful! I'm glad my (female) GP recognises my chicory to make contraceptive choices. At my six week post labour check up she asked me , shoyuld you like to talk about contraception? I did DH is sleeping in the spare room, you've just given me antibiotics for the rampant nipple infection I have and my stitches aren't quite healed yet, I'm fine for now thanks. She just laughed, said fair enough just book an appointment if you want to go back on any type of contraception in the future.

I saw a gynaecologist about cervical erosions caused by years on mini pill. Apart from the erosions it was the only pill that suited my brain and didn’t make me too hormonal. I asked about the implant as an option and he told me it was, “cheap, 3rd world contraception and he would never recommend it to his own daughters.” He refused to elaborate too much but eluded to the huge amount of hormones you are hoping is released properly over time. He wouldn’t recommend the coil for anyone who hasn’t had kids and said it doesn’t suit everyone. So in the end I decided to put the contraceptive problem into my partners court and we used condoms instead. Now we have 3 kids and my now dh is waiting for a snip.

But I can well imagine from the drs conversation that day that they like the implant because it’s cheap, effective, and not as straightforward to remove. I wouldn’t be surprised if there is some public health policy to get the young female population onto this kind of contraception and to stall it’s removal as much as possible.

This is the issue with free healthcare provision there is always a state-agenda attached. If You were a fee-paying customer I’m pretty sure you wouldn’t have any of those issues about your age being a factor. The state doesn’t want you to get pregnant and will try to prevent you if possible.

This is pretty easy for the GP's on the thread to resolve in their personal practice.

When a woman says: "Take this thing out of me", you do it as soon as possible/practicable.

You don't 'sit her down' and 'have a chat'. You remove the item that she wants you to remove. Having her sign a consent form for the actual procedure of removing it.

Done, dusted.

Remember mentioning to a nurse that i struggle with hormonal interventions (about a year into my issues bleeding daily, severley anemic, passing out etc as well as daily excruciating pain) and mentioned my partner was thinking of the snip so i could come of it all
Her reply was " why would he need a vasectomy when theres all these options for you "
Nearly blew my lid!
Turns out i had severe adenomyosis and certical ecroption plus after they told me an ablation and sterilisation would fix the problem ended up with the ablation failing and post ablation sterilisation syndrome.
If they had given me the hysterectomy when i asked for it at the start they could have saved me 2 years of hell.
Apparently us mere women should shut up and put up
I do feel for the gps on this thread. There is one fantastic gp at my surgery. Not denying there are some who go above and beyond. Just sadly in my experience the bad outweigh the good.

This is the issue with free healthcare provision there is always a state-agenda attached. If You were a fee-paying customer I’m pretty sure you wouldn’t have any of those issues about your age being a factor. The state doesn’t want you to get pregnant and will try to prevent you if possible.

Believe it or not, it was actually a private female GP who subjected me to a 10 minute haranguing about how to properly take the pill, as well as sniffing that it was the last time she’d prescribe it as I was turning 35.

I’d actually gone in to discuss a fairly serious health issue (blood tests taken by another consultant that clearly indicated an issue) and asked for a refill scrip as I was there anyway. She was far more interested in making sure I knew after 15 years on the pill that I need to take it the same time every day than discussing that I potentially had lupus!

erm, would you be doing that if you had to bear the £100 +fitting costs of the new one? And actually it's the lowest dose of any contraception we have and will do you no harm

Is it that you think the published side effects are in no way harmful or that you believe the published side effects are not caused by that lowest dose of ‘contraception’ but perhaps by something else? Or made up?

There are doctors who think they're going to be sued for removing LARC at the request of an adult patient?

SmotherOfFive thank you, yea, our experiences don't matter, we get told we "must have misunderstood" or that our experience is the minority - even though there's tons of threads like this on mn alone and evidence elsewhere that women especially are being dismissed.

It's simply not good enough to keep writing us off and trying to shut us down.

Tolleshunt thank you too. When I started that other thread I really didn't expect some of the most awful, shocking stories. Not just in terms of outcomes but in 2018/19 we shouldn't be in a position where we get better service if we take a man with us or if we're lucky enough to be assertive, articulate patients. It makes me seriously concerned that the most vulnerable patients who are least likely to be able to manage this won't get anything approaching a good service.

I've seen this happen, my mum who is a long term victim of dv, generally quite a shy, softly spoken, non forceful person anyway ended up admitted as an emergency to a&e after nearly a year of suffering classic gall bladder disease symptoms finally got taken seriously and by that point it had to be removed. She hadn't said anything to me about her symptoms which is typical of her as she "doesn't like to worry people" since then she is more honest with me thank goodness. But even without someone to talk to outside the GP it really shouldn't have got to that stage!

I dread to think how those with mild possibly undx learning difficulties are dealt with.

"The only time I would encourage people to persevere is with irregular bleeding in the first few weeks or months of an implant: this often settles or can be helped to settle with medication so it is worth keeping going if that is the only problem." Wow! See to me that shows you don't get it, despite claiming you do. Why is it up to you to decide that this is an acceptable side effect to tolerate? That a patient should take yet more medication to treat a side effect that can easily be remedied by removing the device? And less confident, assertive patients are easy to "encourage to persevere" aren't they? They're unlikely to challenge you, much less make a formal complaint (and don't even get me started on what can happen to patients who do make formal complaints) so you and similarly acting Gp's think and assure yourself you've acted appropriately and ethically when actually that patient is still suffering unnecessarily because you haven't allowed them their full autonomy.

"I do remove things sooner if the issue is something other than bleeding though" why is problematic bleeding not a good enough reason? Have you personally ever experienced this? It can be really soul destroying dealing with this and may well be accompanied by pain.

IAmNotAWitch - exactly! It's not difficult. It's what should be happening. And I wonder if that was happening if the stats on how long patients were "happy" to use LARC would dramatically alter, if it would signal to the powers that be that actually maybe these devices aren't as wonderful as is claimed.

"Apparently us mere women should shut up and put up...Not denying there are some who go above and beyond. Just sadly in my experience the bad outweigh the good."

That's been my personal experience too, that there are a few really excellent Gp's who go above and beyond which I've been lucky enough to be served by, but the complacent, dismissive, arrogant ones far outnumber the good ones.

And as per Fuckets post I've also had specialists and not just gynaecologists but orthopaedic, neuro & gastro specialists remark that my or dds symptoms were blatantly obvious/textbook and certainly warranted a referral far earlier than we managed to get. Indeed with my gynae issues I never got a referral pre diagnosis, it was as a result of the surgery for my 2nd mc which included one of the embryos was ectopic that I "accidentally" ended up getting, after 14 years of classic endo symptoms the DX. 2 of the referrals were made by locum Drs which from my linked thread I am learning is quite common too. Dds specialist was pretty sure she knew what the problem was just by looking at dd walking into the office (her disability I now know had certain physical markers), which is as far as I'm concerned another reason no way it should have taken 11 years to get the appropriate referral, even more so given the regularly and clearly reported symptoms, which included reports from frequent a&e admissions.

I've had GP appointments where the dr literally never even looked at me, was looking at their computer screen the entire time!

It makes me question the training Gp's are receiving, both in terms of which conditions are covered and if the often different presentation by women patients of conditions which affect both sexes is covered.

Oh Graphista so disheartening to read and all the distress and differing that goes on as a result.

I think I know the thread youre referring to, didn't realise it was yours, but I had to nod to knowing what was going on in it

I added up once, that one of mine had been either seen by a doctor or spoken about to a doctor on 22 separate occasions before ending up collapsed on the floor of the doctors with tachycardia, this after being told off by the previous quaxkquack who visited and declared 'absolutely nothing wrong with this child get dressed and outside' it honestly drives you insane when you are distraught with worry over your child and despite telling them, you're ignored and they end up like that. Blue lighted from the gps.

It's infuriating.

When dds disability was DX and I started learning about it I was horrified and dismayed that some things I'd been really hard on her about (constantly tripping and bumping into things, wearing through clothes and shoes at a rate of knots, difficulties dressing herself, spilling food and drink constantly, not chewing food properly and then small choking incidents...) weren't her fault and are very much part of her condition.

She was also getting a hard time from Drs, nurses and school in this time for the same things, X Ray techs joking about how we saw them so often they'd have to start charging or give her a machine of her own...

NONE of the MANY medics that saw her, despite what we later learned was textbook presentation of the condition AND she has physical characteristics that point to it (very tall and slim though her dad and I short & dumpy, eye shape, "knobbly" joints, velvety skin, shape of jaw...) even considered that she might have the condition and at least a few of them had studied the specialism and as far as I'm concerned should have spotted it.

It was eventually a combination of me and dd both being at end of our tether and at that appointment with a locum GP (who hadn't studied the specialism) we insisted she consider dds full history (umpteen sprains and strains, fatigue, muscle cramps, painful joints and muscles most days, the clumsiness, but we also included things we actually didn't think were related like infections running rampant in odd ways, stomach cramps, palpitations loads of stuff we just kinda "threw" dds entire medical history at her inc her birth and why she was in scbu initially despite being a full term good weight baby)

The locum listened, look dd over and in looking her over noted the state of her shoes, which were relatively new but clearly worn down in an odd way, she also noted the style of shoes (lace ups) when the fashion for a girl that age for school shoes locally at that time was very much ballet pumps and she asked why and we told her it was because dd literally couldn't keep that style of shoe on her feet and they didn't last 5 mins with how she wore shoes down.

Locum made a referral but didn't say what she thought was wrong. Specialist pretty much took one look and was like "I'm pretty sure I know what's wrong" but examined and tested her to be sure.

Even after the DX it's been a huge learning curve for dd and I and a massive adjustment for her in ways that have been really tough, she's had to give up hobbies she loved, not overdo things, be careful to look after herself in certain ways...

Infections that other people shrug off have landed her in hospital because her disability makes her more prone to them and they affect her differently (even post DX we've had Gp's not listening when we've explained this and fob us off with standard treatments that didn't work, then when we've gone back not believe that the treatment was completed correctly, when even if they'd just googled "disability + X infection" it would show that it's not straightforward treatment that is indicated)

It's incredibly frustrating!

Gp's seem to think they don't need to listen to patients.

I don't expect them to know every condition and certainly not everything about every condition but at least listen to patients who DO tend to know about the conditions that affect them, do the most basic checks you've a computer right there in front of you during the consultation

And I just KNOW the next comment will be "we haven't time to be googling all day" well it actually saves time in the long run, because certainly in dds case and also with some of my stuff it would mean we'd need fewer appointments to deal with the same issue, in dds case it would have prevented at least 2 long hospital admissions (and that's not my assessment but that of the hospital consultants and dds specialist!)

The simple fact is not listening to patients, assuming you always know better is arrogant and frankly not good enough.

New NHS slogans - Working 'With' Patients

• to save £'s

I know oura are not isolates incidents from hearing the number that come away with exactly these types of experiences

Even women centred services like midwifery, there are stories over and over of messed up deliveries. Consultants frightening women over delivery choices ad nuseum

Oh dear, is it very bad that I got to page 2 before I realised that the OP wasn't about breast implants? I did wonder why only one needed to come out!
The only reason a competent adult should need for contraceptive implant removal is that they bloody well want it.