To think doctors, specifically GP's need to change their approach to patients

[GlasswareisOverated]

We live in the technological age. We have access to information at our fingertips, that someone fifty years ago, hell even twenty years ago would not have been able to comprehend.
Am I being unreasonable to think that drs need to lose the 'we know best about everything medical' attitude.

Obviously I won't be performing brain surgery any time soon or stripping legs of vascular veins to be used in cardiac surgery but I can read a laboratory report and understand what it means and I can get the gist of most medical studies.

"Half of what you are taught in medical school will be wrong in 10 years’ time. The trouble is, none of your teachers know which half"
Former dean of Harvard medical school, Sydney Burwell.

Reading blood tests results really isn't rocket science, a patient only has to know what is normal for her to be able to assess whether something has changed. For example, I know what range my potassium levels, creatinine count, A1c, iron levels and white blood cell counts normally fall into. So I can tell at a glance if my latest results are within range. If they aren't I will require an expert to tell why they aren't, and to discuss what, if anything, should be done about it. But I am the best person to spot if the results are abnormal for me.

Like @HmmmNo1 I have a genetic condition, 2 of my 3 (adult) DCs have the same condition so collectively we have about 80 years' experience of living with it. None of us has ever met a GP who knows as much about it as we do, in terms of how it affects us specifically. The specialist clinic we go to, well that's a different matter entirely, they are stunningly good; I will try anything they tell me to, no questions asked, because they have always been right.

Obviously GPs have to cover so much ground, you can't expect them to be experts. But a few of them seem unwilling to accept that sometimes patients do know what they are talking about. A little more listening, and a little less arrogance would not go amiss, on occasion.

Half of it is wrong now hence why they don't like you looking.

Are you new here? This is not the place to say what you said. Just do what you need to do to keep your family healthy and let everyone else do what they think is best.

@dhaka22 , @Norush4 and @Stabbitystabstab ... skin conditions are one of the particularly tricky areas, I have learned in the last nine months, and among friends of similar age who have had medical issues, there's only a few that haven't experienced skin troubles as a side effect.

And I sympathise on the discoid ezcema... dermatology are still investigating but phototherapy, steroid creams and emollients helped once we got on top of the infection that appears to have kicked it off.

lljkk Given men have far worse health outcomes than women, adjusted by age/deprivation/any specific condition, it makes sense to me that men should have more money targetting their health needs. <ducks & runs for cover on that one>

But isn't that due mainly to the loss of genetic material when the chromosomes in the womb divide so as to make a Y chromosome meaning a certain reduction in immune capacity? Thats what I was taught in human biology! And greater risk taking of course but neither can be assisted that much by later health care.

Any woman with an endocrine disorder knows how shit GPs can be.

Despite a long family history of autoimmune disorders my gp insisted my symptoms were pnd not thyroid. A second gp agreed. It wasn't until I was hospitalised that I got treated. My tsh was 450 and I had 0 t4. It took 10 years to get to a reasonable level again and even then I had to fight to get them to refer me. I know what my levels should be and EVERY SINGLE blood test I have to explain why I am fine with a repressed tsh (which Addenbrookes agreed with).

And now I'm menopausal i'm not being listened to again. Thankfully I have learned to be a pain in the arse and keep on.

When I went to my gp about my neurological disorder, he knew right away what it was but asked me to give him a week so that he could go read up on the latest guidelines etc. I was pretty impressed.

Any woman with an endocrine disorder knows how shit GPs can be

to be fair, and not downplaying your experience at all they aren’t much better with Males. Ds has an Endocrine problem and the GP is next to useless. Thankfully his Endo nurse is always on hand to help.

I knew what he was asking. I clarified over 100. RESTING PULSE.

Majority of knowledge for most specialists is from the years of post graduate training, professional exit exams, peer reviewed publications and post CCT fellowships which no amount of google can replace.

Thats a bit presumptive. Who do you think reads these peer reviewed publications? And how on earth do you think any medical negligence lawyer or judge understands them sufficiently to deal with them in court? Expert witnesses speak to specific points of evidence only, and are only one authority taken into account in any case.

The point is that it is not, and never has been, only doctors who can understand medical information. There has to be oversight by other persons in order to ensure fairness. Doctors are not gods, and never have been. Obviously, Lexis and Westlaw are not google but as a research tool for finding a certain quality of resource, theres nothing actually wrong with google.

Is that true?

I thought although women have a longer life expectancy than men (having said that, I believe female life expectancy has fallen in recent years while male life expectancy has remained broadly stable), it’s been observed that women spend more of their lives in poor health and disability, and that’s largely why the government has launched the Women’s Health Strategy?

A little knowledge is a dangerous thing.

This is exactly what I think about GPs .

I have a friend who is a GP and regularly tells me that she doesn't know how I can continue researching and reading research articles as she is done with studying for life. She is considered a Very Good GP, largely because she scares patients away who would otherwise come in about minor matters.

But no research? Who is letting her get away with this? Where is the oversight? I don't know of another professional role with so little day to day accountability. You can hardly practice evidence based medicine without the evidence. But anything requiring that usually needs referring up anyway.

A dear family member is a brand new gp and far from declaring himself well versed after many years of study, he is quite happy to admit that being asked about medical matters ad hoc is trying only because of his overwhelming ignorance about anything mentioned. And he really doesn't know, I've had the opportunity to see that. It is astounding what he doesn't know. But eventually he'll be amazing because he'll choose to be - sadly not because he has to be.

I have several degrees and have diagnosed every major health problem by myself, got the appropriate referrals and have never found this going in a different direction to what I'd anticipated. There's plenty I don't know but I can easily get myself in front of the right person and that has never been the gp. I would far prefer a system where specialists were directly accessible rather than people being half dead by the time they speak to someone who knows what they're talking about. GPs are encouraged to be slapdash with risk and even if they're not, they're the bottom of the pecking order and scared to make referrals. But why oh why if they're so very busy are they introducing completely unnecessary elements into their appointments? Surely someone else could be weighing everyone or advertising the coil when you've only gone in about your tonsils.

There's no getting away from it. Some are remarkably bad and they're allowed to continue being remarkably bad. AI will easily outperform most of them. I would not go into general practice.

Gp’s are enjoying very long retirements on full pay with a pension at the end of their very long retirement.

I think we’d be better off without them & an easier access route to specialists. Cut out the middleman who really hasn’t got a clue anyway.

There are 300 GP million consultations per year. Only about 1:20 need hospital input. Those clueless middlemen provide 90% of healthcare for 8% of the NHS budget. An outpatient appointment costs 10 times a GP one. I hope you’re ready to pay a lot more tax and wait years for your hospital appointment.

And we won’t just need another 300 million hospital appointments (at a cost of £60 billion). It will be a lot more. Let’s say you have a cough. Who are you going to see for that? Respiratory medicine, perhaps? But coughs have many possible causes. You might actually need a cardiologist, gastroenterologist, neurologist, oncologist, endocrinologist, ENT surgeon or even gynaecologist (choriocarcinoma). GPs’ clinical experience allows them manage most patients themselves, and to refer those who do need specialist input, while minimising harm from unnecessary investigations. Yes, with 300 million consultations per year, and literally anything presenting to them, GPs don’t get it right every time, but it is an immensely difficult job. Anyone who thinks medicine is simple understands fuck all about it. And that’s doubly true of general practice.

GPs’ clinical experience allows them manage most patients themselves, and to refer those who do need specialist input, while minimising harm from unnecessary investigations.

It's nice that you think that but it's really not true. Most consultants from a professional rather than financial standpoint would far rather carry out investigations they deem necessary with their understandably superior knowledge and expertise.

Again, anyone who thinks medicine, especially generalism, is easy is displaying their own ignorance of the complexity involved. Many things seem simple when you don’t really understand them.

As for your doctor friends, clever people are often self-depreciating. Most genuinely clever people don’t feel the need to boast about how many degrees they’ve got, and feel a bit embarrassed for people who do.

What does that even mean?, GPs work with consultants to investigate appropriately. We’re all following the same guidelines.

I standby what I say. Get rid of all of you & let us go directly to a specialist.

My dh is alive despite his Gp not because. He’s got a trach & a RIG feed, his op cost god knows how many thousands he had four anaesthetists alone keeping him alive. Not very cost efficient is it? How much is his rig feed going to cost tax payers every week?

Still, at least we didn’t spend years getting fobbed off by the Gp. Saved the nhs loads having a Gp to go to.

I standby what I say. Get rid of all of you & let us go directly to a specialist

Well and good until you don't know which specialist you need.
Stomach pains for instance- could need emergency surgery, could need a gynaecologist or a gastroenterologist or another person altoegther. Seems much less cost and time efficient to traipse around them all rather than seeing someone who can filter the referral to the right person.

BTW, the waiting list for one particular specialist at my local hospital is around a year at the moment. I know this because a family member is on the list. People self referring for problems which they can't help with is not going to help.

Let’s say you have a cough. Who are you going to see for that?

You are aware coughs have been outsourced to long suffering pharmacists and most infections end up in a and e because the GP wouldn't/couldn't see them and the receptionist thought it not important enough?

Very poor example of the importance of GPs.

People self referring for problems which they can't help with is not going to help.

I have never once been referred to the right person by a GP. They stand corrected after the consultant's letter comes back. It is a familiar pattern.

People are already self referring and paying for their medical care because this service is so awful. No one else thinks it's any good. We're not envied. I've lived in Africa and it was better, frankly, even in the public health system. You waited all morning and you were seen.

I would say Dr Google is very informative but much is geared to US medical care which leans to intensive treatments for everything as you are paying for it. This is not necessarily the best treatment.

I work in a GP surgery (as an extremely lowly HCA before anyone asks so no medical knowledge whatsoever and wouldn't claim otherwise!) Even I know that it is just so much more complicated than people are claiming on this thread, and I completely understand why it requires 10+ years to train to be a GP.

I find the idea of going directly to a specialist absurd. Do you know how many patients we get presenting with very vague symptoms ranging from 'tired all the time' to headaches, chest pain? How on earth would they possibly begin to navigate what specialist they need to see? Like others have said it could be a completely different one than they thought they needed.

Lots of the issues patients attend with can be treated and resolved by GPs for far less money and time than sending them to secondary care. Then there is all of the routine chronic disease monitoring that GPs carry out day to day, which do occasionally result in deranged blood test results, detecting and intervening in problems that the patient wasn't yet aware of.

In summary, GPs are worth their weight in gold and we need them. Google, web md etc tend to follow the same algorithm of which symptom = which problem. Real patients are so much more complicated!

The long post I did not manage to get posted the other night, due to Mumsnet glitches.
As an example, I had a voice problem, it was husky and sounded very abnormal, I was finally referred to ENT, after six GP appointments.
Once there I was diagnosed with silent reflux, prescribed with Gaviscon advance, and sent on my merry way.
During this period, I had moved areas and had changed GP as a consequence. I discussed the fact that the Gaviscon advance did not seem to be helping ( a month or so in), the GP told me that I had to follow the treatment protocol for three months before they would review. This was after a good two year period of not having a voice that functioned as it should.
I was working for an NHS trust and had a meeting, where my head of division was present. She heard my voice and got me seen by their top ENT specialist within three days, who diagnosed me with Vocal Dystonia (vocal muscles not functioning as they should, specifically the one on the left hand side).
I got referred on to another ENT specialist, to have botox injected into the vocal chord.
I then saw a neurologist privately for a separate issue, a tingling sensation in my scalp, related to neck problems I have suffered with since the age of sixteen. The neurologist pointed out that the vocal dystonia was a side effect of the medication I was on treat my bi-polar disorder, the medication was acting as dopamine antagonist, effecting my brains ability to communicate with my left vocal chord. I stopped taking the medication (having considered the pros and cons of staying on the medication and continuing with the botox injections) my voice is over ninety percent recovered now.
I did not figure out the problem on my own but at the same time, it should have not taken six GP appointments and four different consultants (three ENT and one neurologist) to figure out a)what the issue was and b)how it could be resolved effectively.
Recently, my partner was suffering with vocal problems. He was referred on the two week wait pathway to ENT and seen in five days (impressed with that).
He was diagnosed with Silent Reflux and prescribed with a three month course of Gavison Advance.
He had a separate infection occurring at the same time, within three days of the second course of antibiotics prescribed for the separate infection, his voice was back to normal.
The ENT consultant, he saw, was a totally different one, to the one I saw, so it comes across to me, that if there are no identifiable polyps and you don't see an ENT person, with the experience of the one I saw on the second occasion, you will be by default, diagnosed with silent reflux.
I have been diagnosed with Fibromyalgia, Bi-polar disorder and PCOS.
From my own reading and research alongside the four occasions of my Free T4 levels being sub-normal with TSH still in normal range, I believe there to be a suggestion that there is something wrong with my HPA axis.
I was also shown to have POTS, with my previous GP, who did the blood pressure test, but despite this being clearly shown through the blood pressure readings he took, it hasn't even ended up on my medical records.
And I have a C-Section, recorded as having been a vaginal birth.
So yes I do think doctors and in particular GP's, do need to listen a bit more and also record things accurately as well.
Long post finally done, off out now to gad about town and get some real life stuff sorted.

@AchatAVendre
calm down most patients who visit are not medical negligence lawyers or judges. And even if they are, often still appreciate their Dr explaining things to them that they are more than capable to understand without. And you call me presumptuous!