To think the doctor could do more for my mother?

[MadameFantabulosa]

She’s been in pain for about three months now. Severe pain, that makes her cry, in her left side and back. The doctor - who would only do a phone consultation - kept telling her she had pulled a muscle and it would get better on its own. Finally agreed she could have an x ray as it wasn’t getting any better. X ray showed she had pleurisy, so she was prescribed antibiotics, a 5 day course of steroids and Tramadol.

She finished all of these tablets a week ago, and the pain is no better. She managed to get another phone consultation with the doctor yesterday, who has told her to take 8 paracetamol a day (obviously spaced out). My Mum has been taking paracetamol since the Tramadol ran out, and they’ve had no effect on the pain at all. The doctor told her just to carry on taking them. She’s just phoned me, crying in pain, and saying she can’t go on like this. I don’t know what to suggest. She said that the doctor said that perhaps the ribs that she broke eight years ago hadn’t healed properly, and this might be contributing to the pain. My Mum told her not to be so stupid!

Where can she go from here? She’s nearly 90, and feels like she is constantly being fobbed off, and no-one is interested. I live overseas, and am coming back to see her in a few weeks, but I don’t know what else, if anything, I can do to help her. But surely they can do something about the pain?

Has she tried A&E? I would think any severe internal pain would be a potential emergency. What if it’s her kidneys? Or Pancreas? She needs blood tests and scans.

Can she go to a walk in clinic? It sounds like the gp isn’t going to escalate so you need a change of practitioner. I’d suggest gp again but ask to see a different gp or a walk in clinic.

Yes, she needs blood tests at least. Complain to the practice manager or change GPs. Agree that if she presents at A&E in severe pain this may be a route to help. I m disgusted on her behalf and hope they're not fobbing her off because of her age!

She’s had phone consultations with three GPS at the practice now. I’ve suggested she go to A & E but she doesn’t want to go that route. She is scared of being admitted as she had a bad experience when she broke her ribs (discharged too soon, back in a day later, one of the nurses stole her money and her gold chain, she had no money to pay for the taxi home). I’ve suggested a private GP but she says no. She lives rurally, so getting to A & E isn’t easy, nor is changing practice.

Well if she wont take herself to A&E, she can call 111 and try and get an out of hours urgent GP appointment which would likely be run out of the local hospital. The problem with the GP route is that it isn’t for urgent medical issues like very severe internal pain. The GPS are likely thinking the pain is not that great because if it were as bad as she says it is, she should be going to A&E. Plus there is sexism at work in that women are judged to exaggerate their pain levels. However, 111 may advise her to call 999 and take an ambulance to A&E.

If she won't go to A&E and doesn't like the advice she's been given, what are her expectations? What does she want to happen?

Do you have power of attorney for her for health OP? Do you think she's giving you the full picture?

Or if the GPs think it's muscular, can she get a physio referral?

Why don't you email the Practice Manager at her GP surgery. The fact it's an email, a paper trail, they won't like and are more likely to action?

Like it or not Aand E or a walk in centre might be the only option. What does she have an expectation of, poor woman. It must be so hard for you being far away.

@hashbrownsandwich I think she would like the doctors to take her seriously, treat the pleurisy, see if there’s anything else wrong (blood tests, great idea, she’s asked, they’ve said no) and give her some drugs that help with the pain. This is also bringing back memories of what happened to my Dad - the GP told him that there was nothing wrong with him, that he would do blood tests, if that would make him happy. Hours after the blood tests he was blue lighted to hospital, and he died a few weeks later from lung cancer that the doctor had failed to diagnose.

”Going to A & E” isn’t that easy. The hospital’s about 7 miles away, and as I’ve said, she’s rural. Taxis are very hit and miss and she no longer drives (thank goodness). And she doesn’t want to call 111 - she has called them before, they said a doctor would call her back, and they called back 16 hours later, told her to take paracetamol, and to ring her GP in the morning.

@Oblomov22 I think emailing the practice is a good idea and will do that in the morning.

The problem with this kind of pain is that it's easy to fob people off with strong painkillers but unless investigations are carried out there is no way of knowing what is really going on. My DH was in agony with back pain a few years before the pandemic so not the backlogs in hospitals there is today. He is the type who never complains. Their records would have shown that he had never been in a doctor's surgery for more than ten years in yet so t he ey kept fobbing him in off with stronger and stronger painkillers. Refused him a scan and advised him to 'exercise through the pain' this was a man who was in normal circumstances an 80 mile a day cyclist with a physical job telling them he had crawled to the kitchen for his painkillers. Eventually we got a private consultation with a back surgeon who ordered a scan on NHS after feeling bulges in his back. Turned out 3 herniated discs plus other things. The advise was don't try to work through the agonising pain you are in. On good days do the things you like and can do. On bad days rest so you don't do more damage. He has followed this when he has flare-ups for 10 years and manages his issues well. The point I am making( in a very long be winded way) is that your dms gp can't possibly possibly know what's wrong from a phone diagnosis or even one in the surgery. Your DM needs tests including a scan so that a proper diagnosis can be made. Unfortunately doctors seem to be reluctant to order expensive tests unless they have to. I think it may be age discrimination adding to the problem and you will have to help your mother by pressing for the appropriate tests. 💐

Doctors seems to have forgotten that a proper, thorough clinical exam is also vital in helping to pinpoint problems and to aid diagnosis.
It amazes me that they seem to be able to make diagnoses over the telephone just by people describing stuff.

May I suggest you are going to have fight, hard, to make sure she isn't fobbed off again. A very polite but firm email. Ask for a phone call, to you. Remain very polite, always, but firm, and don't be fobbed off.

YABU. If she's that unwell and in that much pain and has been for weeks she should go to A&E and stop making excuses. And maybe leave her jewellery at home this time.

This happened to my dad recently, it’s a spinal tumor in his case & he was fobbed off for 6 months, please do everything you can to get her to go to A&E. Does she have no other family or friends that can take her?

"I'm really sorry but this is totally unacceptable. "

"I really feel that she is being fobbed off repeatedly and I am very unhappy with the current situation. "

"Moving forward, what exactly are you going to be able to do ? "

"I don't want her just repeatedly given painkillers that aren't working, without addressing the core issue. No one seems to have actually investigated what is going on here. I really feel that a more thorough investigation is required, and if necessary referrals to physio / pain relief / abc etc. "

Op you need to have this all written down ready in note form, so that you are prepared, when they do ring you you've got it ready to say and you yourself don't get fobbed off again.

I'd recommend she calls for an ambulance. Your mum is in severe, acute pain. She Iives alone and she's nearly 90. It's an entirely reasonable course of action. She needs to be seen urgently and the paramedics will be able to assess her.

I'm looking after my 93 year old mum after a fall and have had to call an ambulance several times over the past few years. We've had to wait for hours - once all night - but they've always been extremely helpful.

OP tell her to ring and book a taxi to A&E, or better still, you do it, that way you'll be able to explain how imperative it is that she goes, and then tell her to only take a credit card (if she still has one) or a couple of bank notes with her, sufficient to pay her taxi fare there and back, and enough for a few hot drinks if she needs them. Then she will know exactly how much she has on her, rather than having just a vague idea of how much was in her purse, so she will know immediately if any money were to go missing. Also make it clear to her not to wear any jewellery or take anything else of value with her. It sounds like it could be vital for her to have a thorough physical examination, and fobbing her off with telephone consultations at her age is an absolute disgrace! I'd definitely be having words with her surgery if I were in your shoes. I hope you manage to get her some help A.S.A.P.

Most GP practices have access to a "care community" staffed by a whole MDT of health professionals who can support vulnerable people in their own homes, see if your GPS can refer her to theirs?
What happened with the nurse who you say stole from your mother? Was that reported to the police?

You are potentially BU.
There are no magic pain killers, they all have risks. At 90 yrs old your mothers renal function may rule out some pain killers, if she is very frail then 8 paracteamol per day may not be appropriate either. Opioids are no longer recommended for chronic pain (>3months) unless cancer and they are highly addictive with horrible potential side effects including hyperalgesia. Historically yes opioids would be given but this is no longer the recommendations if none cancer pain that has lasted three months, and thats even if there are no other pain options available. The NHS is actively deprescribing them. How would you feel if they prescribed something which damaged her kidneys, or caused a potentially fatal fall due to making her spaced out (life expectancy after a hip fracture is very short in the elderly).

Yes they should be investigating further but I'm sure the GP wont be leaving your mother in pain without some rationale.

So sorry to read your post, and how worrying for you. Telephone consultations can be really useful in some circumstances but this is not one of them. Severe pain should always merit a physical examination and further investigation. My DH was wrongly diagnosed as a result of such things, but that was during covid restrictions. Now things are more or less back to normal. Hopefully you have the legal right to advocate for your mum, or data protection laws will prevent anyone in authority speaking to you.

Emailing the practice will do nothing IME. FIL's practice couldn't have given less of a shit when I emailed them. Well, he's dead now so I think the practice are probably happy not to be bothered by him/us. And when MIL was in mega pain for approx 3 years, they kept fobbing her off and eventually managed to diagnose the cancer when it was way too late and now she is also dead.

If you want help, you will really have to force the issue somehow. I do think A&E is the best route when the GP refuses to help. If she doesn't want to, she will continue to be fobbed off and in pain.

I would be looking for pain management rather than diagnose. Especially if she doesn't like hospital ect. I would call the practice and raise a concern over their duty of care. It's unacceptable that someone be left in agony. I get sooo frustrated about the lack of empathy for our elderly😡at times it's like they don't matter! I'm a nurse with a hugeeee passion for elderly care.

At 90 she will be admitted.