GP diagnosis based on receptionist notes

[DrBlackbird]

And without speaking to me….

I am resigned to the 45-60 minutes wait to get a GP receptionist now. I am resigned to the waits of up to a month or more for a regular GP appointment now. I am resigned to telephone appointments with a GP unfamiliar with me or my medical history. I am resigned to GPs not reading/not having time to read my medical notes so repeating it ad nauseum for every new appointment now.

However, as of today, it is a new one to find out that my GP’s office (an amalgamation of 5 practices rolled into one super practice for ‘the patients benefit’) now diagnoses and makes treatment decisions for its patients on the basis of the receptionist’s notes rather than actually speaking to the patient.

It’s too long to go into details, but I am ill with something that I’ve been ill before with and am aware that there are new treatments available with which to treat it. After waiting the usual 45 minutes to get a receptionist, the receptionist agreed to put me down for a telephone consult with the GP.

After waiting a while but no call, I noticed a new text message. From the GP. Stating that she has "reviewed my symptoms", that "there is no indication for treatment in the vast majority of cases" and gave me links to a website for self management at home. The symptoms that she ‘reviewed’ can only be what the receptionist wrote down.

Now, you can have any opinion you want on my illness, but AIBU to think this is a new level of crazy for a GP to base their diagnosis and prognosis of my symptoms based on whatever notes the receptionist jotted down? Rather than speaking to the patient?! She assumed that I wanted a particular treatment (I didn’t), but even then how can she know that I fall into the ‘vast majority’ or not without talking to me?

What the fuck are they playing at?

I assume the receptionist has spoken to you and taken information from you. They are essentially passing the message on to the doctor, then the the doctors decision wether to invite you in or go off the information given.

Also, any doctor can access your medical history via your notes - it's all there, even listed as current significant problems and past problems in bullet points on a summary page. Not many doctors will know every single one of their patients medical history off the top of their head.

Oh wow, this is bad. VERY bad.

I assume the receptionist has spoken to you and taken information from you. They are essentially passing the message on to the doctor, then the the doctors decision wether to invite you in or go off the information given

Yes. The receptionist spoke with me. She asked what my symptoms were. I started to tell her, she replied with ‘oh a bit of everything’ which was not correct, but I let that pass assuming that I would be explaining my symptoms to an actual GP.

The AIBU is asking if this is an acceptable way to make treatment decisions? I don’t think so myself. If so, why are we bothering to speak to our GPs at all? Why not let the receptionists pass on all the information they need?

That is bad. We have similar here where you speak to the receptionist first and explain your symptoms. The receptionist makes notes and a doctor from the practice phones back from lunchtime onwards to hear from you exactly what the symptoms are and decides if they need to see you or can just authorise a prescription which they electronically send to one of around 10 pharmacies. You just need to tell them which pharmacy you want it sent to. I have never come across a doctor relying solely on the receptionist’s notes though.

@Ciela I have never come across a doctor relying solely on the receptionist’s notes though

This is a first for me. On a Friday too. So if symptoms worsen over the weekend my only recourse is A&E?

I think it is awful, but sadly this level of "service" (a term I am using very loosely here) seems to be becoming all too common. It has really kicked in since the first Covid lockdowns and some surgeries are still continuing it.

My mother's surgery is dreadful for this sort of thing, if they even answer the phone in the first place. She is elderly and no longer in the greatest of health, but hasn't actually seen a doctor (GP) at all in the last three years. I keep suggesting that she could re-register with one of the other surgeries in her town, but she won't/doesn't want to cause a fuss etc.

I think that the government should now oblige GPs' surgeries to actually start seeing patients again, or at the very least phoning them. I mean particularly those who upped the drawbridge and have never lowered it since.

I can see how that process should work, for example I recently filled out an econsult form for my gp as I’ve been struggling post covid with my lungs and as an asthmatic knew prednisolone would help. If I’d called the GP, spoken to the receptionist and they’d passed on that message that would be fine.

However that is not what has happened with you and that’s really unacceptable.

That doesn't sound acceptable at all. I'd consider speaking to the practice manager - not necessarily a formal complaint, but definitely feedback.

When I told the receptionist that my migraines (bad enough to lead to several hospitalisations in the past) had come back, she said "so you're getting headaches, then?" I wouldn't want a doctor's decisions to be made on her notes!

This is astonishingly bad. Please insist on speaking to a doctor and please formally complain.

Depending on what's wrong, you might be able to see a GP at a walk-in centre.

This.

This happened to me too. But not twice! By the time I had finished the discussion with the head of the practice, I now get a GP appointment every time I ask for one. I know for a fact that others at the same practice are not getting the service they need, but won't complain about it so they continue to get a poor service. I don't.

If your symptoms worsen over the weekend call 111 or do the online symptom checker. The good thing is that the GP actually has to call back then if that's what they say is the best course of action.

This is astonishing. I would expect to be considered negligent if I did the same with one of my patients, and I'm a vet!!

This is bad. A receptionist has no clinical training and reductionism means they might not write down every last thing you said anyway, and they won't necessarily know what's a clinically significant change about your condition.
Your options:

1. Ask to speak to the practice manager and complain


2. Change practices (if possible)


3. Complain about doctor to GMC because I'd be amazed if their practice guidelines allowed this when my mum wasn't even allowed to speak to the nurse at 111 on my behalf when I had a tooth out and excessive bleeding and couldn't speak for myself many years ago.

This is a first for me. On a Friday too. So if symptoms worsen over the weekend my only recourse is A&E?

If your symptoms worsen within the next 7 days contact 101 OR go straight to A&E. Either way inform them exactly what your GP did and said.

101 is non emergency police. You want 111.

This makes no sense. I've sometimes said something like "I'm having problems with my periods" and not really elaborated any further. I mean, how would the receptionist help? And saying that could mean absolutely anything. If I've got several symptoms, I'm probably not going to mention them all to the receptionist either.

Crazy system!
I find even phone consultations to be rubbish as there’s no physical exam if needed - I get not all symptoms need one but some do, to give a rough ‘idea’ of the issue at least.
i hate telling receptionists why I need an ‘urgent’ appt - er, cos you haven’t got any for 3 weeks and I’m in pain etc.

Yanbu. I got this with my four-year-old a few months ago. My four-year-old! I said I didn't accept the first response that was passed on to me and kept pressing for an appointment with a GP. When we finally got to see her she was very thorough, agreed that my child seemed really quite unwell, and prescribed the antibiotics that got her better.

It's not acceptable for treatment to be based entirely on a conversation between patient and receptionist. I have finally worked out that at our practice there is a special question the receptionist asks at the end of the conversation: "Are you hoping for a specific outcome?" And the answer you have to give is "I would like my child (or myself, whoever) to be examined by a GP please." It seems to be the magic passphrase.

Our GP has this drawbridge system since I’ve been here - so at least 8 years and I think it works well. You phone on the day you can make an appointment, the GP phones you back and decides themselves if they need to see you, rather than the receptionist gate-keeping appointments. It’s less helpful for routine things, because you also have to phone on the day and I feel bad for the ‘same day’ service when it’s something that could wait and it’s hard to arrange childcare, but they are minor drawbacks.

I’ve always had contact with the GP though, unless it wasn’t needed as previously agreed with a GP (like when DD had recurrent UTIs. I dropped in the sample, they tested and sent the abx over to the pharmacy, and I picked them up. No need for a call, although they still often did)

@DrBlackbird post a review on Care Opinion as anonymous and you’ll get the practice managers attention and the CQCs

Do it asap x

FFS, I was a receptionist many years ago, NEVER allowed to give advice. What would happen if they gave the wrong advice?

I am a Dr- it is very hard to see a good justification. I mean, it might be if receptionist had passed on message - “uti symptoms x, y, z” and the gp had said “ please ask patient to hand in a sample”. And then had prescribed if positive. But this is presumably a bit more complicated than that, and so yes, I would expect you to have spoken to a GP.

I do usually find the GP bashing in here quite frustrating, but in this case I think it is an example of poor practice. I would call back and insist on speaking to someone, and also make a complaint.

@Jerabilis I can see the benefit where it’s you filling out an econsult form to send to the GP and I would’ve happily done something like this myself.

@Siepie yes I’ll look for a walk-in Centre.

@PeekabooAtTheZoo this is the final straw for me as I’ve been thinking about moving GP surgeries but you never know if the level of care will be any better. Perhaps the question now is could it be any worse?

@Mysaucepanbroke thats a good idea as well.

And thanks to everyone suggesting I take my concerns to the Practice Manager. In writing I think will be best.

I get the use of a drawbridge system and whilst irritating, accept its need. It’s the presumption on the part of the GP to make treatment decisions without ascertaining a full picture that gets me. Even if they texted to say there wasn’t time for a telephone consult today but booked one for Monday with advice etc. But, no my only other choice is to go back in the 45minute receptionist telephone queue.

Thanks again to all who replied with commiseration and helpful suggestions.