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AIBU?

Share your dilemmas and get honest opinions from other Mumsnetters.

Original poster

To complain to my GP practice?

54 replies

OhhLaaLaa · 14/04/2023 15:35

Firstly, my GP practice are normally fab and I've been very happy since moving to this new town and therefore new practice a couple of years ago.

However. A couple of months back I had to have a full blood test done for a ongoing physical health matter. That came back that one of my meds for a different physical health matter needed adjusting. I had a phone call from one of the receptionists saying that the GP had stated I needed to more than half my dose, actually it was reduce it to nearly 1/3 of current dose. I queried this straight away as I have been taking this medication for nearly 40 year and the dose has only ever increased, and usually only by a small amount each time. She said she couldnt comment - that she could only state what the GP had said. So as I had just ordered my repeat prescription I had more than enough to reduce to this new dose. I arranged a repeat blood test for 8 weeks as requested.

I have just had that repeat blood test, where the results show that I am now significantly undermedicated! My GP rang me this morning to discuss this and neither of us could understand why my range was all over the place (I was silently panicking at this point as I have a variety of health issues that I am trying to come to terms with and genuinely don't think I could cope with anything else). To give the GP credit, he was very determined to get to the bottom of it, and after a length phone conversation, it turns out that the receptionist had read the GP info wrong - the strength of the tablet was correct, but it should have been 3 x daily. I was told 1 x daily.

For the past 8 weeks I have really struggled physically and mentally whilst not understanding why. My existing health issues hadn't changed, the only thing that had was this medication so I know it was that that was making me so sluggish and irritable.

I know anyone can make mistakes, but the fact that I questioned it at the time, then again when I saw a nurse about something else, and a third time with another nurse (couldn't get in to see GP) yet it was only because of the GP's perseverence this morning that we got to the bottom of it. I now have another 8 week period of adjusting followed by another blood test to check that my levels have returned to normal.

AIBU to politely bring this up with the practice manager just to remind receptionists to check the information they are passing on?

OP posts:
Hankunamatata · 14/04/2023 21:39

Next time you could ask for a new prescription and that should have the correct dosing information on the drug label when dispensed, as a double check

KittyAlfred · 14/04/2023 21:39

This should be discussed as a significant event. This means it is documented, record of it is kept, the doctors will look at what went wrong, why it went wrong, how it can be prevented in future etc.
I would suggest you speak to the practice manager, say you assume it’ll be discussed as a significant event, and if possible you would like to see the outcome of that discussion.

It’ll be a simple mistake, human error, but that doesn’t change the fact that it needs discussion and reflection. As you say, in another situation the outcome could have been much worse.

Gemstar2 · 14/04/2023 21:45

I sorry this happened to you - to be set back 2 months in terms of your health for something you queried must be so frustrating.

I understand you don’t want to make a fuss, but I do think you should complain, as much for others as for yourself. If the word “complaint” is what makes you feel uncomfortable, focus on the fact you’re trying to prevent it from happening to someone else, rather than for the purpose of highlighting the mistakes of that individual - and your language can completely reflect that: “I would like to draw your attention to this so that it doesn’t happen to someone else in future.”

The flip side would be the horror of reading in your local paper in a couple of weeks that the same mistake had happened again but with fatal consequences…you would definitely want to go back in time and flag it up.

Original poster
OhhLaaLaa · 14/04/2023 21:46

Hankunamatata · 14/04/2023 21:39

Next time you could ask for a new prescription and that should have the correct dosing information on the drug label when dispensed, as a double check

That's such a simple but good idea, thank you! [Flowers]

OP posts:
Leftbutcameback · 14/04/2023 21:46

I think of that sort of information is being given by phone it should be also in writing, even if that’s a text message. And that’s whether it’s a receptionist, doctor or nurse. It’s so easy to misunderstand or forget or mishear. Maybe that’s what you could suggest to them, then it’s not personal to the receptionist (after all, the doctor misread it too)

Leftbutcameback · 14/04/2023 21:46

And I’m sorry that this happened - I know from relatives how hard it is to get the dosage right and how much it affects you.

Original poster
OhhLaaLaa · 14/04/2023 21:52

Leftbutcameback · 14/04/2023 21:46

I think of that sort of information is being given by phone it should be also in writing, even if that’s a text message. And that’s whether it’s a receptionist, doctor or nurse. It’s so easy to misunderstand or forget or mishear. Maybe that’s what you could suggest to them, then it’s not personal to the receptionist (after all, the doctor misread it too)

I think initially this is where the phone call with the GP this morning was heading - that I must have misheard as he had his notes in front of him which definitely stated the correct dose. I then politely stayed my case that I definitely didn't mis hear as I immediately questioned the dose I'd been told, not once but three times.

He listened to me, went back through other notes and read out what the receptionist had typed "patient informed to drop to 100mcg daily". Which was wrong. Actually when I speak to the practice manager next week (she wasn't there today) I may mention how thorough the GP was today.

OP posts:
ImNotAsThinkAsYouDrunkIAm · 14/04/2023 21:53

When my dose of thyroxine is changed I get a message from the GP. In one case I got a confusing message: ‘please continue taking current dose of X’, where X wasn’t my current dose, and I queried it, and the GP clarified. The point is, you should be having these conversations with someone who is qualified to clarify, not someone just passing on a message. I’d complain, this is a very unsafe way for them to inform patients of medication changes.

ImNotAsThinkAsYouDrunkIAm · 14/04/2023 21:56

PS. If you are supposed to be on 300mcg of thyroxine and have been taking 100mcg then I can well imagine how bad you’ve been feeling. 💐

Annietheacrobat · 14/04/2023 21:58

Yes do complain. There is learning to be had.

nokidshere · 14/04/2023 22:01

I have never had a non medical person speak to me about medication. The texts, messages or calls always come from the Dr. If I call to ask I'm told only a Dr can give me that information.

Do you not have the NHS app? It would be on there, hopefully correctly, soon after your appointment

Daftasyoulike · 14/04/2023 22:18

I was once accidentally issued tablets 3 x the strength of my normal prescription and almost died because of it. The doctor who spotted the error totally freaked when he realised what had happened, and while I know this is different to your own experience OP, it IS exactly the sort of thing that could happen, if messages about dosage are being passed on by someone who isn't qualified. I therefore strongly agree with everyone else that you should definitely put your complaint in writing to the Practice Manager, and keep a record of it, just in case further mistakes in the practice should come to light in the future.

PotOfTeaForOne · 15/04/2023 00:23

Complain, but not about the receptionist, complain about the GP. It's not a receptionists job to be advising patients about clinical things like their medication doses. The GP is the one who prescribes your medication; they are accountable for this. They should have taken 30 seconds to quickly do a letter for you, something like...

Dear OhhLaaLaa,

Your recent blood tests have shown blah blah. I am not overly concerned about this, but it would be a good idea to reduce your dose of blah blah to blah, and repeat this blood test in eight weeks.

Yours sincerely,
GP

...then you would have received a copy and it is all in black and white on your notes, so there would be no confusion. The fact that you questioned it with the nurses also suggests that the GP has not updated your notes or prescription, as otherwise it would be obvious.

The GP is unlikely to raise it, as this is his mistake.

It really grinds my gears when doctors make a mistake, and other staff get thrown under the bus for it!

Original poster
OhhLaaLaa · 17/04/2023 17:09

Update - I spoke with the practice manager today and stated that I wished to make a complaint. I didn't specify any person in particular, just explained what had happened. She said it would go to a significant review to see if any lessons could be learned, so I stated that it had really made me doubt the process. Thank you to the pp who suggested getting a new supply of meds each time a prescription changed so that the new dose is on the box (sounds so obvious really!) - I asked if I could arrange for this even if I wasnt due a repeat prescription. Practice manager said yes of course and if there were any issues from either reception or the pharmacy to state that she has ok'd it.

I'm not sure whether I hear the outcome of the review, but at least I have a plan going forward. Blood test in a few weeks so I have a few weeks now of adjusting back to the correct dose and hopefully feeling better. Thanks to all for the encouragement to bring it up as I think I probably would have left it.

OP posts:
GnomeDePlume · 17/04/2023 21:32

I'm glad they have taken this error seriously. It is worrying that the whole change to dosage instruction was handled so casually and with no challenge back in the system.

I'm on a range of medications (including levothyroxine and warfarin). It is worrying that I have to remind my surgery to check drug interactions. They never look at what else I am taking before prescribing something new.

What will happen when we are less confident to advocate for ourselves?

hoover12345 · 17/04/2023 21:42

100% isn't the receptionists job to be passing this info on. And I say this as a GP receptionist but I also know the doctors try and put as much work on to us they don't care if we say we're not comfortable with that. I've had to tell patients things that are completely above my pay grade but there's nothing we can do except tell the PM but it still continues. When you queried it she should of said I'll put you down for a phone call again or she should of said I'll double check with the GP and let you know.

You could email/write to the manager and let her know that you don't want anyone in trouble but there needs to be protocols in place and with out knowing what's happened to you nothing can improve. It would probably be marked as a significant event though because you've been taking the wrong dose of medication by error.

hoover12345 · 17/04/2023 21:43

Also it should have the correct dose/amount on the label of the box of medication. Check what that says. Even though the receptionist told you the wrong info, the prescription should be the correct info.

hoover12345 · 17/04/2023 21:48

OhhLaaLaa · 14/04/2023 16:13

I will definitely ring to speak to the practice manager. There must be a record somewhere of what the receptionist told me as when the GP was reading out aloud from my notes this morning, he read "drop down to 100mcg daily" - he apologised straight away and said it should have stated 3 x 100mcg daily. I'm hoping that's what that means as otherwise it will be just my word against the receptionists. As I had plenty of my meds from my existing prescription I didn't get a new prescription with the new dose written on it.

Ok so it was the doctors fault then. It should of stated 300mcg not drop down to 100mcg if he wanted you on the 300mcg. But the receptionist should of still passed to the doctor if you were querying it.

hoover12345 · 17/04/2023 21:51

Twocoffeesisbetterthanone · 14/04/2023 21:19

Please report. The next patient could be vulnerable, elderly or have learning difficulties and not be able to speak up or understand what's happening.

I had it too when a Receptionist accidentally upped my dose of propranolol from 10mg to 100mg.

It was scary and thankfully my neighbour was a cardiac nurse who found me collapsed on the driveway!

The receptionist had done it before. I asked for a thorough investigation and requested training. She left instead.

How can a receptionist up a medication? They can't sign them off only a doctor can.

JudgeRudy · 17/04/2023 21:53

Yes, I think it's sensible to pass this on to the practice manager. I would hope the GP would do this. On the face of it the admin caller has given out the wrong information however it could well be that she does not have adequate training. Ultimately the practice manager needs to address this.
I work in healthcare and am familiar with the old Latin abbreviations. It's quite possible that the person making the call understood perfectly reduce from 10 to 9 however thought tds was the units. Prescriptions and medication should now say in words and numbers what should be taken eg 1 x 500mg tablet 3 times a day, not tds. We're you issued with a new prescription? What did it say on your medication label.
Don't forget to ask how they will ensure it doesn't happen again.
Hope you're back on track soon.

Wc100423 · 17/04/2023 21:55

OhhLaaLaa · 14/04/2023 16:13

I will definitely ring to speak to the practice manager. There must be a record somewhere of what the receptionist told me as when the GP was reading out aloud from my notes this morning, he read "drop down to 100mcg daily" - he apologised straight away and said it should have stated 3 x 100mcg daily. I'm hoping that's what that means as otherwise it will be just my word against the receptionists. As I had plenty of my meds from my existing prescription I didn't get a new prescription with the new dose written on it.

So it was the GP’s mistake not the receptionists for not writing TDS in the notes? This is serious and a critical incident needs to be raised as out of sync thyroid levels can have a negative effect on so many organs including the heart. Protocols need to be changed and the risks of it happening again minimized. Hope your okay 👌

hoover12345 · 17/04/2023 21:56

PotOfTeaForOne · 15/04/2023 00:23

Complain, but not about the receptionist, complain about the GP. It's not a receptionists job to be advising patients about clinical things like their medication doses. The GP is the one who prescribes your medication; they are accountable for this. They should have taken 30 seconds to quickly do a letter for you, something like...

Dear OhhLaaLaa,

Your recent blood tests have shown blah blah. I am not overly concerned about this, but it would be a good idea to reduce your dose of blah blah to blah, and repeat this blood test in eight weeks.

Yours sincerely,
GP

...then you would have received a copy and it is all in black and white on your notes, so there would be no confusion. The fact that you questioned it with the nurses also suggests that the GP has not updated your notes or prescription, as otherwise it would be obvious.

The GP is unlikely to raise it, as this is his mistake.

It really grinds my gears when doctors make a mistake, and other staff get thrown under the bus for it!

Exactly this! The GP knows he's in the wrong and covering his back. If the nurses haven't told you the correct information after you asking then it has to be the doctor who has wrote the wrong notes. Otherwise the nurses would of been able to tell straight away from the GP's notes that you were on the wrong dose.

Redburnett · 17/04/2023 22:02

Definitely worth a formal written complaint. It is totally unacceptable for a non-clinically trained person to be giving instructions about medication and dose. If a doctor had actually told the receptionist to do that then that also merits a complaint about the GP as no doctor should give such an instruction to a person without clinical training.

Oblomov23 · 17/04/2023 22:07

Yep. This is very poor. Please complain.

Loubymoo27 · 17/04/2023 22:11

I'm a GP receptionist and I wouldn't be comfortable passing on this type of information. I would say something as I think they need to look into and adjust their policies.

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