To ask how can I avoid getting a junior doctor at my appointment tonight?

[Alrueb]

Firstly, I've nothing against junior doctors, not at all!

It's just that I have been dealing with life-altering symptoms for over 2 years now and I have been on a huge waiting list for 18 months - just for a first appointment with a consultant.

I have questions about surgery and would rather speak to the actual surgeon, given how long I've waited.

I am absolutely awful at being assertive. It's from PTSD and it's so bad that it affects many aspects of my life, including my career. I'm having therapy to try overcome this, but it's only taking me so far. It's only recently and rarely I've been able to speak to neighbours or anything!

Does anyone have any tips on what to say or how to word things? Someone said I need to ask at reception, I'm not sure.

Thanks!!

What surgery are you having ... If you don't mind me asking. Many surgeries are completed by the registrar's and because they carry them out more frequently than consultants, they are usually better than the consultants at them.

I don't know where you work but where I am an f1 or f2 would not be allowed near a clinic on a consultation and registrars are senior doctors here.

Can you explain why?

I know it does happen (direct experience). Are you saying I'm a total outlier? Or just a liar?

@Yekaterinap it's all semantics as although registrars are indeed senior doctors they are 'technically' junior doctors. Any doctor that has not CCT'd (completed post med school training, which can take 9+ years) is a "junior doctor". It is all of the "junior doctors" including the registrars that have been on strike recently. The term "junior doctor" is not helpful.

I've worked in many hospitals as all doctors in training rotate. Some will have FY2s and GPtrainees in clinic, some will only have speciality trainees. Either way, the patient should be reassured that no doctor should work beyond their competency and where there are FYs in clinic, there will be at least a reg there too.

Yes and it is an absolute fucking disgrace what this govt have done to the NHS - and I say that as someone who works in it. But you pay tax to see a consultant or a member of his/her team. And that's what will happen.

@LadyCrazyCatLady Thank you, to you and others, for explaining to me that 'junior' doctors can be very well trained, and are always supervised and able to ask questions to the more senior surgeon . specialist, on behalf of the patient. I had no idea how much experience years the registrars actually have. That's actually put my mind at rest, and I won't be so worried again about that.

The speciality is urogynaecology. I have prolapses from childbirth, but as they are still at this stage classed as minor grade, then no surgery is being offered. The consultant said only physio, and has referred me to the physio department of my local hospital, but discharged me from urogynaecology. I've already had private physio who said that it's a ligament problem and that physio won't hurt but won't help. I am willing to try though, as the surgery does not seem like it has a very high success rate (the surgeon said 3 in 10 fail within a year).

I suppose my issue is that I had questions about surgery, and other things, given that it is likely I will probably need it in future as I'm only mid 30s, but he just kept saying that "everyone has prolapse" "it's very common" and that I "shouldn't worry".

@HaveALaff I don't (yet) need surgery, as I am managing day to day, most days, although my symptoms do affect my life quite a lot, but I have multiple prolapses as a result of childbirth. If I were getting surgery, it would be pelvic floor repair I suppose. I'm only mid 30s, so likely will need surgery in the future, and there are quite a few different types of surgery, failure rates etc, so I wanted to ask questions.

@notmorezoom I understand that, I remember back in around 2005/2009 when my children were born, the wait lists to see a specialist were around 2 months. In 2022/23, I have waited 18 months!! . It's just not acceptable. I earn enough to pay tax, but nowhere near enough to fund any meaningful private treatment. What am I supposed to do, just not need any healthcare??

I’d be fine with seeing a junior doctor who tend to have years and years of experience. The term junior doctor is so misleading

i would always refuse to see a physician associate though. Dangerous new role and never want to be seen by one ever again

My prolapse improved massively with physio and time (about a year after stopping breastfeeding). Ligaments firm up after pregnancy and breastfeeding once the hormones are well out of your system and it can take a while. So your original exam saying it was a ligament issue may well be true but doesn’t mean it won’t improve with time.

In a nicest possible way, you need to be a little more assertive during your consultations. I am non-medical clinician and it baffles me how many people are "hoping" that the doctor brings something up instead of asking them directly (example, patient with severe depression referred to our specialist physical health service due to secondary symptoms, didn't tell their GP as was hoping they would notice and bring it up; patient with indicators of sleep aopnea, didn't tell their GP about their sleep problems but did about other secondary symptoms which were then put down to a different condition etc.).
You mention in your later post that there are multiple options for surgery so, of course, the consultant could not have taken you through every single one of them but you should have insisted they answer more general questions you have about treatment. A little assertiveness goes a long way:

• Dr, can you tell me a little more about X
• Oh, don't worry about, it may not happen
• I understand that, however, I am really anxious so it would help me a lot if you could answer this question.
• Oh, I really don't think you should worry about it at all
• Yes, but I do so can you give me some information please

We are generally very happy to answer questions and consultation times allow for that (I appreciate that 12 minutes with a GP is not enough but in specialist services we often have up to an hour for an appointment). However, it is sometimes difficult to cover every eventuality i.e. we may not feel it is necessary to go over details of five different procedural options for managing a condition, but we might tell you what would be the most likely next step if current management plan isn't working.

In the NHS, a junior doctor is anyone who isn’t a consultant or fully-qualified GP.

https://www.bma.org.uk/advice-and-support/international-doctors/life-and-work-in-the-uk/toolkit-for-doctors-new-to-the-uk/doctors-titles-explained#:~:text=Junior%20doctors%20are%20qualified%20doctors,a%20general%20practitioner%20(GP).

And it is a requirement of their training programme that SHOs do clinics. They have to do at least 20 per year in IMT in order to remain in their training programme. Not sure about non-medical specialties.

https://www.jrcptb.org.uk/sites/default/files/IMT%20ARCP%20Decision%20Aid%202019%20%282023%20update%20FINAL%29.pdf

I'm sorry you're suffering OP. The treatment options are variable depending on type and degree of prolapse and exactly what symptoms are being caused.

Definitely engage with the physio, I'd also recommend the 'Squeezy App'. If your symptoms are not improving, call your consultant's secretary and ask for a follow up appointment. Make sure you take someone with you who can advocate on your behalf. I'm medical and still forget all my questions or am so programmed to 'people please' that I take the first answer offered, even if it doesn't actually address what I was asking.

I should clarify that I forget my questions when I'm the patient, not when I'm the doctor.

I do the same in other circumstances such as parent's evenings. I nod and smile and then leave feeling like the teacher hasn't actually answered my question, but I was too ''polite" to ask it again.

I really hope your symptoms improve.

I've had junior doctors, twice, spot things that more senior/experienced doctors/consultants hadn't (NHS) so I would always give them a chance.
I've also had different surgeons turn up on the day to operate on me (major anxiety) but all turned out ok.

To ensure you get a consultant pay to see them privately. Otherwise just be like everyone else.

Depending on the specialism someone who is a "Junior Doctor" can have been working for 5+ years post medical school.

You’re neither an outlier nor a liar. I’ve had more than my fair share of NHS specialist clinics across multiple hospitals (and trusts). I’ve experienced similar in a few clinics.

@Canisaysomething Thanks, but I'm over 14 years postpartum!

@Catza I know, I try really hard to be assertive, but I have PTSD (not from anything medical though), and I end up just freezing and getting spoken over. I had my questions all prepared and then when I asked them (difficult enough for me), the consultant just said "don't worry about that" or "it's normal to have prolapse" and then I didn't say much after. I could've used the phrases you put down, but I just freeze.

@LadyCrazyCatLady Thanks that's exactly it - I people please and just take the first answer, even if it doesn't answer my question. I even go into a sort of 'trance'. It is a grade 1 uterus and also rectocele but he wasn't sure of grade for that. I've been to women's health physio already but they said it's not my muscles it's my ligaments so they couldn't help and discharged me after 1 appointment. This is a different physio department though so I am happy to go and see if they can help in any way. I already have the squeezy app, do everything to prevent constipation, have the squatty potty thing, am healthy weight etc. That's why I am disheartened, because this whole year I've waited, I've done everything to help myself, and I just feel fobbed off because my questions were just glossed over. I was discharged from the list before I even got out the waiting room! I went to the desk to see about the physio referral and she said "you've been discharged from here, but you will get a letter about physio". So I can't even email to ask for another appointment 🙁🙁

I'm not in the nhs or UK.

How fucking rude. Wind your neck in.
We are not "crappy" nurses.
We are hard working, highly educated and skilled professionals.

I work closely with outpatient bookings. You can insist to see a consultant by just asking. However be prepared to wait even longer. Consider seeing someone more ‘junior’ for the reasons stated. Unfortunately all patients are in the same boat with the long waits. It’s shite, I’m sorry, everyone’s trying their best but it isn’t good enough for our patients.

No, but you're paying (via your taxes) to be seen by a team, not a particular person.

@Alrueb from what you've written, I think a follow up appointment would be wholly justified, if only because you feel dismissed after the first one.

It's important that patients feel their concerns are listened to and taken seriously and a 'plan b' arranged if initial management doesn't work. I.e we'd either arrange telephone follow up or self-arranged follow up - where we ask you to call us in 6 months if physio has not worked and we bring you back to clinic.

I think, if I were you, I'd telephone the consultant's secretary as they may be able to sort a follow up appt for you, if you explain you're not happy with the outcome of the initial consultation (specifically being discharged from their care). If they're unable to, PALS would be the next port of call as they can mediate between you and the treating team.

Worst case, you can ask the GP to re-refer after physiotherapy, but that puts you back to the bottom of the waiting list.