If I make a complaint about my GP refusing to prescribe medication

[Sconesandgravy]

My neurologist asked the GP to prescribe a medication to help with a medical condition. The medication is one can cause birth defects. I spoke to the pharmacist this morning who called to say she was putting the request through to the GP. The pharmacist messaged that afternoon to say the GP has refused to prescribe unless I go on hormonal contraception or the copper coil. He has claimed that guidelines say he can't prescribe if I refuse the above types of contraception.

I want to complain about this for several reasons:

• My husband is completely infertile. He had multiple samples of testicular tissue biopsied and it was confirmed he has a condition that means his sperm count will always be 0. The only way I'm getting pregnant is with a sperm donor. I obviously can't do this by accident. The pharmacist made the GP aware of this because she called me this morning and said contraception is recommended, so I said I'm not on contraception and disclosed about my husband.

• I checked the guidelines myself. NICE guidelines state the need for effective contraception must be expressed. The BNF says effective contraception must be advised. On gov.uk there is a 2022 safety review of the medication that states health care practitioners "should fully inform the patients of the risks and advise them of the need to use highly effective contraception". Nowhere specifies what contraception should be used, and none of the above bodies specify that medication should not be prescribed if long term contraception is refused. The only thing I can find is that alternative medications can be offered if the medication is long term and the patient doesn't want to use any form of contraception.

• Condoms and abstinence are also effective forms of contraception. If I were a man these would be recommended as they're the only available form of effective male contraception. It seems discriminatory to suddenly decide they're not considered effective contraception just because I have a vagina.

• I'm an adult with full capacity. I have the right to make an informed decision about what I put into my body.

In all honesty it just feels a bit like the GP has refused my prescription and intentionally given me misinformation about the guidelines to try and coerce me into going onto a contraceptive that he deems the most effective, rather than allowing me to make an informed decision based on my own personal circumstances. I know this is dramatic and I won't put that in my complaint but I just needed to get that thought out of my system

AIBU if I complain?

HE could be female.

I was prescribed sodium valproate for bipolar disorder, when I was 17. There was no conversation about contraception, or the risk of birth defects.

A few years later, I saw a psychiatrist who was absolutely horrified that I'd been prescribed it. I knew none of the dangers and I'm truly grateful to that woman!

It is something that we (the professionals) have learnt more and more about over the past 20 years. When I qualified just under 20 years back, there were no restrictions on valproate in pregnancy. It was considered to be appropriate (alongside high dose folic acid) if the risk of seizures/relapse in mental health was greater than risk of medication exposure. Studying outcomes of women taking it showed us that the risk of harm to the foetus are too great and now pregnancy is an absolute contraindication (like thalidomide and isotretinoin). As Pp have mentioned, guidelines have been tightened even more this year to include men fathering babies when on treatment

Well he did, because I was on it for a couple of years.

Topiramate can actually affect the efficacy of hormonal contraception like the Pill, so other methods are preferred. My GP must have taken the husband's infertility into account.

Make the appointment to see the Gp in 3 weeks.

Wouldn't it just be simpler to agree to the pill and just not take it?

I've found they will always go with the "we can't assume your husband is the father" mindset. It sucks but it is what it is.

I am on a similar medication. I would just see a different GP in the practice and explain. I'm sure it will be fine and they will prescribe. Some GPs are just difficult. I have to sign to refuse pregnancy tests for some treatments in hospital even though my DH has had a vasectomy and 0 sperm count. I wouldn't complain yet.

I am also on topirimate and I don't take contraception.

Bloody hell, this is extremely concerning. Not all women can take or want to take, hormonal contraception. Ditto the coil. Denying women under 55 effective medical treatment because of their other health issue, or their wish to exercise autonomy over their own body is dreadful discrimination. I’m not sure that would be legal if tested in a court.

Are you sure the arrangements doctors upthread have mentioned of signing to say you understand the risks doesn’t still stand?

That MRHA guidance is for a specific medication, as it is considered so high risk.

No exceptions at all. It took me a bit to get my head around but I sort of understand why. People's lives change, horrible things happen, pregnancy can be a result of a number of situations.

I think the prescription dosage is 180mg and the OTC one is 120mg, so you could buy the one from the chemist and split the pills in half with a cutter, and then take the 180 if you found that helped.

I take it combined with cetirizine and monteleukast, and all three are on prescriptions.

and occasionally the steroid nasal sprays and creams, which I tend to buy from online pharmacies as I never seem to get an appointment in time to get them when I need. Or the optician can prescribe the prescription-only eye drops.

The recent guideline changes are clear that the issue is that women are getting pregnent without them having been advised of the risks. The fault for that lies with the prescriber, not the women.

If properly informed then I suspect most women would be entirely responsible and take steps to ensure they don't get pregnant. Or would be aware that if they did become pregnant, a termination would more than likely be recommended.

And whilst the guidelines appear to imply that certain contraceptions MUST be taken, it clarifies that a discussion needs to happen with the patient and their circumstances taken into account. It also states that a risk assessment must be completed and an annual review undertaken.

Yet again, women are let down by a medical system that treats them as feckless imbeciles.

YABVU. Your GP is personally liable if they prescribe, which is why they are being cautious. Please contact the surgery and ask for a face-to-face appointment. People going straight for the nuclear option and launching into a complaint is one of the reasons why GPs are leaving the system and students are put off general practice.

Only the lower strength (120mg) of fexofenadine is licensed to treat hayfever. The higher strength (180mg) is licensed for long term allergic skin reactions (chronic idiopathic urticaria) such as itching, swelling and rashes. Therefore, if 180mg is being prescribed for hay fever, it’s outside the product licence , and not been clinically proven /licensed to work for this condition.

That's certainly what I take it for, although it's hard to distinguish skin symptoms from hayfever that often co-occurs.

I think I have heard of others who are prescribed it for hayfever in the main, though I don't know what strength they get - perhaps they are only prescribed 120mg., or like me they have other symptoms as well. I think the monteleukast tends to be prescribed when skin symptoms are quite intense.

Re: hay fever meds. Personally I just buy mine over the counter and take more of them up to the BNF max for any indication. My body my choice and then I'm not involving any medical professionals in sanctioning my choices which they are entitled to disagree with. Unfortunately each individual prescriber is responsible for their own prescribing so a note on your file from one GP who was prepared to go over BNF max is not binding on another one who isn't.

She absolutely should stand against this crap. I'm sick to death of these people having so much power. It's probably to do with costs.
I wouldn’t think so, I’d think it’s more likely they’ve been threatened/sued in the past/ had something happen to a patient as a result of something similar. I’m happy for gps to have power, their power sometimes means they argue for something and get you/ your kid an appointment that would have otherwise taken you years or money you didn’t have to get it.

You need to have the conversation with the Gp not a three way with the pharmacist. I'm not sure why this hasn't happened to be honest.

I was prescribed 180mg for hay fever years ago when it first became available in the UK. I’ve taken that dose since. I’ve tried the 120mg OTC dose and it’s not strong enough for my hay fever, so I still have to get the GP to prescribe.

Update: The pharmacist rang me today. The GP has apparently asked her to communicate with me as he is too busy.

He has made it clear he will not accept a disclaimer. He has also told the pharmacist that he cannot take my word for my husband being infertile because in his medical opinion there is no such thing as total infertility only subfertility and there is always a chance of getting pregnant regardless of whether someone is "subfertile". This is categorically incorrect. There are multiple disorders that cause total male infertility - klinefelter syndrome, Y chromosome microdeletions, Sertoli Cell only Syndrome, cystic fibrosis gene mutation, immunologic infertility and so on. My husband has one of these conditions and is waiting for his karyotyping to see if it's caused by a Y chromosome deletion.

The GP has said he will only prescribe medication if I either go on contraception or my husband gives consent for GP to access his records to assess the level of my husband's infertility because he can't he infertile, only sub fertile. I was sat on the phone sobbing the entire time because the fact we can't have biological children breaks me. It's taken me over a year to get to a point where I'm not triggered by babies and pregnancy. Being told my the GP feels my husband cannot be infertile, when it has been confirmed by an andrology consultant surgeon absolutely sent me over the edge, because while yes the GP has gone through years of training... He's a GP, not a specialist.

My husband will not consent to the GP viewing his records because he is really pissed off that the GP wants to dredge through his medical information because he doesn't believe in total infertility.

I know people will disagree with me but the approach to this situation has been absolutely awful. And it really does feel like the GP is trying to coerce me into doing what he wants. I'm going to ask to speak to the practice manager because this has gone from a situation that could be easy to resolve to something that has left me deeply stressed out and distressed. It's not even about the refusal to prescribe anymore. It's about the approach, the attitude and the sheer amount of ignorance around infertility. I'm absolutely disgusted by how this has been handled.

The pharmacist also told me that the fact I can list the risks, explain the impact of the risks and am willing to sign a disclaimer saying I recognise the risks and consequences doesn't adequately show I understand the risks of falling pregnant on topiramate 🤨

@SpidersAreShitheads I appreciate there would have been no way to foist contraception on a bloke, but if the risks are so high surely he should have been warned about getting me pregnant?! Nothing was said. Topiramate prescribed without a murmur

That’s absolutely not how medicines and potential birth defects work. Some medicines that can cause potential birth defects if taken by women, will have no effect on spermatozoa at all so a man does not need to use contraception. Some medicines work the other way round and damage spermatozoa only, and have no effect at all if taken by women, so women don’t need use contraception if the man is; and some medicines affect both men and women.

Interesting, I was given Toprimiate over a phone call consultation for chronic migraine via a GP and wasn’t asked one question about contraception. At that stage I hadn’t even seen a neurologist (it followed a few months after). The drug has helped immensely.