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?

Yeah. I’m an idiot.

It was the middle of the night, I was tired and I didn’t really think it through properly. In the cold light of day it’s a bit of a facepalm moment 😂🤦🏻‍♀️

I could edit my comment but I’ll probably just leave it because trying to cover up the fact I was a dickhead looks even worse 😂😂

I need to leave the internet alone when I’m only half awake.

Fuck this, go back to neurology, state the GP will not prescribe you this medication and ask specifically for botox or a CGRP injection. Bypass the GP completely.

When I was getting signed up for chemotherapy, I was told it was vitally important I not get pregnant during and for some time after treatment due to birth defects. My word that my husband had a vasectomy was enough, however.

I think it's barbaric, quite frankly, to insist that a woman having medical problems also needs to subject herself to the potential side effects of birth control in order to access treatment for it.

and yet while your ability to cite the risks and your informed consent is not adequate deemed inadequate, the same people are happy to hand out puberty blocking drugs like sweeties to teenagers.

I am so sorry you are going through this OP.

until this update I was in the don't complain camp, but they could have handled it SO much better. at least directly given you a call to discuss.
♡♡

I don’t know the ins and outs of infertility, but surely the dr asking permission to look at your dh’s notes is a good thing. It means he’s willing to prescribe the medicine providing he has all the information at his fingertips. I see that as progress.

However, I do believe though that the neurologist should have issued the first prescription, and any letters they write to gps are only ‘suggestions’ and not ‘orders’. GPs are legally liable for any prescriptions they write, hence their due diligence.

This! Even stricter guidelines in men due to new evidence of effects on sperm. Will be out of use soon. Rarely gets started I psychiatry now due to risks

I'm with the HCPs here. Fertility is never 100% impossibility.

Actually it is. Ask me how I know.

surely the dr asking permission to look at your dh’s notes is a good thing. It means he’s willing to prescribe the medicine providing he has all the information at his fingertips. I see that as progress.

I agree. It solves your issues about the contraception and gets you to where you want to be. I get that emotions are very heightened by now, but to characterise it as GP somehow wanting to dredge through your DH's medical records for some pissy reason is self-defeating. Refusing just makes it look like the records won't support what you've been claiming, which isn't the case. Apart from feeling angry, what's the reason for your DH to refuse the solution?

Go on then @CornishPorsche I'll bite....

I was going to suggest this.

OP, I was feeling very unsympathetic towards you at the start of this thread. I felt you were inflexible and dogmatic. But the more you post, and your most recent post in particular, has turned me completely.

How dare the GP refuse to have a conversation with you about your health. And to say the incredibly thoughtless things about fertility, knowing that it is a very sensitive and personal issue.

I strongly urge you to write to the practice manager and the surgery's patient liaison group. Give them the facts of the situation and how it has impacted your physical health (through not prescribing recommended medication) and mental health (through their lack of compassionate communication with you).

So NICE guidelines trump the GP's professional opinion?

Not sure I'd be happy with that.

Because the way the GP has handled this is atrocious, he doesn't feel comfortable giving a GP access to his records after said GP has said he doesn't believe real infertility exists, and quite frankly it's not my DHs medical issue. It's mine. It shouldn't have devolved into demanding to see his records as proof.

Also the GP has told the pharmacist that women do get pregnant by other men. So by his own logic he doesn't need to see the records because he's made it clear I could shag someone else 🤷🏽‍♀️.

Lastly I've offered to have a conversation, sign a waiver Yadda Yadda Yadda. At this stage the GP can forget the prescription and deal with the complaint about the atrocious way this has been handled.

I mean the consultant androgolist, who is a world renowned expert in male fertility, has been in his job for the last 20 years and did my husband's surgical investigations is confident he doesn't produce the germ cells required to make sperm. The condition he has is congenital and means he is 100% infertile and always will be.

I'm going to trust the specialist over the GP.

Fair enough, you make many good points, but I still think it's shutting the door on a simpler solution and regarding this -

he doesn't feel comfortable giving a GP access to his records after said GP has said he doesn't believe real infertility exists

I can understand disagreeing with the GP and not respecting his opinion, but I don't really see what there is to be uncomfortable about. Nothing is going to happen to your husband by allowing access and the GP's belief can't hurt him. At best, it will resolve the issue and the GP see that you're right. At worst, he won't be convinced for some reason and you'll be no worse off than now.

They don’t trump the GP’s opinion necessarily, but the GP will need to have justification for why he’s not adhering to them. If a patient is being refused treatment they are entitled to under the NICE guidelines and there’s not a good enough reason why, the patient has good grounds to complain.

This is my area of expertise. You cannot demand a GP prescribe any medication as it is their responsibility regardless of the right to autonomy. You have the right to refuse treatment, not demand it. However, it may be that GP is unclear and a constructive evidence-led conversation will achieve the outcome as it may be the doctor has an educational need. You should see the scary alerts we get about some of these meds. If that doesn't work, and the guidelines are right, then seek another GP. Confrontation will not achieve your aims, though.

If I may point out the flaws in your statement without wanting to be seen as difficult:

1/ You may change partner and forget to tell the surgery
2/ The guidance is to protect an unborn child, so male contraception doesn;t matter
3/ As expressed above, autonomy doesn't matter with prescribing requests. If anything should go wrong the GP would be responsible.

I can't guess the name of the drug so can't assess the guidelines .

Hope that helps.

But the GPs belief has hurt him. Infertility is an incredibly emotive subject and my husband is quite upset that the GP has decided to deny the fact that total infertility exists, because it effectively invalidates everything he's gone through. All it would take is a simple Google search to confirm that yes, total male infertility exists.

Why should my husband have to let a GP he doesn't like, doesn't have a good relationship with and refuses to see due to other reasons, go through his medical records for something that has nothing to do with his body?

As it stands it's MY medical issue not my husband's and imo my husband not consenting to record sharing isn't a valid reason to point blank refuse to give me the treatment I need.

I've offered to book an appointment and have a conversation about the risks so that the GP can inform me of them himself, I've offered to sign a waiver to confirm that I'm aware of the risks and anything that happens due to not being on contraception is my own responsibility.

But he is doing absolutely everything to try and "prove" I need to be on contraception.

I even requested this go to a different GP because we're going round in circles, because I'm not going on contraception and he's refusing to have a conversation or move forward because I won't go on contraception... and the GP told the pharmacist to tell me he's only happy to work collaboratively with another GP regarding this because I'm refusing to engage which is a potential risk to a foetus.

The pharmacist also told me the GP is now only willing to prescribe if I have a coil because he suspects I will dispose of a pill.

Letting my husband have the right to medical privacy isn't refusing to engage.
Asking for a conversation and stating I'm happy for a waiver also isn't refusing to engage.

In all honesty the stress of this is going to give me a migraine. I just want want an actual conversation.

No wonder you get migraines. You've made all of this incredibly hard work for yourself. Instead of accepting these are the guidelines the GP is following, you've taken it personally, and refused to agree to him writing a concurrent script for the birth control pill, which you are under no obligation to actually take. You seem to have found it a better use of your time and energy to get on your high horse and ramp up the level of difficulty at every step.

The pharmacist also told me the GP is now only willing to prescribe if I have a coil because he suspects I will dispose of a pill.

Oh, good work.

I honestly think I’d be looking to change GP at this point, if he’s telling third parties he thinks you’re not to be trusted. How can you trust a HCP who violates your privacy in this regard?

Or…it’s like loads of women have promised not to get pregnant on valproate then did and now doctors can’t trust their patients.

This is the conversation you need to have with your GP.

I would if he was willing to have a conversation. But he won't. He hides behind the pharmacist and seems to have told her that if I refuse contraception I can't have the meds. They won't let me have a conversation

The GP has made it hard work by refusing to have a conversation with me and by putting me in a position where I had to consider if I was willing to throw away a prescription. I don't want to lie to my HCPs because I have a chronic medical conditions and I need to be honest because lying about things makes things more difficult.

I understand there are guidelines to follow. But the guidelines state I must be advised about the risk of serious birth defects and the need for effective contraception. The GP isn't obligated to follow guidelines if he feels the risk of pregnancy is too high. I recognise and accept this. However, I want the GP to speak to me, and look at my medical history and my personal circumstances before he decides the risk is too high. NHS Healthcare is supposed to be patient centred. It's not patient centred if the GP is making decisions without taking my own records, history and current situation into account.

My situation: I have one DD. Who is 10. I fell pregnant on long term contraception when she was 5 months old. I miscarried, changed my contraception as soon as I was advised it was safe to, and haven't had a pregnancy since November 2013.

Between 2013 and late 2022, I was always on some form of long term contraception. I only had my coil removed after we found out DH was infertile. All of the above can be accessed in my medical records.

The further into this I get, the more I am left feeling as though the GP just sees me as a walking uterus.