To wonder why the NHS has such a high threshold for blood work?

[SailAwaySandra]

In a nutshell, my folate levels are actually low after all. But they’re NHS borderline.

For about 6 months now, I’ve felt like utter death. Really stanage symptoms, fatigue and joint pain making me feel like walking through treacle.

It turns out my folate levels are borderline and actually low. And the ideal is that they’re much better than they are!

I’ve had 3 blood tests via the NHS, each time going to the GP very worried as I am only 26 and physically felt like my body was aging! Sometimes I had to flinch to move a leg, for example, if I had to sit for a minute or so and get up again

GPs kept saying all was normal. Nothing to worry about.

Paid for a blood test and told within 72 hours that my folate levels are too low. And to take folic acid (I’ve already put loads of it in my diet)

Why or why did no GP say ‘it’s within normal range but your folate is in the low side. You might want to consider buying some folic acid and introducing more of it into the diet’?

They can be like it with ferritin too.

I've had this with my thyroid. I was on the border of the lower bound. Paid to see a doctor and he said clinically I fit the case for diagnosis. My life is changed now I'm being medicated correctly. Id been going to NHS GPs for years trying to get it resolved

I wish we were aiming for optimal health rather than minimal.

I have several conditions that overlap and would love to get stuff tweaked so my thyroxine, hrt, various vitamins and amitriptyline were working together.

Because they think it saves money. It means only the very serious cases need to be treated.

Very short sighted though as people with symptoms such as yours then (understandably) make multiple appointments and have various tests to try to figure out what is wrong with them, which probably costs more than just treating you in the first place.

They do it with everything. If it fits "normal" they don't care. Despite the other symptoms you might be experiencing alongside.

In an ideal world they would do exactly as you said. Everything is but, this is on the lower side of normal and with your symptoms you may benefit from xyz. I guess a lot of people would want them to prescribe something and want follow ups etc which is more time/cost.

I'm with @Cantfindanavailablename I struggled to get thyroxine. My TSH was high for ages but until my T4 finally went into the NHS acceptable level (low) I was refused it, even though research states it should be given when the TSH is raised as its a clear indicator that your thyroid is struggling.

Thyroxine is very cheap....my theory is that once you're on thyroxine you qualify for free prescriptions and the NHS need the prescription fees, so keep you off it as long as possible.

I think a lot of them actually believe the NHS reference ranges to be correct.

Personally I would not believe anything then NHS told me unless I was able to verify it from other sources.

The entire aim is to save money and treat as many people as possible as cheaply as possible.

No interest in helping the individual to have quality of life.

OMG yes. I've been in the floor with this. Been just above threshold but my symptoms have been horrific. I was treated on NHS in this case. But agree with other posters in general though, the aim isn't for optimal sadly.

Totally agree. Private blood test options (no consultation needed) exist now and would just skip the begging the GP but, but obviously not affordable for all situations.

Spending a bit more on diagnostics and treating deficiencies like yours would save the NHS in the long-term and in GP appointments. Just pointless gatekeeping.

Same with TSH (thyroid) - when I finally saw an endocrinologist (after a decade of trying to be referred) he said the lower limit should be 0.5, not 0.1.

I can only imagine the reason is costs… cheaper to leave people undiagnosed and unmediated.

Also, most of these issues affect only women. And women’s health is not a priority in healthcare.

The NHS is a public health organisation, it is set up to treat society as a whole.

Private medicine is set up to treat the individual.

This is one of the implications of that. It’s in the same bracket as the NHS deciding that certain drugs are too expensive for them to offer. There’s no flexibility to say “this is normally considered normal but it obviously isn’t for you”.

@Cantfindanavailablename I’d be interested to hear your experience - did you have a low TSH too? What was it, what meds did you go on and how have they helped you?

Why didn't you just buy folic acid over the counter if you were that concerned? I don't really get the mumsnet obsession with borderline (ie not low) ferritin, folic acid or TSH. Iron tablets have side effects (constipation & black tarry poo), and overtreating sub clinical hypothyroidism will cause hyperthyroidism. Folic acid deficiency doesn't usually cause symptoms unless you are anaemic.

This is, in fact, a massive massive problem with the GPs.
It is not because of time, or workload, or money, is it? The test is done, it is in front of them.

Dh is finally understanding this issue, he is facing 6 weeks of daily treatments for an issue we’re not sure he actually has. The NHS believes it’s not worth the blood test and surgeon appointment until we see if the treatment works. It’s maddening and can’t possibly save money in the long term (never mind the cost to the health of the patients)

What are the ranges the NHS think ok and the ones others suggest?

Same here, it was my T4 dropping that triggered it and they gave me 25mcg (I'm 5ft 10 and heavy) which did fuck all
Eventually for 75mcg which got my level to 4.5 TSH which they said was perfect

I changed GP and now on 100mcg

Thank you. It must also feel a bit shit as a Dr, knowing full well you’re sending a patient away who’s suffering, and you haven’t actually helped whilst knowing you do know why they feel that way?

I am not blaming the GP - I know there are guidelines. But I just don’t know how you can do a chipper ‘great news! Everything is absolutely normal’ when that’s not the case

Agree with the PP, why not just buy over the counter supplements? Why did you have to pay for a private test? They would show exactly the same values as three of your NHS tests.
I would imagine that blood results as well as everything else done in the NHS are governed by NICE guidelines. It means that the clinical body looked at population-level evidence of what are normal levels. It doesn't actually cost anything to your GP to say "take supplements" so I don't see where you think they are saving money by suggesting your levels are normal.
NICE also look at risks vs benefits and cost vs benefits. And yes, sometimes on a population level the risks and the costs are too high. And they cannot assess or assume risks for your individual situation. They can only look at what research data tells them.
Private clinics are "pay to play", very different. They are not bound by NICE guidelines and don't care about costs because you are the one paying.
Funny how people object to private ADHD diagnosis but have no problems whatsoever with other diagnoses from private providers. It's the same, isn't it? You pay and they give you what you want.

My ferritin was 3; I was hallucinating and passing out while pregnant. I had to beg, plead, cry and explain I thought that I would die to get iron infusions. They saved my life.

My blood test results said "your ferritin is a little low. Iron supplements should help"

I have a condition that means iron isn't absorbed which is on my medical records.

Agree with the PP, why not just buy over the counter supplements?

How do you know what to supplement if you don’t have the tests? Unfortunately, the levels required to boost certain deficiencies aren’t available OTC so you do have to go private to get a prescription.

Why did you have to pay for a private test?

Because for some tests, the NHS simply won’t do them any more, such as vitamin D. Also with private tests you get a GP interpretation and recommendation.

I don't really get the mumsnet obsession with borderline (ie not low) ferritin, folic acid or TSH.

For me my borderline ferritin level meant my hair fell out, levels not low enough for NHS treatment but not high enough to support hair growth.

We had this with DS(9) - took him to the GP for the second time because we believe he gets far too tired for a child of his age. Had blood tests both times and were told they were normal.

Fast forward a few months and DS is at an NHS paediatric dietician where I showed her his latest blood results via the NHS App. Turns out his ferritin is 1 point/whatever above ‘Low’ and yet neither GP seemingly couldn’t join the dots between the reason for the blood test and the literal borderline result. The dietician was not impressed and said it’s quite obvious that low ferritin was the issue.

I think it depends on the GP - mine has prescribed ferrous fumarate for me when my iron levels weren't quite low enough to be classed as clinically anaemic, but were causing symptoms.