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’?

Oh, and also whilst I am ranting, the iron tablets that the NHS routinely prescribes (ferrous sulphate) are some the least absorbable by the body!!!!!

@MargoLivebetter

I was offered anti-depressants though!!!!!!!

I believe that at one point (maybe still the case) that GP's get additional funding for "managing" patients with depression, as they do "managing" diabetes, etc.

So basically, the more patients they diagnose with depression, the more funding they get.

It always surprised me that at my annual diabetic reviews, one of the tick box questions was asking if I ever felt depressed. They never asked any other "general" health questions. Then I read somewhere that depression diagnosis triggers additional funding, and suddenly it all made sense why they asked.

@taxguru you can buy the prescription strength over the counter for a few pounds

@MargoLivebetter

DS has a chronic bowel condition and the management of it is deplorable. He regularly has blood tests outside of range and the notes just say 'no action required'

Yep, same here with my T2 diabetes as I mentioned upthread. It's only with me insisting on being told/given the results that I discovered readings weren't right considering the quantity and type of medication I'm on and having to be very assertive to get a consultation with a diabetic nurse. GP had marked two consecutive blood tests as "satisfactory-patient can be informed", when they were too high for the medication I was on, and because of that, the receptionist wouldn't give me a consultation with either a diabetic nurse nor a GP to discuss it!

I feel like this too - despite working for NHS for 37 years. Everything comes down to cost.

I’m with you. I just take iron all the time now, mine is so low and causing knock on problems. Test results come back ok but actually low:

Sorry to hear that.

Thats not to say I think the medical staff are bad at their jobs - just a lot of them get stuck in “NHS land” and believe it’s the only way rather than maintaining an awareness of how things are done in other countries etc.

Like computer says no basically.

Just because something isn’t routine on the NHS doesn’t mean it won’t work for some.

Yes I'm a GP but obviously this can't be individual medical advice.

Thyroid is monitored by blood tests.
HRT is monitored by symptoms, as is fibromyalgia.

When there are two possible conditions causing one symptom (i.e. fibro/menopause can both cause fatigue) it can be tricky and the best way is to make one change at a time and give it a decent amount of time to bed in e.g. start HRT and change nothing else for at least 3m - have symptoms changed at the end of that time? Or titrate up amitryptiline dose gradually over a few months and change nothing else.

Blood tests generally unhelpful apart from the thyroid monitoring.

So basically, the more patients they diagnose with depression, the more funding they get

Nope. Categorically untrue. There was at one point a tiny amount of money within QOF just for asking those depression questions in the diabetes review, not sure if it's still there, but it is also good practice to be on the lookout for MH issues in those with chronic diseases.

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

I guess because you’ve not been badly affected by any of the above? Many doctors also consider being below the normal range ‘borderline’ if you’re not that far below it. I was refused thyroxine because my TSH was low, even though my thyroxine level was a little below the normal range. When I paid to see an endocrinologist, he ran a bunch of tests and said my problem isn’t my thyroid, it’s the pituitary, which makes TSH, and wasn’t making enough. Being on thyroxine made a big difference to me. Years later, when I had to go through my medical notes for another reason, I discovered I’d been tested for thyroxine years beforehand and my levels had been much higher, so it should have been apparent that there was a problem.

Humans aren’t mathematical equations, not everyone reacts the same to the same levels of things (which is precisely why there is a range), so while ‘borderline’ can be fine for one person, another person can feel terrible at that level. And the fact different countries have different ‘normal’ ranges for thyroxine underlines the fact that the ‘normal’ range is an estimate, not an absolute.

Which also came with the advice to take more folate whilst the NHS tests resulted in "normal" where "normal" varies by postcode not patient.

A 26 year old with a folate rich diet experience symptoms described for six months or more should be followed up. As I'm sure you know.

Telling them to try OTC folate in the first instance just to see if levels change in a few weeks with a repeat test is one thing, dismissing symptoms described by OP and others on this thread as "normal" is not good treatment and risks delaying diagnosis of other conditions including the kind of absorption problems treated with supplements not available OTC. As I'm sure you know if you are involved in blood testing.

I didn't realise I could ask for a blood test printout (even with extra huffing) so thanks for posting that.

I've had a recent blood test but I have no idea what they were testing for but apparently it's satisfactory. I know what my symptoms were but did they test for vitamin deficiency, iron, low thyroid or whether I'm from outer space (since race can affect certain things too). And yes I do ask which tests were performed but apparently all I need to know is that they were fine and I shouldn't worry my pretty little head about it anymore.

EDIT - and no, I can't make another appointment to discuss my symptoms because the blood test says I'm fine. Can anyone explain that reasoning because I would love to know.

@Bookgrrrl

Humans aren’t mathematical equations, not everyone reacts the same to the same levels of things (which is precisely why there is a range), so while ‘borderline’ can be fine for one person, another person can feel terrible at that level.

I agree, things like body weight/mass, general health, fitness, etc., all come into the equation, especially re the impact of drugs etc.

My OH's first week of chemotherapy for his cancer nearly killed him. So much so that the second week had to be cancelled. When they did the blood tests, his "scores" for the blood cancer markers had halved! The consultant couldn't believe it and said that kind of effect usually happens after two full rounds of the chemotherapy, not just half of the first round.

It took my OH to suggest to the consultant to use a lower dose of the chemotherapy for the next round the month after. (He'd researched the drug and found that there were 3 different strengths and he'd been started on the highest!). Thankfully, the consultant agreed, and he had the middle strength for month 2, and the blood cancer markers halved again.

He was still very poorly, so asked the consultant to give the lowest strength for the third month. Consultant agreed. And the blood cancer markers halved again, to virtually zero. Instead of a six month course of chemotherapy, the consultant decided to stop after three months.

He said he'd never seen anything like it and said he had "reported it up the chain" whatever that means.

OH also chose not to go through the next stage of "normal treatment" which was a stem cell transplant. Consultant and the stem cell consultant both told him his life expectancy could be as low as 18 months without it!

He's now on permanent low dose chemotherapy drugs and, again, despite the consultant putting him on the highest dose at the start, causing all kinds of side effects, he asked the consultant to reduce, and no he's not only on the lowest does, but also not even taking them every day like he should, but taking them every other day, and having two weeks off between cycles instead of one week. Blood cancer markers still remarkably low and no sign of them increasing.

So yes, different people, different bodies, react in different ways to medication. He's now survived six years after they gave him a life expectancy of 18 months!

Doctors etc need to stop basing all their decisions on their text books and start to properly listen to their patients, take more "holistic" approaches, etc. I think this is why, as a couple of other posters have mentioned, that sometimes more alternative methods of treatment/care may work better - simply because they're more likely to listen to the patient and look at the "whole" rather than the individual symptoms/markers.

I made no mention of blood test results as normal or abnormal. Just like the previous poster, you move goalposts to further your own argument.
I simply pointed out that she had three blood tests on the NHS which is factually correct and is information you somehow missed in your haste to prove me wrong.
I am not involved in blood testing but I routinely see blood tests of patients who are referred to our service. I see enough new patients per week to be able to confidently say that vitamin D tests are routinely performed in the NHS. We get referrals from up and down the country, so it is not a specific Trust protocol.
Further above, I explained the process of establishing NICE guidelines which is also factual. I explained why "normal levels" at a population level is what NHS service is tied to. I again, made no mention of OP's test results.
Furthermore, OP was advised by a private clinic to take supplements. The exact same course of action she could have arrived to independently if she was concerned as to competency of her GP. I see no mention of further testing on management plan from the private clinic. Your argument, therefor is null and void.

Good grief Catza, did you bang a gavel at the end of that?

Despite me being seriously low in Vitamin D at least twice in my life (to the point I had to immediately go to hospital for an injection), my GP never did a follow up test to see if my levels had risen sufficiently or even discussed as to why they had got so low in the first instance. Same with my folate levels. So yeah, they do limit them.

Catza, I haven’t “moved any goalposts to further my own argument,” as you will see from my later posts. You seem a little angry - but it’s clear from the many posters sharing their experiences on this thread that this is a real issue within the NHS. It’s not a thread for point scoring and trying to catch people out. It’s posters sharing their experiences of this really important matter.

Because GPs and the NHS is general have next to zero accountability; they still get paid whether they fix or break their patients. They have no fear of repercussions for piss-poor work, because there are none. Dont think theres any other career in existence (apart from maybe soldiers in war zones?) where your incompetence can literally result in people dying before their time, and yet you face no real consequences

I work for the civil service; I know incompetence and apathy when I see it. My colleagues and I often joke you'd have to kill someone to get sacked.
GPs do it on a daily basis; literally everyone has a horror story of their or a loved ones health being damaged (or worse) because their GP either wouldnt see them, wouldnt listen, woudnt act, or gaslit their symptoms until it was too late

I had folate levels so low they were undetectable following DD2's birth in 2022.
I'm under rheumatology and it was picked up on my routine blood tests when DD was 3 months old, and a letter was sent to my GP saying I needed treatment. They ignored it. I wasnt cc'd in, so none the wiser.
6 months later at my next rheumatology appt (could barely stand up by this stage!), another blood test showed the same, and another two letters were sent to my GP, which again went ignored.
It was only when I downloaded the NHS app to sort out prescriptions, that I saw all these letters and found out what was actually wrong with me.
I could and would have sorted the problem out myself if someone, anyone, had just picked up a phone / wrote to me directly!
Its my body and my health thats gone down the toilet, all for the sake of needing some bloody supplements!

I am now supposed to be getting referred for assessment for nerve damage due to the fact this went on unchecked for so long, but my GP still hasnt made the referral despite me calling on a weekly basis, and even once the referral is made, its over a year on the waiting list

And still we clap for them like trained seals.. 🙄

And here is one of the trained seals of which I speak..

@Juanhundred

Because GPs and the NHS is general have next to zero accountability; they still get paid whether they fix or break their patients. They have no fear of repercussions for piss-poor work, because there are none. Dont think theres any other career in existence (apart from maybe soldiers in war zones?) where your incompetence can literally result in people dying before their time, and yet you face no real consequences

And this is why you never see the same GP twice anymore. The more different people you see, the harder is it to make anyone responsible. You end up with "collective responsibility" for mistakes, so no end ends up disciplined nor sacked!

My own family/regular GP told me this back around 2000. He'd been our GP all my life as far as I remember, along with his partner (it was a two partner practice). Very rarely I'd see the partner if my GP was on holiday etc., but nine times out of 10 it was him. They were both ready to retire so "merged" with a large town practice. During the merger, he told me he'd probably never see me again as the "new practice" didn't believe in having a single GP and that future appointments would be randomly allocated among all the GPs, and not just that, but maybe not even our local surgery as again it would be random as to which surgery we'd have to see the random GP. And so it turned out. Passed from pillar to post, never seeing the same GP, even for non urgent appointments - simply impossible to ask for an appointment with a named GP. This was back in 2000! Even my own ex-GP was annoyed with it, as he said he was now always seeing different patients from other surgeries, even though he was still there and had planned to stay on for "transition" for a couple of years. He left after six months as did his partner!

The person being so unsympathetic up thread has clearly never been severely anaemic

40-400 sounds like normal for a male.
The female normal is different: 13-150 ng/Ml.

Labs are generally in or about those numbers, not significantly lower or higher.

It may be “normal” for menstruating women to be low in iron but I’m not sure it’s good for them!

It’s also not normal for post meno women. I’m not losing blood every month any more so my levels shouldn’t be so low.

@Pixiedust1234 the print out wasn’t formatted for a layperson, mind. It was medical technical jargon, hence why I needed Dr Google to go through it. I didn’t mind but not sure everyone would have the confidence (by that I mean I have worked with people with poor literacy - it would be a challenge for some). I think that’s why the receptionist first said I had to fill in a form, I suspect it would have been something like a subject access request, because it’s my data about me, but not “meant” for me iyswim.
I’d be interested to know if the formatting on the NHS app is friendlier and easier to understand.

Ahh okay, thanks for the heads up. I was going to go tomorrow morning and stomp my foot. Perhaps I'd better not 😂