To be a put out by this GP referral

[AppleDumplings]

I have just had a GP referral letter written for me to have a private MRI Scan on my neck. I have downloaded it, and for some reason have been a little upset about it. It reports that I have had "caudal epidural and lumbar facet blocks" done by a particular surgeon. I have actually had this procedure done multiple times by multiple surgeons after an epically failed spinal surgery. I think the fact it has been done multiple times is relevant to my current issue as it shows a possible degeneration which I was always aware was a possibility.
It also states "requesting Diazepam increased today as well as a new script for Co Codamol and Naproxen". I have had Diazepam, Naproxen and Dihydrocodeine prescribed for me for the past 15 years, as between these meds I am able to carefully manage my back injury with minimal GP input. For context I am an Advanced Nurse Practioner in an acute setting and an Independent Nurse Prescriber, so kind of know what I am doing with meds. Also, the locum GP a few months ago took me OFF Naproxen and reduced my Diazepam to 7 tablets every 4 months without my knowledge, as she was concerned about the medication I was on. I personally requested to come off the Dihydrocodeine for a "lesser" analgesia of Co Codamol, so seeing it written down that I have requested it, just seems a little unnecessary, as it is out of context.
For clarification, I do not take these drugs regularly and can often go weeks without requiring pain relief as my pain tolerance is quite high, but, through trial and error of many meds and therapies, when I do need to take them they are the only combination of meds that manage my pain. There was no mention that I was approved for a small trial surgery by a specialist neurological team, which would be relevant in my opinion due to the possible progression of the nerve damage ( I eventually declined due to the risk of paralysis), and then the letter says "has history of PTSD". This was very briefly, over 15 years ago which was successfully treated and which I had completely forgotten about. I feel the inclusion of this statement has no bearing whatsoever on neck and arm pain but everything combined seems to read to me like I'm some sort of drug addled crack ho!! Please tell me I am being over dramatic and should be grateful she has written a letter!! At the moment I'm feeling a bit cross about it!!

You are being very over dramatic and they have reported the facts they see as relevant. You can add to those in the appointment. If you prescribe yourself you will understand exactly the dangers they are trying to avoid as they pass you to someone else and that that is to keep you safe.

How long do you think we have to do these letters?
It doesn't have to be war and peace - basics are fine.

It’s all factual though isn't it?

You have had that surgery.
You are on those drugs.
You did request one of them.
There's no need to mention the trial surgery as it never happened.

I do agree with you about the PTSD. Every single letter of mine has "history of anxiety and depression ". It is true, but it was from a death nearly 25 years ago and imo, no longer relevant.

I have a history of severe depression and on a combination of meds but they hardly ever mention that for referrals for physical problems, wonder why it seems to vary?

It's an MRI: they don't need the whole history, just the immediately relevant information

Thanks for the replies as it is great to have someone else's opinion. I am curious though why the PTSD was mentioned as it was so very long ago and was successfully treated very quickly. I think taking it all apart this is probably what is bugging me. All the other stuff, after reading your replies, I agree with. It is relevant so I will get back in my box!! But the mention of PTSD along with the meds. I don't know. I'm just being silly.

I think the PTSD is relevant for the MRI in that you have to be in an enclosed tube with loud noises. This may be triggering for some PTSD sufferers so is relevant for the staff conducting the MRI.

This reads as a fully comprehensive referral letter showing that a thorough history was taken into consideration and written by a clinician that is paying attention. A referring clinician needs to give a full history that is clearly relevant to the diagnostic requested which includes prescriptions relevant to your pain issues. Any consultant I've worked with will also read through a patient history to be sure nothing is missed especially if a referral is a bit "sparse". I would be pleased with the attention to detail in this letter. Whilst the PTSD was successfully treated it is still something to be made aware of.

It’s just a referral for the MRI, no? Any slight inaccuracies won’t be an issue in this instance, or affect the outcome.

Do you know I never even gave this a moment's thought! You may well be right.Thankyou.

I think you are being a little over dramatic here, it is only an MRI not a Consultant referral I presume. I am also an ANP Nurse Prescriber and I fear sometimes we have too much knowledge (although not necessary a negative) we like things to be correct.

Selective presentation of facts can create a particular view though can’t it. That can be intentional or unintentional. It may be a ‘read between the lines’ hint to the person who reads the letter, prompting them to interpret results in a certain way. There definitely used to be doctor ‘code’, less so since patients often get copies.

"requesting Diazepam increased today as well as a new script for Co Codamol and Naproxen"

Stating that the patient is requesting a new script may be a mistake or may be suggesting that the patient is drug seeking. If the referral letter suggests the person is looking for an excuse to be prescribed serious opiates then, since all MRI can contain anomalies that are not always clinically significant or it’s unclear as to the extent, this could affect the interpretation and the delivery of the results.

If GPs are going to include an history as extra information then it needs to be exact.

They should also be direct enough to address concerns like drug seeking or hypochondria directly with the patient.

Thank you @lessertenantry.
You have put my concern in a more eloquent manner!

This was my thought too.

I understand your feelings. I've seen things written on doctors' letters about me bringing up completely irrelevant things about me that have made me feel really icky.

You are not being over dramatic and @lessertenantry is right. It would be my impression that the GP is trying to present a particular image of you to other healthcare professionals, which will impact on how they interact with you and treat you.

☺️ I get it OP. I’ve been on there with inaccuracies that became Chinese whispers and delayed diagnoses. It’s not imaginary.

If you’re unlucky enough to have frequent gp changes or locums etc then when they scan back quickly through notes these errors or implications can give a particular impression. They often don’t have time or the will to take their own history or form their own opinion. Time is wasted correcting or explaining and it doesn’t help a doctor/patient relationship to look like you are arguing. It can be really unhelpful or harmful.

@lessertenantry
Thank you for this ❤️. I'm sure I don't help myself though because I am acutely aware of GP time constraints so rather than beat around the bush and wait for things to be offered I will just ask for them if I know they work! My previous GP, 20 who I had for many years always joked that I was the subject matter expert on pain control, and my dissertation was on this exact topic so he may have been on to something!

It's more detailed than some of the referrals I get at work which are "bang head on desk" levels of frustrating, or "copy and paste the entire medical history from the care portal" levels of irrelevance.

I get it, I'll forever have health anxiety on my notes, because in a period of 4 months 9 years ago I had two separate illnesses, a burst appendix and then sepsis after never being ill in my life significantly.

So I was absolutely anxious for a few months after, and apparently I'm never allowed to forget it!

Must admit I've also been a bit miffed sometimes now that I can see GP/nurse notes on the NHS App. Things I thought important enough to mention not written down and other irrelevances made a note of. I also think that the notes are written in such a way to "protect" the GP in case of misdiagnosis etc - can't really put my finger on it, but it's just the manner in which the notes are made with seemingly trying to evidence picking out certain things I've said or certain aspects of my medical history to make it fit their treatment/diagnosis but ignoring other things that would point to a different diagnosis, as if I didn't say them.

Eg, a recent case, during a diabetes review appointment, I mentioned in passing that I used to binge eat up to a couple of decades ago. Upon checking the NHS app, they'd put a note on to say I was a "binge eater" (current tense), with no mention of it being in the past. At the next consultation, I made a big thing of telling them my binging was 20 years ago and asked her to make a note that I wasn't currently binging and it was in the past, so as to correct the medical history! To her credit, she did, but it shouldn't have been wrongly noted in the first place.

I do wonder what has been wrongly noted in the past 40 years or so of seeing GPs as an adult. Back before computers, the GPs used to make hand written notes on the card in an envelope, which was basically just jotting down a one line summary of the consultation. Despite being old fashioned and antiquated, the GPs seemed to be able to check your history a lot quicker just by scim-reading a card, as opposed to how it seemingly takes them half the appointment these days to flick through screens and delve into computerised notes etc.

@taxguru
Well done you for getting it corrected! I'm starting to wonder what my notes read like but am too scared ask!!!

Did it say you were 'pleasant'?

Because on the card was one line- at best. Possibly totally illegible. That was acceptable at one point- now its not.

Yes- medics practice defensively. Because its an era of litigation- gotta cover your back because its possible that someone will decide to complain 10 years later- then all you've got is your contemporaneous notes.

Re the diazepam. Stating that you ( the patient) has requested an increase is trying to make the point that symptoms have worsened, the condition is not properly controlled and therefore the scan is justified - its not trying to paint you as a drug-seeker.

I have never read a letter from a consultant or GP about me that hasn’t muddled up something I have said.