Please tell me what to say to the GP in my appointment

[Journeyintomelody]

Posting here for traffic as I really need some help.

Hurt my knee mid November. It started gradually when running. I treated at home ice, compression, elevation, ibuprofen - all the usual stuff. Got worse so saw a GP. She diagnosed it as Chondromalacia patellae after examining for approx 3 seconds and quite honestly I'm not convinced. It has now become so bad I can barely put weight on my foot. Taking 400 ibuprofen every 4hours and it's doing nothing.

I have underlying health conditions. A couple of years ago I fractured my pelvis (no trauma) and it took 6 months for an x-ray because noone took me seriously.
Last appointment GP said if it was anything serious I wouldn't be able to walk into the surgery... I do have a Very high pain threshold - I spent 6 months walking around with a fractured pelvis.
I'm a single mum with a very mobile 9 month old and I'm really struggling. I don't know what to do or what to say for her to listen. Also starting to feel some pain in my other knee 😭
I have an appointment with the GP today at 3pm.

Please help. What should I say?

They don’t read your record, they just sit there and ask you what brings you in. That’s why you need the info in your hands, organised, bullet-pointed, time-lined or whatever: otherwise you’ll leave and then think “Oh no, I forgot to mention x y and z”

@WinterBones given her osteoporosis she should have imaging before - or at least alongside - being referred to a physio

I agree @DuckDuckG00se has given great advice, OP. Also good advice from others.

I think you need imaging tests. DF was sure he’d injured his knee playing tennis. After a similar progression of pain his GP referred him to an orthopaedic surgeon, who did an
X-ray first thing. This revealed a soft tissue tumour, cancerous.

That was an extremely unlikely outcome and PPs have suggested several much more likely possibilities. I don’t mean to panic you. But you never know.

I agree with letting the GP really see you/mobilising.
I'm medically trained, and I used to always go to the waiting room to call people in, and walk with them back to my room.
It's amazing, sometimes what you can gauge by doing this; you can get a lot of information about someone, both physical and sometimes their emotional state by doing this. It also gives you a few moments to engage in a few pleasantries, also, often helpful.
OP, as PP have said, be explicitly clear on the deterioration, the pain scale and degree of disability you are experiencing.
Ask, specifically, for a plan/ next steps...
Mention needing the large doses of painkillers. Taking 400mg of Ibuprofen every 4 hours has risks of its own.
Best of luck, sounds really miserable. X

Thank you everyone for the really helpful comments. Although I understand that it helps for a GP to see you at your worst I just can't perform. I'd feel like such a tit. However, I am now armed with a bullet point list. The thing that's worrying me most is my daughter, she is toddling around (9 months) and still very wobbly so I need to be there for her. If it gets any worse it's going to be a real struggle.

agree.. i'm in same boat, but getting imaging done is pie in the sky, the current wait for MSK here is 60 weeks and then they are the ones who refer for MRI. i was referred in june but it'll be august/july before me and my worsening DDD get seen, meanwhile i've gone from needing a walking stick to crutches to being an ambulatory wheelchair user.

physio are keeping me ticking until then.. barely.

OP can you not self refer for physio? Not sure how long the wait is for you in your area. Often there is not a need for imaging but given that you have osteoporosis at such a young age and are struggling to weight bear - I would want to rule out any fractures.

Be precise and specific. Make definite positive statements of actuality - and of needs - such as: It has got worse. I can barely put my weight on it. When I walk or bend or move or reach for my 9-month-old child it's a sharp excruciating pain. I can bear a lot of pain and I have osteoporosis and had broken bones but this t makes me physically sick / scream. I need to get to the bottom of this and know what is causing it. I could have a broken bone or damage to ligament or tendon and not know and do further damage by putting weight on it. I need diagnosis and treatment. I need a scan and treatment. I need a crutch or walking stick. I need a physio if that's the solution. It is essential that I have a plan and treatment. I have to be able to continue to care for my child. I need a second opinion.

You don't need to 'perform' you just need to be at your worst. So for example don't take any pain meds that day and don't try and hide the pain with your high pain threshold etc. You've just said how important it is to be there for your daughter - well then pull up those big girl pants and be direct, assertive and do not allow yourself to be dismissed. It sounds to me like you need to bring someone with you to help you with that.

I put things in writing for two reasons - it helps me articulate what I want to articulate and people tend to take notice when things are in writing. If unhappy with doc apt I suggest you email the surgery afterwards stating why you are unhappy etc....

@Journeyintomelody i have just found out I have a meniscus tear (xray, before it, also showed arthritis in both knees). I can’t pinpoint an exact point of injury.

I’m struck by the similarity of our location (Under, slightly to the inside and staring to wrap around the back of knee) of pain.

i went to the GP and accepted physio, I then went back and was really pushy. I looked up and quoted all the stats that supported my belief I had arthritis (I didn’t believe I had a meniscus tear - but I would have done the same with this).

..so I found a stat that said woman of fathers with knee arthritis are the most likely to develop etc.

it sounds like you know when the pain started, so that could support a meniscus tear.

Firstly, you need to be firm and say what you want to happen. Secondly, you could use the e-consult function to request your further investigation.

I find my written requests that clearly state what I think needs looking at are actioned as per my request, when sometimes if you ask in an appt you’re told to ‘watch and wait’ and the doctors’ notes on the NHS app don’t state what you’ve asked for. - so there no record it ever happened.

In my trust you can self refer for X-rays, with doctors prior agreement. Although I only got my MRI as my rheumatologist requested it (on the back of the arthritis diagnosis).

HTH.

An x ray and physio would be a helpful starting point

In fairness, GPs cannot simply request an MRI (for most things) and pretty sure you'd need to be referred to a musculoskeletal clinic of some kind/knee clinic

If its anything like here the hoops to jump through for knees is ridiculous. GP refers to physio who may, after assessment and some treatment, refer onto orthopaedics or the local msk team if there is one.... Here the wait for physio on the NHS is 12 weeks. I had a fall a decade ago - x-ray showed nothing and physio wait was too long so I self referred to an orthopaedic consultant who specialised in knees. After MRI it was discovered that I had broken the rear of my kneecap and the pain was caused by shards of it sticking into other bits of my knee joint! Had surgery to remove debris but the damage is so bad I need a replacement- currently still too young for the NHS to do it (it's just over £10k privately).

I'm too late to be any use for the GP appointment, but are you not still seeing rheumatology for the lupus? Lupus can cause nonerosive arthritis. I'd be looking to see them soon.

Thanks for all the advice. The GP was fantastic. Absolutely top notch. I've got a physio referral, X ray booked and a trip to rheumatology 6th Jan. He really listened and took me seriously and did a thorough examination. It's going to be a journey but felt like I was in good hands.

@SleepingisanArt that sounds terrible!!

@Journeyintomelody
Glad you are getting sorted now
Good luck with everything OP.X

Thank you! X

That's great news, really pleased for you op :)