To think my GP just dismissed me

[NuttyNut98]

I went today for a couple of issues which I told the receptionist about on the phone. One was insomnia and headaches. I did explain I was stressed at the moment. Her first thought was to prescribe anti depressants with a sedative effect. Apparently these ones help you sleep quite deeply which I don’t feel too good about as I’m a single parent to a young DC. I also think she didn’t try and get to the cause of why I felt stressed or even do any things to see why I’m getting headaches so often, she just went straight to anti depressants. I also have chronic shoulder pain, which gets worse and when it flares up, I’m struggling to move it. I thought she would have a look and ask me to put my arm into positions so she can see where the pain is. She also didn’t ask me if I’d injured it or try to see why it might have started. I was just asked to self refer to physio. Aibu to feel dismissed?

You wanted to talk about insomnia, stress, chronic headaches and shoulder pain in a 10 minute appt?

That was your problem to start with.
Can you even write your history/symptoms and current management attempts for all that down in 10 minutes because I don’t think I could.

Probably not but I did say to the receptionist and rather than say I’d have to make a separate appointment, she said I could discuss all these at the same one

The headaches/stress - how can a GP help with this? Surely this is on you to figure out the underlying problem and address it. Honestly, sometimes people think GPs are miracle workers.
You should book a separate appointment to address the shoulder pain.

The headaches/stress - how can a GP help with this?

Chronic headaches seem a perfectly reasonable thing to discuss with the GP. Not least to rule out anything serious.

What age are you, OP? Insomnia and shoulder pain were two of my perimenopause symptoms. Also increased stress. If you're not sleeping it's likely to make stress and headaches worse anyway.

Did she prescribe amitriptyline? If so, she might have been trying to target the insomnia without prescribing sleeping pills, rather than necessarily going to antidepressants as a first resort - it's quite effective for inducing sleep, I'm on it partly for that reason as i have a sleep disorder. I've heard the same about mirtazapine though I've never been on it.

I’m in my 30s but I am having extremely irregular periods at present

yes it is the mirtazapine. I’d never heard of it before now. I used to sleep well but now I’m waking hourly or I just can’t shut off for the night until the early hours

Definitely go to physio.

For the stress is it something she would be able to assist with?

Sounds like it might be early peri or some sorr of hormonal thing. It's worth investigating as early meno can have health implications. Hormones start depleting from age 35.

Someone recently told me their daughter had headaches and shoulder pain for years and was dismissed by the doctors but when they eventually investigated they found she actually had done something like dislocate it and needed surgery.

Since she had the surgery the headaches are gone, she can sleep at night again and her energy levels have increased. I would book a physio session as they might spot something with the shoulder that could be causing the issues - the doctor might take it seriously if it’s referred back by the physio.

I'm on mirtazapine. It does not make you sleep so deeply you need to worry about not waking up for a cold. In fact it doesn't help my sleep at all. It is mildly "sedating" though in that I feel a bit woozy about an hour after taking it. Some people find this helps them sleep. I do not. And have no problem waking up or being roused by noise.

This. The headaches and shoulder pain could very well be connected and should be investigated. I get a lot of headaches and they are all from tension in my shoulders and neck.

I'd go back and emphasise the shoulder pain and headaches.

You also need to discuss the irregular periods with a doctor if you haven't already. Probably at a separate appointment if you can't get a double one.

Shoulder pain can be helped with physio, and reduced shoulder pain should lead to better sleep
I hope you are feeling better soon

Mirtazapine is a sedating antidepressant. If is much safer to use sedating antidepressants or sedating antihistamines to tackle sleep issues than actual sleeping tablets which are addictive and have some very serious potentially side effects. I thought maybe she'd prescribed amitriptyline or nortriptyline as those are both sedating antidepressants that are also used for chronic pain treatment. Takling the insomnia first makes sense as then she can get a better idea of what are underlying issues and what are caused or worsened by the insomnia. Lack of sleep for instance can make pain worse. If there's several things you need to talk about there's no time in a standard consult to do anything more than highlight the issues. The receptionist perhaps gave you an unrealistic expectation of what you could deal with in an appointment.

I am not sure if that is the GPs fault. Headaches, insomnia and shoulder pain are too much for one appointment. I would be more tempted to raise this with the practice manager. The receptionist shouldn’t be setting such unrealistic expectations.
I think the gp directing you to start with a physio for shoulder pain is pretty reasonable.

What a shame. It’s an awful feeling isn’t it? I know they’re under a lot of pressure currently but still. I work in healthcare & had a similar experience. I never go to the G.P. unless it’s serious but I went with similar peri-menopause symptoms like you plus more and had to really push for HRT. Changed my life. Go back. See someone else. There may be a menopause specialist at the surgery. Headaches likely related to lack of sleep. Maybe a natural remedy or anti histamine could help in the meantime.x

I know some doctors just like to lump every thing under stress if they have no idea what is causing the problem but it sounds like all your issues might really revolve around stress. I had very irregular periods - none for months - during a time of immense stress. I am not sure what the doctor can do about your stress - is there anything you can do to reduce the stress you are under.

God the replies on this thread. This is partly why the state of healthcare is as it is in the UK. You do all realise this isn’t normal in other countries? That if you go to a doctor they actually attempt to investigate and diagnose your issue?

YANBU OP. You should make another appointment and demand that the headaches and shoulder pain are properly investigated.

Also you should look into the irregular periods x

Receptionist was wrong to tell you you could discuss it all in 10 mins.
Each of those problems needs 10 mins to try to figure out what could be causing them..in that time the doctor is also expected to do your notes to a good standard (just in case a patient decides ro sue them 10yrs later - only reference available then, are the notes) before the next patient turns up. Yabu.

I fail to see where your GP dismissed you. I think you had unclear expectations when making the appointment.
You say they didn't even try to understand the reasons for your stress. I say it is not a medical issue. Surely, if you sit down and look at your stressors in a comfort of your own home, you will be able to figure it out without GP's guidance. If it is your job, your relationships, financial pressures etc. what exactly do you think a medical professional can do about that? The GP offered you medication to cope which is within their scope of practice. If you want counselling, you need to self-refer to your local IAPT.
For your shoulder, GP advised you to self-refer to a physio - a clinician who is trained to diagnose and treat MSK issues and who has much more time to spend with you exploring your pain than 10 minutes. A physio can also arrange further investigations if needed. Some physios are also prescribers. But people are so fixated on seeing a medic, they forget that there are trained AHPs who deal with specific conditions.
There are no specialist services who deal with insomnia. Insomnia is quite difficult to treat and, again, the GP only have medication at their disposal. You need to self-refer to CBTi (sleepstation might fund a course in your area). If insomnia is stress-related, then anti-depressants seem like a good idea.

I don’t think you were dismissed, I think you have unrealistic expectations. In a ten minute appointment a GP cannot help you unpick your life stressors - that’s for you to work out.

A physio is the best person to deal with MSK (musculoskeletal) problems - neck and shoulder pain is their bread and butter and I wouldn’t be surprised if your headaches are linked to this. Entirely appropriate to refer you to them, or self refer.

I doubt very much you are perimenopausal - not everything is hormonal but in many cases it’s life! Insomnia is related to stress so a low dose of mirtazipine can aid sleep and then you’ll be better able to deal with your stressors. If the problems persist despite sleeping better and seeing physio then of course you go back for review.

The receptionist shouldn't have told you you could discuss all those things with one doctor in one appointment.

DH was prescribed 10mg of amitriptiline a night, when an acute painful condition was preventing him from sleeping, while the treatment took time to cure it. I found he was also much less anxious the next day. Win win!