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?

Actually, sounds like shoulder pain is connected to your other problems. My sister had a shoulder in a spasm for nearly a year. It was stress related, physio confirmed. Her husband was cheating at the time. There's no way GP would have sorted it. She had to.... once she sorted her personal problems, the shoulder pain eased.

I agree with others about identifying your own stressors, rather than thinking a gp should do it. Then you can take steps to try and address them. Quite often a referral to physiotherapy for msk is the first step. How long have you had the shoulder pain ( you refer to it as chronic).

i suffer with chronic tension headaches due to stress and my dr prescribed amitriptyline. I initially thought it was an antidepressant which I didn’t need but they have massively helped my headaches reduce in frequency and severity

So, your doc could refer you to a physio for the shoulder pain but it would be a long wait.

The headaches and pain could well be connected so best to rule that out first.

I would start with a self referral to physio - if you have health cover at work this can often be directly without GP referral. Also maybe some over the counter anti-inflammatories.

Then focus on a bit of self care, bedtime routine, less screen time, book a good sports massage and so on, hot milky drinks and bath/ book.

Also check your pillows as they could have an impact.

If none of this helps in a few weeks, go back to the GP.

You also need to get to the source of the stress and try and find a solution for that if you can, its hard.

Going to a physio is the best first step for the shoulder issue, and the headaches might be connected (my chronic headaches, which the GP just prescribed amitriptyline for, were cured by the physio, when she identified tense shoulders and neck as the cause and prescribed the right exercises to loosen them)
Mirtzapine is pretty commonly used for insomnia, my OH uses it, as did my ex. I prefer sedating antihistamines though, less side effects but in your case mirtzapine might be better as might help with the stress.

Me saying the OP had unrealistic expectations has nothing to do with the time of the appointment. It was prompted by her saying "she didn’t try and get to the cause of why I felt stressed" which is not a medical issue. If I go to the GP and say that I am stressed and they ask why, does it mean I am less stressed now? If I feel anxious because I am going through a painful breakup, is this really a medical issue that GP can do anything about? Of course not.
I also said OP had unrealistic expectations because she felt that by referring to a physio rather than doing a physical exam, the GP "fobbed her off" whereas referring to a physio was exactly the right thing to do. Physios are trained to diagnose and treat MSK conditions. GPs (depending on their training placements) may have near zero experience with hands on examination. In fact, the receptionist should have booked an appointment with a physio to begin with but, as you said, you object to the idea of disclosing what you are booking for. So you end up going to the GP for triage and get upset that they refer you to an appropriate clinician to help with your issue.

The current situation with GPs is completely impossible for both parties: doctor and patient.
I have been waiting weeks for an appointment to discuss the tingling/numbness/ weakness/loos of function in my limbs. It is seriously impacting on my life. It could be a whole raft of things .... one of the many drugs I am on for a heart problem, musculoskeletal, neurological .... no way is he going to be able to look into all this in 10 minutes .... it is a farce!

Self referral to physio is standard now in the NHS. If you are lucky you will get a message in about a year asking you if you still need the referral 🙄

I think it was quite reasonable actually, she's gone for a sedative/anti-depressant to see if that helps with the insomnia. Stress causes insomnia and insomnia causes headaches so it's a sensible option.

The shoulder pain will be much better tackled by a physio who will have the time and specialist skills to assess it properly.

Try the drugs for a few weeks, there's nothing to stop you going back if they don't work.

I also think she didn’t try and get to the cause of why I felt stressed

Did you tell her the cause? Do you know it? Was there any hope of unpacking it in such an appointment? I think if a person goes to a GP because of stress, it's usually presenting that as the issue and needing to get signed off work or similar. That can be dealt with and they can be helpful and supportive. If it's more of a vague/general feeling stressed along with several other issues, they're not going to start digging into what might be causing the stress. That's the kind of thing a counsellor does and it's not a short conversation. If you think the headaches are stress-related and the stress is from something known in your life, then again that's something you'd have to resolve, not a medical issue. As others have said, the meds might well help the sleep issue which might help the stress to some extent and then the headaches and shoulder too if they're related. Meanwhile the physio can assess and help you with the shoulder. It sounds like the GP made some progress on at least two of the issues in 10mins. It's clear at our surgery that you aren't meant to bring more than one issue per appointment, so perhaps it was the receptionist being unrealistic that's the issue.

A PT can very much diagnose MSK conditions. They are trained to do exactly that. They can rule out differential diagnoses, order scans and refer on to a medical professional for issues that fall outside of their scope of practice. Band 7 AHPs often have diagnostic powers in specialist services. Our entire service is run by AHPs without medical oversight. We do refer to medical services if there are any indications of possible underlying disorder which we identify in the initial assessment.
My partner went through a physio with hip pain who ruled out muscular issues and subluxation through physical examination, ordered scans and referred on the rheumatology with suspected psoriatic arthritis which was later confirmed. This was after multiple GP appointments and refusing to see a physio for 18 months because "they are not a doctor".

It's rarely used as an antidepressant these days as there are better, less sedating options for that. It's mostly used now for sleep problems and pain relief as it relaxes the muscles. I was recently prescribed it because of shoulder pain by my orthopedic surgeon.

Yes, and that's the job of a Physio.

I am taking the same medication for insomnia and headaches.

I very much agree with this. I hope you find help, OP 🍀
You also say you are a single mother to a young DC: do you have any support? It must be very stressful and the problem with stress is that we've all been numbed to the term, but it can be very serious. (Not saying it's only stress, but that the stress should not be happily dismissed, as many doctors do).

Quite. Some responses here are insane, and seem to be posters berating an OP for the sake of it.

Fair enough I stand corrected, I didn't know they could do so much!

All of the areas to discuss are likely symptoms - could be of one thing or a few - this non holistic one thing per appt is a bit odd for this. All of these could for e.g. point to perimenopause, stress in general, split into a number of things a bit of peri, an arm injury requ straight forward physio or could be something else.

They probably were dismissive in their approach - many middle aged women go in with this sort of vagary and they tire of seeing it - not saying thats a good approach

Depends where you are. Our PCN (primary care network) employs a small team of physios shared around the locality. Our patients can self refer or be referred by us and are seen usually within a week. I referred a chap on the 27th December and he was seen the same day.

The general public really needs to change their view of thinking that GPs are the go to for everything, and they are being “fobbed off” if they’re told to see someone else. There are so many other HCPs or services that can be infinitely more appropriate or helpful. Within our PCN we have:
GPs
ANPs
Nurse practitioners
Practice Nurses
HCAs
Phlebotomists
PAs
Pharmacists
Physios
Paramedics
Social prescribers/living well teams

With our increasingly ageing and unwell population it is entirely proper that GPs skills are directed at the patient care that only they can do. There are plenty of other people that can offer care. That’s the whole point of having a well skill mixed team.

I find some of the replies
Here really weird. How can a doctor diagnose a problem without knowing rhe symptoms? And there is absolutely no way for the patient to know which symptoms are relevant- they could all be linked or part of seperate issues- so mentioning them all seems logical to me.

As various posters have said - stress can cause all she symptoms here, the shoulder pain could be causing the other ones, it could be hormonal, or it could be four or five completely seperate issues. How on Earth is the OP supposed to know - this is the doctor's job! Isn't it?

The problem is the lack of time a GP has, not the number of symptoms a person has.

Getting physio on the NHS where I live is quite difficult. In the past my GP has told me to go on to certain websites and look at the exercises. This has helped me as much as going to a physiotherapist. Exercises do help BUT only if you do them. The NHS wastes so much money by physiotherapists giving people exercises they just don’t do. I refused to take an elderly aunt to see her physio because she didn’t do the exercises after the last time she went.

How did we get to the point we accept such low standards?

What's your solution? To not offer a referral because patients exercise their right not to engage with treatment? I expect if we took away all the physio referrals, there would be an uproar as well.
Ultimately, nobody can force you to engage. We have plenty of in-person groups as well and drop off rate is very high. People prefer to take medication rather than explore self-management strategies. It's their choice really. We are obligated to continue to "waste money" by running the service because there isn't really any alternative and people who do engage still benefit.

self refer to physio means you refer yourself.
Unless there's something on the page saying you can't self refer for a particular pain, you just do it.
This is one local to me
physiodirect.northerncarealliance.nhs.uk/

I'm a physio. We definitely provide a diagnosis and the consensus in the evidence base is that when it comes to musculoskeletal conditions we do this more accurately than GPs (who i think are fab). I work in GP practices, most patients can see me within a week without seeing their GP. I have an undergraduate degree and a masters degree, I can prescribe medication, request bloods and scans (in my area physios have the ability to request a greater variety of investigations than GPs) and I can refer on to anywhere the GP can. I am able to direct refer for joint or spinal injections and can take cases to conference with a variety of surgeons. My training covered the recognition of conditions that masquerade as musculoskeletal pain (cancers, infections, neuro, inflammatory conditions etc). I contribute to the training of GPs in musculoskeletal conditions and the management of chronic pain. I work really closely with GPs everyday, their job is hard and their input is valuable. Some of the things going on in the NHS are absolutely awful, but I truly believe that being able to see a physio as a first contact or self-refer is a positive thing.