One appointment, one issue

[monkeymamma]

I genuinely think this policy (at our GP surgery and I assume widespread) is deeply harmful to patients.

I was given an appointment today with the paramedic - no idea why not a GP - to talk about worsening symptoms (painful, bloated belly, difficulty urinating, sickness, reflux, dizziness). I mentioned that the symptoms are making it hard to know what to take for migraine (chronic sufferer). She snapped ‘that’s a separate appointment.’

The thing is, it’s not really is it? The symptoms I’m having are clearly hormonally driven (worse/unbearable around ovulation) but she didn’t ask about that or really anything about me as a person.

And how do you decide which symptoms are connected to the issue you’ve booked in and which aren’t? Aren’t they going to miss really obvious things if they refuse to understand what is going on with the patient as an actual person, as opposed to a single symptom or problem?

As a HCP in general practice I have to put my point across from the other side.
I am given 5 minutes for eg a vaccination appointment. 50 people have appointments in a row. If even one person starts the ‘while I’m here….’ then is that fair on everyone else having to wait? Aside from genuine emergencies.
I absolutely am not saying there are not problems in general practice but I also think sometimes common sense must prevail.

Every health expert, interviewed on telly or radio etc will applaud a holistic approach to medicine. In practice, this does not exist in the NHS (though I am very much a 'fan' of the NHS).
You are a knee, a hip, a low mood, a migraine, but nobody ever considers anything remotely approaching holistic health care.

HCP is doing vaccinations is different though. And actually not really relevant to this…

Our GP lets you book a double appointment for more complex issues?

I agree OP it's madness.
Things are obviously interlinked i.e throughout the mind and body.
Who tf came up with this?
Wasteful, inefficient and dangerous.

Yanbu a lot of stuff is interlinked, my cancer kept getting dismissed as anxiety and I basically wasn’t allowed to list off all the things I was having issues with as “you need another appt”, I ended up having a private drs appt, it wasn’t even particularly long appt, but I was just like please let me list everything and listen to me and that was basically what got the ball rolling on someone taking me seriously, was for someone to listen to me and to all the symptoms not in isolation.

It's bonkers. A friend was telling me a similar story the other day. A range of symptoms and issues she thinks are all tied up with peri-menopause so was keen to get bloods and hormones looked at. But because she's also got an ongoing issue which is part of the mix she was told off and told they couldn't discuss that as it's only 1 issue per appointment. Even though there's a chance it's all connected.

It's so dangerous for other conditions or symptoms too. Like, some cancers have a range of impacts on your body and if you're only honing in on one at a time you miss the bigger picture. One symptom on its own might seem minor but if you're also losing weight, feeling exhausted, other stuff it could indicate other investigations.

Yes we had this with my daughter. She is a coeliac. The diagnosis took longer as she was first assessed for stomach issues and then separately for skin inflammation (eczema). Turned out the eczema was from the stomach issue. She was given gaviscon and steroid cream for a while separately until one GP finally looked at both. Really silly and potentially dangerous approach.

My mother was harmed by exactly this policy. I’m still furious about it now, ten years later.

Perhaps my choice of using the vaccines as an example wasn’t the best. Another example would be I am given 15 minutes to do a smear. This includes all history taking etc. Quite often women will want to talk about contraception or HRT within the same appt. It’s not always possible due to time and it’s classed as a seperate appt.

I also think those who are knocking the skills of a paramedic practitioner should look into their scope of practice more fully. They are a lot more skilled than you may realise. The same for ANPs.

@justaquickquestionifyouplease I think we would all agree that if you’ve got an appointment for a specific thing like a vaccination or smear test or a blood test… that is not the time to raise any other issues.

But if you’ve got your 10 minutes with your GP, it’s entirely logical to want to bring up more than one thing. The 10 minutes isn’t particularly realistic.

But I have long given up puzzling over GPs are set up the way they are. The whole NHS model is hugely problematic and needs changing.

One of my former GPs, now retired (this poor lady had the misfortune of seeing me a lot when I was constantly ill in my 20s) ..she used to talk about the bureaucracy as taking more time than actually seeing patients and we have got to find a way to undo that.

she was always running late to see patients often by about an hour. No one complained because you got looked after properly when you saw her. she was the most in demand doctor at the practice. I dropped in to see her on her final day - after her surgery had finished that morning, she did say to her patients to come and say hello - and I was probably the first one there because I popped in at lunch. You could not move for flowers in her office.

That was more than 20 years ago and it shows how much patients value a good doctor.

She may not be allowed to work the way she did now, though.

The paramedic at my surgery is a bit incompetent. I mentioned dealing with her twice, once was actually earlier this morning where she prescribed an antibiotic for a UTI. Despite me telling her that the one she mentioned is not suitable for me due to other health issues, that is what she had prescribed when I went to pick it up earlier. The dispenser at the surgery went to get her and she came out and told me that that specific antibiotic is the “only one we would ever prescribe for a UTI”. Which is so obviously nonsense I wonder about her ability to function at all. I insisted she speak to a dr, and surprise surprise, it turns out there isn’t literally one antibiotic for UTIs (which is something I think every single person on this thread would know, regardless of medical training), and he confirmed I couldn’t take the one she’d given me and gave a different prescription.

I appreciate one person is not representative. But she isn’t a great advert for the training paramedics in GO surgeries must have.

I really hate this policy as I think so often it misses key things that as a patient we dont necessarily link together but if we had time to discuss our health as a whole there may be things that we see as unrelated, that actually paint a bigger picture.

Ive had exactly that happen and it took a year for me to realise a couple separate issues were related but because its 1 issue per appointment and appointments are so hard to get, I just focus on the most important thing at the moment. Its the wrong way to do things I think especially when complex health issues are going on.

100% agree with you @monkeymamma How are we to know if our symptoms are linked without speaking about all of them. Then having to decide which issue is the first one you make an appointment for?

It must be more efficient to discuss several issues at one sitting than to have multiple appointments. Many things will only require a minute's attention or a note making for a referral, rather than an in-depth discussion.

I can book a double appointment without the need for an interpreter.

If I am going in with an issue, I will bring a list of any symptoms, and if they want to bring me back for another appointment, I’m happy to do that. It seems the problem isn’t with the system, it’s with one or two rude doctors. Mine are fine with it.

I agree about ANPs. The ones at my GP are my go to for most issues initially. And 90% of the time they can deal with it.

I can’t book a double appointment

I’d have to get past the receptionist and then they would run it past the doctor and they would decide whether it was worth a double appointment or not.

I actually don’t have a problem with that. I’m just surprised to hear that you can get one easily.

It takes me on average 6-8 weeks from booking to see a GP, a double appointment can double that wait. I started seeing them for an issue in June, I had to wait 8 weeks for an appointment then 2 weeks for bloods then another 6 weeks for a follow up. They found concerns in both my bloods and urine tests and follow up is still a 1 month wait. So from initial contact in June im waiting until November until my next point of contact whilst having multiple concerns.

I cant often get a double appointment but if there is a chance of one popping up, thats months of waiting. Years ago I would absolutely say the same but in the last 2 years our GP appointments have become like gold dust.

I went to a doctor’s appt yesterday; it is a six-week wait here. I could have been Princess Diana risen from the dead sitting there, because the GP did not look at me once. Just muttered “How can I help you?” whilst tapping at the computer (obviously not about me as I had not yet said anything). My appointment lasted no longer than five minutes. It could have been dealt with on the phone, but you are not allowed to request a phone appointment - the receptionist is the judge of that.

The other thing is if you look at my GP practice’s website, you think Gosh, they have 20 GPs - great! But oh no - they may have 20 GPs, but all except one are part-time. In fact, a lot are extremely part-time - one day or even half a day a week. Setting aside any continuity (impossible) - how do these GPs develop professionally? You’re not coming across a lot of medical issues if you’re only working one morning a week.

Well if you need to discuss 6 issues then it would take 60 minutes. If a GP clinic is 3 hours, they would then be able to see 3 patients per clinic. In a practice with e.g 8 GPs, for 10000 patients.

Which means you will wait 6 months to be seen. Like for an e.g. Orthopaedics appointment, where they get longer to see patients.

If you want to sit and talk to a GP for half an hour, why don't you pay for a private GP? It will cost you hundreds of pounds of course.

All this 'waste of money' - waste of whose money? It's free! And GPs are often dealing with 50+ patients a day, so they are hardly fleecing the NHS by refusing to discuss your 5 things.

The general public don't deserve the NHS, especially GPs, and I will be glad when people have to pay and realise what they have lost.

Yep have had this happen to me, it makes you feel like you don’t matter at all. Without building a profile of what’s going on how is anyone supposed to work out a plan forward? What if you want to request various medications? Won’t this just end up with people having to take up multiple appointments for each separate question? Don’t get me wrong I know they don’t want to run over and fit every appointment in but when you can be sat talking about what’s stealing you’re quality of life from you and you are being timed to the minute (literally sat looking at the watch saying you have two minutes left) it don’t give you much hope :(

Yes, I agree the paramedic was unreasonable.

I understand that someone coming in for an ingrowing toe nail also wanting to discuss contraception would need two separate appointments but there will be plenty of cases where things are inter-related.

I agree op. A GP who listened to my complaint about something connected, by not the appointment issue caught my cancer and meant I had the treatment needed in time.

At a follow (post op) appointment, I took her some flowers as a thank you. She said she had never received flowers from a patient before … she saved my life, why would I not thank her?

I went to the surgery as I had the most horrendous flooding the night before (embarrassingly I’d never come across it) and she explained it was the start of menopause. As I got re dressed I said that I thought the menopause was supposed to stop the bleeding and I thought it annoying that I not only had to deal with spotting mid month, but now flooding too. “Tell me about the spotting” she immediately said. I was at the hospital being scanned that afternoon.

i can’t see that a layman would be able to tell which connected issues are important, if they are interrupted and shut down.

It seems we are just very lucky here! Really good GP provision and never a problem getting an appointment. South East and near a major teaching hospital.

Atrocious that provision is clearly so patchy.