Gps paid extra for depression diagnosis but not menopause

[WarriorN]

I don't know the ins and outs of this and would hope a Gp would put the patient first but if true it's really not great. You can see how a culture of depression diagnosis over peri symptoms becomes the predominant idea.

I’ve gone private for HRT, and so have lots of women I know.

There are one or two GPs locally who are known to be well informed on menopause, so those who can get appointments with those GPs are treated well though.

It felt to me very risky to take pot luck on getting a GP with enough interests and training to lead to good outcomes.

This is the only time I’ve ever gone private for anything.

Private healthcare doesn't cover perimenopause or menopause unfortunately.

When I say that I mean private insurance, paid for monthly. Of course you can always pay for medical advice but it's not covered by any providers as part of a plan.

Why on earth isn’t it covered by monthly health insurance?

I don’t have a policy so it PAYG

I logged an e-consult with my new GP at 8am (moved into area 10 years ago but never moved GP) asking for HRT. GP rang me at midday and by 1.30pm I’d taken my first Kliofem. The surgery was highly recommended for their approach to menopause.

@MotherOffCod same reason pregnancy isn't I guess. I get Bupa through my work but I'm paying separately for a private Bupa menopause consultation next week.

I went to my GP 2 years ago saying I though I was perimenopausal. He prescribed anti depressants.

I don't think our doctors are paid by diagnosis (Canada) but I was offered antidepressants when I was first feeling menopause symptoms. I got almost no sleep for months because of hot flashes at night. Thankfully my GP at the time prescribed HRT but everyone was hysterical at the time about the cancer link etc. I got off it as quick as I could and I regret it now.

Do you understand how GPs are paid, and those documents you linked to?

Women are treated abysmally within the NHS. I've come to the reluctant conclusion that the dire state of women's care must be due to the structure of modern medicine being designed by men. Either that or sheer bloody mindedness.

It would explain why low iron and anaemia are so frequently dismissed and downplayed, too, in spite of their debilitating effects. Women's problem, innit?

Hey: female doctor here.

I understand people don’t want to feel “fobbed off” when they go to the GP expecting HRT to be prescribed. However, antidepressents given at low dose DO help treat hot flushes effectively in 50% of women. Offering them to women is NOT saying the women are depressed or trying to deny them treatment. Also, it’s not a one time offer, if they don’t work then they can always try actual HRT.

If the major symptom is hot flushes, they really can help. Especially because they don’t have a (small) risk of increased breast cancer, which conventional HRT does.

Not saying woman shouldn’t get HRT: I’m a strong advocate for it. But don’t view the offer of antidepressents as a palm-off: every woman’s needs (and risk factors) are individual and, honestly, some people do really well on low dose antidepressents for menopause, it’s not a failure to try those rather than just giving everyone HRT automatically.

PS no-one knows WHY certain antidepressants cure hot flushes, it was apparently noticed as a side effect when they were testing them for depression, that lots of womens’ hot flushes vanished as a side effect.

Sorry but you need to get yourself on a menopause course.

Antidepressants are serious business and they are handed out like candy with five minutes consultation.

This is not news to me! So wrong.

@DocsAreWomenToo

Hey: female doctor here.

I understand people don’t want to feel “fobbed off” when they go to the GP expecting HRT to be prescribed. However, antidepressents given at low dose DO help treat hot flushes effectively in 50% of women. Offering them to women is NOT saying the women are depressed or trying to deny them treatment. Also, it’s not a one time offer, if they don’t work then they can always try actual HRT.

If the major symptom is hot flushes, they really can help. Especially because they don’t have a (small) risk of increased breast cancer, which conventional HRT does.

Not saying woman shouldn’t get HRT: I’m a strong advocate for it. But don’t view the offer of antidepressents as a palm-off: every woman’s needs (and risk factors) are individual and, honestly, some people do really well on low dose antidepressents for menopause, it’s not a failure to try those rather than just giving everyone HRT automatically.

PS no-one knows WHY certain antidepressants cure hot flushes, it was apparently noticed as a side effect when they were testing them for depression, that lots of womens’ hot flushes vanished as a side effect.

@DocsAreWomenToo thanks for that clear and useful post. My question is: why isn't the treatment pathway commonly explained to menopausal women in this way? Because I don't think it is, and I don't think the idea that they could later try HRT if needed is being communicated in the way it should be. That still makes me suspicious of an agenda, and of outdated views of female patients too often still in the mix.

@ShakeTheDisease, hi. Basically because the nature of general practice in the UK is that it’s impossible for every doc to learn everything about everything in huge depth. So GPs pick up as much general info as they can, and then try to learn about things as their patients need, by looking up guidelines, going on courses, asking colleagues, referring to specialists. Along the way we learn stuff to try to raise the bar as much as possible. Some docs will get into eg diabetes, heart disease in more depth, others into menopause, contraception, etc. But not everyone has the same level of experience (or style of communication). GP is free at point of access and clinicians do vary so yes, there is sometimes a bit of a lottery as to how experienced the one you see is, or how confident they are in explaining things.

@Nottodayta, bless you for thinking of my education. Can I refer you to the Menopause Matters website (it’s really quite good)?.

www.menopausematters.co.uk/

There’s a also a subsection of the Royal College of O&G dedicated to Sexual and Reproductive health, I can assure you their courses and information are decent quality.

www.fsrh.org/home/

as to the 5 minutes consultationmention : unfortunately the DOH claims ten minutes is all a doc needs to discuss things for any medical GP issue. we’d love 20-30 minutes but that isn’t what there are resources for. also there are several thousand GP vacancies in the UK due to recruitment issues and underfunding of the service, so not enough docs to provide longer appointment times. please do lobby your MP if you’d like that to change, otherwise it’s the best that can be offered with the current workforce constraints. and yes, some people do choose to self pay privately precisely to get more time with a clinician which they are totally within their rights to do.

I do take the point that some women do get fobbed off by doctors (not just men!) when they try to raise their symptoms, and I am utterly against that attitude. Life’s hard enough without having to fight to be heard.

I’ve had far more sympathetic treatment from male doctors than female ones, who have often been dismissive of problems with first, periods, then menopause. (Sometimes male doctors have hinted that they have family members who have had problems.)
With half the population being women, most of whom will menstruate and then go through the menopause, it’s rather odd that many GPs seem to know or care so little about these issues or bother to make an effort to find out about them.

I do take the point that many some women do get fobbed off by doctors

You also concede that drs don't get enough time to properly assess patients.

Which just underlines the points made - whatever your excuses, women are not getting the care they need.

@Yepyes. Not making excuses or disagreeing with you. I agree the current system often doesn’t have enough capacity to give women the time and care they deserve. That’s the NHS system and the way it currently works, most NHS staff are as frustrated by that as you are. Take it up with your MP or vote/lobby for change if you want it differently.

[quote DocsAreWomenToo]@Yepyes. Not making excuses or disagreeing with you. I agree the current system often doesn’t have enough capacity to give women the time and care they deserve. That’s the NHS system and the way it currently works, most NHS staff are as frustrated by that as you are. Take it up with your MP or vote/lobby for change if you want it differently.[/quote]
Ok. Sorry for being terse, I've had a nightmare trying to get appropriate help.

@DocsAreWomenToo I acknowledge what you're saying about limited consultation times. However, you explained it very concisely above. Would it be so difficult to fit that into a consultation? Given that anti-depressants are a commonly prescribed treatment, I would assume it's a recommended treatment pathway for the condition, so GPs are effectively told or strongly encouraged to offer it. Either that or they are all doing their own research individually and determining that anti depressants should be initially offered, but aren't including the explanation of why for patients. However they arrive at it, though, it fits with my view that communicating their diagnosis effectively and making the different options clear is not something GPs are routinely expected to do well and develop skills in. This is a central point in many patients feeling their problem has been dismissed or misunderstood. Do you have any thoughts on that?

To provide some balance, a week ago I called my dr's reception and asked for an appointment to speak to someone about the menopause.

They arranged an appointment a week later.

Yesterday I spoke to a GP who asked about my symptoms and general health. Agreed it sounded like the menopause, agreed I sounded like a good candidate for HRT. She shared the www.menopausematters.co.uk/ web address and details about the various options for HRT so I can review the side effects etc.

She then arranged an appointment for just over a week's time to see me face to face to do the physical checks and to complete the prescription.

I suspect my practice may be particularly good based on the care we have received across the whole family.

I do think that being very open with the receptionist has been helpful in getting appointments with the right person, virtual or face to face as required.