Keep having to see the Practice Nurse rather than GP

[recall]

Each time I make an appointment to see a GP, I end up seeing the Practice Nurse. I wouldn't mind this, but she is diagnosing and prescribing. I recently went with pain and photophobia in my eye, and she told me to take chloramphenicol eye drops and see how it went. I questioned the photophobia, and she changed her mind, and told me to go to A&E. I had an ulcer on my cornea.

My Dad made a GP appointment for his chest infection, and she said it wasn't an infection, and prescribed him steroids. These had no effect on the chest infection so he went back and insisted on seeing a GP who diagnosed a chest infection and prescribed antibiotics.

My friend ended up seeing her, and she said she had a sore throat, but it was viral, so could not be treated. She ended up being quite ill with tonsillitis, and was seen at the hospital and prescribed antibiotics.

I am loosing confidence in this Nurse's ability to diagnose, but I can't understand the NICE guidelines. Should the be treating patients in this way ? I know that Nurses can prescribe, but I didn't realise to this extent, should she be diagnosing ? She has misdiagnosed an eye ulcer, a chest infection and tonsillitis. Anyone know more?

If she has done and passed something like a minor illness course yes she can diagnose and if done and passed a prescribing course can prescribe.

With a corneal ulcer often given chloramphenicol to ensure no secondary infection but does need diagnosing especially if is herpes caused. The tonsilitis there is good evidence of when and when not to prescribe antibiotic, remember pus on the tonsils may not appear for a couple of days or hours so difficult to know with your friend if it was missed diagnosed or was an illness developing. One criteria for antibiotics is sore throat of 7 days not improving.

Likewise chest infections signs may not be there at first consultation.

So it is difficult to know whether these illnesses progressed over time or were incorrectly diagnosed.

I have exactly the same with my GP. My DS1 was ill before Xmas and we where given an appointment with the duty nurse. He has other health issues, and she gave me the wrong advice for his condition, I challenged her on this and she just shrugged her shoulders ( he had a consultants appointment a week later and he confirmed I was right to ignore her advice). What really annoyed me is I had explained to the Receptionist when making appointment that
my son had other health issues bur was told the nurses have access to the doctors if necessary. Next time I will refuse to see her and explain why if questioned,

At our surgery it's the other way around. The nurses are more knowledgable than the GPs.

Agree with bugsy. Most GPs would not give antibiotics for a sore throat unless it had persisted and other symptoms had developed, likewise chest infections can take a while to build so it is not reasonable to assume she is incompetent.

In order to prescribe she will have have taken a prescribing course (taken over 6 months at degree or masters level) and to diagnose, a minor ailments course (usually through a university or college of nursing). These courses are not easy.

Having said all that, some nurses are better or worse than others, same with GPs.

The problem with this type of prescribing is that 99% of the time it will be fine as most people who see the GP have minor and self limiting illnesses.

BUT every now and again she will miss something serious, because she doesnt have enough knowledge to spot rare and serious conditions. So someone will be fobbed off, who will end up in A and E or may even die.

Happens all the time. It happened to a mum I knew. She was seen by a nurse, and later the same day by a paramedic for chest pain. Given antacids and sent away by each of them. She had a long family history of early CV death, but no one paid any attention as it is unusual in a pre menopausal woman. She died of an MI in the night, leaving 2 young children.

Gosh elastamum such a sad awful story

I suppose this is drip feeding, sorry......my Dad has COPD, and 2 years fell into a coma due to pneumonia. He was advised to go straight to the GP with any sign of a chest infection to get antibiotics. (if needed)

My friend's tonsillitis was misdiagnosed (in my opinion ) because she was in hospital within 24 hours, and I believe had pus present and was systemically ill, I doubt that she deteriorated that quickly from a simple sore throat ( from what she told me )

My eye was so bad, that I had to cup both of my hands over it to prevent any light getting in, and was clearly in pain when she switched the light on to examine it. When I did get to A&E, the doctor I saw said if left untreated could have been sight threatening. Simply applying chloramphenicol eye drops was not appropriate treatment, and I had to have it scraped in order to identify the specific bacteria present in order to treat it with accuracy .

I didn't go into detail in my initial post because it seemed to be a bit of a drag, but I thought I would just explain in a little more detail.

I am anxious regarding my Dad and his chest, and feel very upset that she may have delayed its effective treatment.

I think that she has missed something serious three times, and this is just in the last month. It feels quite scary to not have access to the GP any more.

I am/was a nurse, and my Mum has some medical knowledge because she was a radiographer. We both feel that if we didn't question this Nurse's actions, there could have been possible nasty consequences. I'm concerned for other patients who don't have any of this sort of background and don't think to challenge her......we shouldn't have to second guess her, isn't this dangerous ? Or AIBU/hysterical ?

Do you feel confident enough to discuss this with the practice manager? That would be the best course of action if you want to take it further. The practice are then obliged to investigate and take action or put support in place if it is needed.

Re your Dad. It is considered good practice to allow COPD patients, over a certain level of severity, to keep a course of steroids and antibiotics at home to use in case of illness so they don't have to faff with appointments when unwell and can start treatment earlier. Ask the GP if your Dad would be a suitable patient for this.

This is quite worrying if a practice nurse is misdiagnosing illnesses. I agree that discussion with the practice manager might be a good thing. And request to see the GP in future.

Agree with timidviper re stand by antibiotics and steroids if it is appropriate. Means that if he starts to become unwell at the weekend there is no delay in treatment.

If you speak to the practice manager just speak about yours and maybe your dads case, as you do not have first hand knowledge re your friend and they should not discuss it with you.

As you obviously do not have confidence in the nurse it would be appropriate to see someone else.

Pus on tonsils alone is not an indication for antibiotics and yes you can deteriorate that quickly (I do). Or it maybe that they would have been indicated at first appointment. DC had febrile fit diagnosed with viral tonsillitis but became obvious it was bacterial less than 24 hrs later this was not a 'wrong diagnosis' as such just signs were not there at the time was a consultant who made the initial diagnosis.

recall although that is a very sad story DOCTORS misdiagnose ALL THE TIME to.

My own father had a heart attack at 42. The GP he as seeing had been qualified 20 years and was convinced he had indigestion.

I don't have much confidence in nurses in any shape or form. I always insist on an appointment with the GP herself. I was particularly annoyed when I tried to book a private appointment for a Yellow Fever jab and they still tried to fob me off with the nurse.

Although it is a bit naughty I keep supplies of the antbiiotics available on the internet and then get paid for prescriptions for a couple that are not by saying I might need them when abroad. Having been refused medication for tonsillitis some years ago and ending up in hospital as a result I'm not happy to be fobbed off.

When I have phoned, the receptionist asks if the nurse can deal with it. I have said NO sometimes, and given a GP appt.
Last time, as it was only an insect bite that had made my whole ankle and leg swell up, I agreed to see the nurse, and nurse assured me they know as much as GPs ??!!
She diagnosed Cellulitis and prescribed ABs, but did contact GP who dictatated which AB.
Gps also can misdiagnose, though.

Generally you would expect a nurse to know (a lot) less than a GP, however, some GPs are just not very good.

I have bad experiences with both and that is why nowadays I bypass both and only (1) go private whenever possible or (2) straight to A&E. Not ideal, but at least I have a better chance to be seen by knowledgeable people.

Increasingly you are very lucky to have a good GP/GP practice.