GP trying to prescribe wrong/unhelpful things and getting cross with me

[OnceThereWasThisGirlWho]

I just want to check I'm not barking up the wrong tree here.

Have endometriosis. Pain very severe first day of period, lessens afterwards. Currently take codeine on the first and sometimes second day, which helps a fair bit. Gynaecologist suggested Tramadol, for the first hours/day when the pain is extreme, and said he'd include a note in his letter to GP to say I should be given it if I need it.

He didn't do this. Also, had a brain freeze during my GP appt. that meant I couldn't remember the name of the drug either. Fair enough, GP can't/won't prescribe (although I'd assume he would be able to work it out himself or prescibe some other suitable strong painkiller, but nevermind).

GP then offered tranexamic acid. Had issue with previous GP giving this to me; it's for heavy bleeding (which I don't have) and apparently you're not supposed to take it if you don't have this symptom. Plus, I can't find anything that suggests its intended for pain. I explained that I don't have heavy bleeding, blah blah, and GP just acted like I was making it up, telling me it relaxed the muscles (or something) and would help the pain. I again repeated that on the patient info leaflet it specifically says: do not take if you do not have heavy bleeding! He got all huffy, saying he was the one with the medical degree, what did I know, and looked it up and patronisingly read it out to me. Of course, it was all about menorrhagia, no mention of pain. He still acted like I was the one being awkward though.

Then he offered me mefanaemic acid, which some people swear by, but for me it doesn't touch the pain. Think it's because it's best of you take it before the pain starts but my period isn't predictabe enough to do this (and when it starts pain goes from 0 - ARGH in 20mins). Explained this, and that I'd tried it. He again acted like I was being awkward, almost as if he didn't believe me it didn't work.

Finally - and bearing in mind I'd explained I currently use codeine - he offered me co-codomol. Was more unsure of my ground here, but I have been prescibed co-codomol before and it didn't touch the pain. I can't take enough for the codeine to work without overdosing on the parcetamol element (explained both these things to GP). However, I'm not sure if they are in theory supposed to work together in a way that is better than a higher dose of codeine alone..? It felt a bit insulting tbh, being fobbed off with paracetamol as if i'm too stupid to have tried that before, or he thinks I'm exaggerating the severity of the pain.

Ended up in tears, speaking through gritted teeth trying not to completely lose it, trying to explain to him that prescribing me something for heavy bleeding, which I dont have, is not helpful, and no it's not me being awkward. And that surely co-codomol wasn't as strong as paracetamol. Had to keep repeating the same basic sentences again and again.

It reminded me of abusive ex(es) - the way their whole manner is acting outraged at you being so difficult and like you're doing something dreadfully wrong; an argument that you are provoking and they are innocent. Doesn't matter how much logic or cold hard truth you can politely supply, or how irrational they are being, they still act as if youre the one in the wrong. The actions and manner doesn't add up with the actual conversation being had.

I'm sorry, just really upset by this. And so frustrated. Have contaced gynae's office to hopefully get a letter sent and get painkillers. (FWIW gynae is awesome, explains everything simply and efficiently.)

I was at the dr a few months ago and he said its now known for pain relief to be more effective taking paracetamol and codeine separately rather than as co -codamol.
Sorry you are having problems with your GP.

ive probably told this on here before but my daughter had a urine infection she was 18 months old i knew she had one the nurse on the phone knew she had one i went to the emergency doctor (it was the weekend) and he said there was nothing wrong with her and no he was not wasting NHS resources on a healthy child i was covered in puke and refused to move till he agreed to test for a UTI he relented but put in her notes i needed watching as i was showing signs of munchausen syndrome by proxy turns out she had a massive infection and a defective kidney but that note will be forever on my daughter's file accusing me of child abuse

I do wonder if part of the issue is that I'm "read" as a longterm unemployed, childless (ie. not a proper woman, even) member of the underclass. So I'm just not viewed as worthwhile/on the same level.

I have noticed a change over time, having grown up in a middle class family and being quite used to having professionals in the social circle. And I annoy them further by acting as if we're on the same level, I suppose...

Random doctors who have no idea about my life or mental health still "read" me as middle class because of my RP accent. They start letters with "This pleasant lady..."! Gynaecologist in particular is opposite of GP and explains everything efficiently, as well as having the spirit of scientific enquiry to actually diagnose and treat the problem.

(Not that longterm unemployed "underclass" etc etc means anyone should be spoken down to.)

Muddling I only use the codeine on one day a month, sometimes two. If it's over two days that means the pain is only red-hot rather than white-hot to start with, but then grinds on over a second day. So I use significantly less codeine per day.

Scuttle From what I've heard of Tramadol, I suspect I will take one, be out of it for a few hours, and then not need more (or be able to take just a little codeine).

I do understand the GPs reluctance to prescribe, and wanting confirmation from the gynae to do so. That's fine. It's just the way he dismissed it entirely, as if futher investigation somehow negates the pain I suffer from a previously diagnosed and operated on condition. It's also clear from my notes how little codeine I get through - I got boxloads of it the first time (different GP!) and didn't need another script for over a year.

I would really, really like to wire him up to that machine that mimics labour pains - I'm sure we could make an "endo pain" setting!

cocolepew You're not hot Coco, are you? Am I thinking of someone else ...

Well I am a bit of a babe..

I think you are thinking of someone else

Sorry you've had a tough time with your GP. Sounds like there's been a breakdown in the relationship and best to see someone else. Although your gynaecologist sounds lovely they haven't actually provided you with your treatment- a one month supply of tramadol!! It is standard practice that if a hospital consultant starts/recommends a new drug they should prescribe it via the hospital/outpatient pharmacy. If they want the GP to continue prescribing it then this will be written in the clinic letter which usually takes several weeks to reach the GP.

I don't want to be unkind, but your GP is right: he has a medical degree and knows what he is talking about, you don't. Your approach to it is that you want THAT drug. His approach is that the more persistent you are over it, the more it hightlights his concerns as to why he doesn't want to prescribe it.

As it's been said, Tramadol is very addictive and therefore, it is likely that your GP has protocols to follow about how and when this is prescribed, protocols probably set up by your CCG, that you will know nothing about.

I am not medically trained either, but I can guess that there are two issues with him prescribing it to you, firstly that it is for a condition that is likely to be on-going, occuring monthly, meaning an increase risk of addiction through constant taking. Even if you took it only once every month, there is still a risk of addiction after months of taking it.

Then there is the issue of mental health, which again could make you more vulnerable to addictive behaviour. The more you shout about wanting this particular drug, the more your GP is going to be concerned about the risk.

It's not just you. I have an extreme fear of flying, and after almost being denied access because of excessive drinking to allow me to get on the plane (no aggression at all, just could hardly walk!), my OH said that he would never go away with me again unless I found another way. We had just moved to a new area and registered with a new GP who I'd never seen before. No surprisingly, when I asked for some valium to help me with my fear, all alarm bells went on. He asked me zillion questions about where I was going, when etc... and only prescribed the strict minimum for that flight, and told me I would need to come back for the next one (a few months later).

It took 3 years of him getting to know me, coming before each flight (and after year 2, once a year) for him to be reassured that it really was a one off flying issue for him to be happy to put on a repeat prescription.

Doctors are not there to prescribe drugs. They have your overall health to take into consideration and that involves medical care that as a non medical practitioner you are unlikely to fully understand.

Trust is a massive issue and indeed, at this point, I think your relationship is broken for good and you will be better to look to register with another one, however, next time, do listen to what they tell you and accept that if they refuse to do what you are asking them, it is likely because there is a good reason for it.

He will be obliged to follow up on your mental health. Tramadol is an SSRI of a sort, though obviously not prescribed as one as it is heinously addictive. (And it interacts with SSRIs.) It may also trigger major hormonal depression, which is a risk with endemetriosis anyway.

I am not a doctor! You should change your doctor to someone you can work with. I hope things get better for you.

I think given the amount of posts you make about HCPs saying you're shouting/being abusive when you feel you're not, there is possibly something about the way you communicate that you lack insight into.

I don't think that is fair, Heknows. Not a helpful post. Obviously HCPs have a very different view from patients.

swing I don't want to be unkind, but your GP is right: he has a medical degree and knows what he is talking about, you don't.
...
I am not medically trained either, but I can guess that there are two issues with him prescribing it to you...

Oh so it's fine for you to "guess" but my actual symptoms are somehow irrelevant? My GP was trying to prescribe something (tranexamic acid) for a symptom I don't actually have (heavy bleeding)! Furthermore, it is only by my own research that I have found out how tranexamic acid is supposed to work on pain - GP wasn't willing to explain at all (reducing the bleeding, where it is excessive, has knock on effect on pain).
I had already previously been prescribed this by a different GP in error - only on reading the patient information leaflet did I discover it was NOT a painkiller as he'd claimed, and was not suitable for me as I don't have heavy bleeding. It was after this that I saw the gynaecologist who suggested tramadol based on my symptoms. He also insisted on referral to another doctor, which I'm concerned GP thinks is just me making a fuss.

Your approach to it is that you want THAT drug.

Because that is the one the gynae recommended. I'd be happy to try another providing it is for my actual symptoms, not assumed symptoms. And not something I've tried before (paracetamol ffs! As if I'd never thought of that! I hate suffering so much pain and having men dismiss it as nothing.)

His approach is that the more persistent you are over it, the more it hightlights his concerns as to why he doesn't want to prescribe it.

Gosh yes, how terrible of me to want to follow the gynae's advice, and wanting to stop being in horrendous pain every month.

As it's been said, Tramadol is very addictive and therefore, it is likely that your GP has protocols to follow about how and when this is prescribed, protocols probably set up by your CCG, that you will know nothing about.

As I previously posted, I understand him wanting to wait until a letter from the gynae arrives confirming he's recommended tramadol. No problem there.

The issue is he tried to give me (a) unsuitable medication, as well as medication I'd tried before, (b) refused to listen/take it in when I explained, (c) now thinks I need to wait to see a colorectal surgeon before I'm allowed painkillers recommended by a gynaecologist for a diagnosed gynaecological condition, (d) won't explain his reasoning behind this or even grasp that the endometriosis pain hasn't stopped just because I may also have a bowel issue (that I assumed was endo related anyway...). Oh and main offence (e) literally just talks over me nonstop and refuses to listen or take in anything I say to explain or ask questions.

Even if you took it only once every month, there is still a risk of addiction after months of taking it.

Seriously? Do you have any links to info on this? I'm not necessarily disputing it, just really surprised. One day a month?

heknows Thing is, it's almost entirely mental health professionals. Plus GP - who is my main contact for mental health. There is a huge difference in the way the two parts of the NHS operate. Mental health services utterly lack transparency. If there's an error in your notes or a misunderstanding its virtually impossible to correct, and decisions are made without explanation - querying them means you're seen as difficult and professionals become like politicians trying to evade answering. Whereas (IME) in physical health things are explained without even having to ask.

Although I have experienced similar difficulties in this particular area of physical health - treated as a waste of time, making a fuss about nothing, given incorrect information, symptoms recorded incorrectly, etc, with regards the endometriosis (as many women are). But I was eventually able to communicate my actual symptoms (did have to go to PALS at one point) and see a specialist and get diagnosed - with photographic evidence of my insides, too. With mental health there's no hard "evidence" in the same way, so if they focus on symptom(s) X - which may also be a misunderstanding or just their opinion - and ignore symptoms Y and Z, you can actualy point it out or at least have the decision making process explained.

In fact this GP seemed ok (a bit not taking in what I said but basically it felt like a two-way conversation) at first, and I stuck with him as he seemed keen to help me get some psychotherapy. However it's since communicating with the mental health team that he's just become really weird - like he's just trying to get rid of me asap and shut down anything I say. I feel like such a waste of space. I am trying so hard to keep going everyday and this doesn't help.

Have you tried muscle relaxants or antispasmodics?
There is also a drug called danazol that's licensed for endo, might be worth investigating

swing Just to add re. having a medical degree - I would have thought a mindset of scientific enquiry was also essential for GPs. Because by definition they are not specialists - they need to know a bit of everything. Which is a hell of a lot - it's impossible, really. So getting the facts straight, asking the right questions and knowing when you need to look something up are really important.

Think you need to move GPs OP. You could also contact PALS who are there to help in these kinds of breakdown-of-communication situations :

www.nhs.uk/chq/pages/1082.aspx?CategoryID=68

Thanks madam, I'll have a look.

So sorry you're in so much pain. I have the same symptoms as you, although it presented the same as appendicitis at first so I spent some time in hospital, which was where I was prescribed the tramadol & GP was happy to continue it.

It must depend on your location and NHS board - mine have given me a repeat prescription whereas I know others, like you, have had a real fight to get it.

It is addictive though. At one point about 3 months after starting on it I was taking 8 or 10 a day, which the doctor said was a post-surgical dose and he asked me how I was still standing as it should have been knocking me out.

I've been on it for a year now and only take four or six on days when I need them (period and mid cycle pain) and now that I'm not taking them as much or as often, they do have a good effect, but they are still addictive and I have to really restrain myself.

If you can get the tramadol prescribed I think it would be worth it for pain relief as it deals with it in a way codeine and cocodamol just don't, but people are right to warn you about them, and the doctor is right to be wary about prescribing them.

I can imagine that the GP perhaps felt your gynae symptoms should be assessed by the second specialist before embarking on a particular treatment plan - but it would hardly have killed him to explain that, would it? Instead of simply insisting you had to wait for the second referral.

The problem here is that the clinicians involved in your care aren't speaking to each other. If your current gynae wants the Tramadol to be prescribed, he needs to speak to the GP. Have you managed to speak to Gynae number 1 and stress that the GP is refusing to prescribe on your say so (which is good practice given tramadol is a controlled substance)?

I would write as calm an account as you can of Friday's conversation and send it to the practice manager. I would call it a 'breakdown of communications' rather than 'GP is an arse' (even though he is). And suggest it would be better if you were seen by another GP - is this a single-handed practice? If not, why are you still seeing him at all, is it because he has your history and so you don't have to repeat it at the start of the consultation each time?

Haven't been in the UK for a long time so forgive me for asking a stupid question but why can't the gynae prescribe the tramadol?

Natsku, repeat meds for 'normal stuff', i.e. non-specialist drugs are normally handled by GPs. It's partly to do with who has the budget for ongoing courses of treatment. However, I think the gynae could have prescribed, say, a course of 2 tramadol to be taken twice each month (so 4 in total) in order to assess the efficacy of the treatment that he has proposed but seems unable to communicate to the GP.

tribpot I would call it a 'breakdown of communications' rather than 'GP is an arse'

Also, the second specialist is a colorectal surgeon, so investigating different symptoms, not the pain.

Sure, although of course the endo may be 'colorectally located', shall we say - so perhaps this is why the GP sees the two things as linked. I still don't see why the pain can't be treated as a condition in its own right. If you had a complex fracture they wouldn't tell you you couldn't have any pain medication until they'd assessed it and finished all possible investigations, they would treat the symptoms. A couple of tramadol are not going change your primary condition.

Thanks for explaining tribpot

You know what, at this stage I'd just let the gp talk, agree with him and then contact the gynae again.

GP can say he thinks you should wait until you've seen the other doc, and you can say "I see". Then the conversation with the gp is over and the phone is free for you to contact the gynae.

Well it turns out it WAS included in a letter last year. The gynae has now sent another copy to the GP, and is also sending me a copy.

I was told a few months ago that they'd write the prescription without me having to go to GP again, now of course they are insisting I have to have another appointment. So that's 2 weeks longer I have to wait, in which time I will have another period and be in agony. I did explain this but not allowed an emergency appt. or anything.

He's just purposely drawing it out, isn't he?

Also, I'm really worried he'll find another way to fob me off and be nasty when I see him. I don't know how to deal with the games from a controlling man like this. It's the most triggering thing ever. I start to feel panicked in the waiting room these days.