Are GPs trained to “sniff out” underlying issues based on symptoms?

[Judystilldreamsofhorses]

Sorry this is a long boring post.

I’ve been suffering from an un-lovely combination of sinus/allergy issues (long term thing) and acid reflux (last six months) which are causing me to have a lot of mucus in my throat, cough, and sore throat. I “saw” a GP in the summer and tested positive for h Pylori, which I was treated for. I didn’t feel much better, although the stomach pain definitely improved, and at the next appointment he switched my nasal spray for a steroid one, and (not sure why?) took me off the reflux meds. I’m better in my nose, but still there with the reflux and all the symptoms.

Today I had an appointment with a different doctor who I felt was really thorough and really listened. She has repeated the nasal spray, and put me back on the reflux stuff. I said I was very anxious about it all, and she said based on my symptoms she felt no need for further investigations.

Google tells me these are all symptoms of both throat cancer, and of lung cancer. If the GP was concerned, she would have asked me in, right? All of this has been on the phone. I did have a dental checkup a few weeks back with no issues, so presumably she would have picked up on throat problems.

I have no breathlessness, the mucus is clear, and my oxygen sats (based on a pulse finger thing from Boots) are fine, heart rate is 63ish resting based on that device and my Fitbit. My DP has high BP so has a very fancy monitor thing for that and I am in the “optimum range”.

I am peri-menopausal and feeling very anxious in general. My DP says I need to just lay off Dr Google, and trust the actual doctor. If you can hear hooves, it’s probably not a zebra, right?

I VERY rarely see a doctor - not for the first five years we lived here other than smear tests - so just feel a bit weird about it all being on the phone. I have a facial neuralgia thing which means I have a dental checkup every three months, and I feel like I have a good, trusting relationship with my dentist which obviously I don’t have with any GP.

(Absolutely not knocking the doctors in any way, just in a bit of a rabbit hole!)

It sounds like the second GP thinks continuing the spray and restarting the reflux medication will alleviate your symptoms. Give it a try for a week and see would be my advice. If there’s no improvement ask for another review (with the same doctor if possible) and take it from there.
Dr Google will nearly always lead you to cancer so it’s best avoided in my opinion

Some GPs have the intelligence and imagination to try to get to the root cause of illnesses, but most just treat the symptoms. The very worst ones minimise the problem and fob you off.

Personally, I have little faith in doctors - seen too many lazy fuck ups and mistakes - so try to sort the problem out by myself.

If you're not happy then do a bit more research into your symptoms. Reflux and sinus issues are both really common though, so I shouldn't worry.

Thanks for replying! Yes, cancer seems to pop up for every symptom, and I know I am being stupid. It’s just a weird thing not being seen because I think with throat/cough they would usually look in your mouth and listen to your chest. I felt really rushed by the first GP (not his fault, I know they are under immense pressure) but really did feel like the woman today listened. I had everything written down so was very thorough in explaining. She was probably desperate to get shot of me!

GPs are trained to look for things like cancer. In my experience, they actually tend to be over cautious with anything that could be as serious as that - it’s better to refer a patient who doesn’t have cancer, than to not refer someone who does!

But obviously cases do get missed, and if you’re worried about something, there’s no harm in asking your GP whether there’s any chance it could be caused by cancer. Hopefully they’ll just reassure you that there are reasons why they don’t think it’s cancer, but that should still put your mind at ease.

Doctors work on the assumption that if it's serious, you'll return to see them. This is why fobbing people off is often effective, because many health problems are self limiting and won't pose an ongoing problem. They also seem to assume that most complaints are trivial and not of a serious nature. Obviously, some serious things will slip through the net, but most doctors aren't held to account anyway if things go wrong.

If you did have something serious, the medication you've been prescribed would cease to be effective and you'd also develop further symptoms.

If you had lung cancer you'd be having difficulties with breathing, coughing up blood and weight loss etc. Throat cancer causes difficulties swallowing, pain, lumps, weight loss etc.

@Siepie that is exactly what my DP said - if they thought there was an issue they would have you up at the hospital in a shot, never mind in the surgery.

@charabanctrip I have none of those symptoms. I could do with losing a few lockdown pounds, but really just need to lay off the WFH biscuits!

They generally are
I went with tiredness and said the pavement looked a comfy place to sleep - turns out I was really anaemic

I had the best GP ever who was a locum who picked up a diagnosis from blood tests that had been missed. Not life threatening but life altering and she rang me the same day at 6/7pm and told me to go to hospital. After two consultant appointments and about 50 tubes of blood it turned out the GP was right!

Should add the GP knows me pretty well now and said when she see me she thinks zebras (I like the rare hard to spell conditions)

Blimey, @NotMyCat you have a great GP! I guess my worry is I have never seen either of these GPs, and couldn't actually tell you either of their names if I needed to make another appointment. I think I just need to step away from Google though!

Don’t know if this is something you eat, but a family member had terrible acid reflux, they found out by accident it was severely triggered by black pepper! They cut it out and the symptoms were at least 80% relieved.

Dr Google just responds tothe symptoms you are searching.

A GP will know all the other risk factors for a certain diagnosis.

Simplifying and guessing here, but if throat cancer usually a occurs in males, over 65 who smoke 40 a day, it is likely that similar symptoms in a 40 yo female, who is a non smoker are likely due to an allergy.

Have you got dust mite proof covers on the mattress/pillows/quilt? One of dhs coughs went when I went balls deep on dust mite control.

After seeing how GP’s handle dhs health I wouldn’t trust them to tell me what time it was.

@Hollyhead oh god, we do use black pepper a lot. I have tried to cut out a lot of things already, but they do seem to be the things that we eat often - tomatoes, onions, garlic, for a start. Chocolate is a huge trigger, but thankfully I've not got a hugely sweet tooth. I seem to be fine with alcohol.

@Seeline that's a good way of looking at it, thank you.

@Fluffycloudland77 I think I am possibly a bit allergic to our cat tbh - she is a very hairy beast. I've been on prescription allergy meds for years, but things seemed to get much worse when we started WFH and I wasn't out for most of the day. I also had a horrific sinus infection just before lockdown last March and it felt like something was never quite right after that. I was prescribed antibiotics, and would have gone back if it hadn't been for the circumstances. But long story short, no, I don't think we do, so I will add that to the list, and also try and up the cleaning regime!

I was under the impression that continuing symptoms after treatment for h pylori warranted further investigation. I had the triple therapy a few months ago, heartburn and reflux are still awful, so I've been referred for an endoscopy to investigate further.

That’s interesting @Appin - I asked the first GP about that and he said no, then took me off the medication! I do feel like a lot of my issues are coming from my nose draining down my throat rather than up the way but it is hard to separate the two out,

@Judystilldreamsofhorses, all your symptoms are typical of Laryngopharyngeal reflux, also known as Silent reflux. It is very common as you get older (I have it, but I’m 74), and often caused by a lax lower oesophageal sphincter. The usual treatment is to take PPIs (any of the ‘prazoles) but not everyone responds well to them, and they shouldn’t be taken long term.
Lifestyle changes are recommended, as are dietary changes, but it’s not always easy!

So please trust your doctor, if they were at all worried, you would be referred to the appropriate services quick sharp!

If you must google, look up LPR, for more info.

@NanTheWiser that leaflet describes me 100%, thanks so much for posting! I guess the sinus/allergy stuff just adds another layer of yuck.

I collected my medication from the pharmacy today, but feel really awful after dinner which was a ham and cheese omelette, a big green salad, and some crusty bread. It must have been the salad dressing I think? It feels like there is nothing I can eat any more!

@Judystilldreamsofhorses, I hope that link has put your mind at rest somewhat, LPR is an extremely common complaint, and there is no easy “cure” as far as I know.

I have a lot of digestive problems, put down to IBS, and strongly suspect I have hiatus hernia as well (undiagnosed) which is also very common with age - old age sucks! I used to get awful pain and bloating, which prompted me to start eating a low carb diet about 6 years ago. This did help enormously to begin with, but I still get gut pain after eating, unfortunately.

I tried OTC Nexium (esomeprazole) some years ago, but it didn’t agree with me and made me vomit, and having read a lot of adverse accounts about PPIs, I would never take them now.
I’m currently trying out Jarrow d-limonene, which is supposed to help with reflux, but it’s early days, so time will tell.

@NanTheWiser I have two months of Omezparole (?) so we shall see how that goes. I actually do have IBS too, but it does tend to be pretty well controlled with medicine. I’m in my 40s so while not young, I feel too young to be having age-related complaints! I’m really grateful for your post, and am about to check out that link too. Thank you so very much.

@Judystilldreamsofhorses you’re welcome! I hope you get some relief.

Yes that is exactly what GPs are trained to do. Hope you feel better soon.

Thanks @Flyingbymypants, I have just got myself into s bit of a tizz,I think!

Just popping back to update this thread in case anyone is interested…

I had a follow up with a different GP last week - things have been better but not “best”. She was really great, and when she spotted on my notes that I had previously been treated for H Pylori said that can take a long time to heal. She’s adjusted the medication which I should be able to pick up tomorrow.

At the end of the call I asked if, if she thought it was something sinister, would she ask me to come in? I also said that Google turns up cancer and heart failure based on my symptoms. She was so nice, and said she was really glad I asked - then reeled off how I would be feeling with those conditions after months of this. I felt really reassured, listened to, and grateful she didn’t laugh at me! I also was given strict instructions not to listen to Dr Google.

After h pylori treatment, I didn’t start feeling any better until I took a month of strong probiotics! Then, and only then, it was miraculous.