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Should I complain about this GP registrar?

14 replies

lobeliasb · 09/03/2023 18:08

I've been dealing with severe rib and back pain for nearly a year. Rocking back and forth crying, can't sleep, feels like my ribs have been kicked with a boot, knife-in-the-back pain. The pain is almost certainly musculoskeletal in origin, and the symptoms align with an issue with the rib cartilage.

I have been seen by a GP registrar about 4 times with this pain who seems a bit out of his depth. He examined the wrong body part and seemed to be looking for heart and lung problems rather than looking at the area that actually hurts. He checked me for cauda equina when the pain is nowhere near my lower back, and checked my knee reflexes, obviously looking for a spinal issue. Again, the back pain is up near my shoulder blades, not my lower back. Now I understand certain things need to be ruled out, but he seemed to give up looking for a cause after my organs and spine were deemed to be fine and I wasn't about to become paralysed. One of my ribs is moving around and popping and grinding, and it moves about with very light pressure, but I couldn't get him to even look at it.

He also forgot to check my blood pressure at my first appointment, so I had to make another appointment and go back for that. Then he called me after my blood test results came in and asked me to make another appointment for more bloods. I called to make that appointment and was told there were no notes or requests regarding any further blood tests, so that was weird.

At a follow up appointment, he said he wanted me to get a chest x-ray. The senior GP who supervises him was sitting in on the appointment and actually piped up at this point and said she didn't think I needed an x-ray. It would be unnecessary radiation, and she said the area in question wouldn't show up anyway as cartilage isn't visible on x-ray. I said I'd prefer not to get the chest x-ray.

He seems to think it's just a muscle strain, but the symptoms don't match that at all, and what muscle strain lasts a year with no improvement? I was prescribed ibuprofen gel which doesn't do anything. Co-codamol doesn't help either. I had a follow-up phone appointment and he asked if my pain was any better, and I said "No, it's not better at all, it's still horrible." and he replied to that with "So you'd say it has improved, then?" Um, what?

Well, I got an x-ray appointment letter through the post anyway and he also called me to pressure me to get the x-ray. I gave in and did it, since I wasn't going to get any further assistance from him until I did what he wanted. So I got the x-ray.

I had another phone appointment with him the other day and he let me know the x-ray results came back normal. As expected, really, I didn't think it would show anything, and neither did the senior GP! He asked if the pain was still bothering me and I said yes, it's as bad as it ever was and that I almost went to A&E the day before because I was in agony. He told me to keep using the ibuprofen gel (that does nothing). I brought up the popping ribs again and that I am concerned the pain is from the cartilage at the tips of my lower ribs, and he told me that the x-ray was normal and that issue with the cartilage would have shown up on an x-ray.

CARTILAGE IS NOT VISIBLE ON X-RAY!

I gently mentioned that as far as I understand, cartilage doesn't show up on an x-ray and I'd need a different type of diagnostic imaging for that and he wasn't receptive to that. He repeated that the cartilage would have been flagged on the x-ray if something was wrong with it. He ended the call telling me to call back if the pain gets worse. It can't get any worse than it already is, it's 10/10 pain.

AIBU to complain to his GP supervisor? I honestly don't feel like he's competent and I don't want him to handle my care anymore. At the same time, I feel like I'm being mean. But really, how does he not know cartilage isn't visible on x-ray?

OP posts:
SDTGisAnEvilWolefGenius · 09/03/2023 18:11

At the very least you should be asking for a second, more senior opinion, and I wouldn’t blame you for complaining either.

Blindedbythenighttimelights · 09/03/2023 18:14

what muscle strain lasts a year with no improvement
TBF, I’ve been struggling with a really painful muscle problem since July 2020, even with doing daily physio exercises. I’ve just, finally, fixed it by doing a few exercises I saw on TikTok!

Could they refer you for MSK physio? Why have you always seen the reg? Can’t you book with another Dr?

neitherofthem · 09/03/2023 18:15

You need to see a different doctor, that's for sure.

It might also be worth a visit to an osteopath. Get them to have a look at you and see what they think. They know far more about musculoskeletal stuff than GPs do.

Mabelface · 09/03/2023 18:21

Ask to see a senior gp. Explain that you don't have confidence in the registrar as he doesn't listen to you or his seniors and appears to be out of his depth. Subsequently, your pain isn't improving, nor is it managed and you now want a referral onward.

lobeliasb · 09/03/2023 18:22

Blindedbythenighttimelights · 09/03/2023 18:14

what muscle strain lasts a year with no improvement
TBF, I’ve been struggling with a really painful muscle problem since July 2020, even with doing daily physio exercises. I’ve just, finally, fixed it by doing a few exercises I saw on TikTok!

Could they refer you for MSK physio? Why have you always seen the reg? Can’t you book with another Dr?

Oh, I believe you. My symptoms match up perfectly with a kind of obscure condition called Slipping Rib Syndrome, where the tips of the lower ribs detach from the rib cage and move around and irritate the nerves in between the ribs. My lower rib cartilage really obviously moves around and it shouldn't. It should be firmly attached the the rest of the rib cage. It's not something GPs are very familiar with, and only a few consultants deal with it in the UK. I imagine the GP will think I'm crazy if I bring it up. I have a physio appointment later in the month, and hopefully they will notice and flag it to the GP and I can get referred to someone who knows what to do.

OP posts:
Chihuahuasrule · 09/03/2023 18:27

By all means ask to see another Doctor at the practice - but I think a chest xray was a completely reasonable investigation with the symptoms you have and I would have requested this myself.

They were also right to focus on the heart, lungs and spine as causes of the pain.

If it does turn out to be costochondritis (which won't be evident on a scan) treatment is antiinflammatory and time. It can last for months (I've had it myself).

Chihuahuasrule · 09/03/2023 18:28

And yes possibly physio could help

PragmaticWench · 09/03/2023 18:33

I think enough is enough and you should ask the senior GP for a referral to your geographically closest specialist in the condition you think you have. Research first and find the name of a consultant and request a referral to them personally, or their department. You can request to be referred anywhere in the UK. Choose the closest otherwise the hospital may refuse the referral.

Be confident, be polite but firm.

lobeliasb · 09/03/2023 18:39

Chihuahuasrule · 09/03/2023 18:27

By all means ask to see another Doctor at the practice - but I think a chest xray was a completely reasonable investigation with the symptoms you have and I would have requested this myself.

They were also right to focus on the heart, lungs and spine as causes of the pain.

If it does turn out to be costochondritis (which won't be evident on a scan) treatment is antiinflammatory and time. It can last for months (I've had it myself).

I'd definitely agree with that if the pain was in my chest, but it's nowhere near my sternum or upper ribs. The rib pain is much lower in my abdomen, from what I think are ribs 8 and 9. I can feel the rib tips popping and sliding about under the lightest pressure from my fingertips. I have Ehlers-Danlos Syndrome and I suspect they are dislocated/separated from the costal arch (slipping rib syndrome). I'm worried I won't be able to get anyone to really investigate this, though. It's not a common problem and the specialists that deal with it are not close by.

OP posts:
Chihuahuasrule · 09/03/2023 19:00

Have you politely spelt out your concerns?

As a HCP I wouldn't at all be offended if a pt said to me
'I have EDS and I am concerned I may have slipped rib syndrome'

MissyB1 · 09/03/2023 19:12

I was wondering if you have Costochondritis as my symptoms are similar although it comes and goes with me. But I see you say it’s too low down for that. Yes just see a different Dr and politely explain what you think it might be.

ozymandiusking · 09/03/2023 19:16

I think a lot of conditions are diagnosed by a process of elimination, hence this Dr. requesting an x-ray, and not at all unreasonable. And remember not all conditions follow the exact patterns expected.
I do hope you get some help and improvement soon.

FatAgainItsLettuceTime · 09/03/2023 19:25

Has anyone looked for gallstones?

I had them and my symptoms were:

  • back pain on the right hand side, around where back of bra sits, felt like it was in my ribs.
  • the pain would be dull sometimes but then I'd have episodes of waking up in the middle of the night feeling like a stake was being driven through my back all the way out the front. I thought it was muscle/ligament and due to bad posture and a sit down job
  • nothing relieved the pain, when it was at its worst I would be pacing, then curling up in a ball, stretching, twisting to my side trying to find a more comfortable position but nothing helped and neither did pain killers.

Finally ended up in A&E when during an episode I started constant vomiting every couple of minutes and they discovered I had a temperature, bloods showed infection markers and it turned out I had a severe gallbladder infection due to a completely blocked bile duct.

User613 · 09/03/2023 22:25

If the popping is coming from one of your bottom 4 ribs it's almost definitely "slipping rib syndrome". Very underrecognised condition and actually absent from a lot of medical and physio texts. In fairness I didn't have any awareness of it as a registrar either

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