Hip replacement needed. GP doesn't want to know.

[blueskythinker]

I am quite concerned about my Mum. She has been having a bit of trouble with her hip lately, and went to see her GP a couple of weeks ago, who said she should lose weight and take some Ibuprofen. At the time, Mum said the GP was very dismissive towards her, and made her feel like she was wasting her time.

My Mum went to visit my sister in London last week, and on her 2nd day there, her hip 'gave way' and she was in extreme pain. She went to A&E, and was examined and X-rayed there. The Dr told her that she had osteoarthritis, and that she needed a hip replacement. He gave her strong pain killers, and a CD of the X-rays, and told her to see her GP as soon as she got home.

Mum got back last Monday night, having spent the rest of her visit in extreme pain and off her face on pain-killers, lying on the sofa. Since she returned home she has been bed-ridden.

She phoned her GP and asked if she could get a home visit. The GP refused to come out, and appears to think Mum is wasting their time. Mum said the GP was pretty abusive towards her, although I don't know the details. I am really worried about her - she has now spent 10 days in severe pain. Her GP is not taking any action. She has been immobile for this time & I am worried about DVT - she had this about 5 years ago.

I am also worried about the longer term quality of life implications. She lives on her own. We just don't know what to do.

Can anyone give advice as to what we can do about this?

If it were my Mum, I would take her straight to A&E in her own area. Or if you can afford it, make an appointment for her to see a specialist privately - I don't think that precludes NHS treatment afterwards. I would also find out what the complaints procedure is against gps - I'm fairly sure there is one - and I would be raising merry hell. Also, persuade her to register with a different gp.

Well I have phoned another GP in the area with a view to getting her registered there, but they say it takes up to 2 weeks to get registered, and they can't do a visit in the meantime.

I can't contemplate my Mum lying in bed for the next 2 weeks without any sort of medical examination, but Mum now feels so abused by her existing GP, that she says she doesn't want me to phone and insist on a home visit by this stage.

Does anyone know if this acute pain is a stage, that flares up, or is this likely to be the level of pain she will suffer until she gets an operation? Are there any other interventions available?

Are there other doctors within the practice who your mum could ask to see? Otherwise I would return to A&E or badger another practice. If your mum was on holiday she'd surely be seen by a GP sooner than 2 weeks, I bet if they really try they can squeeze her in. I highly recommend phoning and sobbing to a receptionist. Hope you get it sorted - your poor mum.

Its not really a matter of squeezing her in, she needs a home visit. I suggested driving her to the GP, but she says she can't walk to or from the car. To put it in perspective, it is taking over an hour for her to get to the toilet, with help, which is less than 10 feet away.

Sorry you are having such a rough time. I don not know why your gp is not doing a home visit on your mum. Another possibility would be to see if a physio could do an urgent home visit to assess your mum. Physios are available on the nhs. They do not always require a gp referral. Depending on which area you are in your mum may be able to refer herself to the physio. Not sure if this is much help as your mum does sound to be in an awful lot of pain.

Blimey, your poor mum. My 80yo mum had a hip replacement in Feb and it's been marvellous for her. Although she didn't have the kind of acute event your mum had, she was in a lot of pain until the op and was in effect housebound and unable to much for herself. She is overweight, too, but it was never an issue for either her Dr or the consultant.

I'd begin sorting this out by phoning the surgery, say you're concerned about yout mother and ask for events from their POV and how they're going to fix things. If it's possible, can you then accompany your mum to the surgery or request that another GP in the practice comes to see her? I imagine there must be some sort of procedure that can be taken wrt to complaints and threatening the surgery with that might concentrate their minds a bit.

Good luck, I know how worrying this can be.

Ah, I see your mum can't get to the surgery even with your help. Another route to try is the Health Visitor. They deal with older folk (Am assuming your mum is older?) and can lead you to occupational therapists and aids for day-to-day living.

I think if this was my mum taking 1 hour to walk 10 feet and GP refusing to come out I would first phone GP and try to find out why they had refused. I would have thought that almost all GPs would visit someone genuinly housebound with uncontrolled pain, so I would worry that they hadnt been told the whole story (But my mum is terrible for being too easily put off in this type of situation!)

Suedonim meant to say district nurses.

Is there another GP in the practice?

I'd do what tiggerlovestobounce suggests.

I'd call the doctor, politely update them on the situation and ask what they suggest. I'd be very suprised if they didn't visit - I would on this information. People in pain get very scared and I know I don't think straight at all when I'm in pain - it is sadly extremely common for people not to tell their doctor the full story or to put a positive spin on the situation.

I know it is very tempting to call and rant at them but it is much better to go in with a clear head. It would be very useful to do it from your mum's house so that 1) you will be there when they visit 2) you can give an accurate picture of what you can see 3) you can put your mum on the phone so she can give them permission to disclose any confidential information that they may have explained to her but she didn't understand.

(I have had one family where the patient said they had called us and angry relatives called and shouted at me - he hadn't actually called at all as he was worried I would send him to hospital but he wanted to reassure his family that he had called)

Good luck - you need to persuade her to let you call and speak to them, there are lots of things that can be done and she needs help.

Any news, Bluesky?

Thanks for the responses. My Mum is adamant that communication has broken down, and does not want to go near her GP. She wants to move practices, and I spoke to a nearby practice about changing, however when they became aware of the situation, the GP said he would not accept her in the circumstances, given there was an ongoing situation, and he doesn't want to tread on the other GP's toes.

I was able to self-refer to the District Nurse, who came out today to see my Mum, when I was present. She seemed surprised that the GP had not been to visit (the surgery is only 200 metres from my Mum's house!) but naturally didn't make any comment. She is arranging for the OT to visit, but says she can't refer Mum for physio, this needs to be from her GP, so Mum may have to see her GP whether she likes it or not. The GP told my sister that they have made a referral to the hospital for my Mum's hip, and I understand that the hospital aims to see people within 2 weeks of the initial referral, so I think Mum is hoping to be able to hold out until she gets her hospital appt, which should be in about 10 days.

I'm pleased to say that Mum seems a little better, however she is still in a very bad way - in anticipation of the District Nurse's visit, she tried to get washed last night, but vomited from the pain.

The thing is, this is so unlike my Mum, she is 66 (so not that old), intelligent and articulate, and a practising healthcare professional.

Thanks for the advice.

Sounds as though a little bit of progress has been made, then. But I wonder how the GP has been able to make a referral without seeing your mum? That seems a bit odd, unless he received a letter from the A&E hospital that treated her when her hip gave way.

My mum found some relief from the pain by using a TENS machine, so it might be worth checking that out with the nurse, to tide your mum over. Hope that appointment comes asap.

The referral is probably on the basis of the recommendation from A&E. I wonder if your mum being so close to the GP surgery (normally a great thing) is the reason they wouldn't come out? Home visits are quite a rare thing now. You can complain to the PCT that the GP comes under, and if there are other issues going on then your concern will get added to the portfolio, and may lead to action, however GPs are independent businesses, and as such manage their own complaints, so the formal response will come from them and you may not get a very impartial response, especially as your mum has decided to change practice in any case. I hope the hospital appointment comes up soon and your mum gets the care she needs.

Hmm, nooka. not my experience. I have had home visits at my age, despite living very close to the surgery. My GP hasn't hesitated to come out when required. At my last practice (also close) I even had them drop off drugs one evening (although that was probably guilty conscience from the man who missed my tumor).

I'm glad to hear that! I guess I was just wondering if the OP's mum's GP thought that really she could have made it around to the surgery as it was so close. However my professional opinion is that there are some fantastic practices, a lot of OK ones, and I'm afraid too many with no concept of customer service at all. However I used to manage a PCT complaints service, so possibly am biased, as we tended to deal with the iffy ones far too much.

Well good news - my Mum's GP phoned to ask how she was - still isn't coming out to see her (although Mum didn't ask again), but I think the district nurse rang the GP and advised her that Mum really was in a bad way.

So at least lines of communication are open again.

We're hoping the hospital appointment will come through quickly, and the district nurse is coming out again next week.

If your mum has been been referred to an orthopaedic consultant then you are within your rights to ring the consultants relevant secretary to expedite her apt. Although an A/E doc has said she needs a THR does not necessarily mean this will be the opinion of an ortho cons. Osteo arthritis is graded on levels of severity and many consultants are reluctant to cut away at ANY remaining healthy bone. Therefore many wait until the entire cartilidge has worn away before proceeding with a THR. Of course your mums xrays may be such that she goes immediately on the waiting list. However, some consultants prefer to exhaust all conservative measures before embarking on surgery. These being, adequate pain relief, walking stick and physiotherapy. A/E docs are not ortho specialists so don't take what they say as gospel. Just thought i would prepare you for what may transpire from the apt. For now, if your mum has no allergies or any other medical conditions, the best pain relief would be to take paracetamol AND ibuprofen on a regular basis. Just ring your surgery and check that she's defo ok to take these.

Good news that your Mum's GP has made a move. I'd still have hoped he'd make a visit, just to assess her pain levels and how urgently she needs to be seen. But it sounds as though the nurse is on the ball. Do keep us updated wrt to developments.

I am wondering if your mother has in fact broken her hip. it just doesn't sound right that she had a sudden acute event and now takes 1 hour to get to the toilet having been able to walk before this. Osteoarthritis, generally, is a progressive thing and you wouldn't expect such a sudden deterioration so that she couldn't walk to the surgery. The xray in A&E may not have shown it and it sounds like she needs another xray asap. My husband is an A&E consultant and he says he would have no hesitation in xraying it again given this history it may be that the doctor she saw was junior. I am a long time lurker.

Is the pain in her hip or groin? It is entirely plausible that if her pain is presenting in her hip as opposed to her groin then it may be referred pain from her back. OA hip pain more often presents in the groin. If she has fractured the neck of her femur the affected leg is likely to be shortened and rotated. OA can often be suddenlt painful, particularly if their is little cartilididge left. Also if she was away visiting she will likely have been sat travelling. After a prolonged period of immobiltiy many OA patients experience acute pain.

I Think at the end of the day, if she is showing no signs of improvement and her levels of pain are still severe, despite regular painkillers then i would take her along to A/E in her local area.

Any update, Blueskythinker?