I need some opinions on this letter

[TinkerBellesMumandFiFi2]

Some background. I had a fall about 3 1/2 years ago, I landed hard on my back but it didn't hurt at the time. I was 19 weeks pregnant and five days later it and labour set off PGP. I carried on with PGP type pain in the three months until I got pregnant with Tink, through my pregnancy it got worse. It carried on for the next two years until I got pregnant with FiFi. Since then it has got so bad I ended up on crutches at 18 weeks which I'm still on and I take co-dydramol for the pain. I can't walk as far, I can't lie on my side, I can't pick Tink up...

My obstetric physio said that there is more going on than physiotherapy can fix and I should make sure I am sent on to an orthopaedic surgeon. My obstetrician, immunologist and rheumatologist all said the same thing. When I had my section the anaesthetist refused to do an epidural, I was told the same thing and that it looked like there may be a fracture - I was told "I don't know how you've managed for over three years with it".

I told my GP when I went for my six week check. She didn't tell me she was referring me to our own physio! The physiotherapist was rather harsh with me. She asked where it hurts and when I pointed it out (I have the "impression" of three steps still on my back) she said she didn't want to know where it hurt!? She said that the anaesthetist didn't do an epidural because he didn't want to upset me (she doesn't have any papers from him).

So I was talking with a friend who works in a hospital office. She said to write a letter for my GP to sign that basically scares them into the referral I need. I don't know why I didn't think of it myself as the support group for my autoimmune disease recommends it all the time when a doctor is making a potentially dangerous decision (which is quite common with this disease). So I have had a go at it and decided to post it here as you were all so helpful with my last letter, I'm not sure what else to add.

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I am entering into the notes of [TinkerBellesMum] that I feel that although she was told by different doctors and an obstetric physio at [Maternity Hospital] and [General Hospital] that she should not have further physiotherapy until she has been properly assessed by an orthopaedic surgeon and although the anaesthetist who was at the birth of her last baby refused to do an epidural because he felt there was more going on and agreed with her other doctors that she needs to have further investigation before any physiotherapy as it was felt there may be a fracture, that the best course of action at this time is physiotherapy.

How about:

I am entering in the notes of and as 's GP I am reccommending that the Head of Physiotherapy (or whatever they call them) re-thinks the decision to stop the course of physiotherapy. I feel that it is in the best interest of my patient to carry on with this treatment.

My patient was told by (2) different Doctor's and the Obstetric Physio consultant at and hospital, that she should not be having anymore physio until further tests have been carried out by an orthopeadic surgeon.

I have read notes and spoken to the anaesthetist (get him to ring the hospital or write letter) who refused to give an epidural during the labour of her last child.
This aneasthetist felt there was something 'more' going on with my patients back and felt it necessary to avoid the Epidural. An agreement was made between the aneasthetist and the doctor's that would need to be put through further investigation.

Im a little bit stuck here as to why your GP wants you to have physio if it has not been recommended. IS this what you want?

My GP obviously thinks that regardless of all that I need physio. My GP won't write it into my notes because of the unwritten line "I take full responsibility in the case of litigation" any GP would be stupid to - this is a good tip when you feel that a Dr is playing with your health.

After so long I want to make sure there is nothing going on before I have physio or have it dealt with if there is. Basically I just want appropriate treatment and a physio isn't the right person to say that.

I get you... Yes so the way you wrote it, it seems fine. I get it now. So you dont agree with your GP though?

Because they're saying that there's nothing there if they carry on and do physio and have signed their name to it then it will come back on them if there is something more.

I did tell the GP when I first went everything that has happened and what had been told to me at the hospital. I assumed that was what I was being refered for until I turned up to my "triage" appointment and was told I was having physio.

I think it would probably be the Royal Ortho that I went to, although Selly is quite close too.

You can ask him to refer you to the orthopedic team.

You need an x-ray!

I wouldn't worry about the liability letter at this stage, but why not write a formal letter to the practice manager -- they are obliged to reply within (I think) ten days?

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"I am writing with a complaint and associated query relating to my recent treatment by [name of GP practice].

In the late summer of 2005 I had a bad fall when 19 weeks pregnant that resulted in severe pelvic girdle pain and the premature delivery and neonatal death of my eldest daughter. The pelvic girdle pain has continued unabated for the last three and a half years, and has worsened further in my two subsequent pregnancies. I am currently on crutches and taking co-dydramol and am unable to walk more than [suggest distance] or to lie on my side.

During my most recent pregnancy I was advised by

(a) my obstetric physiotherapist, [insert name]
(b) my obstetrician, [insert name]
(c) my immunologist, [insert name]
(d) my rheumatologist, [insert name]

that in their specialist opinions physiotherapy would be inadequate to resolve my PGP problem and that I should ensure that I was referred to an orthopaedic surgeon.

During my caesarian section my anaesthetist [insert name if you have it] declined to administer epidural anaesthesia and stated that in [his/her] opinion there could well be a fracture associated with the original fall. [He/She] also said that I should consult an orthopaedic surgeon.

I recently consulted Doctor [GP's name] at your practice and informed her of all the above facts. She refused to refer me to anyone other than the practice's own (non-specialist) physiotherapist, [insert name]. In turn, [physiotherapist's name] told me that I was wrong and (without, so far as I am aware seeing any relevant papers or speaking to the anaesthetist) that the anaesthetist had refused to administer epidural anaesthesia because [he/she] "didn't want to upset me" and not for the reasons stated during my caesarian section.

I am very concerned that the opinion of five separate specialists has been overruled by Doctor [GP's name] and that I have not had the onward referral to an orthopaedic surgeon that I have been repeatedly told I require.

I would like to be referred for assessment by an orthopaedic surgeon, given that this appears to be the appropriate course of action in my condition.

I would also like clarification on the circumstances under which General Practitioners in [name of practice] are authorised to overrule the opinion of other more specialist medical professionals within the [name of PCT] PCT, and the basis on which it has been done in my case."

The whole point is they won't. If they've already decided I need physio and the physio says I do then I can't force them to change their mind. If I go along with them and there is a problem it's down to me because I didn't push. If they're so convinced (which they can't be without proper tests) they'd sign.

It's a standard technique, my Hughes support group recommends it all the time and many have done it, and I was recommended it by a friend who works in the NHS and deals with this sort of thing.

I've not had any tests, no scans/ x-rays/ MRI. The thing I was told over again was even if there is nothing there the physio needs to know what they're working with.

My plan is to go back to the GP and say I'm not happy to be seen by a physio without an orthopaedic surgeon giving me the all clear to. If the doctor says that they won't send me I'll produce the letter and say "are you willing to put your name to that?"

(Just noticed I didn't say in my OP, my fall was down some stairs which is why I have the "impression" of the stairs on my back)

Sorry x-post there (I've burnt my fingers and typing rather slowly today, not looking forward to going out on my crutches )

I'm trying to do it without getting formal, I know they won't sign anything, to be honest I'm hoping I won't need to get that far if I can show them I'm not happy to go with the physio route. If they were to sign it then I'd be making a complaint, no doctor would be that stupid without back up.

I'm just thinking that you haven't, yet, actually officially told the practice that you're unhappy.

And if you do, then I can't see a practice manager (whose job it is to worry about that sort of thing) reading the detailed breakdown without getting "potential lawsuit" warning lights going off in his/her brain anyway.

And if the practice as a whole doesn't know that your GP is behaving this way it alerts them to what may be a larger problem.

That's why I'm going to tell them first I'm not happy, the letter will be my back up plan. It's the boiling a frog situation I think. I'm new at the practice (although been there before) and so they're looking at it fresh not that they've seen me when I've come in in so much pain I can't move and had to have Tink handed to me because I couldn't bend to pick her up. Or that I have been on prescription painkillers for over a year. Or that I've been in regularly in pain etc.

I'll tell the doctor I'm not happy with having physio without everything else being ruled out by a specialist. If the doctor is adamant I'll test how adamant. It will probably be a different doctor as our surgery is book on the day or about a month in advance if you want a particular GP.

I actually like PaL's letter.

I don't see what writing a letter on your GP's behalf will acheive. But agree that - especially as you are new you perhaps need to give the GP another chance to sort it.