The most frustrating Dr apt ever ....

[MiniCooperLover]

Oh FFS ... (sorry, just ranting). I had a phone appointment to get my HRT prescription renewed. I get it privately as I started during the pandemic and haven't been able to get into my GP for a review as when I ask for an apt I'm told it's not an emergent apt and to call back and so forth, and then life happens and I realise it's been a couple of months so I make another private apt.

The Dr I just spoke to said he wasn't willing to prescribe any more until I had my smear. I told him I've had the NHS letter (only last week), I've rung my Dr surgery already many times to try and book an apt and been asked to call back so I am trying and will continue to do so.

He then goes on to tell me all the risk of cervical cancer, breast cancer with HRT, etc. Except ... I thought that had been debunked now ??? He tried to say 'you've been on this 1.5 years now, I'm not sure you should continue'. WTAF?

I got so cross with him on the phone and told him if I run out and he refuses to prescribe any more and my GP won't see me as they don't consider it important enough he'll set me back and my system will suffer as it took almost 6 months for me to feel the benefits as it was. So fucking depressing.

He's finished the call by saying 'oh right, well yes ok then I'll prescribe it, but you MUST get your smear'. I've been trying ... bloody hell.

Any risks when on HRT are individual and can depend on things like age, type of HRT, lifestyle measures etc. They’re detailed in the Nice Menopause Guidelines. www.nice.org.uk/guidance/ng23/chapter/Recommendations

im not sure what specialist you saw but the smear test dips to detect the HPV virus which is nothing to do with HRT. The majority of cervical cancers are caused by HPV s not sure about the fixation on this (though of course important to get it done when you can arrange this).

it would probably be best (and cheaper) to only deal with your GP for HRT with an annual review and persevere if possible, even if it means writing in to get it.

So he threatened to withdrawal medication until you had a smear test?! Is that not unethical?

A private doctor said this to you? NHS, wouldn't surprise me at all, they always aggressively push smears. But private...blimey.

I'm at a loss to understand what having your smear has to do with a renewed prescription for HRT?

What kind of 'private dr' is this?

How did you choose them?

Are they listed as a menopause specialist on the British Menopause Society website?

As a by the way, my HRT is from a private consultant but they are a gynaecologist and all my smears for years have been done by them (they regard the NHS wait of 5 years for older women far too long.)

If this dr was so keen, why isn't be doing the smear for you?

Seriously, I'd go elsewhere.

They used to pressure me about smears every time I asked for the Pill. I think in the US they used to say you had to have an annual smear to get your pill.

It's a private doctor, in so far as it's privately paid via AXA Healthcare. It's just clearly a private GP who has no idea of menopause or menopause medication. Problem with this service is you rarely speak to the same one twice. Plus to the poster saying it would be best to deal with NHS GP, I truly would if I could get through and get an appointment but the rare times I can phone at 8am they tell me it's not an emergent appointment and that I should call back. When I do, I'm then told to call back at 8am for an emergent appointment. So I can't really win. So I pay £48 every three months for my HRT.

That's the point I guess. HRT has not been proven to have any impact on Cervical Cancer or Breast Cancer, this guy was just going off his old knowledge and what they used to think. To my knowledge it has no link to either cancer, but it was thought so (I think) quite a long time ago (though this Dr didn't really sound that old, he's just been taught badly I guess).

Go to someone else!

I can PM you details of an online service that I am sure is 100% better, and is cheaper than going to see a menopause consultant gynae ( average cost with someone like that is £300 for 1st appt.) Menopause not covered by insurance.

I would be super pissed off to pay that amount and get someone who wasn't up to date. I think you should complain to your insurer and I am not a complainer.

Is this private dr a GP via your private insurance? Some insurance companies offer that service, where you can make an appt with an online GP service.

It's not likely someone would get the same Dr twice and I doubt very much if they are there for ongoing consultations regarding something like HRT.

It sounds as if it's not meeting your needs. There are other options.

@EmmaH2022 The £48 is (I think!) for the prescribed HRT - 3 x Oestrogel and Utrogestan.

Yes, but if you're paying private health, I guess I'd expect more up to date knowledge.

Yes, that's true.

I think the OP could explain here (if she wants to) so it's clear what the set up is.

The virtual GP appt is usually 'free' (it was a service introduced during lockdown etc by some insurers). Obviously, she's paying for the access as part of her policy for everything else.

The issue may lie in the questions that are asked when she makes the call for an appt. Whoever filters the calls should try to match the GP with the needs of the caller and not all of the GPs will be up to date with HRT.

That's the point I guess. HRT has not been proven to have any impact on Cervical Cancer or Breast Cancer, this guy was just going off his old knowledge and what they used to think. To my knowledge it has no link to either cancer, but it was thought so (I think) quite a long time ago (though this Dr didn't really sound that old, he's just been taught badly I guess).

Just to clarify HRT can have some increased risk of breast cancer depending on various things however not to the extent of what was publicised by the Women's Health Institute which was subsequently found to be flawed. Do have a look at the link I posted above re risks and benefits.

If your specialist can write to your GP they should then be able to take over prescribing HRT. If they’ve already done this and you’re unable to get an appointment I would write a letter requesting it and explaining you are running out, Some GPs have something in place where they request that someone submits things like blood pressure and weight on an annual basis before prescribing again for another year. You could include this information in your letter.

@over50andfab The OP isn't seeing a specialist. It's a GP I think, as part of an online service provided by her private insurance. Some insurance companies did this at the start of the pandemic as an 'extra' and it works like a 'call centre ' where you are allocated a GP via the call centre that the insurance company uses.

HRT does have a link with some types of breast cancer, so that’s not incorrect.

i take it your NHS GP doesn’t have any kind of online messaging service?

That's not really the point in question, is it? This dr she's never met said why would she want to be on it after 18 months (because of the cancer risk.) And there is no link between HRT and cervical cancer!
He's clearly ignorant as for a start the sort she is on has been shown to have no risk for 5 years.

It's not his call anyway. He has to tell her the risks and it's her choice.

Yes, this is right. It's private health care via my husbands employer with AXA Healthcare. They started prescribing it for me during the Pandemic and I pay £48 for the two prescriptions combined, every 3 months. I do a blood pressure reading before every appointment and provide my height/weight to them. I discuss any changes each time (there haven't been any bar my periods are getting longer in between which isn't unusual at 49 I imagine).

My frustration was more with his lack of knowledge and he oddly kept asking 'so do you still have your ovaries' even after we'd talked about periods, no hysterectomy, etc.

I've tried to get an appointment at my NHS GP to discuss this, to start getting it from them and I'm not 100% sure that's not why they seem reluctant to give me the appointment. When I call at 8 as asked I'm told it's not a 'same day emergent appointment'. When I call back to try and make an advance appointment I'm told there are none available. My NHS GP service don't take emails or respond to anything online so I've persevered with the private service for now.

Yes, this was my thinking too. Also my frustration was at his insistence of the importance of the smear and how really he shouldn't prescribe until I'd had one and the results back and he didn't really seem to understand at all that coming off the HRT even for a week or two would be detrimental to me and my health.

It's the downside of it not being a specialised menopause service. When people say 'oh just go private' as though you'll always get a specialist it just isn't true. We'll still just get unaware GPs but still have to pay for it.

@MiniCooperLover Just for info, could you confirm if this GP service is what I assumed? It's a 'free' extra provided by your insurers? (Many started to offer this as the start of the pandemic when GP practices were closed for f2f.)

How did it work? Did you call a central number for the GP service and were then asked questions about what you needed the appt for? Or asked to give some kind of info to help them choose the best GP?

All I can suggest is that you keep calling your GP practice every day to get an appt, (if you work you may even have to take time out to say it's for a medical appt, even if it's actually to MAKE the appt!) or to use e-consult if they provide that.

When people say 'oh just go private' as though you'll always get a specialist it just isn't true.

To be fair, that's not what is being offered. I assume it's a free GP appt and that's clear on their website.

Outrageous that you can't access your smear test on NHS - would you consider making a complaint about this? Perhaps via Pals if you can't email the practice?

No, I knew it wouldn't be a specialist, but that said you have to make it clear what you need the appointment for before they allocate a doctor, so I would have expected a certain amount of (correct) knowledge. I don't think that's unreasonable.

so I would have expected a certain amount of (correct) knowledge. I don't think that's unreasonable.

I agree!
I understand your frustration.

But going back to your GP is really the next step.

Or taking your HRT needs completely out of the NHS and seeing a consultant (properly qualified) as your HRT specialist. Or seeing a private GP (in person) who knows about menopause.

They need to do a BP reading annually and although you can provide this remotely, you aren't getting best practice care by using that kind of service for something that's going to be long term.

Good luck with getting through to your GP!

Just to update, I finally managed to get an appt at my GP for a HRT check. I could hear the receptionist muttering to herself 'no, not that Dr, he won't have a clue' when she was trying to find me an apt. I had a lovely young female Dr who was fully up to speed with current NICE practice and has prescribed me the same set of HRT that I was already on, has given me a 12 week prescription and was very encouraging when discussing ways to try to lose weight. She understood it was 'a different kind of weight' and harder to lose than the average, etc. and really made me feel better about it all, rather than 'you just need to lose weight'. So I came out feeling much better (plus my wallet will be happier too).

Still haven't managed the smear as I ended up with a period starting the day before I was due to have it, but I have another apt in a week to try again.