Confused about when to call GP

I'm kind of confused about when to call my GP. The way I usually think about these things is:

a) you only call a doctor if you are ill

b) you only call the doctor if you can't fix the problem yourself

c) you try to avoid calling the doctor any more than you have to because he's clearly busy

Except that doesn't seem to work well with my GP. He seems to get a totally wrong picture of what is going on with me. A few weeks ago that resulted in a really uncomfortable conversation where he summarized what he thought was going on with that felt really off.

It felt like he wasn't taking account of my history (this is not the first time a cold has turned into a multi-month illness. In fact, i'd say its the norm for most of the last thirty years!). It also felt like he didn't really have a sense at all of what influences my ups and downs and what triggers acute flare-ups. It also felt like he thought that I'm doing horribly all the time and that I'd only had four good days in more than six months. In fact, I've actually only had four really rough periods in the last several months - the rest of the time I'm either on the mend, doing well, or things are going downhill but haven't gotten really bad yet.

Early on he was really good at listening to me, so I didn't think I could just blame him for being clueless (I know many people here have met with some pretty clueless GPs). I spent a lot of time thinking about why and concluded that something isn't working in the way we communicate with each other. Part of the problem seems to be my assumptions about when I should call the doctor. So i've been going against my usual ideas of when to talk to doctors. While he seems to appreciate the change, it isn't really comfortable for me because it is so different from my usual way of doing things.

For example, last week, I went against my usual assumption that one only goes to the doctor when ill and deliberately made an appointment during a period when things were going really well. I got the impression that he appreciated my doing so and that I've made things hard for him by not letting him know more often when things are going well.

Today, I went against the grain again. i've had a really really good run for the last three weeks, but the last two days had a lot of signs that were worrisome: I was really tired, it kind of hurt to breathe, my peak flow was stuck in my yellow zone. yesterday at least the peak flow would go back up to 440 (not quite personal best but close) if I used ventolin. This morning it barely made it to the top of my yellow zone and then went back down.again. I'm more vulnerable to triggers causing acute attacks when things are like this, but it doesn't always happen. Normally i only call him if an attack actually happens. I feel like, otherwise, I feel like I'm just bothering him with a big maybe, raising false alarms, and wasting his time.

It occurred to me that if I only call my doctor after an attack happens, he's left with nothing to do except to clean up the mess after the horse escapes the barn. If I call him before when there are warning signs, there isn't really a lot he can do (I'm already on a lot of meds), but i don't really give him a chance to think of something or even just make the decision to do nothing. I've already made it for him.  It occurred to me that yes, he might not want to be bothered by a false alarm. But it was also possible that he could be kind of pissed. i'm obviously not a doctor, but I think if i were in his shoes I'd actually be upset if i felt responsible for a patient, but the patient only told me about problems only after the fact (i.e. after an attack) rather than before when I *might* at least be able to give advice to help avoid the attack. (I'm on a lot of medication, so he really doesn't have a lot of options other that raising the prednisone, which isn't want either of us want given we're trying to taper it)

This time, instead of waiting until after an attack happened, i made an appointment simply because there were a lot of signs that there were problems. As it turned out, by the time my appointment rolled around later this afternoon, my lungs had decided to behave and respond to ventolin and my peak flow was back up to 460. So I felt kind of stupid going to the appointment. Yet it turned out that he actually appreciated my coming in to see him even though things did start turning around on their own.

All this is way out of my comfort zone: I hate asking for help and calling my doctor more often rather than less just isn't comfortable, even though he seems to appreciate it.

Any thoughts?

3 Replies

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  • Hi Beth! Hadn't seen you on here for a while, was wondering if everything was ok or you'd just decided to have a break. Hope things are going ok/better.

    I wish I knew the answer to this one! I also am reluctant to go unless it's 'really bad' and often second-guess myself. I am starting to realise after a bad period where I ignored warning signs that it's best to get on top of things earlier. My GP actually agrees with me (better a little pred now than more later, he thinks, and pred is the only 'step-up' I have). Sadly if I even ask for advice from the hospital when just slightly bad and/or they get me in, I just get a 'well you don't need pred, put up with it' which is less than helpful (not that I particularly want pred but I want to feel better and to stop it getting much worse, and I could have got the same result staying at home without feeling ticked off and spending time and money getting to the hospital!)

    So that has made me more reluctant to do anything - though tbh I get the same response even when worse (except this time I was told to REDUCE Symbicort because I 'don't need that much') so I am planning to just go to my GP next time as in the past he has been more willing to be proactive, which now you've put it that way is a good idea so he gets to see me in various 'states'. I do actually feel my GP knows me fairly well now and this may well be due to him having seen me bad, better and much better - of course it helps that I generally find it easier to talk to him and feel that he is taking what I say on board and responding to it.

    I also realised one thing from a disastrous recent appointment at the hospital, which was that it might help them - assuming they pay attention - to see PF and symptom diaries etc from a variety of periods. I have mainly been keeping them only when bad, which I realised when the consultant seemed to think I wasn't bothering to try to reduce the number of puffs of Ventolin. I wasn't very happy about this but on the other hand I did realise it looks like that because he's been seeing my records of how many puffs I take when I'm struggling, even though there are periods in between which have been a lot better. He also seemed to think my PF was normal even though it was in the yellow zone and not so good for me, so I am now trying to keep a record for a 'good' period so I can show him that a) I have them and b) they look different from a 'bad' one. Not sure it will help given the way he's been confusing the numbers recently but worth a try (spiro at last appt 2.7, in Nov 3.7 but apparently 2.7 is fine? Not crisis time by any means but for me, 'could do rather better'.)

    Of course, my PF is being its usual stubborn self but in reverse now. Usually I get normal-looking PFs when struggling (the variability is what shows me things are starting to go but that's hard to chart). Now my PFs are stubbornly refusing to come back up out of where they were during the flare - not much use this way round either, plus I have no idea why they're doing that when they're usually ok!

    Sorry for that aside...I don't know if this has been any help but guess I'm saying I can see your points! It seemed like you have a good relationship with your GP most of the time (is that right?) and that he does listen to you and pay attention, but clearly you have to be giving him the input and letting him know everything that's going on, good as well as bad - then he can get a better sense of what's 'normal' for you and what's 'heading in the wrong direction' and perhaps even fine-tune when you can't avoid pred and when you can get away without it.

  • Hi Beth! Hadn't seen you on here for a while, was wondering if everything was ok or you'd just decided to have a break. Hope things are going ok/better.

    Apart from a really rough week just before Passover, things have been going particularly well recently aside from the current minor flare (which isn't quite as over as I thought when I saw the doctor). I've been feeling better during the last two weeks, than I have in months and in some aspects, even years. (Amazing what happens when one can really breath easily).

    As regards not being around here much, mostly i just needed to take a break from thinking about asthma - mine or anyone else's. But I've also had computer and network problems, family in town, a holiday season with a lot of preparation (Passover week and before).

    .

    I wish I knew the answer to this one! I also am reluctant to go unless it's 'really bad' and often second-guess myself. I am starting to realise after a bad period where I ignored warning signs that it's best to get on top of things earlier. My GP actually agrees with me (better a little pred now than more later, he thinks, and pred is the only 'step-up' I have).... so I am planning to just go to my GP next time as in the past he has been more willing to be proactive, which now you've put it that way is a good idea so he gets to see me in various 'states'. I do actually feel my GP knows me fairly well now and this may well be due to him having seen me bad, better and much better - of course it helps that I generally find it easier to talk to him and feel that he is taking what I say on board and responding to it...I also realised one thing from a disastrous recent appointment at the hospital, which was that it might help them - assuming they pay attention - to see PF and symptom diaries etc from a variety of periods. I have mainly been keeping them only when bad, which I realised when the consultant seemed to think I wasn't bothering to try to reduce the number of puffs of Ventolin. I wasn't very happy about this but on the other hand I did realise it looks like that because he's been seeing my records of how many puffs I take when I'm struggling, even though there are periods in between which have been a lot better. He also seemed to think my PF was normal even though it was in the yellow zone and not so good for me, so I am now trying to keep a record for a 'good' period so I can show him that a) I have them and b) they look different from a 'bad' one. Not sure it will help given the way he's been confusing the numbers recently but worth a try (spiro at last appt 2.7, in Nov 3.7 but apparently 2.7 is fine? Not crisis time by any means but for me, 'could do rather better'.)... I don't know if this has been any help

    Of course it has been a help! I really helps to hear about how you (and hopefully others) are learning to deal with their doctors. This was exactly the sort of feedback I was hoping for.

  • Of course it has been a help! I really helps to hear about how you (and hopefully others) are learning to deal with their doctors. This was exactly the sort of feedback I was hoping for.

    Glad it helped! tbh right now the way I'd like to deal with my consultant is a) possibly illegal b) definitely very immature and c) not repeatable lol - last time really didn't go well and he confused me horribly as well as not listening - but good to know my experiences helped you, even if it's just 'how a consultation shouldn't go'. Communication - both ways - is so important and while I've had plenty of doctors who are rubbish at it, I'm aware I'm far from perfect.

    Also v glad to hear things have been good for you recently. :) Hope it keeps on that way - I know what you mean about it being nice not to have to worry about breathing. My problem is every time I get to that point i seem to take it too far and then I'm reminded.

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