Change of consultant (and a rant - sorry)

Ok, I assume others on here will have had experiences of changing consultants, I need a consultant while i'm at uni to be my 'person' when i'm in hospital. However, i don't think i can tolerate my current one anymore! Can my GP change me to a different one? can he change me to a named one? If thats not how it's done, how do i do it? I was also wondering if what happened today (which is exactly the same as previous appts) is sufficient reason to change?

Basically, I went to an appt thinking that if it was miserable i'd think about changing consultants, and whilst he didnt actually make me cry, it was awful. I walked in and immediately after doing a spiro for him he made me do a peak flow, and for the first time in a long time it was as high as 75% of my personal best, usually (because he just discharges me from hospital if he can even slightly justify it) he only sees me when i'm very ill, so my peak flow is around 50% even when i'm discharged. And he went on and on about how good that was, and yes, 75% isn't too awful, but i get 90% and above on good days at this time, and those days aren't very often, but do happen and i want them to happen more.

I then had a long lecture about how fat i am and how i should stop steroids. With regards to the steroids, i can't stop anymore, i've had a test and my adrenal glands aren't currently working, i have an endo consultant at home who will be looking into whether its an option in the future, but right now she wants me to have a period where i'm stable. And currently i cant exercise due to the poor asthma control, and whilst my steroid dose is low it is enough to make me gain weight, i'm getting less than 2000 calories a day (1500 maybe) and still gaining weight, but i really don't see how much i can do about it without just stopping eating which i really hope he isn't recommending!

He was really patronizing about me stopping antidepressants. Given that it was something i asked for in the first appt i had with him (i don't need them, i had been on them for a brief period) and he refused, and there were several occasions where him/his reg tried to increase them in an attempt to say that it was anxiety causing issues (until the psych doc told them that i really didn't have anxiety issues and that they should let me stop the antidepressants) and now when he noticed i'd stopped them he called me a ""good girl"" which is just really patronizing, and not anything to do with him, he's respiratory, so unless its affecting my asthma (or his meds are messing with my head) i'd rather he just ignored that side of things, esp when i don't even need them!!

He then went on to talk about how my asthma was affecting me, and i said that yes i am in hospital less (its been nearly three weeks - still not amazing), however I am still relying heavily on ventolin and having lots of attacks. I certainly cant do any exercise, and can just about do most of the things i want to do, but not with ease or do all the things i normally need to do (walking to lectures, cooking, etc.). I dont really care if he increases my meds as i'm under a consultant at home but i think its important he knows whats going on. Anyway, he then said that because my PF has gone up i should be decreasing my meds. I said that given that i couldn't get on with my everyday life, that my PF are lower than 50% most mornings, and that actually, this high PF is still only 75% at the best time of day for me! He did to his credit leave it at that.

Then he asked if i needed any prescriptions sorting, and i said that i'd finished my emergency supply of omeprazole this morning, and given that i'm seeing my GP on Thursday I am able to wait until then (repeat would take that long anyway) but if he was offering, so i asked for this and he said that he would just write me a GP recommendation letter, and not a prescription, as this is 'quicker' (?) so i just said that that would be pointless as my GP was more than willing to prescribe my regular medication to me, but said that a letter might be helpful to explain that i would be needing an awful lot of ventolin prescriptions given that my asthma is so uncontrolled. He then gave me a good few minutes explanation of how GP prescription targets work - really not interested and actually knew it anyway as my sister is a GP, and has moans about this kind of stuff - and surely this is a waste of appointment time.

None of these things are particularly awful, but in the past (a fortnight before my short synacthin test) he tried to stop my steroids without even mentioning the possibility of adrenal issues with me (i was on 30mg, then to 5mg, then to 2mg then stop after two weeks, so quite a rapid reduction anyway given that i'd been on them for 6mnths) and it was only my cons at home that discussed the fact that my adrenal glands were probably not working! He also blatantly refuses to accept my personal best PF, despite me showing a spiro result (done about 2-3mnths ago) showing my best PF, and so is using the wrong percentages when calculating my PF currently. Is this enough justification to change consultants? I just got absolutely no value out of this appt, and left feeling really down about my weight (which isn't too bad anyway) and miserable about the mads that i'm on, that i need to be on!

thanks for letting me have a long rant - feels very therapeutic!!

8 Replies

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  • OMG Soph!! Sounds horrendous!!

    A consultant is supposed to be an expert in their field and not belittle you and make you feel like rubbish!! He should be listening to you and the problems you are experiencing, not doing what he is doing! I thought as a respiratory consultant, his main concern should be that your asthma is not controlled, not making you feel silly!! Though what do I know? I'm not under a consultant (though been told my only further meds option will now be a maintenance dose of pred?! lol)

    Take it up with your home consultant/gp? perhaps they can advise? They clearly understand your needs more than anyone else!!

    Makes me mad ... they are meant to be all for their patients, and he clearly isnt :-(

    Take Care! xxx

  • OMG Soph!! Sounds horrendous!!

    A consultant is supposed to be an expert in their field and not belittle you and make you feel like rubbish!!

    Glad its not just me who thinks that!!

    his main concern should be that your asthma is not controlled, not making you feel silly!!

    And most of the stuff he was complaining about would be sorted if my asthma was controlled anyways, weight especially!

    Take it up with your home consultant/gp? perhaps they can advise? They clearly understand your needs more than anyone else!!

    seeing my GP on thursday so i think i'll discuss it with him then!

    thanks for the reply :-) glad im not being unreasonable!!

  • you're really NOT being unreasonable, it must be so frustrating!!! Sending huge hugs!! Try not to let him get you down!

  • Sorry, I've not got experience of changing consultants at a hospital, just had different consultants at different hospitals when living in different places. I guess that sufficient reason to change would be a lack of confidence in the person treating you (I can't say that I'd feel confident with someone who wants to settle with pf 75%), or is my faith in the NHS regarding second opinions missplaced? Providing you have more than one consultant at your hospital, at the hospital where I grew up we had one respiratory consultant who was there two days a week.

    He shouldn't be settling for 75%, when you get 90% somedays, it almost feels like he's saying oh that'll do. He should be willing to put a bit of effort in and fiddle around with meds and get you to 90% most days and able to do normal things and exercise again. It's taken a while to sort my meds out, but I think we might be there now, and me and my cons are happy with it for now, being that I get 90% most days when well. He should also be taking the advice of the pych doc and endocrinologist too.

    Hopefully others can give you some ideas about changing cons, but for now, if I was you I'd be trying to see the cons at home as much as possible and ignoring the one at uni. xx

  • Definitely grounds for switching consultant. Actually, I think if you explain the situation to your GP, it shouldn't be too difficult. I had a similar experience with a non-asthma consultant, and my GP referred me to somebody else for a second opinion. He should certainly be paying attention to the endocrinologist's advice, so I would imagine that alone would do it!

    Also, just to reassure you about steroid weight, I was in a similar position and was told that although being overweight is obviously not ideal, and weight loss can help some asthmatics with their asthma, you can't reduce your calorie consumption too much without compromising the nutrition you get out of your food. And, if you're prone to infections and illnesses that set your asthma off, obviously this isn't great either. So I'd say just ignore him on this one, be a bit careful about unhealthy stuff and try to have a balanced diet.

  • Do you actually need to have any clinics with this consultant, given it sounds as though most of the prescribing decisions and med changes are done by your one at home? If it were me, I would telephone to cancel your next out-patient, pretending that you are away or in exams or something. With my consultant, at least, he is so busy that one missed appointment is usually rearranged for several months later. You can then do the same thing again - uni time will just fly by! If you get admitted and you see the consultant you don't like on the wards, you don't have any awkwardness of having changed consultant or anything, and just act all innocent and explain if he asks after your missed appointments, sticking to the same story as before.

    A bit of a fudge of course, and not really tackling the problem, but perhaps an easy way out now, and still enables you to see him again in the future it either things became intolerably bad or you felt sufficiently strong, mentally and physically, to cope with an appointment with him,.

  • Change consultant you are not being unreasonable

    a conslutation with a medic/ cons should be helpful not make you feel bad.

    Luckly put off cons referal due to my gp's budgit

  • Thanks guys - discussed it with my GP and he agreed that a change in cons might be a good idea - gonna ring them today i think to sort it (really hate doing that - don't like to make a fuss), will be glad when its done!! :-)

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