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Pernicious Anaemia Society
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Doctor's protocol for B12 deficiency

My brother of 87 years has just seen his doctor. It appeared that his B12 level was 84 a year ago. He was given one prescription but was not told what it was for and was not followed up. He was not aware that there was a B12 issue!

At my insistence he saw his doctor last week to request a B12 test because of a four generational family history of B12 and/or auto immune thyroiditis. The practice manager phoned to say the test was OK and no further action was required!

He was not happy with this and asked for a doctor's appointment. I insisted he find out the level which he did. It was 119! At this point he asked what it was a year ago and was told it had been 84!

The doctor refused to prescribe injections or high dose pills but offered him a script for 50mcgs by mouth daily. My brother pointed out the facts as relayed by me and was told that he shouldn't use the internet. My brother responded that in his experience it was the only way to be well informed about health issues.

I am outraged by what I consider frank negligence.

He has arranged to see a female doctor at the practice for a second opinion and I am going to tell my brother to ask for a printout of the guidelines she is following if she does not correct the previous GP's gross negligence.

***The reason for this post is that I think this could be a useful tactic for anyone being confronted with an unhelpful, ill informed or negligent doctor. It may prove more fruitful than presenting all the evidence about correct treatment. It would also put the boot on the other foot of the doctor having to justify their mismanagement.

5 Replies


Now, what an interesting post, and situation.

The doctor's behaviour is clearly totally appalling but I am wondering what symptoms your brother is experiencing and what he has told the doctor about his symptoms.

Could this be having any impact on the response of his doctor, do you think?


He has been complaining of dizziness which makes him nervous about falling and has been to the doctor for that complaint, but he rarely complains and makes light of things. I expect he puts any problems down to old age and dismisses them.

The interesting thing is that he was referred about a year ago for a pacemaker, which was fitted. He had no particular symptoms but was referred on the basis of ECG findings without any explanation of the problem or the reason for the pacemaker. Afterwards he reported back that it hadn't made him feel any better and was told that wasn't why it was fitted, it was to stop him dropping dead in the night. As his wife had recently died he explained that such an outcome would not have been a problem!

Now when he has a problem that has really significant potential to limit his fitness and independence the correct treatment is denied.

A pacemaker would have cost the NHS thousands, B12 correction would cost a few pounds a year and would have the potential to avoid much more costly medical problems.

You couldn't make it up! The lunatics really are in charge of the asylum!



Like you say, Dewbuc, you couldn't make it up! I think you are quite right in that "The lunatics really are in charge of the asylum" I think that puts it very well.

As you have already mentioned, this has to be negligence and is happening all over ... but the doctors just don't want to learn. B12 is cheap as chips (if not cheaper, these days) but medics would much rather spend money on expensive procedures and scans, spend £££s on devices (as per your brother), spend on expensive medications which will only help the symptoms (if you're lucky) so an ongoing and accumulative cost when all is required is to recognise the cause, and treat, ie B12. After loading doses, it might cost about £10/yr for 'maintenance'. It's a no-brainer - unless you're a doctor!!!

I really don't understand why medics can't see this. They have such blinkered sight and maybe don't want to know coz perhaps it would make them look stupid - as if it doesn't right now!!!


Oh Dewbuc ,

Words fail me. I think there is sometimes age prejudice towards older patients.

I have seen someone elderly decline into severe dementia and suspect it is linked to B12 deficiency .

"doctor refused to prescribe injections or high dose pills but offered him a script for 50mcgs by mouth daily. "

My understanding is that 50mcgs is for treating dietary deficiency (where there is no neurological involvement). I wonder if GP has assumed his low B12 is diet related but I find that difficult to understand because he mentioned 4 generations of B12/thyroid problems.

Good idea to ask for guidelines being followed.

I found that some NHS areas in UK, are using local B12 deficiency guidelines that have not been updated since the BSH Cobalamin and Folate Guidelines came out in 2014.

I wondered if PAS might be able to help?


PAS tel no +44 (0)1656 769 717

Is it worth your brother writing a letter to GP?



Thanks Sleepybunny. My brother has a good diet so it is obviously an absorption problem, so effectively he has been prescribed 5mcgs per day!

My brother is extremely sharp minded and is going to try his luck with the female doctor. He pointed out to the previous doctor that the Japanese regard 500 as the lower limit of normal, which probably accounts for the intelligence of that race! He will fight his corner on the basis of a pretty good understanding. I have suggested he asks the doctor to phone me if he still has a problem, but I'm sure that will be above and beyond their normal activity.

The first duty of a doctor in the GMC code of practice on the Duties of a Doctor is to "make the patient your first concern!" I fail to see how these I'll informed doctors are discharging that duty in so many cases reported on this blog.


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