Why do doctors not listen?

I sympathise with all subscribers whose doctors do not appear to be really listening to their patient's problems.The reason why they do not 'listen' or hear, is because they are not trained to be anything other than general practitioners. This leaves a huge gap in their knowledge corpus and why patients who research their problems in depth often know a lot more in a specialised area than the doctors themselves. This is why doctors refer patients almost systematically onto a consultant in an area, that may or may not address the patient's medical needs. In short, the role of the GP is administrative. They no longer care physically in terms of attending to patients needs beyond the convention of prescribing drugs. When was the last time a doctor examined you for example other than taking your blood pressure and moreover, when was the last time he could diagnose a condition with certainty without interdisciplinary support? There needs to be a paradigm shift in attitude and a total reconceptualisation of the role of the GP to enable doctors to search beyond the conventions in treating their patients, to see both themselves and their patients as active particpants in a type of action research which advances medicine from the inside.i.e. the patient's perspective. Joined up thinking is what is required across all areas of medicine to provide paptients with the information they are entitled to. It is high time that interdisciplinary practice at surgeries is implemented, so that patients can have direct access to specialist advice and not waste their time trying to educate their GP about their condition, about which they know much more.

19 Replies

  • I agree with your comments. We should not need to search and research about our own condition - then when the prescribed medication doesn't make us feel well they refuse to trial (cannot prescribe) an alternative and tell you it is nothing to do with the thyroid when we know it is. They are willing to prescribe other medications for which there is no blood test ,ie, depression, pain relief, etc and when you keep appearing at the surgery (hypochondria).

  • Unfortunately GPs rarely seem to refer these days because of costs, therefore they need to know more about the most common of conditions (hypothyroidism being one and hyperthyroidism not exactly being rare!) If they did refer, and the relevant specialists were all suitably trained in their field (and more endocrinologists not just trained in diabetes!) it wouldn't be so bad. Unfortunately not only do GPs have gaps in their knowledge (understandably as they can't be expected to know everything about every condition) but they don't refer us to specialists who do know enough about the subject. And when people do get referred, it is often to and endocrinologist who knows a lot about diabetes but little or no more than GPs about thyroid disorders.

    I agree that things need to change - drastically, and this is what Thyroid UK and other bodies are trying to achieve. Hopefully it will happen sooner rather than later. The ladies who have petitioned the Scottish Parliament seem to be having some success :)

    Carolyn x

  • I totally agree but I would like to consider continual research and investigation of my own could be further confirmed or negated with reason from my doctor or consultant rather than be made by some to feel uneducated or in some cases retarded...... Not just with some doctors and consultants but even opticians dentists and nurses. I would feel sad to think that I thought someone else was entirely responsible for working it out for me only because like everyone here I believe myself to be an individual with different experiences and perceptions so believe it is up to me to find a way to communicate my problems in a way that is better understood. Before I found this group for example when researching possible reasons for my symptoms even though I knew I was hypothyroid because I believed myself to be fully medicated the list of possibilities included things as far removed and impossible as AIDS to scary and very possible .. Cancer together with a myriad of possibilities between, so it is not difficult to see why whittling down the possibilities to a concrete diagnosis as a GP is a daunting task. Even as a specialist with so many possible co-morbitities and the occasional real hypochondriac it must be very easy to slip into a dismissive slightly uncaring God-like narcissism and forget humanistic communication :P

    I totally agree that a sort of interactive "action research" would benefit all professional, patient and the service as a whole! However, ( and there always seems to be a 'but' doesn't there), for this to happen it needs to be through competent sensitive humanistic interaction between all people concerned in each individual case .... Which would include a well informed patient (whether self-informed or by the GP), medical personnel and those balancing the finances of the individual, the practice and the Service as a whole.

    I stress humanistic because so often attempts to change the system make it worse through attempts to generalise and categorise things into forms that tick boxes!!! How many of us have filled in a survey or questionnaire and felt dissatisfied with our answers merely because the options offered as possible answers do not cover our own situation? What makes it far more worrying is the concept that forms seeking to collect and categorise information of such a diverse nature can so easily be formulated without intent to retrieve a pre-conceived data sett regardless of the safe guards and thus fuel a false premise! :'(

    Perhaps like the concept of Marxism, and I only suggest it as a thought experiment, a fair and balanced idea that many might conceivably consider as a righteous path that in reality when put into practice becomes more like the worst examples of dictatorship and class system due to some of the more debase elements of human nature??? ;)

    Xxx :)

  • "In short, the role of the GP is administrative. They no longer care physically in terms of attending to patients needs beyond the convention of prescribing drugs."

    I agree, GPs here are gatekeepers and no longer need the extended and expensive education they get, nor do they need to call themselves by the title they so covet (plenty of other people are entitled to call themselves Doctor, but GPs seem to take exception when they do!). Pharmacists also know about the drugs being prescribed better than a GP does, so that role is also redundant.

    However this does not apply in many other countries, where patients are free to consult whomever they consider appropriate and where a GP is dependent on his/her patients for their own livelihood and therefore takes much greater care, and has greater practical knowledge, than ours. This has been my own experience anyway.

  • This is a healthy ( excuse the pun) debate and should go beyond the parameters of this platform to encompass the public and their opinions - including politicians and policy-makers alike. I should go one step further and say GPs are 'overpaid administrators'. I don't know of any other nationalised profession who are paid this amount for a service that requires such limited and generalised knowledge to the extent that advise provided often borders on the negligent. As you quite rightly state, GPs are gatekeepers and such investment in their professional formation could be saved in part to reduce training costs and to restructure the profession in line with current day thinking in management reconstruction, and which seems to be going on in other sectors of society, not only as a cost exercise to streamline, but to improve what are outdated systems. The concept of the NHS today is far different to what it was at its conception in 1947.We really no longer need this service in its present form and it needs to be radically changed to recognise GPs' limitations in their knowledge and care.

  • If I had a pound for every time I've heard of a person dying of cancer or a heart attack and were sent home with pain killers from their GP, I'd be rich!

    It's all very scary......

  • I so agree with you here... My grandson, who caught whooping cough at 10 days old almost died because none of the GPs (6!) in our family practice recognised it and kept sending my daughter home with 'it's just a virus, give him some Calpol' ringing in her ears, on one occasion even after the poor little mite almost turned blue during a classic whooping cough fit in front of one of these 'highly qualified' and overpaid individuals! It took a locum from India just two minutes to finally give an accurate diagnosis and get him into hospital straight away to save his life! Thankfully, even though it was touch and go for a few days, he did pull through and is a healthy, happy five year old now.

  • It's really the system I am talking about, not the doctors per se - they just happen to be operating ( another pun -sorry) within guidelines which are no longer relevant in this day and age. It is the infrastructure of the profession; its practice and methodologies which are in need of serious overhaul.

  • One can only assume that GPs are happy to be overpaid civil servants otherwise they would be trying to change the system.

    Bit of a cushy number if you ask me, and I've seen 4 of them who all failed to help me cos they didn't know anything about thyroid conditions.

    Much easier to prescribe AD's and just think of all those funding points!

  • You are so right, but they aren't psychiatrists either. Definitely funding points and money come to mind.

    Jo xx

  • rather than change the system I feel that the change MUST be from the gp's . I myself have an absolutely brilliant gp -- who is also a consultant surgeon at our local trust and also a lecturer at a main teaching hospital --he is reasonably young always listens explains everything [ including treatment / effects ] takes patients feelings into account and more importantly if he refers a patient to a specialist area he has little knowledge of he then researches the condition treatment and other areas of treatment . He plays a part in training gp's of the future and since I directed him to this site he regularly checks it and indeed has incorporated it into his own lectures. he always has an open mind because as he says himself 'as a gp I cannot be expected to know everything about everything , but I can still learn ' . I am sure that he is not the only one in the nhs with this attitude.

  • I guess to be fair that most docs are stuck in a highly flawed system by the time reality bites and they realise what's happened. Even those that awaken to this are probably a rarity, in that most probably won't admit that reality even to themselves.

    Once there and faced with the 'take the money and conform' vs. 'risk listening to your head and heart' type choice most (as in the case of the broader population) vote for the former.

    Those of us funding/buying into the system (at least not until find ouselves ill and needing help) often don't like our rosy perception of an infallible and caring medical system to be disturbed either...

    It's not too surprising, in that it surely in many ways reflects the broader nature of our society. We don't generally welcome those that question whether or not the emperor is wearing clothes.

    There will always be some that are open to seeing, but there's always a sizeable block scared to death that change is likely to disadvantage them that will ignore the elephant in the room.

    The elephant in this case is a pretty highly multi faceted beast - built on stuff like bureaucractic carelessness, self interest/lack of care, mistaken/unwise beliefs about the nature of the human entity, misleading and rose tinted PR/marketing, the power of vested interests, and ultimately the switching off of many professionals in the face of it all.

    It's little wonder that individuals get overhwelmed....

    It's basically a larger scale version of a phenomenon known in management as 'learned helplessness'. britannica.com/EBchecked/to...

    Applied societally it suggests that people finding themselves in a culture that responds negatively and aggressively to rational/reality based thinking (that's thinking that risks disturbing the status quo/undermining the perceptions and beliefs on which the society thinks it is built) find ways to put up and shut up.

    That faced with the cognitive dissonance and unpleasant results this creates (the stress caused by conflict between taught beliefs and reality) they find ways to define their role and responsibility in ever narrower terms. So that the risk of their being forced to confront anything/of incurring blame for anything is minimised.

    The cost is that (a) the real problems are as a result left ignored and unaddressed, and (b) that over time the players become helpless and unable to see the wood for the trees - they will actually defend that status quo no matter how daft it is.

    It's not a stable situation. The organisation/society becomes progressively more dysfunctional over time as people place more and more information beyond their awareness, and invest more and more in propping up the dogma.

    The $1m question is whether or not we wake up before the house of cards comes tumbling down. History isn't very encouraging in that regard :) ....


  • Other problems (among many) include the fact that it's hard to even get an appointment at some practices – I'm in an area that has too few GP practices given the population density, and it's an absolute lottery getting an appointment with any doctor, let alone the one you wish to see. Also, a lot of doctors don't seem to appreciate that a condition may present itself as a whole list of symptoms – they just want you to pick one and focus on that, and you get a ticking off or the rolling eyes treatment if you try to talk about anything else. John Nicholson sums it up brilliantly in his book The Meat Fix – although it's not thyroid he's dealing with, the issues he faces with GPs are very similar.

  • You make a very valid important point when you say that 'a lot of doctors don't seem to appreciate that a condition may present itself as a whole list of symptoms – they just want you to pick one and focus on that,' The nature of the metabolism is such that symptoms present in more than one way and place. The underactive thyroid for example for some people will manifest as loss of hair, cold extremities, low body temperature, etc,etc,and as such a holistic analysis needs to be made. However the 'one condition for one appointment prevails' and at the best, the patient may be offered a blood test. When results come back as normal, within the paramenters of the norm, then doctors tend to use this as their bible benchmark and will not consider the individual who may respond outside these norm values. It is very frustrating, as explaining the interconnectedness of the these symptoms and their relevance towards a correct diagnosis seems to go over the heads of most GPs. In such case, I always take a sheet drawn up as a flowchart to try to explain to the doctor, how I think the symptoms are inter-related, with start dates. They are generally very happy for patients to do this and are genuinely interested in the information the patient provides as it gives them an overall pictue of the medical issues. Despite this, the problem of as one reader said, 'corporate mindset' will continue and until this is changed from the top, then they will continue to sit behind their desks and languish in stagnant waters at the expense of being unable to serve and treat their patients effectively

  • I'm glad to hear that yours appear to listen and take an interest – there are some GPs out there who do at least care enough to do that. But I've found that if you attempt to tell some doctors (eg my current ones!) what's going on, rather than sitting there like a good little patient and taking everything they say as gospel, you can be patronised and labelled an awkward patient. IMHO, some go beyond the "generally well meaning but hands tied by training and the corporate mindset" thing – their ego doesn't allow them to acknowledge that they might be wrong, or that there may be a gap in their knowledge. Or that the patient's research may have gone beyond their general training in a certain area.

  • My attitude to GPs has changed over the years. it now consists of self education in a topic evaluating the options from NHS and private, researching mostly online and discussion with others [provides very little generally ,that sadly].

    Many seem to know the problem but none how to solve.

    This post is incisive as it examines the role of the corporate mindset driving the machine that is now the NHS. Doctors used to look at your nails. feel pulse listen to heart etc but never do now unless pushed.Little pointers to general health not just BP and depression.

    Everwhere the state has intruded has resulted in least optimal outcomes.

    Don't get married [or divorced if you do], don't get ill -or old is good advice but counter to natural law and reality. Children in the modern UK are low on the list of happiness even though we have a supposedly balanced society and economy, compared to many worldwide.

    The case of hypo thyroid being readily underdiagnosed seems a classic case of everday life outstripping the systems ability to stay in front.

    The price of this is much low level -and some high level misery. Fortunately fate has given me a good IQ and a tenacious nature and I am heartened that people on here are sharp, lucid and caring enough to think about -and try to mitigate errors in medicine, in particular.

    It's a slow process but I think with the weight of opinion garnering strength and direction soone or later this 'Thyroid blind spot' will trigger a big review overall by those who decide these things.

    In the meantime I try to keep discourse going and pursue private avenues, for now, as I'm still undiagnosed on the Thyroid front, at least- but have many connected issues.

    I find this site very helpful and I'm glad I don't have the problems at the level of many here.

  • at around £80 -100,000 per annum salary GPs must be the highest paid administrators ever! If this is all they are doing then there needs to be fundermental review of their training and their salaries!

  • My previous employment as a university lecturer changed over the 13 years I was employed there. It became increasingly administrative, with many targets to meet, changes in procedure, with student face to face contact hours exceeding the working framework. I should imagine a similar scenario in other professional fields, police, fire services, schools, medicine etc, and doctors are probably not exempt. I do not doubt they too are working longer hours. This however does not address their lack of knowledge. They train for many years and as part of that training, should be spending at least two years specialising in an area, so that they qualify, not just as GPs but as 'experts' in a chosen medical field. This is what lawyers now have to do to earn their living. The General law practice has all but vanished in most places and they now have to offer specialist departments to deal with specialist problems ie Family, criminal, corporate. If they were to act as GPs, serious litigation woul ensue due to errors in their judgements. They cannot bury their mistakes, as doctors are at times able to. A fundamental review of their training, in line with their remuneration needs to be undertaken by a working review group to provide an updated and better service to clients.

  • How much CPD does a GP have to do?

    There is one GP at my practice who said that he "didn't have time to look things up" when I mentioned that there was a wealth of information about hypothyroidism on this and other internet sites. (I refuse to see him now.)

    Slightly obliquely - I have managed to fix a friend's whiplash problems (something the chiro. osteo. and physio. could not do). When she told the consultant about the treatment (Body Realignment) he just shrugged his shoulders and said "whatever". He was not interested in learning anything new.

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