Professor Steve Field says GPs have 'failed as a profession'

[shaws]

Just read this a few minutes ago.

pulsetoday.co.uk/your-pract...

[lola1956]

Thanks for posting . It doesn't surprise me now which is very sad 😕

[stiltzski]

Depressing but very interesting, thanks. I read somewhere yesterday (not sure if it was on the forum or elsewhere) that, although England, Wales and N. Ireland have 'signed up' to allow patients to vet GP practices, to see how good their prescribing is, for example, Scotland (where I live) does not allow it. I have been looking for a link to post but can't find it!

[shaws Administrator in reply to stiltzski]

I think too that doctors' practices are under attack and maybe too many changes for many of them, with what they are supposed to do nowadays. They have to comply with guidelines (right or wrong) as well. They may well be disillusioned as well.

[Zephyrbear]

I think if you read on through the comments left by various people in response to this article, not everyone feels the same way, in fact this doctor may be in the minority... and possibly have a hidden agenda of his own. As patients all we can do is judge as we find. Not all of them are bad and some of them are actually quite good. What I have found is that when the older doctors retire (many of whom were around when I had my children and looked after us as a family) they are being replaced by a younger generation that doesn't seem to be quite as interested in you as a person or your medical background (they only display your last 10 entries on their computer screens and if the relevant information happens to be entry #11, that's just tough!) and come across as cold and heartless and impossible to speak to. We've only got one 'good' one left at my surgery, but he isn't getting any younger...

[AnnT49 in reply to Zephyrbear]

It sounds like you go the same gp's practice as me I've been a patient there since we moved here in 1980 and until now received great service (totally different to my GP at previous address). I'm certainly not one for confrontation, quite the opposite, and I've never previously argued, or had cause to argue, with anyone in the practice for all that time.

BUT all good things have very much come to an end. All but one of the old partners have taken early retirement and been replaced by useless, but very bossy younger ones. Even the one remaining pre-existing one seems too afraid to go against them, especially one young woman, who seems to have taken over all the budgeting for the practice.

I've seen this particular young lady four times and had three arguments. I'm in my sixies and she literally talks to me as if I'm three years old, and God help me if I question what she's saying or how often she's repeating it, even though I've had the condition she's lecturing me about since my mid twenties (not thyroid) and know far more about which drugs do or don't work with me, than she does. My husband tries to make me laugh about this by referring to her as oberriechsfuhrer, because she has an east german accent, but it does upset me.

I've told the one remaining GP that I'll only see him from now on, and if he leaves, I will too. Perhaps that's what the young doctor wants, as I cost them too much with all the drugs I'm taking.

The problem is that because patients are divided up between the doctors alphabetically, she's officially my doctor, and they won't change that as they say it doesn't matter as I can see which ever one I want. But it does matter, because any correspondence or test results go to her and the next thing I know is that she's telephoning me to tell me what to do.

The most recent example was when TSH result came back as 0.02... She reduced my prescription for Levo. However 6 weeks later my TSH came back as over 12! I had to make appointment with my preferred GP (to make sure she didn't telephone me) who put the dose back up, saying it wasn't a problem for my TSH to have been that low, it does vary from time to time. If he's been the one to phone me in the first place, I would have asked if I could wait to see what the next blood test result was before altering the dose, but I hadn't got the energy to have another battle with her ladyship. So now I'm feeling dreadful, as I do everytime my thyroid hormones become very unbalanced. I hope it settles down in time for Christmas.

[Zephyrbear in reply to AnnT49]

I have to admit that my treatment, so far, has been pretty good, but then again my thyroid has been under the care of an endo. I dread the day he discharges me back to GP care as my TSH is too insignificant to read, my T4 is officially low (6.8) although my T3 is mid-to top of the range. (I take a T4/T3 combo, which is wht the TSH and T4 readings are low). My condition is stable at the moment and I would hate to think that these numpties might start messing about with it... Luckily, I have a brother who lives in Greece so, while he remains there, I will have a ready supply of T3 to self-treat if they withdraw it.

My advice to you AnnT49 is to have that row with that GP and leave her in absolutely no doubt whatsoever that, when it comes to your thyroid, you probably know a damn sight more than she does! I wish you well.

[AnnT49 in reply to Zephyrbear]

Hi Zephybear,

Unfortunately, with hindsight and the benefit of this forum, I'm not that impressed with the endo I was under either. He seemed like a lovely man, but looking back he only seemed to be interested in RAI and then discharge.

He originally said I had nodules and, although he never said otherwise, somewhere along the line, I discovered I had Graves, which was confirmed by the hospital discharge notes. But according to the medics the diagnoses doesn't matter because the treatment is the same. I never had a scan, so I don't know whether nodules were the problem or not, or why he thought I had them, other than they are the most likely cause of hyperthyroidism at my age.

I strongly resisted RAI and was prescribed Carbimazole, with dire warnings about possible life threatening side effects. After a few weeks I developed hives and was told to stop the Carbimazole immediately and take PTU instead, with even worse warnings. However, on doing very little research, I found that hives appearing after a few weeks of taking Carbimazole is very common and I just needed to take an antihistomine pill for a few days until they subsided. This “specialist” apparently didn't know this.

Over the next three years I had three courses of Carbimazole treatment, to make me hypothyroid for months, not euthyroid. But each time the dose was reduced I felt as if I was dying for a couple of weeks until I adjusted to it. And each time I completed the course my T4 shot up again. I was eventually persuaded to have RAI, by the words “ you just one little pill and you're cured, no further problems”. (I've since discovered that this meant no further problems for them, not me!) By then, I'd heard about block and replace and asked if I could try it, to see if Levothyroxine suited me before I burnt my bridges, but I was told they didn't do it for that reason. After having RAI, I also discovered that there was no reason why I couldn't have taken a smaller dose of Carbimazole to keep me euthyroid indefinitely, and even better, after three years of this, the thyoid oftens sorts itself out.

As I said he was very nice and I accepted that he was doing what he thought was best for me, but what did anger me, was that as soon as I had the RAI he discharged me without any warning or follow up appointments. Just prior to my RAI treatment, he had made two passing remarks, one that I had antibodies and secondly that I might need T3. I assumed both these things would be explained to me and checked out on subsequent appointments. But he didn't even wait to see what dose of Levo I needed. I felt so ill, and asked if I could see him once more to see if I improved or needed further help, but his response was that it was up to my GP to monitor me now. Unfortunately, my very helpful GP had retired, and the one I see now won't do or prescribe anything unless told to do so in writing by a consultant, so, as my endo made no mention of T3 to him, I can't have it. (I recently had to see two different consultants at two different hospitals to get him to prescribe a drug I've been taking for 15 years. (Not thyroid) As I said, he's frightened of upsetting the new doctor and is keeping his head down. All that the endo agreed to, when I telephoned him after my discharge, was to tell my GP that it was ok my TSH to be at the bottom end of the range, but not outside it.

[AnnT49 in reply to AnnT49]

With regard to having another argument, with the younger doctor, I've had three and, instead of listening to you, she just talks over you. And if your words should occasionally penetrate, she starts repeating everything she's said over again, a little louder each time, as if you're too stupid to understand.

This was all over something that had been specifically formulated and supplied by a top NHS speciaIist hospital, for people who had undergone the particular type of surgery this hospital carries out, as there was no other suitable product available. Having tried all the other possible options, I had now been using this product for at least 17 years and been a member of the hospital support group for longer. I know far more about about the condition and what treatments are available than she ever would. Trying to explain that to her was a waste of breath. I just avoid her now.

The older one almost whispers, he does listen, nods, but then does nothing. He says something like “it's not your thyroid, but I don't know what it is. The only blood test he'll agree to is the TSH, which is fine (because I lower the dose a month before having it!) and looks at me blank if I suggest anything else, as if he's never heard of it or I'm making it up. E.g .when I asked him about my sudden increased weight since having RAI and taking Levo, he says “we all, including himself, put on weight as we get older and I should eat less”! However I hadn't put on any at all between my 20s to 60s, (8st) but have now gone up- 34 sizes in a few months, despite having very little appetite. I left him a couple of articles I'd printed off about this, as he seems to need everything in writing, but I doubt if he's read them. When I told him of the difficulty I had had with the other doctor, he just whispered “I know what you mean” in a sympathetic way.

Years ago I had to give some feedback about the surgery and I gave a glowing report. I wouldn't do so now.

What a rant! I bet you wished you hadn't responded now. I'm so sorry, but I feel a lot better now I've got all that off my chest. It obviously needed to come out. Thank you for lancing that particular boil!

[AnnT49 in reply to AnnT49]

Sorry 3 - 4 sizes, not 34 sizes, though the way I'm going!

[shaws Administrator in reply to AnnT49]

AnnT49

Thanks for posting as it is important for others to research well when the threat of knocking out/removing the thyroid gland is suggested.

We rely on the doctors to be very knowledgeable: to know what happens if any important part of the body is removed. How to replace the part if possible.

It just goes to show that each 'problem' which occurs after op is not followed up by the department which caused the 'problem' until the patient is 'fit and well'.

If the professionals aren't au fait with 'all' possible symptoms and remove them before discharging the patient over to another who is also also unknowledgeable required the patient themselves to research and we are forever thankful for the internet otherwise an early death might be the result.

Well done to you - and I'm glad you haven't increased 34 sizes. When your TSH is low enough it might be easier to lose the weight.

The most important question is 'how do you feel' at present

[AnnT49 in reply to shaws]

Hi Shaws,

I so much appreciate the information and support given on this forum, so if any of my experiences are useful to someone else, that would be great.

No wonder the endos think the RAI gives such great results for everyone, if they don't follow up afterwards. I was shocked by this. I thought they would at least wait until my blood test results were in range, even if my recovery took a lot longer.

As you say thank goodness for the internet and support forums, because you don't anything like this kind of information from the doctors and you begin to wonder why, if everyone else feels so good with this treatment, then why don't you.

[shaws Administrator in reply to AnnT49]

This is the experience of one member:

thyroidnation.com/fighting-...

twitter.com/lorrainecleaver

[AnnT49 in reply to shaws]

Thank you Shaws. I'll read those.

[Zephyrbear in reply to AnnT49]

You're more than welcome. It just serves to confirm how lucky I have been. Just a thought perhaps... instead of stopping all your medication before a blood test, keep it at the same level so it drives the TSH right down. The lower the TSH reading the more labs will be obliged to test further on T4 and T3... etc.

[AnnT49 in reply to Zephyrbear]

Thank you for your support Zephybear.

I don't stop the medication completely, I just reduce it to the level my GP has prescribed, which I know will be well within the TSH range insisted on by the NHS.

I did make a mistake before by reducing it too late and the TSH came back under, 0.02.., which although it didn't result in the T4 or T3 being checked out, it did result in my GP reducing the amount of Levo prescribed!

In order to get it at least back to what it had been, I then only took the new lower dose prescribed, which resulted in my TSH going up to over 12. They did on that occasion check the T4 also, but as that was mid-range, 13 (9 - 19) the T3 wasn't checked.

I wouldn't want to reduce my meds low enough to make the TSH go any higher, I felt bad enough at 13.

And if I take the dose I feel ok on, my TSH will plummit, along my prescribed meds.

I hope that makes sense. By the way, you probably realised that my comments about my GPs Practice was meant for you. I put it in the wrong reply box and sent it to myself!

One day my brain will work.

Thanks again for giving me the opportunity to ramble on and then be kind enough to offer suggestions. It's very much appreciated.

[shaws Administrator in reply to AnnT49]

We are supposed to be on a level of meds without the swings up/down according to how they interpret and some of us are well on a suppresssed dose.

Before the blood tests were were diagnosed on symptoms and given NDT until symptoms went and we were well. Fibro, CFS, ME were unknown then!

[AnnT49 in reply to shaws]

I wish my GP was as informed as you are.

[Eddie83]

What makes me really sad is that only "healthcare professionals" can enter comments on pulsetoday.co.uk about the article. Those of us in the Thyroid forum see case after case of absolutely ATROCIOUS thyroid care! The fact that wronged patients can't post in the doctors' forum, is a perfect indicator of what the problem is.

[shaws Administrator in reply to Eddie83]

Also when a Professional wrote to the BTA and RCoP about their stance on NDT. He wrote to both and even sent them 3 yearly reminders and never even had the courtesy of a response. Dr Lowe has now died so we have lost another good humane doctor more concerned with relieving patients' symptoms than being dictatorial.

This is also a good doctor who speaks plainly about what he believes is stupid guides:-

drmalcolmkendrick.org/2015/...

TUKs respons re the Rebuttal - I don't know whether they got a response.

thyroiduk.org.uk/tuk/About_...

[Eddie83 in reply to shaws]

Zephyrbear tells it like it is: "self-treat". That is the out, and I wish there were a way to communicate this to all thyroid patients. Of course journalists can't ever say that in a mainstream publication, they would be crucified.

[shaws Administrator]

Pettals I think you know more than many experts There's nothing better than a personal experience.

[shaws Administrator]

If you sign up they don't ask for qualifications.