Avoiding a 'near hit'

[helvella]

We have seen so many people post about receiving results inappropriately - not at all, missed, with the "normal" comment, or whatever. This is from The Medical Protection Society Limited - a possibly interesting source?

Avoiding a 'near hit'

Clinical Risk Programme Manager Julie Price shares simple tips for handling test results

Dr Murphy, I came to see you two months ago and am still feeling unwell. I saw the nurse for the blood tests you ordered and phoned for the results a few days later as requested; the receptionist told me they were all normal so I don’t understand why I feel so tired?”

Dr Murphy reviewed Miss Y’s computer record, accessing the results of her blood test. Most of the results were normal but there was one showing abnormalities – the thyroid function test (TFT). Dr Murphy knew immediately what had happened. He had brought up the issue of relying on the patient to telephone the practice for their results many times. Miss Y had telephoned after a few days, but the TFT results took longer to be returned.

Dr Murphy explained the oversight to Miss Y, offering an apology. He diagnosed primary hypothyroidism and prescribed thyroid replacement therapy. “Phew,” he thought. “No harm done then, but a near miss, or perhaps more accurately a near hit.” Dr Murphy discussed this error with the other GPs over coffee later that morning. He knew the practice test result system was flawed.

medicalprotection.org/irela...

preview.tinyurl.com/HU-TUK-...

Of course, the "no harm" might be in the eyes of the doctor. Two months of possibly significant hypothyroidism isn't something to be dismissed to airily, I think. Could be enough for someone to lose their job, crash their car, and go through all sorts of psychological issues.

[humanbean]

I think you might find it hard to convince many doctors that hypothyroidism was any more serious than having a cold or mild flu. So a diagnosis missed for a couple of months would be considered "no big deal".

[helvella in reply to humanbean]

Couldn't agree more.

[humanbean in reply to helvella]

Incidentally, an off-topic but relevant bit of info...

I don't know if you noticed but your link contained apostrophes and hasn't displayed correctly as a result. I've noticed this happening quite frequently recently and finally sent in a report about it to HU Support a few days ago. I hope they fix it soon.

[helvella in reply to humanbean]

Drat - you are right.

[TSH110 in reply to humanbean]

humanbean

Months? You could change that for years - nearly 20 for me!

[Jodypody]

Amen to that. I did crash my car and left my job as I couldn't cope. Luckily for me my boss likes me and asked me to come back after a few months

[JayPer]

Thanks for that - interesting. I was told over the phone that a range of blood tests were normal - but two of them hadn't got back, including thyroid. It was only when I insisted on getting print outs that they realised. The other two were normal as well, and I trust my doctor would have let me know if they hadn't be (she phoned me about low B12 last year). But I'm not sure.

I like to know how normal is "normal" as well, how close to the edge of the range.

[Marz in reply to JayPer]

Normal is an opinion and NOT a result Many GP's consider an in-range result to be normal - however as we know it is where you are in the range that is important. TSH 1 or under if on medication for most -which Docs seem not to understand. FT4 and FT3 need to be in the upper part of the range. Anti-bodies ?

Ferritin - mid range. B12 around a 1000. Folate mid-range and so on.

If your surgery rang about Low B12 - it must have been very low. What was the result ? How much are you taking ? B12 Deficiency can become a neurological condition when the result is under 500 - and is undertreated ....

[JayPer in reply to Marz]

Can't find the printout now (it was the beginning of 2014) but from memory, folate was good, ferritin had been about 12 (range 30-400) until I took iron supplements, and B12 was well under the reference range too. I had the loading doses of B12 and then an injection every three months, though the nurse now lets me get these every 8 weeks.

So I am not sure what is going on, whether it is B12d, CFS/ME or there might be an underlying thyroid problem. Life is full of interest and learning, isn't it?

By the way, Truro was surrounded by thick fog yesterday. I bet Crete was lovely!

[Marz in reply to JayPer]

Hi JayPer

Just wondered if you now have your thyroid results with ranges ? Did they test the FT3 ? That is the most important thyroid hormone and is needed in every cell of the body. It could be linked to your other diagnosis if low ..... So the FT4 and FT3 need to be towards the top of the range

Ex Truro inhabitant before moving to Crete in 2004 ! - and yes the Docs there missed my Hashimotos/Thyroid problems. Was diagnosed here and the Fibromyalgia diagnosis from a Private Consultant in Truro soon disappeared when I was optimally treated with thyroid hormones and supplements !

[JayPer in reply to Marz]

Hi Marz,

My TSH was 2.50, range 0.27-4.2. FT3 and FT4 weren't tested as TSH was in range.

I have a diagnosis of CFS/ME, and am seeing the CFS consultant in Truro, though as there is no treatment for it, it is more for reassurance that I am doing as much as I can to help myself get better.

[Marz in reply to JayPer]

I would suggest you having the FT4 and FT3 tested - or the whole thyroid Profile done privately through Thyroid UK with Blue Horizon. The TSH is not a good barometer of your Thyroid health - you need the FULL story. Also have the Thyroid anti-bodies tested. CFS is so often LOW T3 - so without the test - how would they know ? Once you have the CFS label on your notes everything will be attributed to that and the appropriate testing will never happen.

thyroiduk.org.uk/tuk/testin...

The testing kit can be sent to your home and the results likewise. Also the above link will give you all the information you need about the thyroid and why the tests I have suggested are so important. I was once diagnosed with Fibro and 5 years later Hashimotos. Once correctly treated for the thyroid the Fibro disappeared Sadly Docs do not know enough about the Thyroid.

You will not recover if your FT3 is low - it is the most ACTIVE thyroid hormone and is needed in every cell of your body. I have seen around 14 test results of people here in Crete and although the TSH and FT4 have been in range the FT3 has been low. Check out Low T3 Syndrome on the internet. It is not being in range that Docs so love - but WHERE you are in the range.

Wishing you well .....

[JayPer in reply to Marz]

Thank you very much for that, will investigate the possibilities.

[Marz in reply to JayPer]

As the name suggests CFS is a syndrome - so lots of causes - so best to eliminate the ones you can

Have you looked at Dr Sarah Myhills website ?

drmyhill.co.uk/wiki/CFS_-_T...

As T3 is needed in all the cells she discusses then best to check the level .....

[Bob00752]

My GP practise asks you to ring for test results in a week and at a given time slot. Twice (over many years) they have rung me after a couple of days saying the results are back and to make a followup appointment with the Dr as one test is out of range.

I now look for the results on line as you can also see earlier test results, graphs, normal ranges etc. Best GP practise is surely to initiate action by a phone call if the results show a need to add or change medication.

[SilverAvocado]

Another issue I've found with this is friends who believe a doctor who says 'this is normal, go away', and then feel they aren't allowed to return if they still have symptoms. Another friend was recently successful getting T3, and told us her strategy had been to go back to the GP every week kicking up a fuss until she got her endo referral.

I think GPs generally operate on this principle -they try things that probably won't work, and rely on patients popping up again if problems continue. But lots of patients will not, or will wait a long time before they go back. Or, as you say, will wait until losing a job, losing a relationship, etc to get desperate enough to go back to the GP cap in hand.

I've noticed this a lot while I've had extremely low mobility in recent years. At times I've been seeing an average of one doctor a week, so seeing my GP in addition was just out of the question.

[Bluemaxx]

When I phoned up the Surgery for my thyroid test results the first time the receptionist airily told me, 'Oh everything's o.k. you just have to get re-tested in three months." I asked for a copy of my results and my TSH level was 6.32!!!! and the page said, 'Possible subclinical hypothyroidism re-test in three months."

I am just outraged about this. I should have been given a doctor's appointment to discuss the results and to ask me if I had any hypothyroid symptoms or, at the very least, the receptionist should have read the whole thing out so I could have decided myself if I needed to be concerned! How dare they play around with our lives like this!

Luckily I had found this website so I knew not to take things at face value.

Oh, and by the way, I only asked to get my thyroid tested because I was considering IVF and that is a requirement. None of the doctors picked up on hypothyroidism as a possibility for all the health problems I had been having - despite frequent visits to the doctors and also having extremely low blood pressure and temperature!!!!!! Why do they check these things routinely if they don't take any action.......

[helvella in reply to Bluemaxx]

My view is that anyone considering pregnancy should be get a thyroid test. No-one should get as far as discussing IVF without that.

[BeansMummy]

I don’t actually trust anyone at my GP’s surgery to take note of any of my test results, whether they are marked as normal, out-of-range or whatever. I’ve been told my thyroid function tests are “normal” before now, have gone to collect a print-out, and found that they are anything but “normal” and are actually out-of-range. I have had to query thyroid and other test results with the GP, and had a dismissive attitude and an “oops, gosh, that needs some treatment”. What’s the point of doing any tests if the results are ignored?

Worse still, I once went for an appointment for something unrelated to any previous appointments. I hadn’t even sat down to discuss why I was there, when my GP said, “please don’t panic, but I’ve just checked your recent heart tests” (recent being three weeks previously), “and you now have to go to A&E, but you can’t drive yourself.” Somebody must have seen those test results, but no-one had thought to contact me. If I hadn’t gone for that particular appointment, would anyone have ever contacted me?? I ended up being under the care of a cardiologist for another 3 years.

[helvella in reply to BeansMummy]

BeansMummy,

And leaving your car in their car park for three years because you couldn't drive it away?

(Obviously not. But if was was OK to let you continue to drive including to attend the appointment, despite it not being OK, they would have deserved the problem of getting your car back to you. Quite a lot of people have no-one who is insured and capable they'd be willing to allow to drive their car for them.)

[BeansMummy in reply to helvella]

Funnily enough, it was the first time I had driven myself to an appointment in a long time - I'd been incapable of driving, and even more incapable of having coherent discussions with doctors - symptoms now sorted out with B12 injections which they resisted giving me for months. My GP did not consider any of those symptoms anything that needed addressing at any point over the previous year (or two). I decided that morning that I felt OK to drive, so packed my husband off to work!

I had to sit in reception, wait for my husband to drive home from work, then walk to the surgery, and drive me to the hospital in my car, which took an hour. I sat there wondering if I was going to die on the spot at any moment as my GP had been extremely concerned. Not, of course, remotely concerned about me for the previous three weeks ...