Hi Di588. The bad news is that all docs should follow the NICE guidelines. I see someone else has posted a relevant link. They are only guidelines, ie not mandatory, so doc is allowed to engage brain, and treat you as an individual (see NHS Constitution).
“The NHS belongs to the people.”
“The patient will be at the heart of everything the NHS does. NHS services must reflect, and should be coordinated around and tailored to, the needs and preferences of patients, their families and their carers.”
“The NHS is accountable to the public, communities and patients that it serves.”
“The system of responsibility and accountability for taking decisions in the NHS should be transparent and clear to the public, patients and staff.”
“Working together for patients. Patients come first in everything we do.”
“We put the needs of patients and communities before organisational boundaries.”
“Everyone counts. We maximise our resources for the benefit of the whole community, and make sure nobody is excluded, discriminated against or left behind. We accept that some people need more help, that difficult decisions have to be taken – and that when we waste resources we waste opportunities for others.”
“You have the right to receive care and treatment that is appropriate to you, meets your needs and reflects your preferences.”
Putting Pts First: NHS Business Plan
“Ensuring that people have a positive experience of care; improving patient experience of primary and hospitals and community mental health care.”
“The Francis report made clear the impact that organisational culture and values can have on care: a top down management system driven by national targets can skew priorities and cause us to lose sight of what is most important.”
If you look at the Code of Ethics for GPs gmc-uk.org/guidance/good_me...
It clearly states you're entitled to a second opinion, and GP has to respect that.
"d. consult colleagues where appropriate
e. respect the patient’s right to seek a second opinion"
" 3.15. You must provide a good standard of practice and care. If you assess, diagnose or treat patients, you must:
1.a. adequately assess the patient’s conditions, taking account of their history (including the symptoms and psychological, spiritual, social and cultural factors), their views and values; where necessary, examine the patient
2.b. promptly provide or arrange suitable advice, investigations or treatment where necessary
3.c. refer a patient to another practitioner when this serves the patient’s needs."
The NICE guidelines direct docs to the BNF (drug handbook).
Which states the following:
"ADULT over 18 years, initially 50–100 micrograms once daily, preferably taken at least 30 minutes before breakfast, caffeine-containing liquids (e.g. coffee, tea), or other medication, adjusted in steps of 25–50 micrograms every 3–4 weeks according to response (usual maintenance dose 100–200 micrograms once daily); in cardiac disease, severe hypothyroidism, and patients over 50 years, initially 25 micrograms once daily, adjusted in steps of 25 micrograms every 4 weeks according to response (usual maintenance dose 50–200 micrograms once daily)"
Looking for a diagnosis? Several sources clearly state that signs and sympomts should be considered.
The identification of the nature of an illness or other problem by examination of the symptoms
Oxford Reference Concise Medical Dictionary 3rd Ed. 1990; Oxford University Press, Oxford (old fashioned book edition, ie not web)
Diagnosis: The process of determining the nature of a disorder by considering the patient’s signs and symptoms, medical background, and – when necessary – results of lab tests and X-ray examinations.
Perhaps putting things in writing, and reminding doc of above may help.
I hope you get the right treatment sooner rather than later.