Professional Negligence - if refusing to test T3?

[Shelley1954]

Surely if GP's are failing to test a patients T3 and by private blood test it is shown to be below range or a poor converting issue, then the patient has a case for a professional negligence claim? There are plenty of companys out there who may take it on with no win no fee claim, a few of those might kick start a rethink into how this sorry issue is being dealt with (or ignored!)

[Clutter]

Shelley1954,

I doubt you'll find a no-win-no-fee legal company to take on a medical negligence claim against a GP who is following local health authority agreements which deem that FT3 testing isn't required.

[Shelley1954 in reply to Clutter]

I understand that, but worth a try, or maybe go to the ombudsman with a complaint. It seems after a complaint with the surgery that is the next step, bombard the ombudsman, if nothing else it gets the issue noticed.

[Hidden in reply to Shelley1954]

Shelley1954 the Ombudsman defends the NHS regardless of mistakes that doctors have made. Utter shower of sh!te and I'm speaking from experience. They employ imbeciles who ignore complaints, lose e-mails and correspondence, misinterpret anything one writes and this is all done cos they want the patient to give up out of sheer frustration.

[Shelley1954 in reply to Hidden]

That sounds terrible for you, I have to say my experience is the opposite, maybe I got lucky. Having been treated so badly have you done anything about it? They should not be allowed to treat someone like that.

[Hidden in reply to Shelley1954]

Shelley1954 you must have got lucky! I've asked for a review as they're defending GPs who repeatedly misdiagnosed, my question was why did they consider that GPs knew more than the NHS Endo who diagnosed me thus proving the GPs were wrong.

I wouldn't trust a GP to tie my shoe laces, as far as I'm concerned nothing has changed since Harold Shipman's time. What other job has no accountability?

[Bluecat101 in reply to Hidden]

Interesting and useful

[Clutter in reply to Shelley1954]

Shelley1954,

A GP won't be found guilty of negligence when adhering to agreements and guidelines issued by the Association of Clinical Biochemistry (ACB); the British Thyroid Foundation (BTF); the Royal College of Physicians (RCP); and the Society for Endocrinology (SFE).

[Shelley1954 in reply to Clutter]

But they are guilty of negligence if refusing to test and then a patient shows that their T3 is under range or not converting. Regardless of guidelines they have a duty to make patients well not fob them off.

What about the endos/GP's that do test and recommend T3, are they guilty of acting against the guidelines?

Its not really the winning of a case that is important but the threat of action that may cause some rethinking of these guidelines.

[Clutter in reply to Shelley1954]

Shelley1954,

Then the bodies that draw up and agree the guidelines are the ones which should be attacked not GPs who are advised that they are best practice guidelines in the management of thyroid testing.

[smudger1 in reply to Clutter]

Maybe that is the way forward Clutter?

At the end of the day they are following guidelines not rules/regulations, maybe it suits them to hide behind this, costs spring to mind again.

[marigold22 in reply to Clutter]

What about the letter Sheila Turner of Thyroid Patient Advocacy wrote to Jeremy Hunt and his reply ? He said "Doctors are encouraged not to rely too heavily on the results of blood tests but to use their clinical knowledge and an assessment of the symptoms experienced by individual patients in making a diagnosis for thyroid treatment. Doctors are free to use whatever guidance they feel is appropriate when making a diagnosis. This includes guidance published in other countries.

I should add that under their terms of service GPs are allowed to prescribe any product including any unlicensed product or product not licensed for a particular indication that they consider to be a medicine necessary for the treatment of their patients under the NHS."

This is Sheila Turner's letter ------

Note from Sheila Turner, Chair of TPA (Thyroid Patient Advocacy)

(Published on 15th November 2013 00:27 Updated 1st May 2014 Number of Views: 956)

Because I could not find the definitive source within the Department of Health for the statements below on the 2 February 2013 I wrote direct to The Rt. Hon Sir Jeremy Hunt MP (Secretary of State for Health in the UK)

Show it to your GP/Endocrinologist if they insist they cannot prescribe anything other than levothyroxine-only and/or cannot prescribe unlicenced drugs.

Show it to those doctors who state they are not allowed to follow other thyroid guidelines other than the RCP’s policy statement.

Show it to those doctors who claim they are not allowed to diagnose if blood results are within the reference range – and help further their education.

The Secretary of State for Health states doctors can use other thyroid hormones other than levothyroxine-only; they can prescribe unlicensed drugs; they can follow whatever guidelines they wish even if they are from another country.

________________________

Dear Jeremy Hunt

I am founder/Chair of Thyroid Patient Advocacy (TPA) tpauk.com.

There are no official guidelines for the diagnosis and treatment of hypothyroidism or guidelines for those suffering from peripheral thyroid hormone deficiency and I wondered what the situation is for medical practitioners when all they have as guidance is a policy statement issued by the Royal College of Physicians.

Are doctors allowed to follow guidance/guidelines of their choice whoever has written them and choose guidelines even if they are from a different country? TPA has thousands of members of their Online Thyroid Support Forum many saying their doctor has told them that they are not allowed to diagnose or treat outside of the RCP policy statement. I would be grateful for a definitive answer to this question please.

Kind regards

Sheila Turner (Chair) Thyroid Patient Advocacy (TPA) tpauk.com

_______________________

DEPARTMENT OF HEALTH RESPONSE:

Our ref: DE00000756922

Dear Mrs Turner

Thank you for your email of 4 February to Jeremy Hunt about hypothyroidism treatment. I have been asked to reply.

I should explain that the Royal College of Physicians (RCP) and the British Thyroid Association (BTA) are independent of the Government. The Department of Health has no plans to ask the RCP to withdraw its clinical guidelines for the treatment of this medical condition. Nor does the Department have any plans to produce guidance on the diagnosis or treatment of hypothyroidism. UK Guidelines for the use of Thyroid Function Tests are published jointly by the Association for Clinical Biochemistry and the BTA.

Doctors are encouraged not to rely too heavily on the results of blood tests but to use their clinical knowledge and an assessment of the symptoms experienced by individual patients in making a diagnosis for thyroid treatment. Doctors are free to use whatever guidance they feel is appropriate when making a diagnosis. This includes guidance published in other countries.

I should add that under their terms of service GPs are allowed to prescribe any product including any unlicensed product or product not licensed for a particular indication that they consider to be a medicine necessary for the treatment of their patients under the NHS. This is subject to two provisos which are:

– the product is not included in Schedules 1 or 2 of the NHS General Medical Services Contracts (Prescription of Drugs etc) Regulations 2004 otherwise known as the Selected List Scheme; and

– GPs are prepared to justify any challenges to their prescribing by their primary care trust.

It is the responsibility of health professionals to decide on the most appropriate treatment for their patients. If a person has any concerns over their treatment or the drugs they are prescribed they should raise these concerns with their GP or consultant.

I hope this reply is helpful in clarifying the Departments position.

Yours sincerely

Peter Wozniak

Ministerial Correspondence and Public Enquiries

Department of Health

[Kitten1978 in reply to Shelley1954]

I admire your feistiness!

[Bluecat101 in reply to Shelley1954]

l like that - not thought that far. Ombudsman is another good thought. And by the way folks l understand from Crime Support that you can take your Landlord to Ombudsman if they fail to protect you where needed - even if it is a Council.

[ThyroidObsessed]

I agree!!!

I went to the extent of actually lying to get my t3 tested!! by saying that i had called a endo at my local hospital and said that they had told me that i certainly need my t3 tested, so my gp did it!! dont think she was happy though!.. but thats just because the surgery has to pay for it!

[MissFG]

Think I'm lucky and my surgery don't question it. But as it was difficult to get me stable then going on to trial T3 I've always had my TSH FT3 and FT4 tested every 4 weeks. I have one nurse who thinks it's all fine automatically then the lab only does TSH and FT4. So the receptionists have to ring up and request it's added on. But overall as I come across and knowledgable polite but assertive I don't have any issues.

I have also however said the odd white lie i.e. "My Endo said...." but only when necessary

[ThyroidObsessed in reply to MissFG]

I have used the "my endo said" but needs must and all lol

[MissFG in reply to ThyroidObsessed]

Yep and usually it takes a week or two for letters to filter thru so they just take our word for it. But wouldn't need to if they were more proactive

[cwill]

In law negligence requires that the health professional be proven beyond reasonable doubt to have acted as others wouldn't. So pretty much as said above with all guidelines hailing TSH and bloods only to treat us the case would be a non-starter with the law as it stands. There would be no end of 'experts' to state that the doctor did what 70% of their colleagues would do and that in fact they were compelled to address the patients case in that way by all treatment guidelines (an easy case to bring for negligence if the doctor goes against them without compelling reason).

It is not ethical or moral to our point of view but that is another discussion. I think that the legal case for everyone that has T3 withdrawn on cost grounds after proving the benifit is on firmer ground but that might still be a reach for the legal process. You need data for cost benefit analysis and quality of life calculations. Anyone wanting to give that a go?

[SeasideSusie Remembering]

It's frequently the case that a GP will agree to test FT3, it gets requested but it's the lab who makes the decision not to test it.

No win, no fee, law firms are notorious for only taking on cases they think they have a high chance of winning.

[Hidden]

In Scotland they have been campaigning the Scottish Parliament to introduce T3 testing..

Surely this is the way forward ?

[Bluecat101]

l too am wondering on this issue - as Soton Path Labs refused to do the testx2 without saying so. One needs exact definitions! l am beginning to understand that if a patient is found in need of certain treatment, l believe they have a right to it under NHS. These Labs appear to be refusing to do it so that the GPs do not have to prescribe (£300 for 2 months) However, a consultant has now done the test at her Hospital - and it carries more weight when requested by Consultant. l will find out Friday if l should need it or other. l wd be happy to buy in France or Greece for 2 euros rather than have NHS ripped off by Pharma. l wonder if NHS wd acknowledge blood tests done privately?

[helvella Administrator Thyroid UK]

Patently not the case.

Are you able to point at a SINGLE case of a doctor being held to account by the GMC for a thyroid-related issue from a patient? Other than Drs Skinner and Peatfield - which were not patient complaints.

Maybe in theory they could, indeed should, be held to account but that does not actually happen.

[helvella Administrator Thyroid UK]

If you think that the typical badly treated thyroid patient is in a position to put in a GMC complaint and see it through, you are on another planet.

[helvella Administrator Thyroid UK]

That there is not a list of thousands of cases is proof that it ain't quite so simple as you are insisiting it is.

[helvella Administrator Thyroid UK]

Please do not say I am scared of complaining when you know absolutely NOTHING about my history of such things.