Who is the best Healthcare Professional to see

[helvella]

I was just on the website of an NHS GP practice. It offers this list of reasons you might need to see someone and identifies who would be appropriate.

Spot “thyroid” in any form! (“Tiredness and fatigue” doesn’t count – too nebulous, not at all specific.)

Given that levothyroxine is just about the most-prescribed medicine in both the UK and the USA (I know, might be number two and it does depend on how it is counted), wouldn’t you expect some mention of thyroid? Obviously, "thyroid" is not worth mentioning.

Who is the best Healthcare Professional to see for the following conditions:

Abdominal Pain — Acute Asthma — Alcohol Advice — Anxiety — Athletes Foot — Back Pain — Blocked ears (wax) — Blood Pressure Monitoring — Blood Tests — Blue Badge Forms — Boils — Breastfeeding Advice — Breathlessness — Bruised Ribs — Burns — Cellulitis — Cervical Smear — Chest Infections — Chest Pain — Children’s Immunisations — Chronic Heart Disease — Coils or Implants — Cold Sores — Colds — Constipation or Piles — Contraception and Family Planning — Cough — Cystitis — Dementia Screening — Dental Problems — Depot Injection (contraception) — Depression — Diabetes Monitoring — Diarrhoea — Diet/Lifestyle Changes — Dizziness — Dressings — Drug Addiction — DWP: GP letters for Personal Independence Payment (PIP) and Employment and Support Allowance — Ear Care/Ear Wax — Earache — Eczema — Emergency Contraception — Eye Injuries — Flatulence — Flu — Flu Vaccine — Forms, certificates and medicals — Fungal Infections — General Advice — Genital Infections including Herpes — Hay Fever — Head Injuries — Head Lice — Headaches — Holiday Cancellation Certificate — Housing – letter of support — Hyperventilation — Indigestion — Infected Wounds — Insect Bites — Insomnia — Insurance Reports — Medical Reports — Medication Reviews — Mental Health — Missed Contraceptive/Emergency Contraception — Moles — Mouth Problems — Nappy rash — Neck Pain — Nosebleeds — Panic Attacks — Passport Forms — Period Problems — Phobias — Pneumoccocal Vaccine — Rashes — Rectal Problems — Removal of Stitches — Shingles Vaccine — Sick Note (Fit Note) — Sinusitis — Skin Conditions — Smoking Cessation — Sore Eyes — Sore Penis — Sore Throat — Sprains — Stings — Styes — Sunburn — Termination of Pregnancy — Tetanus Injection — Threadworms — Thrush (Vaginal) — Tiredness and fatigue — Travel Vaccinations — Urine Infections — Vaginal Discharge — Verrucae — Vitamin B12 Injection — Vomiting — Warfarin Monitoring — Warts

[JGBH]

Not surprised! Doubt they will ever get it...

[helvella in reply to JGBH]

Oh, when will they ever learn?

[JGBH in reply to helvella]

I don’t think learning is what they want to do... Why change the long tested way of ignorance?

[shaws in reply to helvella]

When they develop a dysfunctional thyroid gland and then I hope they will have to jump through the 'hoops' that many members have to do before they get diagnosed, i.e. when TSH is 10 and the professionals are unaware of any clinical symptoms any more and will only give low doses of levo.

[shaws in reply to helvella]

They will learn if they or a member of their family develops it but who remain undiagnosed/untreated.

[FarmerDJ]

Sounds like they admit defeat when it comes to the thyroid lol, referral to endocrinologist is always better.

[fuchsia-pink]

[tongue firmly in cheek] ... perhaps they are tacitly admitting that neither GPs nor endo's are likely to be much use! And perhaps some of us would agree

[helvella in reply to fuchsia-pink]

So what are they much use at? Judging from the list, one general area seems extremely well represented:

Contraception and Family Planning

Depot Injection (contraception)

Emergency Contraception

Missed Contraceptive/Emergency Contraception

Termination of Pregnancy

[greygoose in reply to helvella]

None of which are necessary if thyroid isn't well treated.

[FarmerDJ]

I must admit my GP and endo have both been great. I couldnt imagine having an endo not knowing what they are doing. Must be awful.

[shaws]

Dr Skinner was a no nonsense doctor and a humane one at that, so who reported him to the GMC ? and one of his Admirers did a calculation of how often he had been queried by the GMC - who did the reporting?

After all is there any doctor in the UK who was reported to the GMC for the way they treated a patient, and who would have had 10,000 testimonials sent to say that Dr S saved their lives? Nowadays, (if there was a Doctor who treated patients' 'clinical symptoms' and not a blood test result) there is no doctors left who were trained as students all about the symptoms and how to diagnose a patient with symptoms. Nowadays it is all about the TSH which is from the pituitary gland and they don't know any clinical symptoms whatsoever nor how best to relieve them.

[linda96]

It’s the untreatable treatable condition.

Tiredness and Fatigue looked good for thyroid issues though.

[helvella in reply to linda96]

Not usually indicative of hyperthyroidism, though.

[linda96 in reply to helvella]

In answer to your question- Insomnia?

I’m personally appalled by this unwillingness of Endo’s to deal straight with thyroid patients.

Are the medics trying to get thyroid issues considered at the same level as a cold?

Are they saying we are biochemically euthyroid but have separate unconnected issues, such as anxiety - to push more drugs.

That they cannot see that this is systemic?

[helvella in reply to linda96]

Yes, I found that I would fall asleep, then wake up maybe half an hour to an hour later. And be unable to get back to sleep for hours, if at all.

But we all know that thyroid hormone peps you up so it would be the last thing to give someone with sleep problems. Wouldn't it?

Of course, adequate thyroid hormone and I now sleep pretty well.

Correct - they cannot see it is systemic.

[Hidden]

These look like things a practice nurse, pharmacist or minor illness clinic would deal with rather than a GP... ?? Seems a bit strange to me

[helvella in reply to Hidden]

They don't even end it with "And if you need help with anything else, ask the receptionist when you call."

[Hidden in reply to helvella]

In the practice I work at, barely any of these things would be dealt with by GPs. It doesn’t list the vast majority of conditions GPs would be involved with I don’t think the list has excluded thyroid problems in isolation. Where is cancer for example... that is the sort of condition our GPs are dealing with every day..

[helvella in reply to Hidden]

Yes - I agree. I simply don't understand how they got to that list and why.

Though some of them seem like things the GPs should deal with - like abdominal pain and Chronic Heart Disease.

[Hidden in reply to helvella]

Are you sure this is not some kind of care navigation list explaining to people that these complaints can be dealt with by health professionals other that GPs?? Our receptionists would aim to help people be seen sooner eg by a pharmacist who could help with sunburn, hayfever, thrush, worms, athletes foot etc. Rather than wait several weeks to be seen by a GP when that waiting time is unnecessary for such things.

I believe most GPs will not see dental problems as they are not trained to.

[helvella in reply to Hidden]

Yes - it is a navigation list.

And if you click on one of the items, it tells you who you should see - nurse, GP, etc.

But my point is that they have a somewhat bizarre selection of conditions in the list and thyroid just isn't there.

One example, which could cover a symptom of hypothryoidism:

Tiredness and fatigue

Feeling exhausted is so common that it has its own acronym, TATT, which stands for “tired all the time”.

Further information and help is available from NHS UK

If you feel that you are still experience symptoms of tiredness , please book an *online appointment with your GP, or alternatively please phone the reception desk on <> to arrange your appointment.

They obviously really don't want to see you.

[Hidden in reply to helvella]

I suppose most people would apply common sense to when they need to see a doctor, but traditionally some of these minor things listed would have been seen by a GP years ago. Now things have changed and nurses, pharmacists and clinical practitioners are available to treat many things. GP appointments are more commonly reserved for more complex conditions, people with multiple comorbidities, frail and elderly, more complex mental illness, cancer/palliative and end of life care. There is a national shortage of GPs and waiting times are getting longer as a consequence of this and an ageing population. The waiting times for other professionals are not always as long and they are trained and capable of seeing many things a GP traditionally may have seen. Believe me, a GP would be delighted to see a simple complaint, as it could help then keep running within The allocated 10 minutes per appointment. It’s not a case of them ‘not wanting to see you’ they just want all people to be seen in an appropriate timeframe. Waiting times would be ridiculous if everyone went to see their GP with the listed problems and the NHS as we know it would fail. If nothing changes it will... presumably that is why these care navigation lists are being used to try and help people access health care better. Not a GP but work with them.

[helvella in reply to Hidden]

The way I am looking at it is that if they wish to signpost that we should look it up on the NHS website, try self-help, possibly a practice nurse, or one of the administrative/receptionist roles, and only after that ask to see a GP, then that is their decision. I might not like it but it is a decision.

What we have here is something more akin to road signs that don't mention London, Leeds and Liverpool. Not because there are no roads or no people wishing to go to them, but because the people setting up the signage just ignored places beginning with L. Arbitrary and incompetent.

If we follow the Tiredness and fatigue entry to the NHS England site, we see:

Physical causes of tiredness

There are several health conditions that can make you feel tired or exhausted.

These include:

anaemia

underactive thyroid

sleep apnoea

Great - we are getting somewhere. But now we appreciate these possibilities, we go back to the list of who we should see. And not one of those is on the list.

This type of list needs to be exhaustive - even if the last option is for "anything else" and to ring and ask receptionist what to do.

[Hidden in reply to helvella]

I would probably have to see it to understand what you mean

[helvella in reply to Hidden]

This list is actually in use not just in one GP surgery, but a considerable number of surgeries.

Tiredness will get you into the NHS England website here:

nhs.uk/live-well/sleep-and-...

You will probably end up reading this:

When to see your GP

Symptoms of an underactive thyroid are often similar to those of other conditions, and they usually develop slowly, so you may not notice them for years.

You should see your GP and ask to be tested for an underactive thyroid if you have symptoms including:

tiredness

weight gain

depression

being sensitive to the cold

dry skin and hair

muscle aches

The only accurate way of finding out whether you have a thyroid problem is to have a thyroid function test, where a sample of blood is tested to measure your hormone levels.

nhs.uk/conditions/underacti...

Which, at last, gives some advice.

However, I argue that this is precisely where a blood test should just be done (e.g. by phlebotomist/nurse) and the result returned before having a GP appointment. (At least, if the aim is to minimise burden on the services.)

[Hidden in reply to helvella]

Our nurses would see both of those things and refer to GP in cases of uncertainty

[humanbean]

Blocked ears (wax)

I have read very recently that some surgeries are telling people they don't deal with this any more. The patients are told to use olive oil or products from the chemist, and if they don't work then they have to go and pay privately at places like Boots or Specsavers. I wish I could remember where I read this, but sadly I can't.

I don't know how other people would deal with the list but I would use self-help as much as possible for many of them.

My fear otherwise would be that I would be told my problem was caused by mental health issues. Once that happens then everything you see a doctor about is "caused" by a mental health problem and you'll only get treated for visible problems (if you're lucky).

I have just noticed that the list includes vitamin B12 injections. They have to be kidding don't they? They think everyone with a B12 deficiency only needs a jab every three months and they (the patients) are attention seekers if they ask for a jab more often. Similar dismissive treatment could occur with several other problems on the list.

And I can imagine the reaction if I went to see a doctor with a cough! Total dismissal would be common.

Based on my knowledge of how doctors react to me personally and other people I know or have known in the past, it's a nonsense to suggest doctors treat all those things or take them all seriously.

[Gcart in reply to humanbean]

I had a cyst in the armpit that was extremely painful to wash .

My GP said they don’t do those and I would need a private appointment and pay. £360

I thought I would put up with it

About 2 weeks later I had to have antibiotics for a chest infection and they cleared up the cyst also .

RESULT 🤣

[helvella in reply to Gcart]

Sounds totally arbitrary - we won't do anything about this <bit of body> having <this issue>. Would a painful cyst somewhere else have been treated? Or a different issue with an armpit?

Perhaps that explains the problem. Thyroids are mostly in the "we do not do this organ" category...

[humanbean in reply to Gcart]

That is appalling! And I can imagine a serious scenario where the cyst spread infection throughout your entire system and made you septic.

Is there any way you could make a complaint to your local CCG? Healthcare is still supposed to be free at the point of use, in theory, as far as I know.

[Algic]

There's none for fibromyalgia either and I have both but the fibro may actually be MS. As I've now got proof thanks to the new scan in specsavers I've got optic nerve damage clearly visible. Explains loss of visual field.

[shaws]

I'm positive that was the case and one of Dr S's admirers did a 'calculation' of how often he appeared before the GMC. I cannot remember the number but am sure it was in the thousands to 1.

Also, since Dr S's death his staff have worked so hard to collate all of their research and are on the point of publishing it it when they had sufficient funds.