My GP sent me a letter about my behaviour asking him to look at my private blood tests and refusing to accept TSH only result that he did. He says I was difficult and non compliant with the Doctor Patient relationship. I think once I have seen a private doctor who may disagree with him he will kick me out. I can not even complain, it is awful when patients are treated like disobedient children. Faith.
Doctor sends letter : My GP sent me a letter... - Thyroid UK
Doctor sends letter
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37 Replies
•
I think he's the one that is non-compliant with the Doctor-patient relationship. It's supposed to be a partnership, not a dictatorship. I agree with Scrumbler, you should complain.
• in reply togreygoose
I would complain but he is the doctor who owns the practise and his staff do what he says.
I'm sorry to hear what your doctor has said .. mine has put "difficult patient" and "delusional" on my records which has made me very angry even though it was over 10 years ago. What really gets me mad is the receptionist has also made a comment about me and she is just a pen pusher! The reason she has put something about me on my records is because I asked for a print out of my blood results and she refused to give them to me so I told her it was the law and she had no choice. She then banged her hand on the desk so I asked to see my GP who then printed out my results himself and handed them to me.
• in reply toLora7again
Your do tor sounds worse than mine.
My doctors are the same. Diagnosed last year and I cannot take levo. So asked for something else. They refused and then said I’m refusing to take them. Like it’s my fault 😢 so now I cannot contact them as I’m scared of getting angry because I don’t feel well, In case he strikes me off
That’s so bad, doctors are supposed to be helping us not making things worse. We don’t think they are gods, but obviously some of them think they are gods themselves.
Thank heavens my own doctor is understanding and helpful.
What gets me is they can be rude to us patients but we cannot be rude to them. I have had a few argument with doctors in the past and they have made comments like "You shouldn't use google to diagnose yourself" Well sometimes we have no choice if they don't diagnose us correctly. In my case a hair site told me my TSH was suppressed when several GP's and a dermatologist hadn't spotted it. I kept going back for over 2 years until a new GP helped me after I explained what I thought was wrong with me. He then said he could actually see I had a goitre and listened to it with his stethoscope. I could have kissed him after being ignored for so long.
I have no idea why they think googling a problem is bad! Most of those articles are written by doctors. It must be down to ego.
I’ve got an enlarged goitre and they’ve not even checked it, it’s so wrong that you have to try and take control of your own health. 😢
• in reply toDorey69
I know how you feel we are not children who have been naughty. It is so easy for them to use fear against us.
I’d find a new surgery.
I agree. I complained about my GP and had a long conversation with nhs England who told me gp surgeries are actually self employed (called fund holding) they can refuse you as a customer by saying you are non compliant difficult deluded etc, there is no real complaint process. I also took first Endo all the way to ombudsman and won. However the result is the same you have to get new gp surgery, save your energy, anger and time just get diff Dr. For me I just wanted to prove I was right!!! Wasnt worth the effort.
I'm not a fan of complaints any more either...... i've decided to stick around and be a thorn in my GP's side.
He told me plainly ' the dose is 100, you'll die'.... so it's worth it just to prove him wrong. He has since had to relent and agreed to put my dose back up at my own risk.
It wouldn't be possible to escape his beady eye anyway, since all the practices in my town have been amalgamated, and i'm out of bounds for the neighbouring town.
Even if you gain the satisfaction of being proved right , the consequences that follow in attitudes to your later treatment may not be to your advantage.
(When i was a biker , i complained about some police actions, and the offending constable was reprimanded and made to apologise to me in the station. This felt very satisfying for about a month. Following that i was stopped at every single 'random' traffic check i drove past on that bike for 3 years. It didn't stop till i got a different bike)
Also , my current GP, has physically seen the effect on me of his enforced reduce dose, i'm not sure that a different GP would be willing to believe it if he hadn't seen it with his own eyes.
Brilliant i will now be thinking of you every year going in and saying 'omg look at me still alive!' brilliant 
I like to imagine how much peer pressure he 'll be under, since he's one of the senior GP's, who is now allowing his patient to be 'overdosing' on Levo with a 'dangerously suppressed TSH', while he is forced to admit that when he reduced it, i talked like i'd had a stroke, and became totally constipated.
I wonder how he squares that with 'TSH is infallable' ?
Maybe he's learning something. We can but hope.
• in reply toendomad
Thanks for your advice I suppose thyroid patients have to keep fighting. I wonder sometimes if we live in a democracy.
• in reply toendomad
Thanks for your advice doctors have too much power. I do not think they have read the NHS constitution.
endomad• in reply to
If the drs were doing their job, there would be no need for forums like this! one lady on this forum told me her dr has written on her notes' belongs to trouble making political lobbying group, is a problem patient and compulsive complainer'! so even moving dr i expect she will get short shift from any new dr. I find it absolutely mad that i am prepared to lie to my dr to keep the status quo! i take my husband with me on appts and i find they are far more careful in what they say, i also record all appts on my phone (in case) I have a nice dr who admits to not knowing much about thyroid and says if i feel ok she is happy to follow my lead. The honest truth is i will never trust a dr again.
So sorry for you. Outrageous pomposity of some docs. They learn the basics at med school, that’s it. Hopefully might pick up a bit of empathy and regard for patients but very likely not.
Particularly GP’s are hard pushed to know much about all the myriad of illnesses.
The best you can hope for is one who has the honesty to admit this isn’t their field and refers you on to a specialist.
Then of course there are good and not so good specialists.
I find it best to go armed with research and ask for what I want. We have a few gps to choose from though.
I agree it is a worry and a bind though, having to double check and be your own healthcare advisor because the ones available to you are not up to the job.
• in reply toLiliBili
Where is the evidence research for treating thyroid patients according to their symptoms, it seems not to be there?
I don’t understand how voicing your opinion about your health is considered being difficult, its your health and your concerns are legitimate. Sad!
• in reply toBatty1
Some doctors do as they please, but it seems patients are just unimportant to them. Maybe we should have more choice about which doctors we see.
Batty1• in reply to
After years of battling Endos I finally just started paying out of pocket for my current Endo and Rheumy ... wouldn’t say they are perfect , its better than being told my issues are in my head.
I had a doctor who told me that my thyroid meds would give me a heart attack, that the functional doctor I had been seeing was a quack and then said -it’s him or me, choose one doc- so I said, thanks for nothing, see ya! Jerks
Good advice
We are not allowed to voice an adult opinion and they reduce us to the status of a child, they have all the power if we cannot find a better doctor. I liked your attitude.
The above comment was for Katurajo1 the reply system has broken down.
It *looks* like you clicked on the Reply button for the thread, not the actual reply.
Regardless, if you want to call out to someone when not responding directly to them, follow the help information here:
support.healthunlocked.com/...
This is what happens:
Katurajo1
Get another doctor?? Life with thyroid disease is hard enough with a good doctor!
You express fears that are common in the thyroid community. However, the General Medical Council and the National Health Service are aware of concerns that a doctor may “strike” patient off their list. The GMC has put requirements on the code of practice to help prevent doctors raking such unnecessary and disproportionate actions
Ill take different parts of your post and give you some help and reassurance to give you confidence to speak with assurance to your doctor
1. I cannot even complain.
The NHS Constitution says:
You have the right to have any complaint you make about NHS services acknowledged within three working days and to have it properly investigated.
You have the right to discuss the manner in which the complaint is to be handled, and to know the period within which the investigation is likely to be completed and the response sent.
You have the right to be kept informed of progress and to know the outcome of any investigation into your complaint, including an explanation of the conclusions and confirmation that any action needed in consequence of the complaint has been taken or is proposed to be taken.
You have the right to take your complaint to the independent Parliamentary and Health Service Ombudsman or Local Government Ombudsman, if you are not satisfied with the way your complaint has been dealt with by the NHS.
gov.uk/government/publicati...
So you can complain if you want to.
The GMC say in the specific Code of Practice Ending your professional relationship with a patient
gmc-uk.org/ethical-guidance...
You should not end a professional relationship with a patient solely because of a complaint the patient has made about you or your team, or because of the resource implications of the patient’s care or treatment.
So you shouldn’t be “de-listed” if you make a complaint.
2.I think once I have seen a private doctor who may disagree with him he will kick me out.
Good Medical Practice says at paragraph 16 e that a doctor should respect the patient’s right to seek a second opinion
gmc-uk.org/ethical-guidance...
So you can go to a private doctor if you want to.
In Good Medical Practice the GMC says at paragraph 62
You should end a professional relationship with a patient only when the breakdown of trust between you and the patient means you cannot provide good clinical care to the patient.
gmc-uk.org/ethical-guidance...
Exercising your right to seek a second opinion should not be a basis for a doctor to claim that by doing so, the trust between a doctor and a patient has broken down. Just seeing a second doctor does not automatically mean that your first doctor cannot provide good clinical care to you. Remember, your doctor has to respect your right to seek a second opinion.
In summary
> you can complain if you want to.
> you shouldn’t be “de-listed” if you make a complaint.
> you can go to a private doctor if you want to.
I'll post separately about giving your doctor results from private blood tests.
I forgot to mention that despite the GMC saying patients have a right to a second opinion, patients actually DO NOT have such a right in law.
Having said that, most doctors will accept a request for a second opinion from them. Refusal should be rare, and mostly where the patient lacks the mental capacity to make that decision.
See this document for a further explanation of one second opinions.
I think that the doctor should accept your private blood test results and here’s why.
The General Medical Council produced a Code of Practice for doctors called Good Medical Practice paragraph 16b places a duty on a doctor registered with them to “provide effective treatments based on the best available evidence”
gmc-uk.org/ethical-guidance...
Having looked at the rest of the Code of Practice I can’t find a definition of what the GMC say is the best available evidence.
What is NOT best available evidence?
When the medical profession talk about evidence, they often start talking about “Evidence Based Medicine”. Some doctors assume that “evidence” is only research, and usually reduce that research to Randomised Control Trials, which in turn are generally based on a sample of a population. Some Doctors think that is all Evidence Based Medicine is. But that is not the case. EBM had to be applied to the individual patient in front of the doctor. There is a very good video on Youtube to explain more about EBM and its pros and cons in this video by
In fact, relying solely on Randomised Control trials can be in conflict with the GMCs guidance that good doctors must treat each patient as an individual .
It is important to note the the GMC doesn’t actually say that the doctor must use EBM alone. THE GMC clearly say Best Available Evidence, not solely EBM.
What is best available evidence?
To break down what this duty with regard to blood tests means, I'll discuss what “evidence”, “available” and “best” means.
In general, evidence is anything that can be used to prove something. Evidence of whatever type must be both relevant and “admissible” - in this context usable. Evidence is
relevant if it logically goes to proving or disproving some fact at issue.
It is usable if it relates to the facts in issue, or to circumstances that make those facts probable or (improbable), and has been properly obtained.
hse.gov.uk/enforce/enforcem...
Evidence
For the purpose of presenting blood test evidence to a doctor I’ll say that there are 3 types of evidence.
“Witness” statements. These can be
in the form of letters to the doctor describing signs and symptoms and the results if your treatment
or simply telling the doctor your symptoms in the surgery.
Real Evidence. This means tangible items. In this case it means the patient in front of the doctor. This can be the signs and symptoms of thyroid disease such as weight gain or samples of thin hair. Or how the patient improves stays the same or worsens after a change in therapy.
Documentary evidence. This is the main reason for this article. Blood test results are words and images on paper or an electronic file. They are documents. They are therefore documentary evidence. They prove the facts at issue so they are relevant and they relate to the facts at issue so they are “admissible” i.e. the doctor should accept them.
What does “available” mean?
If we look BAT, Available means
those (techniques) developed on a scale which allows implementation in the relevant industrial sector, under economically and technically viable conditions,
taking into consideration the costs and advantages,
whether or not the techniques are used or produced inside the Member State in question,
as long as they are reasonably accessible to the operator;
To transcribe into the medical world:
The medical evidence developed on a scale which allows implementation in the relevant medical sector,
under economically and technically viable conditions,
taking into consideration the costs and advantages,
whether or not the evidence is used or produced inside the Member State in question,
as long as they are reasonably accessible to the operator;
What does “best” mean?
To me, this means means the techniques that provide the most valid and reliable evidence.
In the general case I interpret this means having regard to the current state of medical knowledge.
In addition, the GMC in “Consent: patients and doctors making decisions together” paragraph 5b places a duty on a doctor to use specialist knowledge and experience and clinical judgement, and the patient’s views and understanding of their condition, to identify which investigations or treatments are likely to result in overall benefit for the patient.
gmc-uk.org/ethical-guidance...
By showing your doctor your private blood test results you are demonstrating your knowledge and understanding of your condition.
Conclusion: According to the GMC, a doctor has a duty to consider your private blood test as the best available evidence of your thyroid hormone levels.
Your doctor say he or the NHS CCG or Trust won’t accept private test results?
This statement is common but completely false. The NHS accepts that some patients will mix private and NHS care. In Guidance on NHS patients who wish to pay for additional private care DoH 2009 The General Principles are:
NHS organisations should not withdraw NHS care simply because a patient chooses to buy additional private care.
• Any additional private care must be delivered separately from NHS care.
• The NHS must never charge for NHS care (except where there is specific legislation in place to allow charges) and the NHS should never subsidise private care.
• The NHS should continue to provide free of charge all care that the patient would have been entitled to had he or she not chosen to have additional private care.
• NHS Trusts and Foundation Trusts should have clear policies in place, in line with these principles, to ensure effective implementation of this guidance in their organisations. This includes protocols for working with other NHS or private providers where the NHS Trust or Foundation Trust has chosen not to provide additional private care.
• Strategic Health Authorities (SHAs) and Primary Care Trusts (PCTs) should work together to ensure that the guidance is being implemented properly in their local areas.
The NHS document goes on to say:
The NHS should not subsidise the private element of care
• The patient should meet any additional costs associated with the private element of care, such as additional treatment needed for the management of side effects.
• Any care which would normally have provided in the course of good NHS practice should continue to be offered free of charge on the NHS.
• Where the same diagnostic, monitoring or other procedure is needed for both the NHS element of care and the private element, the NHS should provide this free of charge as part of the patient’s NHS entitlement and share the results with the private provider if necessary. Patients should not be unnecessarily subjected to two sets of tests or interventions.
• The private provider should normally deal with non-emergency complications resulting from the private element of care.
• The NHS should never refuse to treat patients simply because the cause of the complication is unclear.
• The NHS should continue to treat any patient in an emergency.
The British Medical Association published additional guidance in 2009 The interface between NHS and private treatment: a practical guide for doctors in England,Wales and Northern Ireland
• Patients who are entitled to NHS-funded treatment may opt into or out of NHS care at any stage.
• Patients may pay for additional private health care while continuing to receive care from the NHS. Private and NHS care should be kept as clearly separate as possible.
Patients who have had a private consultation for investigations and diagnosis may transfer to the NHS for any subsequent treatment. They should be placed directly onto the NHS waiting list at the same position as if their original consultation had been within the NHS.
All doctors have a duty to share information with others providing care and treatment for their patients. This includes NHS doctors providing information to private practitioners.(I infer vice versa as well).
Should GPs issue NHS prescriptions for medication recommended during a private consultation with a consultant?
When patients seek specialist treatment privately, the private consultant may prescribe any necessary medication. Often, however, consultants recommend a particular medication and patients ask their GP to issue a NHS prescription rather than paying for it privately. Even though individuals opt for private treatment or assessment, they are still entitled to NHS services. Where the GP considers that the medication recommended is clinically necessary:
he or she would be required under the NHS terms of service to prescribe that medication within the NHS, even if the assessment from which the need was identified was undertaken in the private sector;
however if the medication is specialised in nature and is not something GPs would generally prescribe, it is for the individual GP to decide whether to accept clinical responsibility for the prescribing decision recommended by another doctor. (The same principles apply to requests to undertake diagnostic tests or other procedures within the NHS.)
Thank you holyshedballs
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