Drs receptionists to much power😠

[birkie]

Hi everyone ❤️

Well just another day trying to get an appointment with a gp, now been 4 weeks 😠, after holding for 44 minutes I get through to be told yet again... No appointments available 😠.

So I then ask for an appointment with the nurse as I increased my T3 from 20mg to 25mg 9 weeks ago and I really need my bloods checked to see what the 25mg increase as done, also I'm due for a vitamin D blood test.. Receptionist "you had your thyroid bloods done on Feb 4th you don't need them done again, and there in nothing in the notes from any gp stating you need them done" in the notes it says no further action"!!

I went into the why I need them done again... Being I've increased my meds and need to see where I am now... Do I need another increase, as I was hypo before on 20mg.

Again she fought me saying "there is nothing in your notes so I can't help you".. Getting agitated at this point😠 I asked her to verify this with a gp as a blood test is required after an increase or decrease of thyroid medication, off she went.. Came back "ok you can have your vitamin D done but you will need to ask the nurse if she can do thyroid 🤦‍♀️ there is an appointment at 10.20 today.. OK I had to decline that appointment.. Receptionist.." why".. "Well firstly I've taken my thyroid medication and secondly the appointment for thyroid bloods should be as early as possible preferably fasting"... Receptionist.. You don't need to fast for a thyroid blood test, and it can be taken any time of the day😂.. I corrected her on that explaining... "TSH is at its lowest in the morning then it rises throughout the day" the better picture of how your TSH is in the morning 🤦‍♀️.. Receptionist... "Well I've never heard of that ".. Me..."well I wouldn't expect you would, unless you have thyroid illness yourself".

It got a bit heated when I tried explaining these next lot of thyroid bloods on 2nd may which includes vitamin d, I will be waiting the 7/8 weeks then will need to have another blood test, so can something be done to ensure I don't have to go through this at reception again.

Receptionist... "You will need to take that up with the nurse".... Thanks! 🙄

So, even though I feel like 💩 I will be printing out... When is the best time to take thyroid bloods? we all on here know the answer "AS EARLY AS POSSIBLE" , thyroid bloods should ideally be taken on an empty stomach, water only, stopping all other medication that can affect the out come of the test, "I'M GONA EDUCAT THEM IF ITS THE LAST THING I DO" 😠

This is the crap we have to contend with!!! God help the newbies with any thyroid conditions because Drs receptionists are clueless 😠😠

[tattybogle]

I corrected her on that explaining... "TSH is at its lowest in the morning then it rises throughout the day

presumably that's a typo Birkie .. , i think you know it's the other way round.. but just checking.

Edit .... i think you have to be more realistic about how much power receptionists actually have .. they do not have the power to make autonomous decisions .

Even if they did happen to be well informed enough to know that TSH is highest early am and it is best practice to test thyroid bloods at a consistent time of day and without levo....they would STILL have to follow the official guidelines/limitations they are given by their employer , or they will get themselves into trouble with their employer .

Whether we like it or not , the current NHS position is that thyroid test is a "daytime , non fasting" test and that it therefore doesn't warrant an early am fasting blood slot .. the receptionists are instructed to save these time slots for tests that the NHS say are fasting tests .

you are correct . if the GP increased your dose then he should have left an instruction to the effect of 'retest in x weeks' or longer if he thought it appropriate .. not just written No Further Action.. but while it says no further action on your record , the receptionist would get into trouble for booking a thyroid blood test just because a patient insisted on having one . The issue of the instruction for a thyroid retest needs to be taken up with the GP that wrote NFA on your record.. it's not the receptionists fault that that is what it says.

Receptionists have rather less power than you think.. and will get into trouble themselves if they go against what they have been instructed to authorise , so i know its really frustrating , but don't shoot the messenger

Until the NHS officially tell their receptionists that thyroid testing is best carried out at a consistent time of day before taking that days levo, then receptionist CAN'T authorise you to have one at that time of day .. if you want it at that time of day you have to achieve it by whatever means necessary .. but 'educating the receptionist' won't usually work because it's not the receptionists opinion that needs changing .. it's the NHS guideline that they are told they MUST follow.

[birkie in reply to tattybogle]

Hi

Yeah, I got it the wrong way around on typing, but did tell her the right way.. Brain fog, 😔 I find when Im typing I do stuff back to front sometimes 😁.. I have a printout of when it's best to take thyroid bloods, and about TSH and it changing throughout the day, I will be handing them in on the 2nd of may.. 👍

[birkie in reply to tattybogle]

All true tattybogle, but why fight with a patient on the phone? I had to ask her several times to clear it with a gp, obviously that didn't occur as she just told me I would need to ask the nurse if she could do the thyroid bloods along with the vitamin D, I'm sure the nurse would need a gps go ahead for that because it's happened to me before, she couldn't do thyroid bloods without the gps say so.I asked her politely if my gp could rectify the no further action on my thyroid bloods, again very defensive Action by her, I was not asking her to break any rules just to make sure I don't have this again when I call reception it's better for both of us.

And yes I totally agree the guidelines need changed /updated

Another thing tattybogle, if for instance I had my thyroid bloods done on let's say Tuesday 9am TSH would be at its highest, then the next appointment is say Mon at 5.30 my TSH would be lower, if we have tests like this and not constant like 9am how would we ever know what our TSH trully is, it really Puzzles me, hard to get my head around it🤯 and how do gps work it out? If you've had your last 3 tests at different times of the day... Then what's your true TSH level??

[tattybogle in reply to birkie]

i agree , the phlebotomist is highly unlikely to be able to authorise it either ... i've had that too ...once when i strong armed a receptionist into booking a blood test , when i turned up for it the phlebotomist was still stymied by the "NFA". .....she did do it in the end but only because it was in the middle of the pandemic when they didn't really want any personal contact at all unless absolutely necessary and i pointed out the stupidity of making me waste a GP appt to get it authorised and then having to physically come back in to the surgery another day and doubling the risk of spreading covid round the surgery .

The true 'TSH' is not really a thing .. it is whatever it is when you test it and they are all 'correct' .. At any point in a given day , it's got to be to be somewhere within 40/50% of the result you would get at any other time time of the same day.. because it doesn't change more than that over a single day even in people with this biggest changes, (and some people do not have big changes ).... 40/50% is the absolute maximum difference you'd get between the absolute highest at eg 2 am to the absolute lowest at eg 2pm .. the difference between a 9 am and a 2 pm result will not be anywhere near as big as 40% .. so since it's a relatively small difference between 9 am and 2pm, it only really matters to anyone when their TSH is right close to the top or bottom of the range where a little bit of difference will affect the GP' decision about diagnosis , or dose.

We want it at consistent time so we know we are optimising our chance of earlier diagnosis/ avoiding a dose reduction when we feel ok / or getting a dose increase when we could feel better , because it's us that lives with the consequences , but the difference in TSH during the 'daytime' hours is honestly quite small .. when it's seriously over range . or under range , the test will still pick that up whatever time it's taken.,, and since the NHS are still driven by the "TSH anywhere in range will do" philosophy they are less interested in optimising things than we are.

They know it will still catch TSH over about 6, or under about 0.2 whatever time it's done. .. not good enough i know , but it is what it is until the endocrinology profession decides to tell them any different .

I have developed a certain amount of sympathy for receptionists (well more than i used to have anyway )... i bumped into a mate last year who's daughter went to school with mine , and so i asked what her daughter was doing now .. she said her daughter had recently been working as GP receptionist and had had to leave after a few months because the stress of the job due to dissatisfied patients loosing their rag at her every other phonecall just got too much to bear . she was going home in tears often .. and she had become very stressed herself as result and had decided to go and work at the ferry office instead and was much happier now.

it made me reconsider my previous idea that all receptionist are dragons deliberately barring the gate out of some unfulfilled power complex .. and realise that some of them may well be just kids trying to do a thankless job under a great deal of pressure while getting yelled at by very stressed / tearful patient's all day long, and then being yelled at by their manager if they had a heart and caved in and give patient what they desperately begged them for ..... when you can't give people what they ask for , however much you might like to . it makes you pretty unhappy yourself ... and if you get someone who's already had a morning like that before you get through to them ...then they probably will seem defensive.

[birkie in reply to tattybogle]

Well done for holding out for that test during covid😁👍Actually I have 2 very good friends who are both drs receptionists (not at my surgery) the week end of the grand national I was asked to go out with our group, with these to receptionist friend's, one said she probably won't go, I myself I've not socialised for over a year due to my health, on the Friday nite she posted on our WhatsApp site that she was so glad that day was over as she'd had an awful day😢,.. she was now going out on grand national day and getting pi##ed😂😂😂 I do try my very best not to get into arguments with them, and I always say I know it's not your fault, but I do need you to help me as your my first stop, but some can be dragons tattybogle😂😂😂🐉

[tattybogle in reply to birkie]

ye s , "there be dragons !" lol i have certainly met one or two .

I mostly object to the patronising assumption that i don't know what i'm talking about when i do .

and while i accept that they must have to deal with an awful lot of very frustrated /frustrating people who are fundamentally incorrect in what they are saying .... "i've got small rash ,but mrs next door said it could be leprosy so i MUST have an appointment this afternoon" , and that i can't expect them to know if i'm 'one of those' or if i genuinely do know what i'm talking about .

But you just get to a point where you've had enough of it over the years don't you ... i now have absolutely no patience for those receptionists/ chemists /phlebotomists who choose to look at me like i'm simple and pat me on the head when i've just said something perfectly reasonable.

i once had a phlebotomist say .. "yes (dear) ,but you don't KNOW it's autoimmune DO you" .. "i'm pretty sure it is actually luv " (TPOab >3000)

and once the chemist 'helpfully' said: "there (dear) , we've changed it to 1 x 100mcg instead of 2 x 50mcg so that will be easier for you to manage " ... (i had not mentioned any difficulty 'managing' it, to anyone , and it was 2x 50 because that is what the GP and i had agreed on years ago )... how patronising.

What would have been so hard in saying .. "oh that's interesting , how do you know it's autoimmune ?

or "we seem to have been asked to change to to 1 x 100mcg , is that going to be better for you ? "

[birkie in reply to tattybogle]

Whooooo I forgot to ask you about T3 and what time you have it done.. Can time of day affect that result? Very interesting about the TSH, but is it the same for T3? (on T3 only so T4 doesn't matter) thanks for you info❤️

[tattybogle in reply to birkie]

on 'T3 only' what matters most is "how long since you took the last dose before the test ", and that affects only the fT3 result . but it does have a pretty big effect on fT3 result, so if you test during the first 6 hrs after you took it , then the fT3 result will be significantly higher than it will be at 8-12 hrs .

time of last dose shouldn't effect TSH result though.

time of day does affect fT3 level a little bit in ummedicated people ... but in people taking T3 this becomes irrelevant because the time of their last dose now has a much bigger effect.

[birkie in reply to tattybogle]

That makes sense, I take my first dose at 8am last dose at 6.30pm, so I like to get the bloods as early as possible so I can take my 8am dose.I remember having a thyroid blood test out of the blue by my gp, I'd totally forgot I'd taken my meds, gp rings me up my T3 was well over range, my last one was OK he was bothered I was over medicating myself.. I told him when my last meds were taken about 2 hours before the appointment 🤦‍♀️ so that test went in the bin🤦‍♀️

[humanbean in reply to tattybogle]

Whether we like it or not , the current NHS position is that thyroid test is a "daytime , non fasting" test and that it therefore doesn't warrant an early am fasting blood slot .. the receptionists are instructed to save these time slots for tests that the NHS say are fasting tests .

They are also reserved for men, if mine and my husband's experience are anything to go by. I got refused a thyroid test first thing in the morning, by a scowling receptionist. Just a few days later my husband needed blood taken for testing, and he wasn't even asked what he needed them for. He just asked for an appointment first thing in the morning, and got one without any questions while the receptionist gave him a big smile.

[birkie in reply to humanbean]

This has been my bug bear with our receptionists since my thyroid journey, in the beginning I was unaware of how thyroid bloods should be taken for the best results, I joined this group and the information blew my mind🤯.But the worst thing is when the receptionist tells you things like:

You don't need an appointment, you don't need thyroid bloods done how do they know that?

You can have an appointment any time for thyroid bloods, can't see how that can work as I take my first lot at 8am second at 6.30pm..you can't take thyroid medication before a test between 24hrs 12hrs.. So on an appointment if no morning appointments are available at,2.30 ,3.30,5.30 ive not taken my thyroid medication so that could mean I'm without my thyroid medication from 6.30 the day before until 6.30 that night and I couldn't take the whole amount that's why I split it🤷‍♀️.

Unfortunately the receptionists don't know this, and I wouldn't expect them to, but I would expect them to know I do! , I'm the thyroid patient I take the meds, I'm only trying to educate them in the way we like them taken, if it's 9am everytime we have a test we can get a good indication of how our thyroid hormones are responding that's it in a nutshell, why is it so hard🤦‍♀️🤦‍♀️

[tattybogle in reply to humanbean]

(sarcasm on )

Ho , but obviously he has to go to work to give you your housekeeping so you can cook his dinner doesn't he , and anyway ....shouldn't you still be doing his ironing at 9 am ? , you have no business wandering around getting optimal blood tests for yourself before you've ironed your husbands shirts tidied up the bathroom after him and put his slippers to warm.... i'm appaled ...lol.

(sarcasm off)

[Regenallotment Ambassador in reply to tattybogle]

🤣

[humanbean in reply to tattybogle]

I would score myself as a 2 out of 10 in a "How good a housewife are you?" competition, which makes your reply even funnier for me.

[tattybogle in reply to humanbean]

i'd only give myself a 1 .. i just stopped cooking and had meal deals and pub lunches in secret and left mine to starve until he learned how to cook.

he quite good now .. he can do roast dinners. lol

[Regenallotment Ambassador in reply to humanbean]

this fascinates me, my husband and adult son can get an appointment at the drop of a hat. My adult daughter and I … a very different experience. We are running a family study on this and it will end with a letter to the practice manager. I think it’s so entrenched, the cultural norms, the deep historic inequality, unfounded assumptions about men and illness. Drives me crackers 😡

[tattybogle in reply to Regenallotment]

You have men that are willing to make doctors appointments ? .. where did you get them from ?.. none of mine will think to buy socks when they have none .. let alone contemplate going to the doctors cos their leg went blue .

[Regenallotment Ambassador in reply to tattybogle]

This made me snort out loud! It’s holey underpants the men in our family seem to endure without the need to replace 🤣

[SeasideSusie Remembering]

I corrected her on that explaining... "TSH is at its lowest in the morning then it rises throughout the day" the better picture of how your TSH is in the morning 🤦‍♀️..

Ooops, that's the wrong way round. TSH is highest early morning and lowers throughout the day - see graph.

It really is pointless trying to discuss the ins and outs of how to do blood tests with them, very few medical professionals would know about it (although I think there are a couple of members who do have a clued up endo) and we do say they are patient to patient tips we don't discuss with doctors or phlebotomists.

[birkie in reply to SeasideSusie]

Yep I typed it wrong but told her the correct way👍.. I was a bit agitated typing it, I'm taking the relivent printouts down about when bloods should be taken, and how,👍 I'm just so sick of fighting with these receptionists, how can she tell me I don't need a blood test when A, I've increased my meds, B I was hypo on my last test 😔 only being on 20mg T3 is not enough to move my T3 or TSH much, this I know, and because this was another change in T3 meds (Roma From teva) i started low and are increase slowly, so I need to know what my increase is doing with my T3 level 🤷‍♀️ are we to just guess? Trully I do not feel very well, I've not been since going on Roma, i should have had my bloods done on Dec 18th 2022 that was 7 wk on Roma 20mg..couldn't get any bloods till Feb 2023,which showed hypo, I then increased to 25mg so due another blood test, Im getting really bad stomach pain, I take the t3 at 8am 20mg and 6.30 5mg I find the stomach pain comes on really bad then wears off a bit, then after the last dose 5mg I get it again, these are gelatin capsules so today I've taken the powder out of the capsules and took it that way to see if the stomach pain remains 😞

[SlowDragon Administrator in reply to birkie]

Many people are finding Roma capsules don’t suit them

Did you get on ok with Teva tablets

Teva 20mcg tablets are cheaper than Roma capsules

GP would need to specify Lactose free 20mcg Liothyronine capsules - Teva brand only

Easy to cut into 1/4 or 1/2 to get 5mcg or 10mcg

Current prices

healthunlocked.com/thyroidu...

[birkie in reply to SlowDragon]

Hi slowdragon ❤️

My life😔😔😔😔😔 as you know I was taken of teva T3 lactose free by a gp who said all my symptoms were due to that drug, if you remember she put me on T4 lactose free, I told her I would do that for 7 wks for a trial to see if symptoms go... They didn't.. (symptoms: urination through night up to 4 /6 times, utter thirst, bad bone pain and bone vibration this is a frightening symptoms it honestly feels like my legs and ankle bones are vibrating awful feeling 😢 headache, palpitations, sweating all symptoms are still with me,( and you know I got the flimsy diagnosis of primary hyperparathyroidism in 2020 and in 2022 a private parathyroid surgeon found a nodule in my neck, I'm now still waiting on a pet chlorine scan in Liverpool) it doesn't matter if its T4 lactose free or T3 lactose free these symptoms remain, I got back on T3 but it was Roma, The stomach pain has increased since I've increased from 20mg to 25mg..my routine is 8am take medication with full glass of water, within 30/40 mins of taking it I have a belly ache not a cramp a real bad belly, and a regurgitation of the water with bad acid wash back🤮 I've persisted thinking maybe it will ease the more I get use to the meds, but no it's bad, Mon and Tues I lay in bed most of the day holding my stomach in a fetal position.

So today I've had it rang gp as you no doubt have seen on my post no appointments and fought for my next thyroid bloods 😠 I've taken the powder out and discarded the capsule... And guess what.. No belly pain and no acid wash back with the water.. Could I have found a better way to take this med, it's obviously a bit of a pain taking it this way, but if it means no belly ache and acid wash back I'll do it.

Going to see how I go in the next few days taking it this way👍

Although when I was doing it, I was unsure wether to sniff it or swallow it... 😂😂😂 Reminded me of those folk in the movies sniffing the white powder😂😂😂

[App1]

The NHS Surgery online has enabled patients to bypass the reception. This is how mine went : I wanted a blood test, last had been mid Feb. On Sunday I went online and booked a phone call with GP for Monday 8.45 and filling in a few lines of background. GP rang before 10. Conversation on any symptoms etc, then whilst I was on phone sorted out an early blood test appointment and booked for the next day, Tuesday (yesterday). I think many surgeries are going down this road. I hate that rigmarole of battling the receptionist too, so tend to opt for this alternative.

[RedApple in reply to App1]

App1, 'The NHS Surgery online has enabled patients to bypass the reception. '

What you can and can't do online is very much dependant on where you are in the UK. Wales, Scotland and N.Ireland don't necessarily have the same facilities as England. I think even within England, it can vary from surgery to surgery.

[App1 in reply to RedApple]

Yes of course, unfortunately not available everywhere yet, for me it is via the surgery website.

[birkie in reply to RedApple]

Yes when I saw that post I thought... Not sure our surgery have that app, and I've not see anything on line like that, but it would be fantastic if we had it, I'm in Cumbria we don't have much here😁

[Rocky in reply to birkie]

We have an e consult form that I can fill in online, on the surgery's website. I can fill in exactly what the problem is, without a rude receptionist interrupting and telling me the wrong thing. I also find the receptionist doesn't always listen properly to you. I can also put that I would like a Doctor to ring me back, and more often than not I have had a phone call, or asked to come into the surgery, or had a blood test authorised. I don't like having to do it, but unfortunately it seems to be the only way at the moment. I also realise that not every surgery has this facility

[App1 in reply to Rocky]

yes that’s what I meant, it is so civilised.

[birkie in reply to App1]

That sounds fantastic 👍 so you just ring nhs surgery on line🤔 OK I'm going to look into this, these receptionists have way to much power, honestly I'm the one with no thyroid, I'm the one who takes the medication for the rest of my life, and I've learned so much from being on here❤️ I think I know way more about my thyroid health than a receptionist 👍

[Auders]

my get out is I’m a difficult bleed! Only one phlebo can get me (first go everytime!) so I always explain this to our pet dragons at the surgery. She works for the out of hours team so starts a lot earlier so I manage to get her. Next month I’m doing a BH test that requires a blood draw. I phoned up the local hospital and they do private tests and they open at 08.00. Will go for 09.00 as the test includes cortisol. Think in future if the dragons start being a bit fiery I may ask GP to give me the form and go to the local hospital. I can’t in all honesty complain about our pet dragons, some have been very accommodating!

[serenfach]

Last time I came up against a reluctant receptionist, I just asked to be transfered to the Practice Manager. Oddly enough after a bit of silence, she gave me an appointment the next day!

[birkie in reply to serenfach]

Yeah tried that before we merged with this other surgery, the receptionist just said.. "the practice manager is not in" so I sent her an email.. No reply then wrote 2 letters to her.. No reply 🤷‍♀️