Sneaky GP

[Polo22]

I am fuming, bloody GP. Sometimes I don't always get the full picture during an interaction but it all gets stored, then ra ndomly appears like a video, verbatim. Tonight's showing woke me at 03.55 with a start. Haven't been able to switch off since so in the end got up for tea and toast.

So after appointment last week thought it was a 50/50 result. Got referral's to Endo and Rheumatologist, but the GP sneaked something through that I had not agreed to. She wanted to reduce Levo, I tried to explain why that was not happening. I said " I do not agree to a reduction on my Levo px, I feel better on the current regime than I have for some time. I understand you are concerned so I will take 50 mcg less on 3 days per week , Mon, Wed, Fri 100mcg other days. I do not agree to my repeat px being altered as, if my symptoms deteriorate I will adjust back upwards as needed. Blood test in 6 to 8 weeks and then discuss again. Yes my TSH is low but that is because I am taking T3 which will suppress TSH" (long explanation re what T3 is 🤦‍♀️), Then before I left I summarised for clarity and again said " So to clarify, I do not agree to a reduction in dose , I want the repeat PX to remain at 150mcg daily, and I am aware of your concerns ". I explained fully my SI routine and frequency, reasons for this and my ST with T3 and the justification for it, she looked dumbstruck.

So lots of red dots appeared on MyGP app yesterday and when I had time I looked to see what had been added, wish I hadn't, my repeat px has been reduced , GP has noted " Has agreed to a reduction in PX, to 150mcg/ 100mcg alternate days, to repeat bloods in 3 months, patient has very strong health beliefs" 🤬🤬🤬🤬🤬🤬

[greygoose]

Oh dear! But I'm not sure that she's sneaky, she sounds too dumb for that. I think she's just incapable of independant thought. Does not compute! Does not compute!

[Polo22 in reply to greygoose]

Tell you what she looked bloody terrified , guilty conscience maybe, when I was in with daughter few days after our discussion. Passed her in reception, I thought it odd at the time, made a joke about being an independent woman, 😂, just checked with surgery to get correct email address, just going to load both barrels

[greygoose in reply to Polo22]

Could indeed be a guilty conscience! Make sure your aim is true!

[Buddy195 Administrator]

Having ‘very strong health beliefs’ is needed with thyroid conditions, as so many of members cannot rely on medics to fight their corner. Hang in there Polo22! 🦋

[Polo22 in reply to Buddy195]

I took it as her being dismissive, I am not letting her having a God complex be my problem. She did that tone where they ask you to explain something in an accusatory manner then you hear their eyes rolling and they cut you off mid sentence to make it plain they think your barking. Kept saying " Yes I've had to deal with many previous ladies who have rather strong health beliefs" I mean misogyny from a woman 🤔😱

[J972]

patient has very strong health beliefs" 🤬🤬🤬🤬🤬🤬

This 👆🏼in particular touched a nerve. I too woke in the early hours (nothing new) but my immediate thoughts turned to an appointment I had with a GP yesterday afternoon.

I attended primarily to discuss a matter unrelated to thyroid but made the mistake of mentioning that I continue to feel generally terrible ‘despite numerous blood tests coming back “normal”’. I also mentioned that I undertake private blood tests.

This led her to look at my notes (she isn’t my named GP) and she could obviously see that I’ve been back and forth to the drs about fatigue and pain for the past few years. I don’t have a formal diagnosis of hypothyroidism and self-treat (Drs not aware of this).

What followed next took my breath away but probably is not a surprise to others here. In a very circuitous way, she basically suggested that I’d reached the point where I’d likely benefit from CBT because of my ‘unexplained symptoms’, adding that she sees a lot of patients with unspecified symptoms which can’t be diagnosed. It would help with “acceptance “ and allow me to “move on”, she suggested. (My interpretation: lean into your symptoms, give up, there’s your scrap heap, make yourself comfortable because you’ll be there a while….stop bothering us). She even shared that she had a patient in earlier who told her that they were going to “buy stuff off the internet!”, to which I responded, “I can understand their desperation”. She also said that “we don’t want patients spending [read: wasting] money on private blood tests, most of the companies are unregulated”. I let that one go, not bothering to mention that Monitor My Health is a private offshoot of the NHS, using NHS labs.

Sorry, I’m borderline ranting. Because I’m upset.

The atmosphere was strained, I maintained my composure and achieved my desired outcome (sort of) but also told her that talking about my symptoms was not going to help me. Needless to say, I shan’t be making an appointment with that particular GP again…. I’m not expecting slavish agreement or never to be challenged. I do however expect to be treated with care and humanity.

[Sparklingsunshine in reply to J972]

I wonder how long it will be before they are replacing life saving surgery with CBT, " now if you could just change the way you think about having a ruptured appendix and peritonitis and be less negative, you'd be much better off. You dont need an operation, just think yourself better" 🤦‍♀️.

[J972 in reply to Sparklingsunshine]

Oh my lord, too funny 😂

I imagine there’s a financial incentive involved in referring patients to talking therapies, might be wrong….

[arTistapple in reply to J972]

I don’t think there is a financial incentive involved to talking therapies via NHS. Almost the opposite. Talking therapies get funding from a central source and they have to fight for it all the time. They are externally monitored and you can imagine that the goals etc set are probably not in the least helpful. E.g limits on number of sessions or you might call it rationing. In my experience it’s quite difficult to get excellent quality counselling anywhere. About fifty fifty and you know that saying “You might need to kiss a lot of frogs”! I was so lucky about a year ago to get an excellent counsellor through ‘Talking Therapies’. One thing they totally understand is the NHS. Saves a lot of explanation around having mental health issues being about how you are treated rather than being ‘depressed’.

[J972 in reply to arTistapple]

Thanks for adding that comment 👍

[Polo22 in reply to arTistapple]

Think it really depends on who has the commissioners ear. NHS MH services have struggled for decades, too much need not enough resources. Privatisation by stealth , services undercut by for profit providers then proceeding to try and do everything on the cheap, no thought for patient choice or needs. CBT was rolled out as some sort of panacea for the 21st century, it is not and never will be,

[Polo22 in reply to J972]

Only in that it is their way of ticking a box to say " not our problem anymore" it's ridiculous really, CBT contracts are quite lucrative for the providers and of course if the patient says it hasn't worked well then the patient is not trying hard enough. Why spend money on appropriate treatment when CBT has already been commissioned by the higher ups. I mean FGS they fail to treat thyroid optimally or even adequately but are more than happy to try and shove statins, hypertensive's , diabetes meds that could be avoided if they treated Thyroid appropriately

[arTistapple in reply to Polo22]

I would not accept CBT now. I have tried it. It’s horrible and entirely unsuited to most of our situation. It reminded me of what do you call it? Lifestyle stuff. And more than a whiff about the patient not trying hard enough! It might be suitable for some. Anyway I totally agree about the siphoning off important stuff.

[Polo22 in reply to arTistapple]

They try to send Autists and ADHD and other neurodivergent people into group sessions to teach them how to not be Autists , ADHD and neurodivergent. Would be bloody comical if it wasn't such a waste of time. effort resources and so traumatic for those concerned,🤦‍♀️🤔🤬

[Polo22 in reply to J972]

OOh now forgot to mention, her attitude about " Private blood tests, that appear to show low T3, (she admitted she had never heard of it) wrote I source Tyrogel 25mcg (Tiromel) from a private source , also said that I reported I feel much better on my thyroxine then said I told her my hair feels better, No, I said my hair loss is still concerning. , you rant away no need to apologise at all, I had private dx of ADHD few years back , I found the letter recently and the Consultant had added " somatic syndrome " after ADHD, I was fuming, and let this GP know I fully understood the implications of this and that I find it offensive

[Stills in reply to Polo22]

I hope you told her what your previous job was!

[Polo22 in reply to Stills]

I did, she didn't look very comfortable,

[Alanna012 in reply to Polo22]

Sorry to rudely insert myself, but for context, (and my misplaced curiosity) what was your previous job? I'm relishing the doctors face on being told what your previous job was, because I'm extremely petty and vengefully minded😊

[Polo22 in reply to Alanna012]

1tuppence so nothing fancy, I worked in the NHS for just over 28 years, an RMN for just over 25 of those. 16 years on acute admission wards , think war zone but with heavy duty drugs. Then moved into community as a Care-coordinator till I stopped. Very challenging but could be very rewarding. When I look back I can't believe how traumatic some of the stuff was and I am still standing as Elton would say. Learnt to handle some very manipulative psychopaths (staff) on the other hand some of the patients were erm, memorable 🤫, nicer than the peeps in charge. She (GP) was mostly just the usual, nice but dim, it was when she started to be a bit gaslighty, patronising I pointed out the error of her ways 😜🤭

[Alanna012 in reply to Polo22]

So you've made a pretty substantial contribution to the NHS, are a professional with likely more working experience than her, familiar with dispensing medicines and their usages, used to coordinating in crisis situations, something she probably hasn't done to the sane extent. Clearly are up to the task of complaining if need be, not a push over. She probably did feel somewhat conflicted and uncomfortable after patronising you after finding that out. Hence the underhanded move.

Ha ha ha😄 Stupid.

Me now, they feel they can do that 'I am a doctor, you are a plebeian. Don't try and tell me anything that I know better'

It's quite brass necked frankly, to look someone in the eye who has contributed so much to caring for others and used to be a fellow professional and covertly refuse them a reasonable request to keep their medicines at the dose they already are after they've presented good reasons to keep them that way.

Especially when that time and sacrifice has likely taken a toll on their health!

[Polo22 in reply to Alanna012]

Hey, stop it now I've got my head stuck in the door frame 🤭😉

[Alanna012 in reply to Polo22]

😊

[1tuppence in reply to Polo22]

Wow! Just Wow! Thank you for all you have given.

Having worked in an acute secure mental health unit, I have empathy for what you experienced..... not only from (oooooh I hated this word ).."clients", who, though very unwell, were almost to a fault, kind.

[1tuppence in reply to Polo22]

I'm here along with alanna012

[Alanna012 in reply to 1tuppence]

😄

[serenfach in reply to J972]

Nearly all NHS lab work has now been outsourced. If you look into it, I can bet your hospital testing is now "private" - done by a private company.

[J972 in reply to serenfach]

How very interesting!

[Alanna012 in reply to serenfach]

Really? wow. But that might explain a few things...

[Hidden in reply to J972]

"but also told her that talking about my symptoms was not going to help me"

Absolutely agree, J972

[DippyDame]

Another poorly educated GP who tries to cover up their ignorance by being condescending....which only highlights their failings!

Been there too and it only adds another level of suffering to the situation.

She twisted your words to cover her decision and it could be said broke the code of Patient Autonomy by recording that the dose change was mutually agreed. It wasn't, but it's her word against yours....and this is a huge problem for us.

It's not only ignorance, it's also lack of integrity...and that's a dangerous combination.

Thankfully there are also medics who view their work as a vocation....not a status symbol!

[Sparklingsunshine in reply to DippyDame]

You raise a very good point there Dippy, I wonder if consultations should be recorded via audio so there can be no question of what has been said by either party. It would protect both the patient and the doctor from misunderstandings and things being said which are later reneged on.

Most companies now warn you phone calls are recorded for monitoring and training purposes, even calls to GP surgeries. I appreciate not everyone would want this and obviously there are issues around sensitive data and information. I guess the other way is to covertly record them on your phone for your own information.

[Polo22 in reply to Sparklingsunshine]

If I can work out how to record on my phone might have a go

[serenfach in reply to Polo22]

Covert recordings of conversations cannot be used, but I think a transcript can be useful.

[arTistapple]

It seems there are only two things GPs know/don’t know about T3. They either don’t know what it is - showing enormous ignorance or if they know anything about it they are terrified of it. Not helpful at all.

[Alanna012 in reply to arTistapple]

One GP explained to me that she could be up before the GMC if I later got a heart attack from a measley 25mcg levo increase (with a TSH of above 4, how ridiculous) and it could be proved that she had induced me to be hyper.

She was virtually shouting at me by that point and her face was ashen. So in an appointment where I felt like death, I ended up placating her and soothing her to calm her down so she didn't have a heart attack. I walked out no better off.

What a joke.

But she really believed it.

I do think GPs have the frighteners put into them about T3 and inducing what they truly believe is hyperthyroidism.

[arTistapple in reply to Alanna012]

I think you are correct. We have become much more able to sue etc. Though I don’t see any of it on here, considering so many have indeed been neglected and could sue. It’s strange they don’t think about any other angle, looking after us patients properly for example. Still I wonder what guidelines this one is actually reading. We should be treated from a position of fully understanding the issues as well as the guidelines and the research. I have very little faith. I find it difficult to conduct myself in the face of ‘organised’ ignorance. Thats what is being put out by endocrinology in the UK. The GPs are only too happy to allow that to happen, give the endos the responsibility. It means none of it is their responsibility. Where are the true checks and balances for us patients?

[greygoose]

This is a good example of why appointments with doctors should either be witnessed by a third party, or should be recorded - either with or without the doctor's knowledge/consent.

[Brightness14]

I agree with GG she sounds much to thick to be sneaky you need a much higher IQ than most GP's for that.

[J972]

I’m going to throw a massively controversial comment into the mix….it’s more of a ‘thought fart’ than a properly, thought out idea. Please don’t verbally annihilate me!

So the current NHS model of care, free at the point of access is, in theory, a highly admirable one. And one which is worth preserving, with some major tweaks.

However, is there the chance that this very model, which many of us hold dear, is responsible for allowing ignorant healthcare professionals, who can seemingly do and say what they want without recrimination? And here’s the controversial bit: would a …..I’m hesitating to even write the word……🤢……privatised model not lead to a change in the patient-doctor relationship, whereby there’s an element of financial leverage on the patient’s behalf? Might it lead to doctors ‘upping their game’?

Just an idea. 🫣

[Polo22 in reply to J972]

I won't annihilate you, not yet 🤔 I don't think the NHS model is responsible for the appalling attitude of some , I actually think it is probably more to do with underfunding, a long term plan to deconstruct the Model and introduce the concept of patients as profit potentials. I knew we were in trouble when different community teams started to be referred to as business units, they stopped using the term patients and started to talk about "units". Yes the privatised model may well lead to a change in the patient-doctor relationship but maybe not in a positive way. They may talk the talk but like snake oil salesman once they have the cash they may change their tune, due to their God complex . Plus I'd be more worried about the back office bean counters, we would probably end up with a system like America were even those who can afford the best insurance can end up being denied appropriate treatments because it isn't covered or it's not profitable enough for the company. So you pay extortionate insurance, that may not agree to the best treatment or you can't choose which doctor to see because he isn't approved by the company, then only a percentage of the cost is covered and the rest is "out of pocket charges" People who can't afford die because after all they are of no value as they don't produce profits. How many on here have gone down the private route only to find it was a waste of time and money

[arTistapple in reply to Polo22]

It does not take many bad apples to ruin the NHS. We do see this in endocrinology and I hear complaints about other areas. Then you have the people/patients who think the NHS can do no wrong. Private medicine can be no better though. Remember it’s the same guys doing the work (or not as the case may be). At least within the NHS perhaps someone could report them although this has not got a good reputation in itself. So called Whistleblowers. At this rate we will be self medicating for everything.

[Sparklingsunshine in reply to Polo22]

We tend to look at our NHS or that in the USA, which to my mind is appalling, whilst maybe forgetting countries like Germany, Spain or France, whose healthcare system seems far better than ours. One thing I remember reading during Covid was that we had far fewer ICU beds than Germany, which has a similar population size, and other European countries spend far more per head on healthcare than we do.

Many gripe about how much we pay in taxes but compared to other countries, like Sweden or Denmark our taxes are far lower. And its no coincidence that public services and healthcare are far better there.

[1tuppence in reply to J972]

Until both parties of any consultation have equal parity in what is recorded, I don't think payment would make any difference.

[Alanna012 in reply to J972]

I go to some American forums there are the same complaints. The big difference though is being able to shop around, as they say.

Here every GP is almost a replica of the last one because they all get the same training and it comes down to whether that particular doctor sees their job as a calling or something they were owed for being clever in school and a desire for the prestige that comes with it.

The other big difference I understand is there's less of an inclination to perceive Doctors as gods as there is here. There is an element of making a sale in the background which prevents this.

But overall, when balanced against the downsides I personally believe what we have is better.

I'm going to now be completely contrary and say I do wish I had more funds for private care!

[J972 in reply to Alanna012]

It’s a conundrum, that’s for sure. There’s probably traction in the argument that much of the shortcomings in the NHS are due to chronic underfunding which has resulted in a need to make ‘cost savings’, which has led to the current, sorry state where testing and ranges seemingly reign supreme, at the expense of being interested in how the patient presents and what they’re saying.

Having had a little rant yesterday, I’ve realised that all I’m really looking for in my healthcare professionals is an interest in my situation, some empathy and respect. That would go a long way in establishing some sort of parity in the medic-patient relationship. Everyone has time to be kind.

[J972]

You both make very valid points!

[samaja]

What you should do in this case isto complain to the practice manager and write to the surgery with request to include it in your records (so it's on record and in the paper trail) what exactly you did and didn't agree to.

[serenfach]

This! (thanks samaja ) Get in writing. Any come back further down the line will drop the GP right in it. Drop a letter in and ask that the contents be included in your notes. I dropped a letter in and my notes said "letter from patient" and that was all!