pernicious-anaemia-society....
pernicious-anaemia-society.org/awareness/the-nice-b12-guideline-has-anything-changed/
specifically this bit which suggests asking GP to put reasons in writing... adapt it for use in thyroid treatment problems such as GP not increasing levo dose to improve symptoms etc .
".......As I mentioned, the NICE guidelines are not legally binding but ignoring or failing to adhere to NICE guidelines when making decisions about patient treatment could lead to legal consequences. This is because a doctor must show a duty of care to a patient and failure to do so may lead to claims of negligence. Doctors in the UK are expected to practice in line with evidence-based guidelines. While NICE guidelines are considered a high-quality source of evidence, they are not the sole determinant of treatment decisions. Doctors must consider individual patient circumstances, local resources, and the specific guidance from their respective health systems. There are some circumstances where deviating from NICE guidelines may be acceptable. The guidelines are intended to support a clinician’s knowledge and skills. Clinicians are still responsible for making decisions appropriate for each patient. A clinician may be able to justify a decision to deviate from the NICE guideline if it was reasonable and made in good faith. It is important here to remember the tenets of joint patient and doctor decision making and informed consent – key words in the NHS. This is why we often recommend to our members that they ask their doctor to put in writing their reasons for deviating from the guidelines. It is certainly not sufficient for a GP practice just to say that it is their “policy” or “internal procedure”. They must be able to explain why they are treating you as the patient differently from what the guideline says.
A good example of this is understanding why a GP practice is asking to retest your blood for intrinsic factor antibodies (after a diagnosis of PA) or retest your B12 levels while you are on injections because the guideline is clear that this is not necessary. What is their reason for these requests to draw blood via an invasive procedure when there is no medical advantage in knowing the B12 blood serum result? What is it they are looking for additionally, if your symptoms have improved while on B12 injection treatment? Why are they using their and your time to carry out procedures which are not recommended? Why are they still offering only 8-12 weekly injections to symptomatic patients when the NICE guideline says that more frequent injections may be trialled to see if symptoms resolve? Why are they moving patients to oral tablets when guidelines say that further research is needed in that area?
Healthcare providers in the NHS cannot restrict access to NICE approved treatments without exceptional justification. It says this specifically in the NHS constitution. People often quote “first, do no harm” as being part of the doctor’s oath but you might be surprised to learn that the oath doesn’t actually say that. As often is the way with quotes and sayings they get changed along the way of history. Hippocrates apparently wrote in Greek ὠφελέειν ή μὴ βλάπτειν (roughly translated into Latin as primum non nocere) in his passage from the treatise on Epidemics (First book, second part, paragraph 5); “In illnesses one should keep two things in mind, to be useful rather than cause no harm”
Just wondering if anyone else has spotted this from the GMC website?
General Medical Council GMC "The seven principles of decision making and consent"
I found this off another site.
Monitoring when starting Folic Acid and Ferrous fumerate
