I would like to compile the things that UK GPs tell patients when patients have hypothyroid symptoms but the GP doesnt want to diagnose hypothyroidism. I think that I have answers for most things that GPs say but I havent found a similar thing on the internet. All the information is around on the internet but I cant see it put in one place. Mary Shomon has something similar on her site but not in the format that I think is useful for UK NHS patients. The idea is to have a patient friendly rebuttal manual for patients (and GPs for that matter) to refer to.
For example my GP has said
1. you are not hypothyroid because your TSH is within range
Response to be expanded with evidence is: a reference range is for a sample of a population not an individual , indviduals have narrow set points within that range, many experts suggest treating on symptoms, DoH do not want GPs to rely on lab tests
2. the lab will not test for T4
Response to be expanded with evidence is: Even BTA suggest TSH and free T4 initially, Welsh lab group recommend TSH & T4, Drs Skinner, Durrant -Peatfield, Myhill, Starr, Arhem, Rind, Kharrazian (any others?) recommend TSH, free T4, free T3 as a minimum
3. there is guidance in hypothyroidism that I have to follow
Response to be expanded with evidence is: the oonly guidance docotrs have to have regard to is NICE guidance, NICE do not have any guidance on hypothyroidism, Nice states that that NICE guidance does not override the individual responsibility of health professionals to make appropriate decisions according to the circumstances of the individual patient in consultation with the patient and/or their guardian/carer, there are numerous pieces of case law that states that guidance is only guidance, a docotor is free to use any guidance that is the patients best interests,
4. I cant/wont refer you to Dr Skinner
etc.
Any other examples?
Written by
NBob
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After turning down my request for dessicated thyroid hormone, despite seeing how well I was on it my GP said 'you seem to know a lot about hypothyroidism'. I agreed but didn't continue to say "more than most medically trained".
In the nineties I went to doctor with exhaustion, plus I woke with face grossly swollen most days and muscles around mouth were stiff in morning. He was angry and contemptuous telling me that I was nothing but a "silly, vain woman" who must accept I was getting older and stop wasting his time about my altered appearance.
I was diagnosed hypothyroid eight dreadful years later.
My GP told me that I was depressed and wanted me to take anti-depressants. I refused and at my next appointment when my long list of symptoms had grown he told me again that I was depressed but I was hiding it well! I changed my GP and at my first appointment with him he sent me for blood tests which showed hypo which was treated immediately. He is an amazing GP who welcomes my input. I am very lucky!
My partner was told that her searing pain in her hip was "just old age" and did nothing. We demanded a referral to a rheumatologist who immediately booked surgery for a hip replacement on viewing her X-ray plus sent the GP a very abrasive letter.
"Its just old age" is not acceptable and no patient should accept this "diagnosis".
It clearly is doctor speak for I cant be bothered.
Even if was, the GP should do something to alleviate the pain.
When questioning doctor about some of the listed side-effects of Levothyroxine, notably muscle cramps and severe bruising after only a slight knock, I was told "You've never been this age before..." and when I went to another one of them in the practice with an unexplained abdominal discomfort (couldn't really call it a pain, but it didn't feel right) I was asked to fill out a questionnaire that resulted in my being told I was severely depressed and prescribed anti-depressants which I advised said GP to stuff down her own throat! I have since succeeded in getting my endo to prescribe a T3/T4 combo and am now fine. Like Shaws, I'm now becoming quite well-known (notorious) for knowing quite a lot about my own condition. Quite frankly they should damn well be grateful for the education we are providing them with free of charge! Course fees are not cheap these days!!!
The GP recognise and work within the limits of his/her competence according to Good Medical Practice paragraph 3(a).
Hypothyroidism is within the limits of a GPs competence according to the General Medical Services Contract, the Quality Outcomes Framework, the Royal College of General Practitioners and the General Medical Council
If the GP doesn’t know as much as the patient, the GP has not kept up to date. A GP must keep his/her knowledge and skills up to date according to Good Medical Practice paragraphs 1 and 12.
Please tell the GP that s/he is not up to date and accordingly must reflect on his/her practice in accordance with paragraph 14(b) of Good Medical Practice
If you present your GP with the information you have used to acquire your knowledge they must take that opportunity to become up to date.
According to paragraph 17 of “Continuing professional development: guidance for all doctors” The GP must reflect on all aspects of his her professional work. This should be informed by discussion with others and by specific evidence, such as data from audit, complaints and compliments, significant events, information about service improvements, results of workplace-based assessments and feedback from patients and colleagues. Paragraph 43 of “Continuing professional development: guidance for all doctors” also states that a GP should use evidence from his/her practice, including research, audit, patient and colleague feedback, and other quality improvement information, to reflect accurately on your performance and that of your .team. The GP should then commit to making any necessary improvements
to his/hers and their team’s work as part of your professional development.
Paragraph 44 of “Continuing professional development: guidance for all doctors” requires the GP to ask him/her self Have you identified and are you able to use a range of tools and processes, such as audit, colleague and patient feedback and review of significant events, to identify areas for improvement or development in performance?
Thanks for that NBob... I shall print that out and take it with me next time I have to see yet another one of the 'new' registrars that's there to practice their GP skills as part of their training... He might even pass it on to some of the older ones! Lol!
Despite being diagnosed with Hashi's and having had a brief hyper spurt last Feb, I then felt increasingly tired (as well as anxious and racing heart, despite nowhere near hyper anymore) - I got told then that maybe I was just depressed and not energetic because I wasn't doing enough exercise and advised to do more to get my metabolism working better. So I pushed myself to do so and lo behold symptoms much worse. Might've been fair advice for anyone suffering straight up depression as exercise is proven to be as effective as antidepressants for that but considering my thyroid connection, it was, just as I suspected it would be, ultimately dumb advice.
I'll log that one; its common: your depressed, take some Prozac. No, I'm fed up feeling like this and not getting better you Wally. A better response in line with evidence and GMP on its way.
Take some graduated exercise. I was doing lots of excercise when i got these signs and symptoms you Wally. A better response in line with evidence and GMP on its way.
After TSH came back high but within range, numerous tests and suggestions about what all my symptoms might be, I disagreed and related them back to thyroid. Docs response was; I was obsessed.
Really informative piece of info and will come in very useful. I am tackling low vit b12 at the moment, but when that's sorted will use this info to chase tsh issue.
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This is the voice of influential present day UK thinking in thyroidology. Read and despair.
NICE Guidance on Thyroid Disease - Final Guidance
