Plan of Care

[Narwhal10]

As promised, this can simply be called Plan and the majority of us will see Primary Care Physicians or General Practitioners.

There are LOGICAL STEPS in the MEDICAL world.

1. Person presents. Now if you are a new patient, a Clinician may have to Gather more information.

2. However, in the U.K. when we register with a G.P. Practice we fill out forms which are typed into the COMPUTERS.

3. On the Computers should be stored :-

Employment.

Family History

Social History.

Previous Illnesses and Operations

Current Medications

However, my wording is ‘should be stored’

So, if you are seeing a PCP for the first time, they have to Gather more Information from us by an individuals signs and symptoms.

The Next Logical step is to Physically Examine. Yet, this FUNDAMENTAL STEP is being deleted, erased and missed because of :-

1. The over-reliance on Computers and Artificial Intelligence.

2. Telephone appointments.

3. Doctors rushed for time.

4. The Clinician’s own Mental Biases and I would go as far as saying, Laziness.

This STEP should NEVER be UNDERESTIMATED. I would shout this from the roof tops with a Megaphone and an Air Horn. No wonder people are not being treated for P.A./B12D, the Magic Number on the Babbage Machine says No.

As discussed with WIZARD6787, as an introvert, I have made an informal initial assessment on your physical assessment from the minute you step into my eye-line.

1. How tall you are.

2. Your eyes, weariness, lack lustred.

3. Face whether pale, drawn.

4. Posture.

5. Gait.

6. Any signs of pain.

7. Wheezing, breathlessness.

This is before, we have actually introduced ourselves. Then a Patient relays their signs and symptoms.

Some Clinicians will say Fine and have drawn CONCLUSIONS, are able to DIAGNOSE, REFER/ TREAT. 😤😤😤

When a Clinician is THOROUGH, they will Physically Examine because :-

1. They know that Zebras and Unicorns exist.

2. They are obtaining more information to Exclude serious illnesses/diseases/conditions.

3. More insight into what the patient is suffering.

4. They believe the patient has the right to be properly assessed.

Now during the stage above, most of us are very quiet :-

1. We are concentrating.

2. We are carefully inspecting, feeling, listening and even scent plays a part. Diabetes has a ‘pear drop’ scent.

3. The Human Body behaves in certain ways

4. Joints and muscles flex and extend.

5. Pupils should react to a light shone is them.

6. Eyes should be able to follow my finger.

7. You should be able to touch my moving fore finger with your forefinger.

8. Your deep tendon reflexes should react when I tap them with a hammer.

9. You should be able to say ahh and your throat look pink without any lumps when I depress your tongue with an instrument.

10. Your chest should sound clear without any crackles.

11. Your heart gives a lovely synchronised lub-dub with no extra beat.

12. Your abdomen soft and non-tender.

13. Bowel sounds have a particular noise.

14. You should be able to feel the same sensations when I touch your lower leg and compare it to your feet.

15. I may ask you to walk heel to toe but if I had noted your gait when you staggered in, I would have already RISK ASSESSED and would NOT make you undertake it again.

So, now that I have ALL this INFORMATION, I can make a

PLAN :-

1. Blood tests.

2. Referrals to specialists for further testing and investigations.

3. However, the SEVERITY of a patient’s symptoms should never been underestimated.

On a personal note, years ago, letting myself into my Grandmother’s home, as usual, I shouted Coeee, it is me !!! Very unusual, I heard a weak voice from upstairs. Taking the stairs 2 by 2, I found Doris in bed, I sat on the bed and said, I was going to make her a cuppa. I said, I know you are all cosy but can you just pop on some clothing.

Back downstairs, I grabbed the phone, I am bringing my Grandmother to see you NOW. I have to laugh, she still wanted to drive to the Emergency Department. Doris is as tough as old boots. Any wonders where I get it from.

So, any consultation or appointment ask, What is the Plan of Care please Doctor ? It means explain how you are going to help me in a step by step approach.

🐳

[Jillymo]

That may happen in some practices it most certainly did not take place at mine. Things are now so laxed your lucky if you see a Gp ! I have been at the practise for 12yrs and only seen the Dr twice.

It was very much the same when I saw the consultant. I had written symptoms ect down but the swine didn't give me a chance to refere to my notes before putting his hand up to stop me and saying he only wanted to hear of my current symptoms.

Half of what our medics documment in our notes these days is incorrect or misinterpreted.

[Narwhal10 in reply to Jillymo]

There it is :-

‘the swine didn't give me a chance to refer to my notes before putting his hand up to stop me’.

As an Auditor - Poor Medical History taking, doctor unprepared to listen to patient. So, poor Plan of Care.

I have HIM on missing Data. Did not order correct or further tests or investigations.

😘

[Jillymo in reply to Narwhal10]

Got him ! I went to Pals who pushed the case around for several months. Lets remember Pals address the offender - is he likely to admit he has been an arrogant swine ? They cover their backs no matter which way the case is turned they resort to clever tactics.

Then the case went to the ombudsman /woman. I can honestly say I have never come across such corruption.

[Narwhal10 in reply to Jillymo]

Exactly Jillymo,

Internally reporting to the Trust via PALS has its place but externally reporting is a totally different ball game. People are not informed who they can report to. Dr Stephen Bolsin, had to take his complaint to the newspapers. Even good nurses, doctors and midwives can be sacked because they are ‘whistle blowers’ and Managers are in on the corrupt system.

😉

[Jillymo in reply to Narwhal10]

Years ago patients were supported by an independant lay person. It was through them many years ago I won my case against a endocrinologist. We all sat around a table whilst the case was heard. The consultant was made to appologise and put a note in my file of his injustice and his error.

Today due to the extortionate amount of errors and complaints they go out of their way to hinder patients when complaining. They will even go as far as blocking patients from making contact.

When I suffered heart failure A&E were brilliant. I was being admitted so I mentionded I had a endoscopy at another hospital in a couple of days. He wrote this on the top of my file and assured me they would take me by ambulance if I were still an in patient.

I was taken to a ward where some imbacile had spotted endoscope on my file and put me on a gastric ward instead of cardiollogy ! Every avenue was blocked to stop me complaining.

I have been there, done it and got the ruddy t-shirt. The incompetence of the NHS is constantly on the news and in the papers. It is a little like stabbings which no longer take priority because they are now so common place.

[Narwhal10 in reply to Jillymo]

Of course Jillymo, someone misread something, it happens quite frequently.

Cardiology patients gets locked up in a Psychiatric hospital. Likewise so do those with Pernicious Anaemia and Hashimoto’s encephalopathy.

They receive absolutely no medical treatment and are just treated like Prisoners. 😘

[Jillymo in reply to Narwhal10]

All those poor individuals put in asylums that probably had a B12 deficiency due to ignorance back in those days of not understanding the condition. It was the same with my condition of hypoparathyroidism when I were diagnosed in 1976 little was known about the condition - I fully understand medical science hadn't gone far enough but there is no excuse in this day and age for so many of us to be suffering.

To come on here day after day and read of others suffering is abysmal and it's now time for us to be recognised and heard. Maybe by opening another petition for better understanding and funding.

[Narwhal10 in reply to Jillymo]

Jillymo,

It is still happening today. People are still in Psychiatric Hospitals detained under Community Treatment Orders when they are very physically unwell.

Martyn Hooper was involved in 2 cases where patients had their Hydroxycobalamin reduced or stopped. They became very unwell and were detained under the Mental Health Act (1983). Martyn also attempted to teach Psychiatrists and Psychiatric Nurses about P.A./ B12D, the attitude is, oh it is nothing to do with us. We do not need to know that. This is when people die in Psychiatric Hospitals because their pleas are ignored. They are drugged up to the eyeballs just so the staff can have a Quiet Shift. Then left to rot.

The biggest problem is Psychiatrists have God like complexes and refuse to believe that they are wrong.

This also happens in Old People’s Homes. Out of Sight and Out of Mind. I have always helped the sickest and most vulnerable first. It is how you Triage.

We can come on here and exchange ideas. Those stuck in Old People’s Homes, Prisons and Psychiatric Hospitals cannot. There is a lot we can do for ourselves. They cannot so, I wish people just spare a thought for people who really are powerless.

😘

[Jillymo in reply to Narwhal10]

I am aware of all of that.

Mental health care has declined due to lack of funding and mental health units closing. A lot of mental health patients are left without care or sent to units miles out of their district. In Swindon they closed two excellent units leaving many patients on the streets or in hostels.

My grandaughter works as a carer and witnesses patients not being given their injections. Many of those patients end up in the morgue.

I have thought a lot about those people not only with regard to B12 but the lack of care given. During covid the government turned elderly and vunerable patients out of their hospital beds to stick them in nursing homes to give beds to younger fitter people. It was as if their lives were worthless.

My grandaughter watch as one by one they were carried off to the morgue. Everybody has a mother and father and no matter what age they should have been treated with more respect.

Getting back to B12 Tracey Witty has tried hard to support us with various petitions, Martyn Hooper tried very hard to give support to the vunerable. I admire them both greatly.

The govenors of Nice guidlines are fully aware of this site yet still people struggle to get medicated for a such a life changing condition.

Lets end it there I think enough has been said. 😘

[Cherylclaire Forum Support in reply to Jillymo]

Sadly, there is also a flip-side to this.

My local GP surgery had three wonderful GPs, who did all the right things. They were bright, friendly, tenacious, experienced and very supportive. They cared.

These three always came out to greet you in the waiting room, so that they could carry out the post-appointment visual checks described by Narwhal10

When the problems with getting appointments started, nurses were called to give vaccines, new receptionists triaging calls and face-to-face appointments became impossible, everyone understood this was a pandemic measure. When it stayed in place long after Covid could possibly have been the cause anymore.....

Unable to give the level and continuity of care they wanted in the way that they knew, these three GPs left the practice and went into hospitals to work. These women were all highly-skilled professionals with over 60 years of experience between them. The hospitals must have snapped them up !

Much to my relief, one of them has returned - albeit in a very part-time way.

Luck of the draw now.

[Narwhal10 in reply to Cherylclaire]

Lovely to hear that you had 3 great GPs. Plus, one has come back. I do hope you see the one that you prefer.

COVID-19 was totally unexpected and Front-line Staff really grafted. We have never dealt with a Global Pandemic and it was all hands on deck. So, all other services suffered. We are still dealing with the aftermath and I strongly believe that it will be for quite sometime. This is the reality, unfortunately.

Sending my best.

[Cherylclaire Forum Support in reply to Narwhal10]

They were needed more in hospitals afterwards - they'd gone into rapid diagnosis teams.

I was really lucky to have had such good care.

[Jillymo in reply to Cherylclaire]

That's pleasing to hear and sounds as if your surgery was more stable than most with what sounds like three old school Gps.

Not only did the covid epidemic put added pressure on our practices but so has the vast rate of imigration. Most Drs only do a two or three day week so how the hell do the expect to meet the demand ? Patients are having difficulty getting through on the phones and when they do they have wait weeks for an appointment.

Patients are now being refered to walk in centres at the hospital for ailments Drs once treated which has put so much pressure on our hospitals many patients are having to be treated outside in the ambulances . Simple ailments were once treated by our Drs not the hospital, they did house calls and often came out after hours which no longer exists.

Consultants work privately and are now doing less shifts at our hospitals hence the long waiting times to be seen. There is a 44 week wait to have a colonoscopy, patients wait months to be seen in cardiollogy putting lives at risk. It is not possible to allow thousands of imigrants into the country without expanding services and expect the system to run smoothly.

Narwal10's visual checks are 'long outdated' but could still exist in smaller country villages. The reported failings of the NHS are constantly being reported both on our news bulletins and our paper's.

[Wwwdot]

Hi Narwhal

Lots of “shoulds”, great “historical” summary. I cannot remember ever being examined throughly by a GP - usually I tell them what’s wrong and they disagree it’s anything to worry about! Simples!

However A&E or intensive care take a different perspective and I finally get help.

Only recent exception the GP who spotted my PA when I wasn’t even consulting her!

🤗🤗🤗

[Narwhal10 in reply to Wwwdot]

Wwwdot,

Poor Information Gathering leads to poor Planning which are Leadership Skills. So, misdiagnosis, mistreatment and mismanagement.

😘

[Jillymo in reply to Narwhal10]

And thats exactly what patients are enduring these day - mismanagement which has got worse since going electronic.

Half the time my surgery dont even refer to my notes. I was recently told I didn't need to be seen in cardiollogy because an echo cardiogram in 2019 showed no further follow up. I asked what happened to documentation after that date ?

In 2019I suffered heart failure and was seen at the UCLH in London. The traveling became to much so at my request I were seen in Bath. I have an enlarged Aorta and seen annually for angiograms ! ! !

How the hell a Dr can miss such important facts shows they are not reading notes correctly. I feel I would get better care if I went to the bloody vets.

[Narwhal10 in reply to Jillymo]

Exactly JillyMo,

This is why, I have been posting about GDPR (2018) and Data Laws. Although, I am a Midwife, I first studied Computer Science and Information Systems. I wrote extremely lengthy Algorithms long hand and had formula in my head because that is how we did it in the early 1990’s. I also could not afford to buy a Computer.

In the NHS, I have never seen such incompetence and a slap dash approach to Data before. Please note that on 28 August 2023, there was a System Failure in the U.K.’s Air Traffic Control (A.T.C.), 2,000 flights were cancelled. So, to manage the situation, the A.T.C. utilised their Data Analysts and Mathematicians to rectify the situation.

On Health Unlocked, I have helped people obtain Data from the NHS using the Freedom of Information Act (2000). I have also told people to COLLATE their data, for example : -

1) At [ time ] on [ date ] [ Echocardiogram ] [Reference number on Echocardiogram ] at [ Name of Hospital ], [Ordered by Name of Doctor ], [ Performed by Name of Person ], [ NHS Number ] [ Date of Birth ] and [ Name of Person ].

2. At [ time ] on [ date ] Follow Up Appointment for [Echocardiogram] [Reference number on Echocardiogram ] at [ Name of Hospital ] Reviewed by [Name of Doctor ].

I even know what Programming languages the NHS Databases are written in.

I also know that they have several different Systems or Databases that are totally MISALIGNED. So, a person goes to their G.P. Practice for a Prescription and that Computer System has absolutely no idea that last month the person had a Heart Attack and was rushed in to the large Teaching Hospital.

At the Teaching Hospital, they had no idea that the person was taking thyroxine and had Hydroxycobalamin injections every 2 weeks because they could not access the GP Computer System.

See, how Chaotic the NHS Computers Databases are ? This impacts Patient Safety.

I waltz in and say, Look, here is the Rule Book. You are done for.

I have performed a meticulous scrutiny of Every Data Breach and when Computers are Misused. Well, let us just have a think about what did Donald Trump get up to ? Three counts of Data Fraud. It is big business.

🤓

[Jillymo]

All illnesses are disorder's with some affecting brain function, mood and mental health - hence the term used as mental health. There is an underlining cause for all illnesses be them autoimmune or otherwise. Antibodies wax and wain making diagnosis very dificult, rare disorders are misunderstood by both Drs and consultants alike.

10 years average to get an autoimmune diagnosis is an understatement. I can assure you it has taken me a lot longer than that, I have attended endless appointments all over the country. Autoimmune diseases are dificult to diagnose due to the research being both costly and lengthy and not always conclusive. Much of the research is now taking place in the USA.

With the vast increase in autoimmune disease hopefully more funding will be given but I am not holding my breath. The professor I were under in Oxford has done much of his research abroad. My blood was spun for several months by students which cost thousands of pounds but medical science hadn't gone far enough to give answer's - as yet. In future years maybe they will have the answer's but I dont think it will be in my life time.