Saturday 29 January 2011

Evening doctor.

"Evening Susan." "Evening doctor." (Eyeing each other warily")

He is not my doctor, mine has a day off. This doctor is cruel and dislikes me.

"What seems to be the problem? (As if I don't know, *sardonic eyebrow, smarmy smirk*)

" Well, for three or four days, I've had terible pain in my back. It's got worse and worse until today I had to pull my boy out of school and come to see you immediately. The pain's so intense I can't help crying.  (Tears plopping onto cheek, *don't cry, don't CRY!!!*) It doesn't feel like my normal pain - this is a burning, pain across the entire top right hand side of my body, all of the area beneath my ribcage, around my side and through to my back.

(She's run out of junkie-drops *reaches for prescription pad*)

"Does it say in my notes when I last needed any painkillers?" * Forces him to look it up on the computer to tell me it was nearly four weeks ago*

And that's just under 6 weeks since major bowel surgery. He looks at me as if we are done.

"Can you examine me please?" *Small voice, throw me a crumb here*

Cold stephoscope wearily produced, listens to chest, taps and pushes ribcage front and back.

"Any pain Susan? Here! Or here? Or here? Tippety tap, were done in a snap.

"What do you think is causing the pain doctor?"

*Craving for an opiate hit of course* "Oh, I expect it's just muscular"

"Muscular? It doesn't feel like a muscle"

"Just take the painkillers Susan" *and go, I've got really sick people to see.*

*persistently* "So it can't be an infection anywhere then? or radiating pain from a nasty adhesion?!

"No, no no, just pain. Better soon"
I am dismissed, but I don't want to leave. How did we start speaking different languages? Is there any complaint I could see him for that he didn't conclude was fake? Unlikely. I sigh and pick up my bag.

"What shall I do if it gets worse?"

"Oh, just go to A&E Susan"



My own doctor doesn't treat me like that. My own doctor has read my notes, has seen me have three lots of major bowel surgery. My own doctor knows that if the problem was junkie-drops, I'd have been there long before 4 weeks had passed. My own doctor gets to read the letters from the hospital, my consultants and my discharge letters. Problem is, there are 3 doctors at the practice and soon they will have to decide what treatment I do or don't get. Surely the conversation above shows just why that is a really, really bad idea?


  1. I actually had a night doctor who told me he thought I was addicted to drugs. My wife had phoned him because my chest muscles had begun to spasm. My Own GP told me he'd looked at my postcode and made a judgement. I live in a rough area which does have a drugs problem and obviously, I was just a junkie

  2. This is so chilling Sue and amply reflects my own fears at putting all the power onto the GP ... fine, if you have one who listens and believes... terrifying if you get the other sort.

    This is the irony in promoting these changes as being to increase patient choice. Under the present system, the GP is the gatekeeper but at least they don't have a financial investment in their not always rational decisions on your behalf. Caroline Spelman pleaded with the audience on Question Time ".. but wouldn't you rather that your GP was taking the decisions?".... words failed me ... she just doesn't begin to know!

    I hope you have gone to A&E... or as Dave says "you are a very naughty girl".

    Syzygy Sue x

  3. For the record, i wikio-diagnose gall stones.
    Flippin painful little suckers they are too.

  4. Was it an incorrectly reproduced dialogue or do you allow this person to first-name you, while he or she expects 'Dr' back - and you comply??

  5. If we can't trust GP's to treat people (which is the implication you're making I presume), then how will giving them control of money make the situation any worse?

    Surely we have far more fundamental problems with our health service.

  6. *should read: surely this is a far more fundamental problem with our health service*

  7. Stephen - This is going to be very unpopular, but lots of GPs aren't very good doctors.

    They potter off into general practise and the poor ones don't update skills. You can see a GP who hasn't been near the cutting edge of medicine for 40 years!!

    Even the best ones can't possibly know the details of every condition - that's what consultants are for.

    The idea of personalising decisions on treatment in this way is terrifying. What if the GP doesn't like you? What if he doesn't believe there's anything wrong with you? GPs already act as barriers to care, gatekeepers if you like and a patient often has to be very persistent to get treatment in the first place. What if they look at the black and white cost of treating a complicated patient and decide they're just malingerers and not worth it? What if the budget runs short at the end of the year and a GP has to choose between treating a patient they like and one they don't?

    God help us all.

  8. Admittedly I'm probably not as aware about the structure of the NHS as you. But surely that problem already exists then. I can't see how GP fundholding will make it worse. Obviously some GP's are rubbish, but they already have control over directing treatment.

    Hopefully giving them more responsibility will bring better scrutiny onto them and push up standards. The change involves bringing commissioning of services to the GP's, not changing whether they decide treatment or not.

    I don't see how removing fundholding to a more distant PCT layer and just leaving GP's to be incompetent but without actually having the money really helps the situation.

    Unless I've got this entirely wrong, in which case I retract my statements.

  9. Because the PCT got to decide before!! If you didn't agree with your GP you could write to the PCT or a consultant and bypass them!! They then decided on clinical need not personality!!

    Your argument is a bit like saying if Wayne Rooney never scores another goal, best we make him striker for England cos things can't get any worse!!!

    Also GPs often don't have the expertise to make these decisions!! It just means patient's have LESS protection from unqualified, out of touch GPs than they had before.

    I have an idea. If you know anyone long term ill patients, ask them if they think it's a good idea for GPs to decide the care they get. Watch them shudder in terror. Seriously, I challenge you to find one who thinks it's a good idea.

  10. I'm shuddering already, I'm going to cost them a fortune if they want to keep me ticking over ok!

  11. I don't understand why GPs here treat everyone until they run out of ideas and only then do they send you to a specialist. Why can't these GP surgeries also include several specialists, like Ear Doctors, Pediatricians, skin doctors etc. How can one GP know everything about everything?

  12. General Practice in the UK tends to rely on the GP knowing when to refer to specialist. They are seen as "Gatekeepers" who channel the referrals and hold back the flood of patients wanting specialised treatment!
    You'll find some more enlightened practices where certain Consultants come in to do sessions, and others where GPs develop their own specialised interests. eg my own GP works alongside a Consultant Cardiologist at the local hospital for a few hours every week. Another does the same with a Consultant Psych.
    But it's very much up to the individual GP how much they extend their knowledge

  13. Funny thing is, they don't do that in Italy, and the system is far from overstretched - far from it, because patients are treated in good time, less severe things crop up needing more expensive treatment.
    If you want to see a specialist, you just turn up and wait outside his office on the right day!! I kid you not!
    When my husband popped a rib, A&E took him straight in and kept giving him increasingly strong painkillers until the pain eased!!! We couldn't believe it- it was a different world from he UK

  14. At least you do get painkillers… :/ My GI specialist has said that I can't have any opiates / opioids or NSAIDs to treat my pain. No opiates because of the constipation side-effects, which is likely to bring on a flare… and no NSAIDs because of the risk of GI bleeding and, again, bringing on a flare (or making one worse!)
    The only thing I am allowed to take for the pain is paracetamol, which is useless. Oh, I have also been prescribed mesalamine (asacol) both as an anti-inflammatory and a painkiller… and it was totally ineffective at both.

    I do think you are absolutely right on the attitude of GPs and that they aren't very good at treating people. They seem to be inept at diagnosing anything except the run-of-the mill ailments, such as flu, sort throat, etc.. When it's something more tricky, they seem loath to send you to a specialist because they are not sure themselves and don't want to waste money, time, etc. sending you on a lost cause, as it were.
    Also true are doctors' opinions of you when you dare ask for painkillers. They think you are a junkie looking for a hit or something to sell. I find it disgusting and cruel that people are refused painkillers because of prejudiced opinions - they'd rather you suffer.

    As mentioned above, I don't know how the proposed changes will effect the role of the GP. Hopefully they will either be slightly removed from diagnosing patients or become more responsible now they are handling their own cash. It will be interesting to see the outcome, though! :)

  15. I know Kevin, it's a disgrace. Something I actually set up the blog to challenge. Did you ever read my Pain posts (1, 2, &3)Also I wrote a Pain piece for CiF (search under Sue Marsh)

    The consultant nurse at the leading teaching hospital I go to has been trying to get funding to do a research study into pain and bowel disease, but surprise! No-one's interested.

    I think the trick with opiates is to ONLY take them when you're really desperate - not regularly ie three times a day. I think I can cope easier when I've had a day or two of pain relief, then it builds up again. This also would NOT give you any significant constipation - that's just a smokescreen. Something like tramadol should be perfectly OK.

  16. Sue, I did read your pain piece that was in CiF - that's how I found your blog and twitter :)

    The feeling I get from the GI nurses / doctors is that they are there to treat the bleeding / inflammation and not necessarily the pain.

    I had sourced some Tramadol myself, but again, the specialist told me to stop taking them. I tried to, but as you say, the pain comes back - but, your are correct, I didn't notice any constipation (other than 'normal' bowel randomness :$). Tramadol is also physically addictive, so that's another downside that the doctors don't want to touch.

  17. Also, I would add that most doctors are a bit closed-minded when it comes to pain. They only see opiates as the main, big-hitting, painkillers - but there are more. There is a drug that is an excellent painkiller, but unlike opiates and NSAIDs, doesn't effect GI function. It is also non-addictive and non-drowsy (unlike opiates) as well as having a massive dosage range.
    Unfortunately this drug was controlled under the Misuse of Drugs Act by Labour in 2006 - meaning that it's now a Class C drug. I believe that criminalising and stigmatising the drug in this way means it is unlikely it be considered for pain management.

  18. Did you know there is now a cross party group for legalising ALL drugs. (while we're point scoring, Labour did originally declassify to a C - now it's a B! - also Lab Sticks tongue out)

    Re opiates, Tramadol isn't terribly addictive in the spectrum. I think if you don't take regularly and maybe just for a day here and there when you can't cope any more, it helps me through the next few days. Much less chance of addiction AND if you only ever take when in pain, research shows there is less chance of addiction.

    Also, addiciton-schmiction - If you can't bear it and would rather be dead, it's med time. I think it's a long process of building up trust with particular health professionals. Took me 9 years to be "allowed" to be occasionally out of agony *sigh*

  19. Oh, I don't take Tramadol by the way, that bit didn't make sense, I meant any pain relief for just a dose or two, can help you cope for a few days without.

  20. Sue, I wasn't talking about cannabis ;) See my post in your "Secret World of Pain" blog.

    Regardign Tramadol… it is slightly addictive, it has to be, it's an opioid. :) I took 100mg / day for two months and noticed withdrawals after cessation of use. A horrible sensation to be honest - no wonder heroin addicts have to keep using :/

    …but yes, addiction is a price worth paying to be able to function properly and go to work, etc. Unfortunately, this brings us back to doctors again, who don't see it like that!