Yesterday I saw a locum GP at our medical practice. He was foreign and we had quite a bit of difficulty communicating with one another. I wasn't happy with his competence, or his understanding or diagnosis of my problem. He had to do a lot of searching on his computer and in his book of medications. When I got home I read the patient information leaflets of the medications he had prescribed and I wasn't convinced that they were appropriate for my age and medical problem.
Would I be in order if I tried to get an appointment with another doctor at the practice in order to get a second opinion? If I did, would I run the risk of being expelled from the practice?
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We have a panel of 5 doctors at our surgery. Although nominally registered with a specific doctor, anyone is free to ask to see the doctor of one's choice.
One get's to know which doctors seem to be better at handling different kinds of illness - Dr A for a robust no-nonsense in and out give me the certificate, Dr B because he specialises in Condition X, Dr C because she is a really good listener and discusses symptoms and fears without automatically reaching for the precription pad, etc.
Just going in for an un-booked consultation and joing the queue, the receptionists says which doctors are on that morning, and one can opt for one's choice. There is no feeling of being disloyal or criticising by choosing one over another.
I've never actually asked for an immediate second opinion, but I have occasionally said I'd prefer Doctor D for a follow-up because I got on better with him.
Likewise with my dentist. I don't think some in the practice are quite as good as my long-standing one, so I have no hesitation in asking for him.
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My appointment with the locum GP was given to me by a regular doctor in the practice after I had arranged in advance for a call-back from that doctor following my failure to get an appointment via the normal method of ringing up at 8:30am. If I'd known that the doctor allocated to me would be a locum and that we would have of problems of communication (and possible competency) then I would have tried to get to see a regular doctor in the practice. However, as I said in an earlier post the medical practice is currently in dire straits regarding GP staffing levels, so one has to be careful about trying to be choosy about who one sees.
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Hmm, difficult one...but...you are worried about it and you will continue to be until you address it.
How about going in there, speak to a receptionist..and be honest..and say it's troubling you. Try to get a sympathy vote and deal with it lightly like that.
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>> My appointment with the locum GP was given to me by a regular doctor in
>> the practice after I had arranged in advance for a call-back from that doctor following
>> my failure to get an appointment via the normal method of ringing up at 8:30am.
>> If I'd known that the doctor would allocate me to me to a locum and that
>> we would have of problems of communication (and possible competency) then I would have tried
>> to get to see a regular doctor in the practice.
When I got home after seeing the locum I looked at what he'd prescribed and I found that one item had a similar effect to a pill I'm already taking and would have resulted in me overdosing, and the other shouldn't be prescribed to anyone who has an enlarged prostate gland ~ which I have. This morning I tried the alternative method of getting an appointment, which was turning up at the surgery before the doors were opened. I was first there and first at the reception desk. I got an appointment for 9:50am with a doctor with whom I was familiar and with whom I knew I could discuss the medication. He confiscated both medications the locum had prescribed, adjusted the dose of my existing pill and prescribed a pill suitable for people with an enlarged prostrate gland. Result!
In future, I'll abandon ringing up for an appointment and I'll be first in the queue at the surgery ~ like I did this morning.
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Take that as a warning.
You almost took drugs you shouldn't have taken because you were concerned about going back to a Doctor you trusted with your worries.
Next time, think about priorities.
Politeness matters, but perhaps not quite as much as health.
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In future, I'll abandon ringing up for an appointment and I'll be first in the queue at the surgery ~ like I did this morning.
Been down the prostate route 2003-5 when in 2005 it was removed. It's not simple and 'things' are getting better (I believe) re diagnosis etc. If your situation progresses and if I can ever offer you an insight then post at the time and perhaps the mods will put you in touch. Best regards, Martin.
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>> When I got home I read the patient information leaflets of the medications he had prescribed and I wasn't convinced that they were appropriate for my age and medical problem.
Why not ask the pharmacist who prepared the prescription. He should have enough knowledge as to whether the medication is suitable or not.
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Also, did the pharmacist supply the right drug in the first place?
I had a similar query, emailed the doctor (can't ring I'm deaf) and it was the wrong drug from the chemist - not what he'd prescribed at all! Pharmacist sent the right drug round to my house very quickly...
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I am with VX on this; consult the pharmacist or, if inconvenient, any pharmacist. I read the leaflet in the packet of some sleeping pills I had been prescribed and one of the side-effects was restlessness - very useful!
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>>Would I be in order if I tried to get an appointment with another doctor at the practice in order to get a second opinion?
Yes.
>>If I did, would I run the risk of being expelled from the practice?
No.
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>> Why not ask the pharmacist who prepared the prescription. He should have enough knowledge as
>> to whether the medication is suitable or not.
>>
Thanks VxFan, that was good advice. The pharmacist put my mind at rest over the things I was concerned about. He explained that the medications were the first step and that if they hadn't worked within 2 weeks I should see a doctor (hopefully not the locum!) and progress to the next step which ought to be hospital tests.
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Ring them up and tell them.
"I saw the Locum. I did not understand him sufficiently well. I am concerned. I wish to see another Doctor asap."
This is not your fault. Don't sneak around with excuses, tell them how it is. They need to be aware of the issue.
It would be daft to physically suffer so as not to offend people. I'm all for being careful, but that's a step too far.
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If enough people told the practice that they couldn't understand this chap, then maybe they'd stop using him.
I'm afraid that I lost a lot of respect for GPs when I learned that mine was i/c the company who had employed the German locum who killed a poor bloke (widely publicised a couple of years ago). Apart from that, my GP wasn't a bad chap - pity, really!
Money seems to motivate most GP activity these days. Our practice is largely staffed by part-time women who earn a very good wage by working just 2 or 3 days a week.
Cynical ........moi???
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>>Money seems to motivate most GP activity these days
These days? It has always been a motivator for GPs!
The fact there are so many part-time women in your practice is not money driven: Over 60% of medical students are women, and general practice is typically more family-friendly than a hospital career thus attracts a higher proportion of women.
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>>If enough people told the practice that they couldn't understand this chap, then maybe they'd stop using him.
I suspect they had no choice over whoever the agency sent.
How about "I'm sorry I can't understand you, may I have an interpreter please"?
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>> >>If enough people told the practice that they couldn't understand this chap, then maybe they'd stop using him.
>>
>> I suspect they had no choice over whoever the agency sent.
>>
I feel sure the second time around there will be an alternative.
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"The fact there are so many part-time women in your practice is not money driven"
Ok, then let's say that it is 'money-fuelled'. The high salary means that an intelligent woman can have a well-paid 2 or 3 days a week career and still maintain a family life.
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>> The fact there are so many part-time women in your practice is not money driven:
>> Over 60% of medical students are women, and general practice is typically more family-friendly than a hospital career thus attracts a higher proportion of women.
>>
I thought it was nearer 70%.
Later this year my local surgery will very probably have no male doctors. A lot of unhappy men will be voicing their views, I guess at the receptionists.
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>> I thought it was nearer 70%.
Was heading that way but I think Universities are actively trying to increase the numbers of male students they take into medicine now.
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Years ago it was suggested 'that an apple a day kept the doctor away.' but since all the doctors are now Muslim,
I've found that a bacon sandwich works best!
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Not too bad actually tommo, and the bangers, I've even started eating the Quorn stuff as well :(
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Quorn, Dog? The only bearable one is the "tikka". The "ham" is apparently solidified vomit.
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Eat Drink and be Merry. It ain't what you eat. It's all in the Genes.
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I have had more than my fair share of medical issues and to be fair apart from one brilliant male Doctor, now retired (50 ish) the rest of the males in the practice have been/are Carp. The Women are part time/job sharing. All (apart from one) are caring, clear and decisive and relatively young, currently not seemingly cynical and quite refreshing. The critical thing is consistency of Doctor (if they are competent). Moving between GP's is a recipe for a box in certain circumstances, sometimes unavoidable I know, but planned visits, where possible are beneficial.
MD.
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Don't honestly think I've been to the doctor as many as 10 times in my adult life. Most of those were for medical check ups for insurance policies and such. Once for an ear infection picked up I think in a Cypriot swimming pool and once for a chest infection which wouldn't go away.
The rest of the time they seem to think I'm in reasonable nick, but they did used to nag me about smoking, although it seemed to irritate them that when checking I still had pretty good lung capacity despite trying for so hard for so long to reduce it apparently. Anyway, I've have stopped now so that's done with.
Not to say I haven't felt a bit under par sometimes but usually nothing I felt needed expert intervention.
I've never had a job where it was a good plan to take time off sick. Pay has always been highly or entirely geared to performance. Makes you fairly circumspect about how "ill" you actually feel.
I shall most probably keel over now of course. Whatever...
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>>Quorn, Dog? The only bearable one is the "tikka".
Not tried that one Cc, but I will.
>>The "ham" is apparently solidified vomit.
Possibly true Cc, but when it's smothered in hummus, watercress, cucumber, cyder vinegar and black pepper, it could be dog burger for all I know.
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I'm sure I drove past a restaurant in London the other day called "Hummus and Co" they had a tag line underneath their sign saying "Give peas a chance". Tickled me that. Quite probably, y'know, "cyclists" though...
:-)
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>>"Give peas a chance"
Like it!
:o}
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I have a first class GP. We're on first name terms although, out of respect, I call him Doctor Mike. All the Docs who've dealt with me for eyes.heart/diabetes have been excellent.
The clinic doctors, ' see them once then never again ' less so.
I upset one clinic heart man many years ago. Elderly and probably working his ticket, he noticed a box of drugs had been made in Slough. Having half a dozen students around him he pompously quoted Betjeman's ' Slough ' poetry. He said he didn't imagine I had heard of the poet and started on another of the great man's poems, misquoting him !
His recital ended abruptly and I was dismissed from the consultation after I corrected his mistake in front of all his acolytes.
Oh dear.
Ted
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>> I'm sure I drove past a restaurant in London the other day called "Hummus and Co"
>> they had a tag line underneath their sign saying "Give peas a chance".
>> Tickled me that. Quite probably, y'know, "cyclists" though... :-)
>>
Are you imagining things?
tinyurl.com/pefb4rx
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Last time I went to the doctor I was seen by a new chap, whether a new member or a locum I don't know.
I said I thought the statin I had been taking was giving me muscle pains and anyway had only been prescribed for age/statistical reasons. No one has ever said I have a cholesterol problem. Could I try not taking it for a couple of weeks?
He said, why didn't I stop taking it altogether, so I did. A month or so later the muscle pains - in my hands - have gone.
Lygonos's horror stories about artery clamps on disintegrating old arteries have scared me though. Must I take the damn pill after all? I will consult the I Ching if I can find the coins or the 49 yarrow stalks and remember the counting palaver.
Last edited by: VxFan on Fri 19 Jul 13 at 01:08
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>>>I thought the statin I had been taking was giving me muscle pains and anyway had only been prescribed for age/statistical reasons.
Same here prescribed statins on a statistical basis... tried two different types but both seemed to cause odd muscle cramps shortly after getting off the bike... so I've given them up and will take my chance.
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>>Same here prescribed statins on a statistical basis
Welcome to the minefield that is Preventative* Medicine!
"Wouldn't it be great if we could stop people having heart attacks and strokes rather than simply treating them after the event?"
Great question - the answer to which is to medicate healthy people who you believe to be at statistically higher risk of the disease.
And statins don't make you feel better - they either leave you feeling the same or can cause adverse reactions (usually muscle pains).
In my humble opinion we would do more good putting more effort into cutting smoking rates and increasing exercise - maybe VAT on saturated fat rich foods to pay for free gym memberships for everyone - as giving statins to a smoker is like using air freshener in a room with a turd on the floor: gotta remove the turd to really make a difference.
The alternative libertarian message would be to let people do what they want, provide plenty of education, and let them screw it up themselves.
*ps. the pedants can correct it to Preventive but I think it is a commonly used variant and perfectely acceptable :-)
Last edited by: Lygonos on Wed 26 Jun 13 at 09:11
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>> they either leave you feeling the same or can cause adverse reactions (usually muscle pains).
So, cursed if I do, damned if I don't... but only after removing the turd from the floor? Tsk.
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>> Same here prescribed statins on a statistical basis...
I was put on statins some years ago, and was taken off them because of leg muscle pains after a good walk.
Recently another Doc (previous one having retired) has had another go, and a reduced dose (20mg) of simvastatin doesn't have any significant side effects.
Whether or not they will do any good is another matter.
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>>Whether or not they will do any good you'll never know.
Statins reduce the risk of having a heart attack by about 25%.
If you are destined to die from cancer/dementia/lung disease/etc then every tablet you took was a waste of time.
If you are destined to die from a heart attack there's a 75% chance you still will.
If you dodged the fatal heart attack you'll never know.
You can only measure the benefit looking at populations not individuals.
(of course if you do dodge the fatal heart attack then they were definitely worth it - but again you'll never know!)
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>> If you are destined to die from cancer/dementia/lung disease/etc
>> then every tablet you took was a waste of time.
Having spent most of my working life as an idle fat b, who is still a bit overweight and on hypertension medication, there's a fighting chance the statins are doing a good job.
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>> www.thennt.com/nnt/statins-for-heart-disease-prevention-without-prior-heart-disease/
that isn't very encouraging.
My cholesterol has gone down (a bit).
But I don't fancy getting diabetes.
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I honestly don't know what is 'best' for people who haven't already had a heart attack.
I would suggest that those at high risk, with multiple risk factors (very high blood pressure, big belly, high cholesterol [especially with low HDL cholesterol], family history of heart disease and diabetes), are likely to benefit, and those at low risk are best to avoid (eg. 40yr old with good health, non-smoker, with no family history).
We use a tool called ASSIGN to measure risk - basically makes a prediction of the risk of a patient having a heart attack/stroke/developing angina in the next 10 years.
If the risk is >20% then a statin is probably justified.
assign-score.com/estimate-the-risk/
Needs a postcode, as it generates a factor due to deprivation and postcode is the best guesstimator of this it would seem - try a random Scottish one as I doubt it works for English ones!
Last edited by: Lygonos on Wed 26 Jun 13 at 19:56
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Maybe I'm naive but I'm a firm believer in self help when it comes to health. Keep your weight "normal". Eat sensibly, exercise regularly, keep booze to a minimum and cut out the fags etc. Doesn't cure or prevent everything but it surely has to better your odds doesn't it?
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All that stuff is better than any medicine, Humph.
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the irony - health advice from Scots ;-)
Anyway, an "assign" score of 7 using an Edinburgh postcode.
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I've just come back to this part of the thread 'cos I'm interested in the use of statins.
I've been on a low dose of Simvastatin for many years and my cholesterol has been low all the time.
Since my by-pass, I've been suffering from muscle pains in the legs and some loss of balance, often needing to be holding or touching something solid when stood still. I recently remembered the statin thing and thought that the ones I'm on now might be the key to some of the problems.
The cardiac doctors prescribed 80mg Atorvastatin...which seems a pretty big dose to me. So, I decided to come off the treatment for 7 days, see how I felt and take things from there with my GP. Within 24 hrs I felt an awful lot better. Now 5 days into it, most of the pain has gone and my balance has improved. I'll do another 2 days then I'll resume taking them and see if things get bad again.
A very good friend is also on Atorvastatin, but 20mg, and she is suffering the same. She had already thought of stopping them for a week while she's away in Norway. We will compare notes.
My Physio, a fine looking lass (phoooar ! ) came and bullied me today with an exercise regime and thought what I had decided was a good idea.
Any comments, advice welcome.
Ted
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>>Any comments, advice welcome.
Statins are particularly good at helping prevent future cardiac death in post-heart attack patients.
In saying that, there is not a massive difference in efficacy between, say, 10mg and 80mg of atorvastatin: each doubling of strength reduces cholesterol levels by approximately an extra 5-6% on average (ie. the largest reduction is seen at 10mg, maybe reducing cholesterol around 30-35% with around 45-50% at 80mg - this does vary a bit between patients of course).
The actual beneficial effect of statins is still not fully understood - they do more than simply reduce the formation of new deposits in the arteries, and also have a role in stabilising the plaques that are already present, reducing the risk of them going 'pop' and causing a new heart attack subsequently.
Side-effects are generally dose-dependent (ie. higher dose = more side effects), and occasionally can differ from statin to statin.
If I was post-bypass, and 80mg atorvastatin was making me feel crap, I'd stop them for 2 to 3 weeks to ensure I felt fine and then reintroduce at 10mg daily for a month, then 20mg daily for a month, then 40mg daily for a month. If I felt the symptoms return I'd cut back to the previous dose.
If I couldn't tolerate even 10mg of atorvastatin I'd perhaps try pravastatin or rosuvastatin as (at least in theory) they have a slightly different solubility and may offer the chance of greater tolerability.
This is an entirely personal opinion, and not medical advice. There is no solid evidence to suggest this is the optimum way of managing statin (in)tolerance, and I bet if you asked 10 different doctors you'd get 11 different ways to manage the problem.
The balance is between taking a medicine that can make you feel worse, and its ability to reduce your risk of a heart attack by around 25% (remember if you are taking aspirin or clopidogrel, plus a betablocker, plus a '-pril' you are already reducing this risk quite substantially).
As I have said before - using all the best evidence available it is only possible to be sure what works best for a population : the art of medicine is how to balance all of the evidence with the patient's needs sitting in front of you - very often this leads to two very different positions.
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Thanks for the reply, Doc. I'll keep off them a little longer, perhaps 'til the next scrip is due in a couple of weeks.
I do take enteric aspirin and a blocker daily. I'm not sure about the ' pril ' without looking at my list of medication. I was certainly taking Elanapril ( or something like that ) before the MI for many years.
Bedtime, nite nite all.
Ted
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>> In my humble opinion we would do more good putting more effort into cutting smoking
>> rates and increasing exercise - maybe VAT on saturated fat rich foods to pay for
>> free gym memberships for everyone - as giving statins to a smoker is like using
>> air freshener in a room with a turd on the floor: gotta remove the turd
>> to really make a difference.
>>
>> The alternative libertarian message would be to let people do what they want, provide plenty
>> of education, and let them screw it up themselves.
When you have free health care funded by taxation, not really an alternative.
See Glaswegians... trying to kill themselves early before Alzheimers...
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Well found Henry. That's it.
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>> Well found Henry. That's it.
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What about the one on the M25 bridge?
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I went to my doctor and he said I was too fat so I asked for a second opinion.....
'You're ugly as well '..........
( Acknowledgments to Frank Carson circa 1966)
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Second opinion from a doctor - Cliff Pope
