Annoyed with GP because of their high horse
Discussion
I am a chiropractor and I had a patient in 6 weeks ago complaining of a 16 month history of progressively worsening hip, buttock, groin and back pain. She's 48, no major health issues but breast cancer 10 years ago. GP initially said muscle strain (despite no known onset, which was gradual and progressive) and gave her pain killers and told her not to worry. a few months later she went back....got referred to physio, told to do some exercises and go away. A few months later she went back to the GP who said there was nothing more they could do and just to manage it with pain killers.
I examined her and long story short I xrayed her (before any of you judge, we do not charge for xrays, and only take them if deemed necessary). On the images I found she had widespread metastatic bone cancer in her left pelvis. Eep. I wrote a letter to her GP explaining the situation and suggested she have urgent bloods and further imaging ASAP. 2 weeks later I hear nothing so I call the GP practice who said "yes, we've got your letter and xrays and we're processing everything for you". Great....job done. In the meantime I explain to the patient we need some further tests but if she is happy to try some very gentle treatment she's welcome to do so, which she does. Surprisingly, she actually responds very well to care and is no longer limping.....I asked if she'd heard from GP and apparently they sent me a letter.....I hadn't received one, and she still hadn't had any further tests.
Yesterday I got a letter from her GP and it basically said "we got your xrays and your letter. We will leave it with you to diagnose this patient because you took the xrays".....I was absolutely furious, 5+ weeks this poor woman has been left without tests being done despite me writing a letter stating the situation and then calling up to follow it up. Perhaps I was naive in thinking "we got your letter and are processing it" meant "yes, we're on the case".
I call the GP practice yesterday and spoke to another GP (not the one that sent the letter) and he admitted the GP who wrote back to me was very much in the wrong, they called her in for bloods 1 hour after I got off the phone and she's been referred back to oncology.
Perhaps I shouldn't but yesterday I felt so low and upset about this lovely patient, and because her GP seemingly has a bee in their bonnet that I took xrays or whatever they have risked the quality of life of this patient. Meanwhile I cannot tell the patient she has mets because it is not officially diagnosed with bloods etc but the images are 99+% sure to be mets.
Not sure why I'm writing this, but it genuinely scares me there might be more cases out there like this that the GP just brushes aside and doesn't actually stop and think, and it can potentially be costing the life of someone.
I examined her and long story short I xrayed her (before any of you judge, we do not charge for xrays, and only take them if deemed necessary). On the images I found she had widespread metastatic bone cancer in her left pelvis. Eep. I wrote a letter to her GP explaining the situation and suggested she have urgent bloods and further imaging ASAP. 2 weeks later I hear nothing so I call the GP practice who said "yes, we've got your letter and xrays and we're processing everything for you". Great....job done. In the meantime I explain to the patient we need some further tests but if she is happy to try some very gentle treatment she's welcome to do so, which she does. Surprisingly, she actually responds very well to care and is no longer limping.....I asked if she'd heard from GP and apparently they sent me a letter.....I hadn't received one, and she still hadn't had any further tests.
Yesterday I got a letter from her GP and it basically said "we got your xrays and your letter. We will leave it with you to diagnose this patient because you took the xrays".....I was absolutely furious, 5+ weeks this poor woman has been left without tests being done despite me writing a letter stating the situation and then calling up to follow it up. Perhaps I was naive in thinking "we got your letter and are processing it" meant "yes, we're on the case".
I call the GP practice yesterday and spoke to another GP (not the one that sent the letter) and he admitted the GP who wrote back to me was very much in the wrong, they called her in for bloods 1 hour after I got off the phone and she's been referred back to oncology.
Perhaps I shouldn't but yesterday I felt so low and upset about this lovely patient, and because her GP seemingly has a bee in their bonnet that I took xrays or whatever they have risked the quality of life of this patient. Meanwhile I cannot tell the patient she has mets because it is not officially diagnosed with bloods etc but the images are 99+% sure to be mets.
Not sure why I'm writing this, but it genuinely scares me there might be more cases out there like this that the GP just brushes aside and doesn't actually stop and think, and it can potentially be costing the life of someone.
I admit to being partisan but there are pieces missing from this story. I am not in any way casting aspersions at you OP and I entirely accept your version of events as you’ve recounted them.
However; imagine for arguments sake this GP is a both incompetent and a sociopath. They have no regard whatsoever for the welfare of the patient and their ego has been bruised being told what to do by another HCP. This sociopath does however also know that ignoring metastatic cancer that has been documented by someone else is the sort of thing that piques the interest of the GMC which in turn could threaten their own registration and livelihood. Pure self interest dictates doing something about this urgently and that’s making the worst possible assumptions about the GP.
Occams Razor may apply and I wonder if there has been an administrative cock up? Is it also possible that these are not in fact bony mets? It seems unlikely for example that bone pain due to mets - which frequently doesn’t respond to high doses of morphine - would be ameliorated by your treatment (genuinely no offence intended).
On the other hand incompetent, sociopath GPs do exist - I’ve met one or two - though that’s true of any walk of life.
However; imagine for arguments sake this GP is a both incompetent and a sociopath. They have no regard whatsoever for the welfare of the patient and their ego has been bruised being told what to do by another HCP. This sociopath does however also know that ignoring metastatic cancer that has been documented by someone else is the sort of thing that piques the interest of the GMC which in turn could threaten their own registration and livelihood. Pure self interest dictates doing something about this urgently and that’s making the worst possible assumptions about the GP.
Occams Razor may apply and I wonder if there has been an administrative cock up? Is it also possible that these are not in fact bony mets? It seems unlikely for example that bone pain due to mets - which frequently doesn’t respond to high doses of morphine - would be ameliorated by your treatment (genuinely no offence intended).
On the other hand incompetent, sociopath GPs do exist - I’ve met one or two - though that’s true of any walk of life.
Edited by DeWar on Saturday 19th September 12:37
DeWar said:
I admit to being partisan but there are pieces missing from this story. I am not in any way casting aspersions at you OP and I entirely accept your version of events as you’ve recounted them.
However; imagine for arguments sake this GP is a both incompetent and a sociopath. They have no regard whatsoever for the welfare of the patient and their ego has been bruised being told what to do by another HCP. This sociopath does however also know that ignoring metastatic cancer that has been documented by someone else is the sort of thing that piques the interest of the GMC which in turn could threaten their own registration and livelihood. Pure self interest dictates doing something about this urgently and that’s making the worst possible assumptions about the GP.
Occams Razor may apply and I wonder if there has been an administrative cock up? Is it also possible that these are not in fact bony mets? It seems unlikely for example that bone pain due to mets - which frequently don’t respond to high doses of morphine - would be ameliorated by your treatment (genuinely no offence intended).
On the other hand incompetent, sociopath GPs do exist - I’ve met one or two though that’s true of any walk of life.
It's definitely mets unfortunately. I've had a 2nd opinion from a friend who's a radiologist and when one considers the appearance (soap bubbly, moth eaten appearance of the ischium and pelvis) and the history of breast cancer it is all but certain I am sure. However; imagine for arguments sake this GP is a both incompetent and a sociopath. They have no regard whatsoever for the welfare of the patient and their ego has been bruised being told what to do by another HCP. This sociopath does however also know that ignoring metastatic cancer that has been documented by someone else is the sort of thing that piques the interest of the GMC which in turn could threaten their own registration and livelihood. Pure self interest dictates doing something about this urgently and that’s making the worst possible assumptions about the GP.
Occams Razor may apply and I wonder if there has been an administrative cock up? Is it also possible that these are not in fact bony mets? It seems unlikely for example that bone pain due to mets - which frequently don’t respond to high doses of morphine - would be ameliorated by your treatment (genuinely no offence intended).
On the other hand incompetent, sociopath GPs do exist - I’ve met one or two though that’s true of any walk of life.
I think 1 of 2 things is possible. Her pain is not due to mets and it's an incidental finding, or, more likely, she's responding purely on a placebo basis because she feels someone has listened to her. I am being extremely conservative with care. I am under absolutely no impression to actually help with mets and I apologise if I gave such an impression! I've been a bit upset about this case so may not have been writing clearly!
Cheers.
https://www.nhs.uk/using-the-nhs/about-the-nhs/how...
PALS is effective for the patient.
GMC is effective for a HCP.
PALS is effective for the patient.
GMC is effective for a HCP.
TyrannosauRoss Lex said:
It's definitely mets unfortunately. I've had a 2nd opinion from a friend who's a radiologist and when one considers the appearance (soap bubbly, moth eaten appearance of the ischium and pelvis) and the history of breast cancer it is all but certain I am sure.
I think 1 of 2 things is possible. Her pain is not due to mets and it's an incidental finding, or, more likely, she's responding purely on a placebo basis because she feels someone has listened to her. I am being extremely conservative with care. I am under absolutely no impression to actually help with mets and I apologise if I gave such an impression! I've been a bit upset about this case so may not have been writing clearly!
Cheers.
Your writing is perfectly clear; I misinterpreted. I think 1 of 2 things is possible. Her pain is not due to mets and it's an incidental finding, or, more likely, she's responding purely on a placebo basis because she feels someone has listened to her. I am being extremely conservative with care. I am under absolutely no impression to actually help with mets and I apologise if I gave such an impression! I've been a bit upset about this case so may not have been writing clearly!
Cheers.
To be clear if the GP understood that the XR suggested mets, sat on that information for weeks, did nothing about it then bounced it back to you then that is completely outrageous. I have trouble believing anybody could be that callously stupid.
In general complaints about GP’s must be directed to the practice in the first instance by the patient and can be escalated to ombudsman and upwards if no satisfactory resolution. I believe anybody can lodge a complaint with the GMC and NHS England though in practice I think they would refer the case back to the GP for them to investigate. In response to a comment above, PALS don’t get involved with GP’s (technically GP’s are not NHS employees).
DeWar said:
TyrannosauRoss Lex said:
It's definitely mets unfortunately. I've had a 2nd opinion from a friend who's a radiologist and when one considers the appearance (soap bubbly, moth eaten appearance of the ischium and pelvis) and the history of breast cancer it is all but certain I am sure.
I think 1 of 2 things is possible. Her pain is not due to mets and it's an incidental finding, or, more likely, she's responding purely on a placebo basis because she feels someone has listened to her. I am being extremely conservative with care. I am under absolutely no impression to actually help with mets and I apologise if I gave such an impression! I've been a bit upset about this case so may not have been writing clearly!
Cheers.
Your writing is perfectly clear; I misinterpreted. I think 1 of 2 things is possible. Her pain is not due to mets and it's an incidental finding, or, more likely, she's responding purely on a placebo basis because she feels someone has listened to her. I am being extremely conservative with care. I am under absolutely no impression to actually help with mets and I apologise if I gave such an impression! I've been a bit upset about this case so may not have been writing clearly!
Cheers.
To be clear if the GP understood that the XR suggested mets, sat on that information for weeks, did nothing about it then bounced it back to you then that is completely outrageous. I have trouble believing anybody could be that callously stupid.
In general complaints about GP’s must be directed to the practice in the first instance by the patient and can be escalated to ombudsman and upwards if no satisfactory resolution. I believe anybody can lodge a complaint with the GMC and NHS England though in practice I think they would refer the case back to the GP for them to investigate. In response to a comment above, PALS don’t get involved with GP’s (technically GP’s are not NHS employees).
We shall see what happens, but I feel so sorry for the patient.
Is a motoring forum the best place to air a professional grievance regarding a patient and potential life changing event?
You must have better and more professional settings to discuss this however...
It sounds like there a number of issues here, what is important is to prevent this happening again.
I would suggest engaging the practice manager for discussion about this retrospectively, that way all parties can learn from this and improve patient care.
Otherwise the only purpose of this thread is to post an non objective anecdote.
You must have better and more professional settings to discuss this however...
It sounds like there a number of issues here, what is important is to prevent this happening again.
I would suggest engaging the practice manager for discussion about this retrospectively, that way all parties can learn from this and improve patient care.
Otherwise the only purpose of this thread is to post an non objective anecdote.
PositronicRay said:
Fortunately not all GPs are the same.
Unfortunately those GPs are very busy doing the job right, and the s
t ones are lazy s who last did some self directed study into new techniques 35 fking years ago. I have not got a GP as the practise I'm with haven't reallocated me to one since mine retired. It may not have helped the admin staff empathy, when I stated (On being told hes retired), "Thank f
k for that, hopefully you'll get one who owns a BNF written after 1985" Given that my wife is a nurse and my daughter a hospital pharmacist, there have been a number of occasions where the prescribing and diagnosis has been sloppy, and I've had to fight to get more appropriate treatment.
I was going to type a long reply about my recent experiences with the medical 'system' and how it didn't work for two family members during the last 5 years.
But suffice to say, what the OP has posted does not surprise me one bit. I'm starting to wonder just what the role of a GP is anymore in the modern NHS. It's not to look after a patient and their overall treatment, seems more about pushing pills and then avoiding any kind of involvement once the person has left the GP surgery.
And don't get me started on the 'care' when admitted to a hospital. Shameful.
But suffice to say, what the OP has posted does not surprise me one bit. I'm starting to wonder just what the role of a GP is anymore in the modern NHS. It's not to look after a patient and their overall treatment, seems more about pushing pills and then avoiding any kind of involvement once the person has left the GP surgery.
And don't get me started on the 'care' when admitted to a hospital. Shameful.
Pit Pony said:
PositronicRay said:
Fortunately not all GPs are the same.
Unfortunately those GPs are very busy doing the job right, and the st ones are lazy s who last did some self directed study into new techniques 35 fking years ago. I have not got a GP as the practise I'm with haven't reallocated me to one since mine retired. It may not have helped the admin staff empathy, when I stated (On being told hes retired), "Thank f
k for that, hopefully you'll get one who owns a BNF written after 1985" Given that my wife is a nurse and my daughter a hospital pharmacist, there have been a number of occasions where the prescribing and diagnosis has been sloppy, and I've had to fight to get more appropriate treatment.
Centurion07 said:
Did you tell her something else was likely causing her pain? As in a "you REALLY need to make sure you see your GP about this"? Or is that not the done thing?
It's a touchy subject, because I do not want to worry the patient, but likewise need to get them seen to. To be honest, when going through her xrays I just said something along the lines of "there's something on your xray that isn't 100% clear so I'm going to contact your GP who will want to do some tests soon just to be on the safe side but at this stage please don't worry, I'm just dotting the Is and crossing the Ts". I do not think I'm allowed to tell a patient "you have cancer" and so I'd rather play it that way than say "I think you've cancer so we're going to get some tests done".In hindsight it is what it is, and without knowing exactly what happened at the GP surgery when they got my letter I shouldn't get annoyed or upset, and I don't think I ought to think I should have done more. The most important thing now is that the patient is getting tested and the ball is rolling for her, and I should rest easy knowing that the ball is rolling earlier than it otherwise would have because of my imaging.
I apologise if I ruffled any feathers with this thread, I perhaps spoke in haste.
TyrannosauRoss Lex said:
I apologise if I ruffled any feathers with this thread, I perhaps spoke in haste.
I don't think you did; you're the one who has shown concern for your patient.The problem is when people keep quiet about bad GPs & the people who suffer are their patients. The prognosis for this lady can only be worse because of the delay & the GP should be made to account for his or her actions.
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