Can you do anything when doctors refuse a prescription?

[Lemming Train]

I'm having a real battle with a cellulitis infection in my leg and have become pretty infuriated that none of the doctors are listening to what I'm telling them which is resulting in the cellulitis not going.

Initially I had it in my lower left leg at the start of the year and the doctor I saw (I don't have a specific one) agreed with my diagnosis and prescribed a 7 day course of Flucloxacillin 500mg. Within a couple of days this cured it but I continued the course as directed. Out of blue on Friday afternoon I suddenly developed the same pains in my lower right leg. I was still taking the pills as they didn't run out until the Monday lunchtime but they were having absolutely no effect. (DVT/blood clot has been checked for and ruled out)

On Monday I got an emergency appointment as the pain was brutal and I could barely walk on it. I told the (different) doctor the story and she prescribed me another 7 days of same along with 7 days of Phenoxymethylpenicillin 250mg (8 per day + 4 per day of the Fluc). This combo worked great at getting rid of the pain and within 2-3 days all the pain had gone, no tenderness, but visually there was barely any change on my leg, still pinky red in colour in the affected areas so clearly the prescription was only keeping the cellulitis at bay and not actually killing it.

Tuesday this week I had a telephone appointment to check on how it was going and I reported the above which prompted them to call me in straight away to have it looked at. A different doctor saw me and agreed that there was still evidence of the cellulitis there and prescribed me a 5 day course of Clarithromycin 500mg saying that this was the next treatment for cellulitis when the others don't work. I aired my concerns that if 4 grams of antibiotics per day are only keeping the cellulitis at bay and not killing, how would reducing the dosage to only 1 gram per day work, but he dismissed it and said to take them and it should cure it.

We're now 2 days later and sure enough the Clarithromycin has done absolutely feck all and the cellulitis is now returning with a vengeance so I'm going to be back to square one again.

What is the best way of dealing with this? I am so angry with the useless doctors that I want to put in an official complaint about all of them as none of them have listened to me when I've said I need weapons grade antibiotics to kill this. The ones they've given me have done nothing more than tickled it. I'm guessing there must be stronger antibiotics that they can prescribe so why aren't they doing it? A 5 or 7 day course is not even touching it and I'm also getting pissed off at having to fork out for a fresh prescription each time I go when they could have given me a months worth prescription in the beginning and just kept taking them until it cured.

Any useful tips on how to get doctors to prescribe the PROPER level of treatment you need please?

[smashy]

Hi I think sometimes you have to just have to take charge yourself ,living in London there are private GPs that will see you for £29 .... obviously Dont know where you live is there anything like that near yourself? Thats what I would do because i believe they will work with you not against you good luck

https://doctap.co.uk/home/amp/?gclid=Cj0KCQiA4aXiB...

[lllnorrislll]

NHS constitution for England states you have the right to complain about your GP

The same as any service you are not happy with, calmly ask for the GP practices complaints policy and raise your concerns in person. I suspect that you will get see a senior partner, fairly rapidly.

[Lemming Train]

lllnorrislll said:

NHS constitution for England states you have the right to complain about your GP

The same as any service you are not happy with, calmly ask for the GP practices complaints policy and raise your concerns in person. I suspect that you will get see a senior partner, fairly rapidly.

Thinking about it I suppose my anger should only be directed at the 3rd one. The 1st one I saw was for my left leg and the Flucloxacillin cleared it up and he wasn't to know that it would come back, but in my other leg! The 2nd one in fairness did prescribe a bunch of antibiotics but given how quickly the cellulitis was progressing and the pain I was in I feel that a 7 day course was far too short and inappropriate given how stubborn cellulitis infections are. My anger is really with the 3rd one : why the hell would you reduce the dosage by 75% when it's clear to see the cellulitis is still very much present in the patient's leg? Even I as a non-doctor am fully aware that cellulitis has a very high recurrence rate after the antibiotics course has finished so surely he should have increased the dosage up from 4 gram per day or prescribed something stronger rather the reducing it with a different drug on some waste of time 5 day course? The doctor was well into his 50s or even 60s and not a school kid just out of uni so he should have known that this was likely to happen.

[Lemming Train]

I've just discovered from the Practice website that the 'problem' doctor I saw is the Lead Partner... I don't see a complaint getting me very far .

[PositronicRay]

It sounds like you should have been referred to a specialist.

[Steve Campbell]

Perhaps a word of caution in your assumptions about the 3rd doctor (I'm not in medicine, but I do work in Pharmaceuticals manufacture, including, in my past, of antibiotics).

Clearly the antibiotics prescribed in the first instance were not working to full effect. This could have multiple reasons but includes the infection being resistant to those particular antibiotics.

In removing those and adding a different one the Dr may have been considering this...or potential interactions between the medicines....or a number of other scenarios.

It is never a simple equation and just "nuking" it with multiple different types of medication might not have been the best course of action at the time. The older I get, the more I realise that doctoring is a fine art...….. and they won't always get it right (eg the Dr would not know whether your infection was resistant to certain types of antibiotic......that would only emerge with time).

We see things way too simply....and I'm pretty sure Dr's see 1,000 of patients a year who think they know how best to treat whatever they present with (no dis-respect OP..they should have listened more perhaps)

A Dr will be along in a moment I'm sure.

Edited by Steve Campbell on Friday 25th January 15:29

[knk]

Fluclox (500mg qds) and then clarithromycin (500mg bd) reasonable choices. 4g of one is the full dose, as is 1g of the other
If it is not getting better get back in contact with your practice. No need to complain, they are not withholding the strong antibiotics, they are just following good practice.
They may consider admitting you if not improving (and any signs of systemic upset or sepsis) or be next try oral clindomycin in the community.

[super7]

You are assuming in your prescriptions that all antibiotics are of the same strength. 1mg of the last antibiotic maybe 'Nuke' strength already? 4mg might kill more than you expect?

[Lemming Train]

knk said:

Fluclox (500mg qds) and then clarithromycin (500mg bd) reasonable choices. 4g of one is the full dose, as is 1g of the other
If it is not getting better get back in contact with your practice. No need to complain, they are not withholding the strong antibiotics, they are just following good practice.
They may consider admitting you if not improving (and any signs of systemic upset or sepsis) or be next try oral clindomycin in the community.

It was Fluclox 500mg QDS to start with which cured a small cellulitis infection around my ankle on my LEFT leg. That cleared up in 2.5 days no problem. Then out of the blue I got a much larger cellulitis infection appear in my RIGHT leg from my ankle nearly up to my knee, front and back. For that I was given another blast of Fluclox 500mg QDS and Phenox 2x 250mg QDS, but I was warned that this concoction had a strong likelihood of playing havoc with my stomach and causing sickness, and I should stop immediately and ring if so. I had no such problems with absolutely no side effects at all which I made clear to doc #3 last week when I went back to show him the dosage was working to some extent, but only enough to remove the pain and keep it at bay. The infection was still clearly visible to him on my leg and also the lines that had been drawn around it by doc #2 the week before. So it makes absolutely no sense at all why a doctor with 35 years in the job would REDUCE the dosage by 75%! I can understand changing to a different type of antibiotic but from my research Clarithro is nothing special nor any stronger than the Fluclox or Phenox so he should at least have prescribed a similar dosage to what I was already on as it was obvious to anyone with a brain that the cellulitis infection would easily overpower such a small dosage, which is exactly what has happened.

I've had cellulitis in the past around 20 years ago from an insect bite which was so severe I was bundled in the back of ambulance and swiftly escorted to hospital where I was laid up for 3 weeks on a seemingly never-ending supply of IV antibiotics. This I'm sure will be documented in my medical file and visible to all of the doctors that have seen me so they have no excuse whatsoever in not knowing which drugs work for me and which don't.

If the patient isn't reporting any problems with side effects from the medication then why can they not increase the dosage? The Fluclox and Phenox combo were working well in terms of quickly curing the pain but not strong enough to attack the infection so why not increase the dosage to Q3H or similar and see if that gives it enough bite to start attacking it?

I'm angry with them because they're not listening to what I'm telling them and not giving me a strong enough dosage to attack it. The dosage they're giving me is for little kids. If they don't give me a suitable dosage then I'm going to end up in hospital hooked up to an IV drip which is the last thing I want given my experience last time. I very much doubt that the hospital will appreciate me unnecessarily hogging a bed which could be completely avoided if my doctors stopped being so utterly utterly useless.

Edited by Lemming Train on Friday 25th January 18:27

[gregs656]

Lemming Train said:

I've had cellulitis in the past around 20 years ago from an insect bite which was so severe I was bundled in the back of ambulance and swiftly escorted to hospital where I was laid up for 3 weeks on a seemingly never-ending supply of IV antibiotics. This I'm sure will be documented in my medical file and visible to all of the doctors that have seen me so they have no excuse whatsoever in not knowing which drugs work for me and which don't.

For information there is no such thing as 'your medical file' - your GP will have a history of what they have done for you, but nothing else unless you have told them and they have recorded it.

[Lemming Train]

gregs656 said:

Lemming Train said:

I've had cellulitis in the past around 20 years ago from an insect bite which was so severe I was bundled in the back of ambulance and swiftly escorted to hospital where I was laid up for 3 weeks on a seemingly never-ending supply of IV antibiotics. This I'm sure will be documented in my medical file and visible to all of the doctors that have seen me so they have no excuse whatsoever in not knowing which drugs work for me and which don't.

For information there is no such thing as 'your medical file' - your GP will have a history of what they have done for you, but nothing else unless you have told them and they have recorded it.

So you're telling me that doctors cannot see past prescriptions and treatment and there will be no record visible to them that I had 3 weeks worth of IV antibiotics pumped into me at St James?

If there is no such thing as a medical file then why does it say on my Practice's website that I can have online access to it upon receipt of proof of ID at reception?

[Rollin]

Why do you think less weight means less effective?

Your Clarithromycin prescription is the usual adult dosage.

Which do you think is more effective pain control, 500mg of Ibuprofen or 50mg of methadone?

[gregs656]

Lemming Train said:

So you're telling me that doctors cannot see past prescriptions and treatment and there will be no record visible to them that I had 3 weeks worth of IV antibiotics pumped into me at St James?

If there is no such thing as a medical file then why does it say on my Practice's website that I can have online access to it upon receipt of proof of ID at reception?

Unless you've told them about it and they recorded it, it's unlikely.

You will be able to see the medical file your GP has, if you went to the hospitals you've been treated at you could get access to the files they have - but the idea that there is a central medical file that is 'yours' and is accessible throughout the NHS is a myth.

[Lemming Train]

Rollin said:

Why do you think less weight means less effective?

Your Clarithromycin prescription is the usual adult dosage.

Which do you think is more effective pain control, 500mg of Ibuprofen or 50mg of methadone?

1. I said no such thing and am aware that different drugs have differing potency levels. But I had already researched Clarithromycin and it does the same thing as Fluclox but is prescribed generally only when the patient has a penicillin allergy to Fluclox. I have no such allergy.

2. The "usual adult dosage" is the problem. This is not a "usual" case is it? 3 weeks have gone by and there hasn't been any progress in clearing it up and they are not listening to what I am telling them. Looking in their little book and prescribing the "usual adult dosage" is a complete waste of time because it's clear that the infection needs a much stronger antibiotic and/or higher dosage to tackle it. To my mind the doctor is just fobbing me off and not listening to what I'm telling him and just following his guide book for normal patients that have a normal infection. With 35 years experience he should have seen that a pinky red leg from my ankle up to my knee on both sides was way behind a 'normal' case and needed an appropriate dosage to tackle it. If you consider that 1g of Clarithro per day is equivalent to 2g of Fluclox, then as 2g of Fluclox PLUS 2g of Phenox didn't kill it it's bleeding obvious to anyone with a brain that 1g of Clarithro isn't going to do bugger all, which sure enough is exactly what's happened. Who'da thunk it?

[billshoreham]

OP i think you should talk to the practice and express your concerns with a view to seeing a specialist asap.In the meantime I would follow their advice. If its really tricky then go to your local A&E.
When I had cellulitis it came with a high temperature and I felt really bad. The emergency doctor came to see me and wanted to call an ambulance straight away, I declined the hospital admission for personal historical reasons, I could not handle a stay there.He gave me a massive shot, syringe style, of anti-biotic and I felt better right away. I have not had it since (about 6 years ago). Try not to get angry it wont help . They are probably doing what they think is best but do explain just how bad it is and how it is affecting you.

[Wiccan of Darkness]

OP, I can certainly answer some of your questions. Firstly, dosage has no relation to strength, flucloxacillin is very good for soft tissue infections. There is no such thing as a "strong" antibiotic.

Antibiotics work in one of two ways, they either kill the bacteria (eg penicillins), or they act as microbial birth control (such as tetracyclines). It is, therefore, a myth that all antibiotics kill bacteria. Some of them are chemical condoms.

It's not worth my while babbling on about the pharmacokinetics, but from the sound of it, the infection is the same one back again but its developed a level of resistance to flucloxacillin. Drugs merely enter the blood stream and are distributed evenly throughout the body, so unless it's a topical antibiotic cream, it's not targeted either. Those adverts for neurofen that "targets the site of pain" is complete bks.

What you need is the correct antibiotic. You can take a mega dose of something that has slight effect, and all that will do is increase the bacterial resistance and turn your liver to mush; notwithstanding the havoc it will play with your gut flora.

Or you can take an antibiotic that the infection is highly susceptible to, and it'll clear up in a few days.

Stamping your foot and moaning about the size of the dose will get you nowhere.

If this were I, I would be asking for a sensitivity test, where a sample of the infection is taken and tested to see which antibiotic it is resistant to, and which one will kill it stone dead. Meanwhile, the GP will probably try you on something else like co-amoxiclav 500/125 whilst the test results come back. Takes a few days.

Complaining about not getting what you demand won't get you anywhere, the docs will keep scribbling out prescriptions to shut you up - you'll take a handful of pills, think they're not working and make the infection resistant to more antibiotics, until you have an infection that's completely resistant to everything, the medical term for that is 'up st creek'. MRSA has been around for a few years, but we're seeing completely resistant strains of TB, and now gonorrhea appearing. All these are due to inappropriate antibiotic use over the years.

It is a scary prospect, but sadly a fact of modern life today is that if you develop a serious infection, the chances are the first load of antibiotics you take simply won't work.

[bigpriest]

gregs656 said:

Unless you've told them about it and they recorded it, it's unlikely.

You will be able to see the medical file your GP has, if you went to the hospitals you've been treated at you could get access to the files they have - but the idea that there is a central medical file that is 'yours' and is accessible throughout the NHS is a myth.

In most areas GP practices can access hospital systems, such as A&E, to see a summary of that patient's medical history. Likewise, hospitals are also able to access GP practice details usually through a 'summary care record' that brings together all this information. You're correct that a single, central file doesn't exist - the idea is that relevant bits of information are taken from several systems when needed and viewed as a single record. When GP practices were first switched to computerised medical records, the patient's history was also included - not full medical notes but a summary of vaccinations, prescriptions, allergies etc. When a patient is treated at hospital, a discharge letter is sent to the GP practice electronically (or posted), scanned in, automatically coded and added to the patient's record.

[Easternlight]

Here you go OP take one of these a day.

[Lemming Train]

Thank you gentlemen for your comments and suggestions. Wiccan : regarding the cellulitis sample and blood test I've read that having UV blood irradiation treatment can perform the same function and get rid of cellulitis once and for all, but I may have misinterpreted something along the way. Have you heard of this treatment?