The GP nightmare continues ...

[Guest guest]

Hi, everyone, so this was it ... another useless visit to the GP, I think I'm ready to put in an order at an international pharmacy and get my own medication!This was the 3rd GP in a surgery I registered with end of October 2011; at the time I had been on 175 mcg Levo for about 15 months. After the first blood test with them, I was promptly asked to reduce the dose to 150 mcg and which promptly brought back on a long list of physical symptoms.Today was a deja-vu of my 2nd visit just before Christmas - while I was telling the doc about how poorly I'd been doing since going back on 150 mcg, she kept scrolling up and down my medical records on her PC and referred me to the mighty blood test. Apparently, the one they took in November tested TSH, TT4 and FT4, sorry, can't remember the last two but TSH was listed with a reference range from 0.3-5.5 and mine was 4.9 - say no more! That explains all.[i've requested a copy of all my blood tests from 2010 'till now which should be ready to collect on Thursday, so I should have more details then. Also, I left a page listing all my symptoms since late November 2011 and asked the receptionist to add this to my medical file.]There was just no reasoning with her, I didn't even get to request a more comprehensive thyroid test (e.g. FT3, TPOAb/TgAB) or vitamin/minerals deficiency test. In the end she said I should take it up with a 'senior' GP. (the senior is on holidays and won't be back until 2 weeks' time.) Then I showed her the MHRA news article about the licence suspension for the 100 mcg Levo tablets by TEVA UK, showed her my pill pack and asked if she could write me another prescription and she refused to do that either!The pharmacy that had filled the prescription was just next door so I asked them if they'd exchange the tablets. The pharmacist was very nice and totally acknowledged that I should get a replacement but would need a - duh! - prescription from the GP. So I spoke to the receptionist at the GP's who was kind enough to listen, she went back to that GP's office but came back with the same broken record line - I should take this up with a senior GP! I think the GP felt so threatened she stopped listening and consequently failed to realise that I had a reasonable request. The receptionist then suggested I should request a complete new prescription (usually a 3 months supply) - which I did. Not sure if that will be filled, probably not if it lands on the same GP's desk and if the GP is so paranoid to think I might take more than she authorised. Went back to the pharmacist who was nice enough to give me an 'emergency' refill with another generic on the presupposition I'll give him another prescription - what if I won't get one?Gosh, I'm so angry ... I think I should count my losses and move on. There's something really weird about this surgery - I'm looking for reasons for that defensive and dismissive behaviour - the practice is located in a 'rough' (nicely put) and ethnically diverse neighbourhood of Derby but the GPs seem to be totally inept culturally and seem to mistake questioning and querying for 'verbal abuse' of some sort? Anybody from Derby here who can recommend a decent GP? I'm at a loss.Connie

[Guest guest]

Hi thereThanks, Colin and Bob, for your replies - Colin, I'll check out the link.Bob, actually, I was on the phone with PALS yesterday after that GP disaster. As to the poor service, I was advised to switch GPs. The lady got slightly more interested when I told her about the GP's refusal to exchange my medication. She meant to talk to one of their 'chief pharmacists' but couldn't get hold of any as they seemed to be in a meeting. She said she'd be in touch but I'll call again if I shouldn't hear from her.I'm really not sure where to go from here. I hate the idea of switching GPs in such a short time, on the other hand, and this might just be my paranoia talking, I have the feeling the doctors in that surgery have already attached some remarks/comments to my file so that whenever I show up at another GP's office within this practice, I'll be treated with the same hostile and dismissive attitude. I mean, it is amazing that you visit a GP and he/she doesn't want to listen to your ailments and is more focused on defending their compliance to NICE guidelines (that's what the GP said), than to look into alternative diagnoses!I suppose there's no point in waiting for the big boss to come back from holidays and get an audience with him and neither, to send a formal complaint?Connie>[snip] ... > > Not knowing that a drug product has had its licence suspended is not acting in a "professional" manner ~ it happens ~ so they will jump when PALS contacts them.

[Guest guest]

Apart from " Intraoperative nerve monitoring during thyroid surgery " and

" Retrobulbar irradiation for thyroid eye disease " , there are no other NICE

guidelines for Hypothyroidism:

http://www.patient.co.uk/showdoc/50000020

You may also like to have a look at The NHS Clinical Knowledge Summaries:

http://www.cks.nhs.uk/hypothyroidism

Hopefully PALS will help you.

I mean, it is amazing

> that you visit a GP and he/she doesn't want to listen to your ailments

> and is more focused on defending their compliance to NICE guidelines

> (that's what the GP said), than to look into alternative diagnoses!

[Guest guest]

Hi Colin - thanks for the reply: > Apart from "Intraoperative nerve monitoring during thyroid surgery" and "Retrobulbar irradiation for thyroid eye disease", there are no other NICE guidelines for Hypothyroidism:> The GP was referring to the reference range of the blood test for TSH - she let me have a peek on the screen where I saw upper ref range was 5.5 (nmol/l?) - my TSH was at 4.9. She probably wanted to sound smart.Interesting though that the link you gave me to the NHS Clinical Knowledge gives an upper ref. range limit of 4.5 - which means I was well above that! So, what do I do with the knowledge now?> Hopefully PALS will help you.> PALS called me back and gave me more info on the MHRA statement, it did include a guideline for practitioners which pretty much said they should prescribe a different product if the patient is treated for hypo but keeps experiencing symptoms. The lady said she was going to contact the surgery on my behalf but haven't heard back from her.I don't think waiting for the mighty senior GP to return from holidays (that's how the GP ended the session - telling me to see him) and talk to him will make any difference. I really need to find a decent doctor but how many years will that take? I can't switch every few months?C.C.

[Guest guest]

Hi,

Different labs use different ranges amd from the NHS CKS it states to get the

TSH level into range with treatment:

http://www.cks.nhs.uk/hypothyroidism/prescribing_information/prescribing_informa\

tion/monitoring

" * If the TSH is elevated, titrate the levothyroxine dose up in 25 microgram

to 50 microgram increments until the TSH is within the reference range.

Some people will continue to feel unwell even when receiving adequate

levothyroxine therapy and with their TSH and free thyroxine (FT4) concentrations

within the reference range. Dose increases are not recommended. "

So not very helpful guidelines!

Could you maybe get a referral and choose to see a NHS Endo on Sheila's List?

Otherwise, if you do not wish to self treat, could you see Dr S or Dr P?

C

> The GP was referring to the reference range of the blood test for TSH -

> she let me have a peek on the screen where I saw upper ref range was 5.5

> (nmol/l?) - my TSH was at 4.9. She probably wanted to sound smart.

> Interesting though that the link you gave me to the NHS Clinical

> Knowledge gives an upper ref. range limit of 4.5 - which means I was

> well above that! So, what do I do with the knowledge now?

> > Hopefully PALS will help you.

[Guest guest]

Colin, thanks again, very useful link - I printed it out and am going to highlight the bits with the 'titriating' recommendation. After 4 days of relentless back and forth between me, PALS and GP surgery with regard to getting my last pack of levothyroxine by TEVA replaced with another generic (Actavis), it's finally done.The senior GPs give only audiences at 8am which is completely useless for me as I'm as good as braindead at that time, I wouldn't make a good case for anything, let alone an endo referral!Looks like I have no choice to find another GP although I've lost all confidence in finding one that takes the time to listen and think. Wish I could afford appointments with Dr S or Dr P but that's totally out of my financial range. Supplements, medication and a few blood tests is all I can afford, uh well. I'll be starting another thread with the blood test results of the past 2 years that I got today.Connie[snip, snip and more snip] ...> > Could you maybe get a referral and choose to see a NHS Endo on Sheila's List? Otherwise, if you do not wish to self treat, could you see Dr S or Dr P?

[Guest guest]

Connie, write to your local Primary Care Trust or telephone

them. They will find you a new doctor in your area. You can't do worse than

your last one. They will take care of everything for you.

Luv - Sheila

Looks like I have no choice to find another GP although I've

lost all confidence in finding one that takes the time to listen and think.

Wish I could afford appointments with Dr S or Dr P but that's totally out of my

financial range. Supplements, medication and a few blood tests is all I can

afford, uh well. I'll be starting another thread with the blood test results of

the past 2 years that I got today.

[Guest guest]

Hi Connie,

You are most welcome.

It is good you got the TEVA tablets replaced.

Consider reading Dr P's book if you have not already done so, as it gives lots

of useful information, written in an easy to read style.

Do post your test results when you are able to. I posted mine and got good

advice.

It certainly does seem like a lottery trying to find a helpful GP. The GPs at

my old surgery used to shrug their shoulders during my appointments. One GP

even went into a rant about patients looking things up online, when I said I

researched my low body temp and other signs + symptoms and they seemed to fit

with hypothyroidism. Having used up my whole appointment slot with the rant, I

thought afterwards, this doctor must use this method as an avoidance tactic.

Colin