Can a GP overrule the treatment prescribed by a specialist?

Mindless_Clone

As the title says.

My mum is under an endocrinologist for hypotranaemia caused by SADH. After 3 months in and out of hospital, it was finally stabilised with demeclocycline and she was well enough to return home. Her endocrinologist (registrar) saw her a few weeks ago (not long after being discharged from hospital), did some tests and his ongoing treatment plan was to leave her on her current dose as he felt it was right was right and managing her condition. However last week her GP has ordered a blood test; based on his interpretation of the results, he has decided to discontinue the drug. Given that he's not a specialist and her condition was only stabilised after 3 months when they started to administer this drug, I'm really concerned stopping it will send her into crisis again. She nearly died when she was first diagnosed. Can the GP actually overrule the specialist? Should he even be interfering? She's not been discharged from the care of the endocrinologist.

jenniewb

I've no idea on the legality or answer but I've experienced something different where a Consultant Psychiatrist wanted me to be referred to a special clinic yet my GP says no. I then am told I can get help elsewhere with a small charity. The charity then writes to me saying they cannot help me until I've been to the initial clinic.... So no referral, no help. I contacted the Consultant to say what was happening and spoke to the receptionist who said this was not good and the Consultant would be told- I've no idea if anything will happen because no one has gotten back to me as yet, (to be honest I'm that much deflated and feeling rubbish about everything else that I feel like I've given up myself so if they take it further it wont be me pushing for it, I kind of feel I've done enough shouting and screaming to last a very long time...but that's another story!)

I have a feeling that the GPs say so is the way things work, they have a lot of power and I'd suggest contacting your consultant to say what was happening and say you need their help and support as you don't know what to do and feel very upset and confused at whats happening and your mother's GP isn't being helpful.

I would think thats all you can do- for now but I'd also be suprized if there is not some form of appeal route and your mother's GP him/herself should be able to give you the details for that- maybe if they know that your prepared to take this further they may be a bit more helpful with your mother's condition.

j.e.j.

If your mum has been referred to hospital it's because her condition is such that it's beyond the level of General Practice. How frustrating for your mum to be on the mend and then told she can't continue with the meds which are helping her. I wonder what the GP's reasons were for discontinuing the drug?

I would put your concerns in writing to the surgery manager and as jenniewb says, enlist the help of the registrar if possible.

Philippa36

Did her consultant say it would be life long treatment? It may be that the registrar has written to the GP requesting the blood test and suggesting the meds stopped if the results are good. Don't assume the GP isn't working with the consultant - ring and ask and if they can't help then try the consultant's secretary.

Nicki

Your mum should double check with the consultant, by phoning and leaving a message with his secretary, and if necessary getting an early appointment with him, and a prescription for the medications in the interim until he can be seen. But the GP may not necessarily be wrong, or overruling the consultant, and may just have explained things badly.

I've been on long term medications in the past, initially prescribed by consultants but with repeats given by my GP and had blood tests while on them for things like liver and kidney function. If those tests had come back showing a change detrimental to my health, the GP would have taken me off the medication causing the problem (but should also refer me back to the consultant for a different treatment for the original problem).

Finefoot

I suggest you speak to a patient liaison officer at the hospital and ask their advice. Sometimes sadly, if the drug is expensive, the GP may not want to keep it on repeat. There is a system in place for this, that you can appeal.

melancholly

It could be that something in the recent blood tests suggested that the medication needed changing.... So not so much about over ruling the specialist as monitoring closely and adapting. Worth a phone call and a chat to check the reasons.

Mindless_Clone

Nicki wrote: »

Your mum should double check with the consultant, by phoning and leaving a message with his secretary, and if necessary getting an early appointment with him, and a prescription for the medications in the interim until he can be seen. But the GP may not necessarily be wrong, or overruling the consultant, and may just have explained things badly.

Thank you, this was pretty much what we did. The advice from the consultant was that, if the GP has ordered the tests then they cannot interfere with what he's done... madness really but there you are. Cons has booked her in for a blood test 1 week after the original to monitor and he will re-prescribe if necessary.

Finefoot wrote: »

I suggest you speak to a patient liaison officer at the hospital and ask their advice. Sometimes sadly, if the drug is expensive, the GP may not want to keep it on repeat. There is a system in place for this, that you can appeal.

This is what we suspected (the GP is a right tight wad) but the cons secretary said they were less than £1 her tablet. We have a number of other issues with him though that is being complained about.

melancholly wrote: »

It could be that something in the recent blood tests suggested that the medication needed changing.... So not so much about over ruling the specialist as monitoring closely and adapting. Worth a phone call and a chat to check the reasons.

Yes that's essentially what it is. However her sodium levels (excuse me if being a bit layperson, I only know what I was told) should be 136 to 140something in normal range. Hers was 135 at the blood test. So while she's definitely improved, it's not normal yet and, when in hospital, her sodium levels did not respond to any other treatments except this drug. I am afraid she's decline again as he's taken her off them too soon. But, as I say, she's at least being monitored now so I am less ready to commit a crime against her flipping GP as I was.

jenniewb, I just want to say, I am sorry you're having trouble gettting the treatment you need too. From my own experience, the squeaky wheel is the one that gets oiled... and with the NHS, I find that it really often works out the the onus is on us to push and push and make a pest of ourselves (if necessary) until they actually sort it out. I'm sorry if I sound anti NHS - I am not; they are fab in many circumstances and I've had many great experiences with them - I just think the one thing that does let them down still is the bureaucracy. Every time I have ever encountered a problem with the NHS, it has been caused by paperwork one way or another.

Thank you all for the advice.

jenniewb

Mindless_Clone wrote: »

jenniewb, I just want to say, I am sorry you're having trouble gettting the treatment you need too. From my own experience, the squeaky wheel is the one that gets oiled... and with the NHS, I find that it really often works out the the onus is on us to push and push and make a pest of ourselves (if necessary) until they actually sort it out. I'm sorry if I sound anti NHS - I am not; they are fab in many circumstances and I've had many great experiences with them - I just think the one thing that does let them down still is the bureaucracy. Every time I have ever encountered a problem with the NHS, it has been caused by paperwork one way or another.

Thank you all for the advice.

Thanks,

I used to push for things a lot more a few years ago. I think my mood just got so difficult to deal with (depression and chronic anxiety) and it just feels like a huge ordeal and I just find it hard to find a reason to push myself when everything else (eg getting through the anxiety/depression) feels like it takes up all the energy I had in the first place.
I have in the past pushed for things and got results but it never came easily, it took 2 years to get the pain in my leg diagnosed from a "get over it its just muscle tension" to a tibial stress fracture. Whats worse is I seem to get a huge amount of random illnesses and so on- to have to push for everything just feels a bit too much and I tend to try to live with it. Sorry if it makes me look a little lazy, but I just don't have the energy.

I have gotten back to the consultant psychiatrist though and he felt it was very central to my mood, when I mentioned it to the secretary she seemed very interested but I am waiting for him to get back to me on another matter (the pills he suggested may/may not happen). I don't hold out much hope though, I know how much power GPs hold and I guess I wonder if anything will even help anyway- it could just be a huge waste of money which wont buy me any fans and its just not good to be in that position when you are so dependant on your GPs for various referrals and medication when things get worse.

j.e.j.

jenniewb wrote: »

- to have to push for everything just feels a bit too much and I tend to try to live with it. Sorry if it makes me look a little lazy, but I just don't have the energy.

No, I don't think it makes you look lazy. Not everyone is pushy and bolshy (thankfully!:)) and while the patient tends to get the blame, it is ultimately the fault of the system, and of the "us and them" culture that seems so prevalent in the nhs, IMO.

Mindless_Clone

j.e.j. wrote: »

No, I don't think it makes you look lazy. Not everyone is pushy and bolshy (thankfully!:)) and while the patient tends to get the blame, it is ultimately the fault of the system, and of the "us and them" culture that seems so prevalent in the nhs, IMO.

Agreed. And to be honest, it's often those who are less able, physically or emotionally, that get the raw end of the deal; simply because they don't have the strength to push.

I think a lot of people live with little health niggles and don't do anything about them. I do the same, have loads of stuff I ought to get sorted but my GP is very much one for "heal thyself" (in other words, just like my mum he's a tight wad) so I pretty much get my medical advice from Dr Google... although he does have a disturbing habit of diagnosing everything as either cancer or fatal. :rotfl:

Save it all up and book yourself a triple appointment one day.