advice on doctor's poor attitude

DoubleDoors

ska_lover wrote: »

Things have changed with the NHS- these days you can chose your own consultants and healthcare these days under the choose and book scheme


https://www.nhs.uk/nhsengland/appointment-booking/pages/about-the-referral-system.aspx


The only real difference between NHS and private is waiting times are almost non existent if you go private - but most of the private doctors that people are paying £130 for 15 minutes of their time, they are working in the local NHS hospitals too - so standard of care and access to the same doctors, is pretty much the same - or it should be


also NHS have a complaints system if people are not happy where they are obliged to follow things up I am sure the private system have the same

Not all surgeries have Choose and Book (ours doesn't)

Also you're lucky to get anywhere near a consultant with the NHS, - it's usually trainee registrars if you're lucky.

sillyvixen

Did you go private for your op? Trust me you had it easy - I did not post on your o rigional post as you were awaiting your op and I did not want to scare you. I was under nhs - no hida scan just 3x ercp - barbaric at best - had several members of staff hold me down why endoscopic procedure took place! Nice! Took 8 months for surgery to take place after turning yellow with jaundice... open conversion nearly died twice on the table ( 30 min op changed to 7 hours) sorry to all the private patients who had their appointments cancelled at the local Nuffield while my surgeon battled for 7 hours to save my life!!! By the time I got my op I had waited 7 months with jaundice and my gallbladder was showing signs of gangrene! Given a few days delay I would have been fighting for my life!! I spent a week transfered from the day unit to a dementure ward -I was 34!! There were a catolouge of errors (cross matched blood was in theatre 30 miles from me, I told consaultant and aneathistist of med allergies and the fact I could not have jellifusion due to allergies -had anaphalictic shock under aneasitic as was given this drug as blood not avcatoloug. That surgeon saved my life, dispite everything - that was 10 years ago - I did not complain as a saved life is a good outcome - I have had further surgery as I was allergic to the disposable suture and ended up with an incicisional hernia due to wound breakdown, I was off months and ended up in debt due to being on stat sick - but I lived to tell the tale!! You had your op you had a good outcome, why complain?

MonkeyDr

(DOI: NHS dr, this is not my specialty)

OP, as someone else sensible has said above, you should separate out your two issues.

1. Attitude.
Sounds unpleasant. Don't go and see them again. Depending on exactly how bad it was I might consider writing a complaint to the dr / hospital / private provider. I'm not a fan of online reviews because the dr gets no right of reply (confidentiality), plus there is no proof that you were actually a patient, could just be a person with a grudge.

2. Medical management.
This is tricky. Medicine is not black and white. As I understand it the evidence base for HIDA scans is not overwhelming, and their role is limited to quite specific circumstances (based on your symptoms and other results, which I don't know, although I can guess at your underlying diagnosis). Certainly it is not that case that a positive Murphy's sign = pt should have a HIDA scan. My point being that although YOU ultimately benefitted from having one and a subsequent cholecystectomy, it may be the case that most other people presenting exactly the same way as you would NOT have got that benefit (and some may have suffered some unnecessary harm). Dr isn't negligent if they proceeded in a medically reasonable way.
So, I think refusing to pay or demanding compensation or rushing to the GMC to complain would be disproportionate.

You could, however, write to the Dr (or private provider) / stick in an internal complaint and ask them to review your case and explain to you why HIDA not done. If Dr missed it without good reason then they need to learn. If you are unhappy with their response you could then escalate things.

It can be tricky to navigate medical literature but looking online for relevant guidelines for your condition might help you get an idea of the usual investigation pathways.

I would also have a think about how much of your opinion of the attitude is coloured by the fact that they didn't say what you wanted to hear. 'Thorn in my side' per se sounds like the sort of thing that could be said in jest, and in my experience quite a lot of patients quite like being special / interesting! I am not trying to belittle your experience. But if you had seen this guy twice before and still went back you can't have hated him that much.

ska_lover

DoubleDoors wrote: »

Not all surgeries have Choose and Book (ours doesn't)

Also you're lucky to get anywhere near a consultant with the NHS, - it's usually trainee registrars if you're lucky.

If you are unhappy with your surgery, you can swap, off your own back - simply walk into a new surgery and fill out a form.

I find it strange that not all surgeries would use this, unless they don't have access to the internet. As it is making life unbelievably difficult - In most cases you have the legal right to choose the hospital or service you'd like to go to

omega3dave

MonkeyDr wrote: »

(DOI: NHS dr, this is not my specialty)

OP, as someone else sensible has said above, you should separate out your two issues.

1. Attitude.
Sounds unpleasant. Don't go and see them again. Depending on exactly how bad it was I might consider writing a complaint to the dr / hospital / private provider. I'm not a fan of online reviews because the dr gets no right of reply (confidentiality), plus there is no proof that you were actually a patient, could just be a person with a grudge.

2. Medical management.
This is tricky. Medicine is not black and white. As I understand it the evidence base for HIDA scans is not overwhelming, and their role is limited to quite specific circumstances (based on your symptoms and other results, which I don't know, although I can guess at your underlying diagnosis). Certainly it is not that case that a positive Murphy's sign = pt should have a HIDA scan. My point being that although YOU ultimately benefitted from having one and a subsequent cholecystectomy, it may be the case that most other people presenting exactly the same way as you would NOT have got that benefit (and some may have suffered some unnecessary harm). Dr isn't negligent if they proceeded in a medically reasonable way.
So, I think refusing to pay or demanding compensation or rushing to the GMC to complain would be disproportionate.

You could, however, write to the Dr (or private provider) / stick in an internal complaint and ask them to review your case and explain to you why HIDA not done. If Dr missed it without good reason then they need to learn. If you are unhappy with their response you could then escalate things.

It can be tricky to navigate medical literature but looking online for relevant guidelines for your condition might help you get an idea of the usual investigation pathways.

I would also have a think about how much of your opinion of the attitude is coloured by the fact that they didn't say what you wanted to hear. 'Thorn in my side' per se sounds like the sort of thing that could be said in jest, and in my experience quite a lot of patients quite like being special / interesting! I am not trying to belittle your experience. But if you had seen this guy twice before and still went back you can't have hated him that much.

thanks for detailed reply,

I have done pretty much as you said.

stuck in formal complaint to hospital, got an excellent response and apology

his 'thorn in my side' was not said in humorous manner. He really meant it. He did ignore the fact I had a positive Murphys sign test

is all about attitudes, attitudes determine time scales, quality of care,

this is about attitude, not money, not whether medicine is black or white (there was overwhelming markers/symptoms to flag up gallbladder issue. HIDA scan did confirm that. Is not about wanting a doctor to say 'tell you want you want to hear', is about attitudes

I could have just accepted his attitude, come home to partner and carried on in pain. His plan was to simply do nothing, be better if I just went away. This was not an option or acceptable to me

wrt HIDA scans, here in interesting link

http://journals.lww.com/nuclearmedicinecomm/Abstract/2001/06000/Diagnostic_accuracy_of_99Tcm_HIDA_with.9.aspx

I am feeling better, is early days of course

my pain has been so bad, debilitating. With increased work pressures and trying to maintain work/job, I just didn't need this 'thorn in my side' either

MonkeyDr

Hi OP

I am pleased that you are feeling better, and that the op went well, and that you took the complaint-to-hospital route. I hope that you continue to improve, and get back to your normal life asap.

I get the attitude problem, and am glad that you reported it back.

I really don't know about whether HIDA was necessarily indicated in your case or not (don't know all your details, and not my area). But I do know that sometimes 'doing nothing' really is the best medical option, however unpalatable. And it's not that Drs don't want to do more, it's that they recognise that potential diagnostic yield or therapeutic benefit might be low, and try to act in the best interests of their patients.

(as an aside, I only work in the NHS, and I often wonder if private Drs are incentivised to do more investigations and treatment simply because it keeps them getting paid. I have a certain amount of respect for a private Dr who doesn't keep offering more and more)

Thank you for the article. It is a single study, and quite old. From a quick read of some reviews it seems that whether HIDA should be used or not depends on how 'typical' the symptoms are. As you had GORD as well things might not have been clear cut, and at the end of the day it may come down to the weight placed on certain symptoms and interpreting them.

(e.g. https://www.uptodate.com/contents/functional-gallbladder-disorder-in-adults#H366143604)

Again, I stress that I really can't comment on your own personal management. I just always feel it necessary to comment on these types of posts (as well as spread the word among my own family and friends) that medical decisions are very rarely black and white, and outcomes can be unpredictable, even when the decisions made were reasonable and evidence-based.

omega3dave

thanks MonkeyDr

the uptodate site is good (have used it before), I did have all the conditions for the Rome IV criteria for a gallbladder problem

hey ho, is all done now, I do not regret complaining one jot,
it is through polite feedback, complaints, that instigate change in attitudes

suffice to say I went to the very top of the private hospital franchise in question. Always go to the top, always. There is always one person at the top, one man, one woman. Find out their name. The response I received totally endorsed my complaint

he will think twice about making some useless, unprofessional, unhelpful remark to another patient

in any trade, attitude is everything. Mechanics, plumbers, engineers...

as you said, I will not see the doctor in question ever again. Neither would I want to. He has been implicated in poor communication, resulting in tragedy with another patient in the past (this I discovered after I met with him)

medical decisions are very rarely black and white, and outcomes can be unpredictable, even when the decisions made were reasonable and evidence-based.

there are 4 major organs on the right side. Liver, pancreas, kidney, and gallbladder. Pick one, investigate on basis on presenting symptoms. Testing, as in the engineering profession, is key. Is the process of elimination that leads to a solution based on test results

inaction is not an option when a patient is presenting host of symptoms/pain, that are clearly affecting his/her day to day life

I had a GP doctor last year tell me without any form of testing I was suffering from hemorrhoids for passing blood for over 6 months. I didn't accept this. After CT scan a nasty 2cm lump was found in my colon (and I was 12 months away from turning cancerous, not my words, the GI doctor's)

he thinks I am a thorn in his side, I think his attitude sucks. We move on..brew some ginger tea and relax...

my final advice to anyone is, if you feel sh*t, unwell, unable to function day to day, get to see a good, trusted doctor (maybe a recommendation, look them up online, see what credentials, expertise they have, or don't have), you will know, you will feel it. If you have the slightest doubt, get a 2nd opinion, 3rd, whatever it takes

and don't accept sub-standard attitudes from anyone, in any profession

MonkeyDr

Hi OP,

I agree with the vast majority of what you have said. Great that you complained productively about poor attitude - certainly shouldn't be accepted in any profession. And no doubt there are Drs out there who sometimes make poor decisions.

omega3dave wrote: »

there are 4 major organs on the right side. Liver, pancreas, kidney, and gallbladder. Pick one, investigate on basis on presenting symptoms. Testing, as in the engineering profession, is key. Is the process of elimination that leads to a solution based on test results

inaction is not an option when a patient is presenting host of symptoms/pain, that are clearly affecting his/her day to day life

...

my final advice to anyone is, if you feel sh*t, unwell, unable to function day to day, get to see a good, trusted doctor (maybe a recommendation, look them up online, see what credentials, expertise they have, or don't have), you will know, you will feel it. If you have the slightest doubt, get a 2nd opinion, 3rd, whatever it takes

However, I didn't make my other point very well, sorry. I'll try again, and my apologies if it doesn't quite work.

It would be great if diagnostic medicine were as simple as working down a list of differentials in a sensible order, considering each in turn with the best investigation and ultimately getting the right answer. That approach is the right one to take.

But medical science is not exact, we do not have perfect investigations for everything. Many investigations lead to false positive or negative results, and can cause harm. Or the treatment that results from a false positive can cause harm. Any surgical operation carries not insignificant risk.

Investigations can always flag up unexpected things, which are often completely harmless ("incidentalomas") but start a pathway of further investigations, each with their own risks of harm. For every 1000 CT scans, 1 patient gets cancer because of the radiation.

Our instinct is to Keep Doing Stuff because doing nothing feels like, well, you're doing nothing. However, there are plenty of medical conditions / situations with increasing bodies of evidence that a certain proportion of symptoms will get better on their own (/ with conservative treatment) over time, such that doing the investigation or intervention actually causes more harm than good on a population level (on an individual level some people will still benefit, we just can't predict which ones).

In my own specialty there is a unpleasant disease with sometimes devastating long-term consequences, and we have a treatment for it which generally (not always) works but is pretty nasty in itself. I see people's lives disrupted by the treatment course. But we know that 1/3 people with the disease will spontaneously get better without treatment within 6-12 months. So the decision about who to treat and when is genuinely difficult.

My point is that while I am all in favour of people pushing to get the best treatment that they can, inaction actually sometimes can be the best medical course, even when your day to day life is being affected.

The caveat is, of course, that that has to be communicated carefully with the patient. Leaving anyone with the impression that you can't be bothered to do more is unacceptable.

(I really don't know enough about your condition to speak with authority, but I _think_ the issue with HIDA scans is that a low EF leads to cholecystectomy, and a fair proportion of patients have that and their symptoms still don't improve. So had the risk of surgery when maybe the symptoms weren't necessarily caused by GB in the first place. But it did work for you, so that's a good result.)

I hope that makes sense. Best of luck for your recovery.

omega3dave

The caveat is, of course, that that has to be communicated carefully with the patient. Leaving anyone with the impression that you can't be bothered to do more is unacceptable.

indeed, thanks MonkeyDr

I take your medical detail onboard

thank you and others for feedback, very good forum :beer:

(well no beer for me, I am tee total and on low fat diet lol)