How do you approach a GPs appointment?

[TPMB12]

Basically as in the title.  If you've got something you need checking out do you find you have to play it up or the GP fobs you off? Or do you go in honestly and get taken seriously? Or do you pay it down and get ignored?

[chrisbainbridge]

I do not think there is an answer to this.  if you have an idea what the diagnosis is then do lead with the most relevant symptoms.  So many patients come in mentioning their big toes, aunty gwendoline's wrist, their recent headache and finally mention the numbness in their fingers.  By that time they have used up their allotted time.

Do write down your main symptoms and a timeline.
Do mention weight loss, altered bowel habit, permanent cough, etc
Do not mention your ingrowing toenails.

Do ask on here if you want an unpaid and worth even less steer.

[mrcharly-YHT]

My experience has varied. Many surgeries have been fantastic.

Main guidelines are to be honest. Don't downplay pain or discomfort. Be clear, simple and direct, the appointments are very short.

[ian]

Why would a GP ignore or fob you off? That's not really their business.

As others say, be truthful, don't underplay or exaggerate symptoms (any experienced doctor will have seen it all before). The average GP is astoundingly good at reaching a correct diagnosis with little more than the patient's history.

[Flite]

As Chris says, write down the main points you need to make.
List your symptoms and be as accurate as possible with dates they started. 
Be clear in your own mind what you want resolved.

[Kim]

Why would a GP ignore or fob you off?

Because they think you're wasting their time, probably by deferring to someone with relevant expertise and experience to determine that something isn't serious.  Happens all the time, and is usually down to some combination of prejudice, incompetence or burnout.  Contrary to $insert_stereotype_here, doctors are human, and most of them have had a pretty rough time over the last couple of years.

I've been fobbed off by GPs for being in pain while under the age of 30, and for not being sure whether a serious allergic reaction was infected or not.  It happens.  The catch-22 is that if you have enough medical savvy to know that it's happening to you at the time, you'll probably be able to middle-class-elbows your way out of the problem eventually (eg. by seeing another doctor elsewhere).  Its the people who fall through the cracks that are the real problem.

See also: Gatekeeper receptionists.


As for advice, I don't have much other than trying to short-circuit their possible prejudices by presenting as the relevant in-group.  Be clean, educated and middle-class sounding.  (And ideally, white, male and not overweight.)  Have a STEM background, if not a medical one.  (But don't be a Google hypochondriac.)  Wear a T-shaped shirt with a complex organic molecule on it.  Try not to have a stigmatised diagnosis (mental health conditions, chronic fatigue, whatever) on your medical record.  That sort of thing.  If you can't manage those, be accompanied by someone who can, or at least by someone who can ostentatiously take notes.

[ian]

I'm unconvinced that's generally true, I'm fairly critical of the medical profession, but doctors obviously generally get things right (it's only newsworthy when they get things wrong). Of course, some doctors are less average than others.

Many patients turn up at the surgery armed with fifteen minutes of Google. GPs have six years and a career of training. The majority of consultations do result in a diagnosis of go home and come back if it doesn't clear up, or a pointless prescription (sadly, still too often to antibiotics). Patients do have an expectation of something, which creates a lot of pressure on GP to do that something, even when they don't have a professional belief that their intervention is required. The majority of GP visits don't result in a diagnosis of anything. (We really ought to be trying to understand that, since it takes up a vast amount of primary care resource.)

I think you have to be realistic. While in some ways it's good that people are invested in their health, GP friends of mine all have tales of the increasing number of patients who turn up armed with a diagnosis that is merely presented for confirmation. They're generally wrong but often have a degree of difficulty in accepting that.

[Kim]

I'm unconvinced that's generally true, I'm fairly critical of the medical profession, but doctors obviously generally get things right (it's only newsworthy when they get things wrong). Of course, some doctors are less average than others.

Oh, I agree.  As someone with (now boring and well-managed) chronic conditions, I've seen GPs regularly since I was a small, and I can only think of a couple of incidents where they fobbed me off.  Generally, it's fine.  Though it undoubtedly helps that most of them read me as in-group, and that these days I'm usually there at their computer's insistence.

[TPMB12]

Why would a GP ignore or fob you off? That's not really their business.

Off the top of my head I can think of a few instances I've been fobbed off. Reasons why include the GPs husband had what I had and he never had those symptoms. "You're obviously very fit so it can't be anything serious" comment. Those are just two. Add in the after hours gp surgery I went to in desperation on holiday in Wales who told me to take paracetamol and ibuprofen. Next day I called into a normal gp surgery and sat until lunch time when I nice GP saw me in his lunch break.  Perforated eardrum that a simple antibiotic stopped in the other ear a day after that gp prescribed it and I started taking it. I know there's an issue with overprescribing of A/Bs but apparently they work well on ear infections that are applying visible pressure on an eardrum. Bacterial infection not viral.

Ime I get fobbed off unless I go in playing it up. What's interesting is both me and my sister went to a gp for the same symptoms but mine were more severe. We both got the same diagnosis but in addition to the diagnosis my sister got sent to a neurologist and had a scan just in case. Same family history, same condition but different treatment.  Only difference, apart from severity of symptoms, was one was a 5'7" female and I'm a 6'5" male. Then there's other things too.

It all makes me wonder what I'm doing wrong? Why do I get the lesser treatment for the same condition?

[ravenbait]

I'm unconvinced that's generally true, I'm fairly critical of the medical profession, but doctors obviously generally get things right (it's only newsworthy when they get things wrong). Of course, some doctors are less average than others.

I was going to give some counterfactual experiences, but (“Redacted” – C-3PO)

Suffice to say your observation holds true if you are white, male, and generally healthy. Otherwise... Maybe not so much.

Sam

[ravenbait]

It all makes me wonder what I'm doing wrong? Why do I get the lesser treatment for the same condition?

I've been to our local with the same symptoms as my significant (male) other for a physical injury caused in near identical circumstances. He gets orthopaedic referral resulting in ultrasound and a steroid injection. I get told to take some ibuprofen.

If you work it out, let me know.

Sam

[ian]

There's an inherent presumption here that the lesser intervention is somehow always the incorrect intervention. I can't comment on personal circumstances, of course, but a significant number of referrals for scans etc. aren't clinically necessary, they're borne out of patient expectations and a doctor's not unreasonable 'just in case' worry (and this creates a vast resource drain. In some, if not many, cases, go home and take an ibuprofen may indeed be the correct intervention.

[MikeFromLFE]

My experience - as both a working and retired healthcare professional was entirely positive - until the last month.

I've always been very careful with any thoughts I may have, or have gleaned from Dr Google - in some cases I've been asked what I thought was wrong. It does no harm to say "I'm worried I might have rumbling rhubarbitis" so they can put your mind at rest.

My recent grumble has been that I've been put on the list of a final year trainee GP (in itself not generally an issue) but this chap - perfectly likeable - seems to be in the camp of believing that IBS is 'all in your mind' without saying as much.
I've been in touch with my surgery more in the last couple of months more than I have in the last few years and I worry that is labelling me as a 'difficult patient' - which I don't feel I am.
This example perhaps serves as a reminder for anyone to only contact the GP if you really need to. My respect for pharmacists has increased in leaps and bounds in recent years.

[nicknack]

GP appointment?

What's one of those?

[graculus]

My respect for pharmacists has increased in leaps and bounds in recent years.

This.
The ability to turn up, without an the need for an appointment, and after a short wait get an answer to what's wrong and what can be done about it (even if that is 'nothing'), or be told 'you need to see your GP' is invaluable.

[Wowbagger]

It seems to me, having compared notes with my wife and daughters, that I get taken more seriously/fobbed off less than they do.

I do recall one instance of my diagnosis being better than the first doctor's when I had some odd lumps on my scalp, which I couldn't see, even with a mirror, and I thought were some sort of pustule. Then Dez said to me one day "What's that on your head?" and he described it. Doctors' appointments became a specialist's appointment and she sent me to get a biopsy "To see if it's what I think it might be."

"What's that?" I enquired, really wanting to know.

"It might be a virus, or it might be cancer" was her response.

The biopsy came and went, as did quite a bit of blood (do you know how much a scalp can bleed, especially when the patient is on blood thinners?) and during the intervening period I developed a very large lump at the base of one fingernail. Something jogged my memory about a conversation I'd had with my mother many years before about herpetic whitlows. I googled, and there was a picture of what looked exactly like the lump on my finger. I then looked for herpetic scalp lumps (or equivalent) and found pictures of looked exactly like mine. I had already been to the doc's that day and he had given me antibiotics, so I went back just before the close of business and saw another doc, showed him the ipad pictures, and he happily gave me some antivirals.

I picked those up from the pharmacy and went home. A few minutes after my arrival I had a call from the national dermatology centre in Lancashire to be told that my biopsy results were ready but since they were not qualified medics, I would have to phone my doctor for the results. I did this and got the guy who had prescribed me antibiotics that morning. It turned out to be molluscum virus, not herpes, and the antivirals I had just been given were exactly what he would have prescribed. They worked and my scalp lumps got better. So did the whitlow on my finger.

[Jurek]

I turn up at my GP's surgery at 07:30.
I get to see a doctor by 08:30 or slightly thereafter.
Every time.
Its a cracking service.

[ian]

GP appointment?

What's one of those?

This is sort of the point. We only go to see doctors when we think we are ill, it's a bit like driving your car into the ground, and then going to the mechanic because all the wheels fell off and the engine caught fire. It's completely the wrong approach to healthcare, and ultimately unaffordable. Medicine should be about wellness. It should be proactive, not reactive. Waiting until we think we're unwell before we see a doctor is quite the worse approach to healthcare anyone could think of.

That's also sort of the problem, going to see a GP is a pain, you have to work up to it, and you can generally only be bothered going if you really think you might be ill. That sets up a level of expectation, so when you've done all that, and the GP – within 30 seconds – says it's nothing, go home, it's no wonder people get upset, and expect something. The doctor, of course, is probably right, it is nothing and it will resolve. That said, I will say, this is a terrible practice of medicine. You've worked up all the anxiety to be dismissed in short order. It also wastes a good opportunity to engage in wellness. You're there for one thing, and once dismissed, you are out of the door. No doctor should do that. Sorry, no excuses there.

Things unfixed, cost a lot more. We have to serious about health, and that is a tango for two. I think it's unhealthy to approach a doctor's appointment with the view of how do I convince them I'm unwell (equally, to be honest, I do understand it).

If we don't change the paradigm for healthcare, it'll get more unaffordable and the outcomes poorer.

[MikeFromLFE]

I won't try to quote @ian's post about wellness but it's spot on.

Mrs M was a School Nurse for most of her career - health education and health promotion was the bedrock of her job, with a heavy dose of safeguarding thrown in.

In one of the reforms over the last 12 years this service was hived off to the cash strapped local authority services and is now a bare bones Child Protection service at the legal minimum where equally stretched Social Services aren't qualified.

Health promotion, education and prevention are, as Ian says, key to an effective healthcare service, unfortunately they are extremely difficult to either cost out the benefits, or to monetise (sell off) as services.
Nuff said.

[Snakehips]

How do you approach a GPs appointment?

I look upon it as an opportunity to meet someone new. Since I became an adult, some years ago, I don't recall seeing the same GP twice.

[JellyLegs]

Fortunately I don’t need to go to the GP that often, but when I do need an appointment my experience has been pretty positive once I can force a way passed the special forces armed guards receptionists.  I tell the GP what the symptoms are, how long I have had them and keep to the point and they usually offer a diagnosis and treatment options.  The only times I have ever felt fobbed off were when seeing a hospital specialist.  A couple of times down the years I have had the very definite impression that my condition was far too mundane for them to bother with or that they only had one standard treatment regardless of the condition.  On one occasion, I got the the GP to refer me to a totally different hospital and ended up with a quick outpatient procedure rather than a general anaesthetic and several days in hospital.

There's an inherent presumption here that the lesser intervention is somehow always the incorrect intervention. I can't comment on personal circumstances, of course, but a significant number of referrals for scans etc. aren't clinically necessary, they're borne out of patient expectations and a doctor's not unreasonable 'just in case' worry (and this creates a vast resource drain. In some, if not many, cases, go home and take an ibuprofen may indeed be the correct intervention.

I possibly owe my life, or certainly the avoidance of a lot of very nasty treatment, to my GP’s ‘just in case’ worry.   Eight odd years ago, I rang for an appointment due to a numb testicle.  Triaged over the phone and told to come in there and then.  After a chat and a physical exam, the GP was “99% sure it’s nothing serious, probably a minor infection but I will send you for a scan just in case”. The hospital Ultrasound technician was the most disinterested guy I have ever met until the inner delights of my testicle came into focus on his screen.  I was wheeled into theatre to have it removed 5 days later as the scan revealed a cancerous growth hidden within. From the size etc, I am told it probably would have spread relatively soon afterwards so I was lucky to get away with minimal chemotherapy and a short operation.  The thing is most GPs will only see one or two cases of testicular cancer in a career but will see hundreds of infections.  They do a pretty good job at filtering out the important ones imho.

[Kim]

GP appointment?

What's one of those?

This is sort of the point. We only go to see doctors when we think we are ill, it's a bit like driving your car into the ground, and then going to the mechanic because all the wheels fell off and the engine caught fire.

That's the man stereotype, I suppose.  It's probably true for vast swathes of the population.

But I mostly go to the GPs for endless medication reviews, routine tests and vaccinations and to untangle the occasional bureaucratic cockup, as well as the subset of random illnesses which actually warrant some kind of treatment or further investigation.  And the doctors/nurses I see routinely^[1] seem to be pretty good at it.


_{[1] With the exception of now-retired lovely doctor who emitted a bogon field so intense that no computer system could withstand her attempt to operate it.  There was always a risk that she might try to order a course of trimethoprim and accidentally start a nuclear war.}

[TPMB12]

There's an inherent presumption here that the lesser intervention is somehow always the incorrect intervention. I can't comment on personal circumstances, of course, but a significant number of referrals for scans etc. aren't clinically necessary, they're borne out of patient expectations and a doctor's not unreasonable 'just in case' worry (and this creates a vast resource drain. In some, if not many, cases, go home and take an ibuprofen may indeed be the correct intervention.

In my case it was for a condition that I since learnt that a lot of western countries do send to a neurologist and to get s brain scan.  Often a precaution. Here it's basically a lottery as to whether that happens. First issue is GP,  second I think you have to be in a good commissioning group.  In my sister's case she was near a hospital that catered for military. So I guess well equipped and staffed. She saw an army consultant apparently.  Then she moved to a big city area and got a second scan when the condition changed in symptoms.

Here's me living near a small town back when diagnosed and now an even smaller town. The GP was in a satellite surgery which most practise GPs seem to hate going to. Heavily downgraded in favour of n the main surgery. I get told I making symptoms up or to take a paracetamol. After 20 years I got referred to a consultant and got offered heavy duty drugs the GP could not prescribe. That was because although my attacks were too infrequent to normally get given these drugs my attacks were so severe the drugs were offered.

My point is there's so many ways a GP can choose to treat a patient. I don't think I get their a game unless I go in looking like shoot or playing up the symptoms. If I do all I get is the treatment others get anyway. If not I get sent away with a fob off. I don't know why that is.

[IanDG]

I don't like googling symptoms and getting ideas but maybe prior knowledge and some idea of what you think an illness is before visiting GP is a good thing.

For example: I had slow recovery from long bike rides - fatigue, aches and pains. GP picked up on fatigue and did blood tests and decided I was iron deficient. No improvement and within 2 months I was struggling to get out of bed and out of a chair. The aches and pains were more relevant than the fatigue. Second GP visit diagnosed polymyalgia rheumatica. Now on steroids and making an improvement.

GPs are pushed for time. A symptom of the current crisis in health care. No time to spend with a patient, quick diagnosis and move to the next one. Unfortunately, not always right first tme.

[TPMB12]

Well I'm about three visits in for fatigue, aches and pains. A lot more for various symptoms that have been labelled as IBS by the first GP and that's enough for all the other GPs so I keep getting drugs for IBS that do nothing for me. I'm from a family with a high incidence if bowel cancer which was enough for my another close family mender with same symptoms to get the camera check a few times.

I'm of the opinion I'm doing something wrong or my gp practice really hate making referrals if your white, male and look like you're fit/ active. What can I do.  Keep on going back with the same symptoms until something happens?