Monday, November 29, 2010


I had to go and see my GP today. Nothing's wrong - it's just that every so often there will be a note on my repeat prescription asking me to make an appointment for a "medication review" and then I have to attend.

Since I got all the diagnostic tests and the medication-juggling and so on dealt with while I was still living in Lowestoft, by the GP who'd known me since childhood, the doctor who has been "my" GP for the three years I've been living here doesn't actually know me - so it made no difference that she's ill today and I ended up seeing a different doctor. Today's appointment was much the same as every other and pretty much went as follows:

Good morning, how are you?
Fine thanks, yourself?
Yes, fine, thank you. Please take a seat. So, what can we do for you today?
Well, I had a note on my repeat prescription telling me it was time for a review.
Ah, okay. *taps at computer* You're on X, Y, and Z, yes?
That's right.
Any problems with any of those?
How are you generally?
Same as usual, nothing new to report.
Nothing you need to raise?
*taps at computer some more* okay, that's done. Do you need me to do you another prescription today?
I don't mind, I've got a couple of weeks' worth at home still.
In that case shall we leave it and you can just pick up your repeat as usual when you need it?
Sounds good to me. Are we all done?
Yes, unless there was anything else?
Nope, all good. Thank you for your time.

The trouble is that, as a patient with an ME/CFS diagnosis, there are no other answers I'd dare give. I'm too scared of being labelled a malingerer. So I get defensive and clam up.

A plethora of medical blogs teaches me that patients like myself, with chronic illnesses that don't seem to get much better or much worse, are despised. "Heartsink patients" is apparently what we are called - we walk in the room and the doctor's heart sinks because he knows that all he can do is dole out the drugs, which is not the role he slogged through medical school to attain.

The heartsink patient presents vague symptoms that the doctor can do nothing about. They bother the doctor with pointless questions and ideas and they seem to have no idea about what sort of thing actually warrants bothering a GP and taking up his valuable time. The caricature is of a patient holding a sheaf of newspaper clippings and internet printouts about quack therapies, because it is wrong to be concerned about your health if you don't have a critical scientific background. You should leave that to the expert who sees you for eight minutes a year.

And then there's the whole ME/CFS physical/psychological debate. What is the difference between a headache that exists and a headache that the sufferer only thinks exists? Personally I'm not sure there is a difference. Both patients are experiencing pain. Speaking for myself, I underwent psychological assessment in the earliest phases of my illness and was considered to have all screws firmly affixed. But that's buried many years back in my notes. Many doctors still consider ME/CFS to be a manifestation of depression, or attention-seeking, or even painkiller-addiction, and nothing says 'mental health problems' like the statement "the shrink said I was sane!" so I keep my mouth shut and hope beyond hope that the doctor will take me at face value.

So thanks to the medical bloggers letting me know how they view me, I feel resented as a patient, and obliged to take up as little of the doctor's time as possible. I do not dare mention to any medical professional the links and patterns that I've noticed since my condition and medication settled, lest I be categorised as 'obsessed' with my health. I have a normal human desire for people to not think badly of me and that includes doctors.

Paradoxically, there are things I probably should be mentioning. I mean, earlier today when the doctor asked me - actually asked me - if there were any difficulties with my medications, that was probably the right time to mention that for the last eighteen months or so I've been feeling really quite queasy about thirty minutes after taking ibuprofen in the afternoon or evening (but weirdly not in the morning). But I don't know! If I say that, is it going to be a case of "right, we'd better try you on something different for a while," or is it going to be more "FFS, stop wasting my time and clogging up my surgery with your hypochondria!"

To be absolutely clear, this has nothing to do with any of the GPs I've ever seen at my local surgery. They have never been anything less than courteous, professional and efficient. It's the ones who dropped the professional veneer, albeit with anonymity, to come online and let the patients know just how contemptible we are.

So, GP bloggers, off we go. Complain about those bloody heartsink patients who don't know how to behave. Because frankly, I have no idea how to behave and if you could give me some constructive pointers I'd be grateful.


Ron said...

Haven't see my GP at the surgery in 5 years, and not at all for 2. (ME/CFS, COPD, other stuff related to being struck by lighting).

He doesn't seem to care and, as long as he churns out my repeat drugs, I'm happy. It's not as if seeing him actually does me any good anyway - just wastes time for both of us.

Mary said...

I think I have an underlying concern that eventually someone will go "well why are you on THAT?" and refuse to repeat it.

The Goldfish said...

My sympathies and empathies. I'm with a new GP, at the working out what he makes of me stage. I've had no less than four excellent GPs (number due to moving around a lot) but there's always that fear there. Although to be honest, to stop a repeat prescription suddenly would be a big step for a GP - to say you shouldn't be on something you're on would be questioning a colleague's professional judgement. They might suggest you experimented with your drugs, that's all.

Ibuprofen can damage the lining of the stomach, so do take care with this and talk to your GP again. If this happens, you can end up with serious stomach problems, and because different stomachs have different chemistries, some people are more vulnerable than others. But long term use obviously makes you more vulnerable. Or it could be something else, but your doctor would have to be pretty awful to identify you as a fusspot just for that.

Anonymous said...

Ibuprofen is an anti-inflamatory and should ALWAYS be taken with food or else it damages your stomach lining.
Perhaps in your case, you are having something substantial in the morning with your Ibuprofen, but not really bothering with much before the afternoon dose?
A cup of tea isn't good enough m'dear - a slice of toast or a couple of biscuits may do the trick though.
Could you maybe for a couple of days try eating the same thing before each dose and see if that helped?
I also found myself being queasy after some of my meds and it helped me - your mileage may vary -but it is a very good excuse to treat yourself to tea and biscuits in the afternoon :-)

Mary said...

To reassure Terri and Goldfish - I always have food with all of my tablets and I have a little stash of biscuits wrapped in twos for this purpose. And we're not talking about severe pain or vomiting or blood from either end, just feeling a bit nauseous.

This is the thing, really. If I was vomiting blood then I would feel perfectly justified in calling NHS direct and unsurprised if they told me to go to A&E. It's the ongoing minor things that cause mild concern over several weeks rather than immediate acute symptoms that warrant panic.

I want to be able to say to the GP "I know it's probably not important, but you have a medical degree and I don't so I thought you'd be the one to ask," without the fear of being slapped with a label of hypochondria or self-obsession or 'worried well'.

Mary said...

From Twitter (twitlonger)...

@batsgirl I'm going thru that now - new doc, hoping to hell she hasn't read my notes from old doc yet, as I mistakenly told him of abnormalities that worried me. Won't be doing that again.

kitty said...

I don't think you should let medical bloggers put you off. I believe they only write that stuff because they know it's controversial and it will kick up a fuss (i.e. give them more blog views). But I have no doubt some do genuinely feel like that but I try not to read them as it just makes me angry.

I'm so lucky my GP is so lovely. He says come back in two months so we can check how you're doing. And on more than one occassion he's said to me "I think you're doing really well, considering." and I think that helps. A doctor that can empathise despite not being able to really help, that is what we all need until there is something magical that can fix us!!

Good luck with your meds, as somoene said above, ibuprofen with food may ease your nausea x

Mary said...

Thanks, kitty. As I said above, I am having food with my tablets and there really is nothing alarming going on, just a bit of nausea.

At this stage in my illness I don't feel like I need regular appointments as things are pretty much settled, and I get enough empathy from friends. But I wish I could properly trust GPs rather than second-guessing and feeling like a time-waster.

You're absolutely right that it's better not to read medical blogs - I think the only one I read with any regularity is Random Acts of Reality. But they do pop up now and again, and I wish we could have some constructive "do"s rather than just the "don'ts" and disparagement.