Excellent and sensible advice from Dr Johns. His own confidence is now developing from his current experience. I would agree that over a third do not need admission & can either be discharged or managed as an Outpatient. The key here is to have Acute Physicians with at least 3 times/week urgent access/early discharge clinics available, working closely with these GP's
Of course GPs should consult 'amenable'Consultants by phone. In my specialty of Acute Medicine I would advise appropriately from: simple advice to GP, see patient in MAU, See in rapid access medical clinic, see at home or see PP, ie whatever is most appropriate or wished for by the patient. In most cases I would endeavour to see patient myself. I speak as an experienced Generalist who believes in doing what is in the patient's best interests( not the hospital's or mine). All the above are easy to carry out.
Why not simply switch to Simvastatin 20mg/day as advised. It will still do the job in most patients, you are following advice & it is cheaper.
There is no doubt in my mind that though statins are safe drugs & of benefit in reducing risk in vascular disease their nuisance side effects have been under recognised by the medical profession and played down by the drug companies.
Read 'the diet delusion' by Gary Taubes. Plenty of references in there.
Perhaps it is easier to get a Consultant PP appointment than a GP NHS one! It often is. Patients now take the quick way out whether it be A&E or a Consultant appointment. There is no law saying a GP referral letter required. However a letter to the GP expanding on the circumstances would be reasonable and you got it. I agee with you that with difficult patients (& this sounds like one) the Consultant should provide the script. I also agree that patients should be described exactly as they without using unnecessary superlartives!
You are correct. In insulin resistance whilst new therapies can be helpful the correct diet is even more important and that means reduced carbohydrate intake & when they are used they should be unrefined complex long acting carbohydrates.