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Consultations that make you reach for a pistol #1,738

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Patient arrives in emergency surgery clutching our standard, ‘You have got to be kidding me’ leaflet, dished out to rejected repeat-medication requests.

But the issue here is that she’s under the mental health team and wants a shedload of as-yet-unauthorised industrial-strength antidepressants, antipsychotics, mood stabilisers and sedatives.

I groan inwardly and then, when I explore further, outwardly. We have the list of drugs she reckons she’s taking, the list of drugs already on her repeat medication template, and the list of drugs recorded at her last appointment with the shrinkiatrist.

And guess what? They don’t tally. And simply reading through each list has already used up the time allocated for the appointment.

I try stalling, but she says, ‘I must have them today, doctor,’ in the tone of someone who knows that anything less would require a tantrum/threats of coming over all suicidal.

Muttering barely-concealed obscenities, I look back at the lists.

Of the few drugs that do match up, the strengths aren’t the same, or if they are, the dosage regimes aren’t.

In desperation, I phone her care worker, then her CPN, then, finally, her psychiatrist. After half an hour, I have managed to knock together a regime of drugs they rubber-stamp, and one which makes some sort of therapeutic sense. It could still floor a psychotic bullock, though, and the consultation has certainly floored me.

Exhausted, I set up the new repeat templates and finally print off the prescription, which takes another five minutes.

I hand it over, expecting her to say, ‘Thanks, doc.’

But she doesn’t. What she does say is, ‘Anyway, I don’t think the medication’s working.’

And that’s when I reach for the pistol.

Dr Tony Copperfield is a GP in Essex. You can follow him on Twitter @DocCopperfield.

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Readers' comments (62)

  • Ever get sick of thyroid patients coming in with their pain, fatigue and misery, despite 'normal' TSH on Levothyroxine? Ever feel like looking at their Free T3 just out of curiosity that the levothyroxine is converting as you were told it would? No? Just reach for the horse strength antidepressants instead? Thought so.

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  • What a completely irrelevant comment for this article. Seems like the 'hypothyroid lobby, have found their way onto this site 'for health professionals'

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  • An otherwise enjoyable article.

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  • This comment has been moderated.

  • Message to 8.09: Your intelligent, insightful comment would predictably provoke the immature, uncompassionate responses above. You've touched a nerve there 8.09 - very well said!

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  • 10:35 my comment was that this is not a lobbying site. the article wasn't even about hypothyroidism. i'm up for reasonable debate and listening to opinions where they are placed in context relating to the article being commented on. this is not an open forum it is a site for health professionals

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  • Want to have a pop at GPs?

    Urrrr....write a negative review on your next patient survey
    Urrrr....go on '' and let rip
    Urrrrr..write a letter to the daily mail, they'll likely publish it your whinge on the comments section of PULSE

    The list is ENDLESS..there is NOWHERE GPs can escape. Not even on a General Practice 'Health Professions' only web site. Were ever you go they will find you, they will seek you out and they will 'gob off'

    We are nothing ...we are here to serve, be scrutinised, criticised and complained about. For the crime of, naively in our youth, choosing a job trying to help people.

    God help anyone who decides to become a GP.

    We are scum.

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  • And my comment was in response to the 'muttered barely concealed obscenities line in the article. As a former heart sink patient, I was embarrassed to continually hound my GP. It was undignified to repeatedly visit an already overworked doctor with the same unremitting symptoms. I have great sympathy with the stress doctors work under. But I and many more thyroid patients are diagnosed with depression of varying degrees when we infact don't have depression or bi-polar but T3 deficiency. If you are content to prescribe brain altering chemicals without blood tests, why must thyroid patients jump through TSH shaped hoops for much needed hormones? How do you satisfy yourself this patient is truly depressed for no known cause if you don't check that the magic beans called Levothyroxine are doing what they are meant to do and convert to active hormone T3? I would like to see doctors get a bit of peace, I just don't see how you can if you blindly follow guidance from the RCP that is based on Expert Opinion only.

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  • Anon at 10.52, you can google my name and see that I don't hold truck with GP bashing. I have great respect for them and the incredible workload they deal with, as well as the ridiculous burdens placed on them by ever increasing targets and initiatives. Rating doctors initiatives etc are nonsense and designed to divide and conquer. Patient's aren't stupid and still hold GPs in great esteem. Sadly though, from our view, GPs are so worn down with these initiatives they can't stand up for their autonomy and effectively work outside of constant guidelines if needed for fear of the GMC fitness to practice issue.

    If Endocrinology did a better job and if RCP guidelines were based on peer reviewed evidence instead of 'expert opinion', GPs would have fewer heartsink patients and that has to be good for everyone. But no one seems to want to listen. At least the European Parliament, Scottish Parliament and SIGN are.

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  • Lorraine - one simple request. Get off our forum!

    We use this for shared banter, building resilience and exchange of views between other GPs. We do not want you sharing your soap box views which are totally irrelevant to the article.

    Go and whinge on a patient forum.

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  • Oh charming, and you're a GP trainer. God helps us.
    I realise it's a light hearted article but yes, I made a serious point, that there is a lot of misdiagnosis around depression. You carry on believing you're practising medicine when it's clear you medicate symptoms for a living. My view is not irrelevant to the article, the heart sink depressed patients coming back time and again. I don't whinge either. I get off my ass and campaign for change. Oddly, the only group deaf to it is GPs and it's stupid to dismiss a massive patient group as whinging when you're all so up against it right now.

    Funnily enough, it was ignoring GPs wisdom that got me well. I'm not about to start taking it now, thanks all the same.

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From: Copperfield

Dr Tony Copperfield is a jobbing GP in Essex with more than a few chips on his shoulder