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Am I permitted a rant?

stuffedolive

stuffedolive

Well-Known Member
Messages
542
Location
The Marches
Type of diabetes
Type 2
Treatment type
Diet only
Dislikes
Daily Mail, you know the sort
Why don't so many GPs listen to the patient?

I recently had some bloodtests for my increasingly frequent night-time headaches. I was pleased to get the tests as I have not had a diabetes review for 15 months and that was the only one in nearly 2 1/2 years.

I managed to talk to a GP today - a locum I think, who had just one thing to say, your Hba1c is 50 and you need to go on metformin and statins. Nothing about my headaches.

I tried to inform him (not that he was listening) that I have manged my T2 by diet and exercise for 20 years helped by having regular 6 monthly reviews, and that I have kept records of blood test results and dietary and exercise regimes to back up my success in keeping my T2 in control, with Hba1c usually in the mid-low 40's. And my GP has always congratulated me in the past.

I tried to suggest that the reason my Hba1c was 50 was because I had not been tested for the last 15 months and my normal routines had been upset my the pandemic,. Consequently what I really needed was a return to regular 6 monthly testing so that I could 'keep my eye on the ball' and get that Hba1c down without medication as I have in the past. Also I questioned his advice regarding statins as my records show I have had an adverse reaction to statins in the past which compromised my ability to exercise. Again he wasn't listening.

He wasn't interested in anything I had to say. He told me that what I had said didn't make sense, although he didn't explain why, and just repeated that I needed to be on metformin and statins because my Q-risk was 21% (this is, of course, wholly a factor of my age and T2 status and therefore outside my control).

20 years of successful management of my condition, dismissed, just like that. This was the most disappointing experience I have had with a GP in the last 20 years. Thankfully, I'll be moving house soon and moving to a new GP.

Rant over. :-(
 
He's an idiot as you've gathered. Sad that others will be treated by him. Statins should not be given based on the Q score (which is nonsense anyway). They should be prescribed based on a blood test lipids 'panel'
 
There seems to be a NICE recommendation that everyone with diabetes over the age of 40 should be prescribed statins regardless of your diabetes management, cholesterol. diet, exercise regime, ... It is not based on your lipid score (unless you are under 40).

Thankfully, when I passed that age threshold, this was told to me by a sensible endocrinologist who explained the reason is that for those who have a high Hba1C, are overweight and do not exercise research has shown statins reduce the risk of cardio disease. She went on to explain there has been no research on the benefit of statins for those of us who exercise regularly have lower Hba1C and do not have high cholesterol.

Given the lack of evidence that additional medication would be beneficial to me, I declined the statins. This has been recorded on my records ever since.


Regarding the title to this thread @stuffedolive
YES Absolutely. One of the great benefits of this forum is being able to rant with like minded souls,
 
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He's gone to your recod in the minute before he called you or called you in and the computer said Statinate Statinate! He gets a performance tick for doing so regardless of the nuances of lipids and your individual concern over side effects.
As you know the very best way to improve your actual CVD risk is to get your blood glucose levels normal. Maybe some strips will help though your GP won't prescribe them and a firm request for a 6 monthly check too of course.
Although your doctor was irritating in his not acknowledging what has clearly worked well for you, don't dismiss metformin as a helpful way of reducing the glucose in your body but I am sure you can get your bgs down again via a renewed focus on food and exercise habits. Who knows there are some great GPs like David Unwin, Ian Lake or Jo MacCormack and the The Freshwell Low Carb project who DO get it and will be open to your experiences.
Let us know how it goes as its great to hear success stories on what's worked. Plus I hope the encounter didn't make the headaches worse...
 
I recently had my MOT, anf the GP rang me. Your HbA1c is too low- It needs to be at 56 or above, I asked How Come? and he replied it is the current NICE guideline. I checked, and he is almost right. NICE sets it at 53 for T2D adults who take a glucose lowering medication, unless they can show that they have good control and no hypo's. He was not interested in me providing this proof, and said he was considering withdrawing my scrip for Gliclazide if I did not comply. Heck, its only one half dose tablet a day, so this is moneysaving par extreme.

It seems Big Pharma is fighting a rearguard action with the GP's. Still it was not as bad as the Hospital diabetes consultant who wanted me to wake up with fasting levels of 12 to 15 even though I was not on insulin and they had stopped my other meds too, It took a bit of effort to get Eatwell under control, but I managed it. My HbA1c went up from 42 to 45 after the two months of my stay. I was being force fed digestive biscuits because my readings of around 6 were dangerously low. The asylum is being taken over. Now as I stated, my current 46 is also too low.
 
stuffedolive said:
Why don't so many GPs listen to the patient?

I recently had some bloodtests for my increasingly frequent night-time headaches. I was pleased to get the tests as I have not had a diabetes review for 15 months and that was the only one in nearly 2 1/2 years.

I managed to talk to a GP today - a locum I think, who had just one thing to say, your Hba1c is 50 and you need to go on metformin and statins. Nothing about my headaches.

I tried to inform him (not that he was listening) that I have manged my T2 by diet and exercise for 20 years helped by having regular 6 monthly reviews, and that I have kept records of blood test results and dietary and exercise regimes to back up my success in keeping my T2 in control, with Hba1c usually in the mid-low 40's. And my GP has always congratulated me in the past.

I tried to suggest that the reason my Hba1c was 50 was because I had not been tested for the last 15 months and my normal routines had been upset my the pandemic,. Consequently what I really needed was a return to regular 6 monthly testing so that I could 'keep my eye on the ball' and get that Hba1c down without medication as I have in the past. Also I questioned his advice regarding statins as my records show I have had an adverse reaction to statins in the past which compromised my ability to exercise. Again he wasn't listening.

He wasn't interested in anything I had to say. He told me that what I had said didn't make sense, although he didn't explain why, and just repeated that I needed to be on metformin and statins because my Q-risk was 21% (this is, of course, wholly a factor of my age and T2 status and therefore outside my control).

20 years of successful management of my condition, dismissed, just like that. This was the most disappointing experience I have had with a GP in the last 20 years. Thankfully, I'll be moving house soon and moving to a new GP.

Rant over. :-(
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If this should ever happen again, in any practice/clinic, write to the Practice Manager or in the case of hospitals, contact their PALS site. I have had excellent results every time!
 
Oldvatr said:
I recently had my MOT, anf the GP rang me. Your HbA1c is too low- It needs to be at 56 or above, I asked How Come? and he replied it is the current NICE guideline. I checked, and he is almost right. NICE sets it at 53 for T2D adults who take a glucose lowering medication, unless they can show that they have good control and no hypo's. He was not interested in me providing this proof, and said he was considering withdrawing my scrip for Gliclazide if I did not comply. Heck, its only one half dose tablet a day, so this is moneysaving par extreme.

It seems Big Pharma is fighting a rearguard action with the GP's. Still it was not as bad as the Hospital diabetes consultant who wanted me to wake up with fasting levels of 12 to 15 even though I was not on insulin and they had stopped my other meds too, It took a bit of effort to get Eatwell under control, but I managed it. My HbA1c went up from 42 to 45 after the two months of my stay. I was being force fed digestive biscuits because my readings of around 6 were dangerously low. The asylum is being taken over. Now as I stated, my current 46 is also too low.
Click to expand...
The world is going mad!
 
Oldvatr said:
I recently had my MOT, anf the GP rang me. Your HbA1c is too low- It needs to be at 56 or above, I asked How Come? and he replied it is the current NICE guideline. I checked, and he is almost right. NICE sets it at 53 for T2D adults who take a glucose lowering medication, unless they can show that they have good control and no hypo's. He was not interested in me providing this proof, .....
Click to expand...

I checked the NICE guidelines and they say above 48mmol medication can be considered - there's no 'must'. The guidelines are quite clear that a personalised approach must be taken and that lifestyle changes are the first option. There was no way this GP was following the guidelines as he didn't want to hear how my lifestyle changes might have affected my Hba1c nor what I intended to do about it. NICE is also quit clear that my Hba1c should be tested more regularly than it is.

And don't get me started on his insistence that I should be on statins when it has been shown that over 65s (tick) and those undertaking endurance sport (tick) are more likely to suffer negative consequences. And statins would also raise my BG levels, possibly to the point that I would require medication. Totally counterproductive. But I don't suppose our overworked GPs have the time to see the 'bigger picture', they just assume the patient knows nothing and hasn't the
wherewithal make the necessary changes.
 
After 10+ years of control by diet only, and refusing any meds, I have given up expecting praise and curiosity around what I have achieved and how. I used to come back disheartened and crying. Now I just get my results, listen to the scolding for not taking stains etc, and for my weight. Listen to the comments about how I must eat a lot to be so heavy, despite the test results staring at them from the screen. Then I walk out and take a deep breath. I hate being implied that I am a liar, which is what,vin effect, happens, but I can't cure their willful ignorance and stupidity. I just spread the low carb message where I can.
 
stuffedolive said:
I checked the NICE guidelines and they say above 48mmol medication can be considered - there's no 'must'. The guidelines are quite clear that a personalised approach must be taken and that lifestyle changes are the first option. There was no way this GP was following the guidelines as he didn't want to hear how my lifestyle changes might have affected my Hba1c nor what I intended to do about it. NICE is also quit clear that my Hba1c should be tested more regularly than it is.

And don't get me started on his insistence that I should be on statins when it has been shown that over 65s (tick) and those undertaking endurance sport (tick) are more likely to suffer negative consequences. And statins would also raise my BG levels, possibly to the point that I would require medication. Totally counterproductive. But I don't suppose our overworked GPs have the time to see the 'bigger picture', they just assume the patient knows nothing and hasn't the
wherewithal make the necessary changes.
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I was classed as being allergic to statins in 2012. In May I had the finest set of results in my entire life!!
 
Sorry OP, very frustrating :(

I have finally got control of my diabetes, trying really hard past couple of months, had my diabetes dietician appointment this week, I was told that they had never seen 100% in target (libre), #smugface, “how did you go from 15% in target to 100%?” You guys know the answer. Starts with an L and ends in a C.

“Ok we need you to eat more, aim at 80% in target” #notsmugface, on my kids lives that’s true! They want me to do less good. :( you couldn’t make this up.
 
That's crazy!! Well done for getting 100% in target Libre, all your hard work paid off.

Well you know what to do with their advice!! You know best what works for you.
 
Fenn said:
“Ok we need you to eat more, aim at 80% in target” #notsmugface, on my kids lives that’s true! They want me to do less good. :( you couldn’t make this up.
Click to expand...

You've left me in emoji limbo. First thought, a winner for the out of this world result. Second thought, a hug for the 80% in target suggestion. Final thought, a funny emoji for the craziness of your team. Can't they just say "whatever you are doing, keep doing it"?

Seriously, that is a completely fantastic result. I am in awe.
 
stuffedolive said:
I checked the NICE guidelines and they say above 48mmol medication can be considered - there's no 'must'. The guidelines are quite clear that a personalised approach must be taken and that lifestyle changes are the first option. There was no way this GP was following the guidelines as he didn't want to hear how my lifestyle changes might have affected my Hba1c nor what I intended to do about it. NICE is also quit clear that my Hba1c should be tested more regularly than it is.

And don't get me started on his insistence that I should be on statins when it has been shown that over 65s (tick) and those undertaking endurance sport (tick) are more likely to suffer negative consequences. And statins would also raise my BG levels, possibly to the point that I would require medication. Totally counterproductive. But I don't suppose our overworked GPs have the time to see the 'bigger picture', they just assume the patient knows nothing and hasn't the
wherewithal make the necessary changes.
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It is Section 1.6.9 of NG28[2022] that applies to me as I am still a driver. And I was, at the time of the call. on Metformin as well as Gliclazide so not monotherapy. In my case the GP knew me well, and knew I was not having hypo's except when induced by hospital treatments (insulin)
 
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sue512 said:
The world is going mad!
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I guess that’s a given. But who exactly decided that we all have to keep hearing about it every day? Actually, nobody in particular, it just happened. Which again proves your point.
 
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Well, you would all make a horrible advertisement for diabetes care by the NHS. Granted, the horror stories get talked about the most but the amount of self-satisfied obtuseness shown by some of these doctors is almost beyond belief. In the end, it always comes down to “Who’s in charge of my health?” The answer ought to be “me.”
 
david4503 said:
Well, you would all make a horrible advertisement for diabetes care by the NHS. Granted, the horror stories get talked about the most but the amount of self-satisfied obtuseness shown by some of these doctors is almost beyond belief. In the end, it always comes down to “Who’s in charge of my health?” The answer ought to be “me.”
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Whilst I agree with you, I am aware that the majority of diabetics do not read this forum, and many are quite happy for someone to tell them what to do and when. They do not question why? and are unaware of their rights as a citizen of the world. In most cases the 'specialist' is assumed to be right because they have authority over us. If my GP refuses to issue my scrip then I am in a difficult place, so I must comply.
 
david4503 said:
Well, you would all make a horrible advertisement for diabetes care by the NHS. Granted, the horror stories get talked about the most but the amount of self-satisfied obtuseness shown by some of these doctors is almost beyond belief. In the end, it always comes down to “Who’s in charge of my health?” The answer ought to be “me.”
Click to expand...
I'd agree mainly because as a type 1 , I was told by my childhood diabetologist that I would always know more about my own diabetes than him. I believe that and act in this way but still feel the huge power imbalance that occurs when you enter a consultation room and get dictated to rather than consulted with!
 
Yes, the whole power imbalance situation in the exam room. I can’t tell you how much that irks me. I think the best answer is to make sure you’re on the same wavelength as your doctor and let everyone else know what that wavelength is. Myself, I’ve put a lot of effort into picking my doctors and staying with the ones who I feel do a good job. The same with whatever health facilities I need to go to. I get the sense that this ability to choose doctors and other healthcare resources is not so readily available through the NHS.
 
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