Practice Nurse- Tail wagging the dog?

[Unbeliever]

I may have mentioned , from time to time , my disquiet at the current tendency on the part of our underpaisd and overworked GPS to leave far too much to the Practice nurses - even those caloling themselves DSN's.
At the end of the day, nurses are not doctors.

I have an ongoing issue with the pracice DSN about my blood pressure. She has a bee in her nurse's cap about home BP moniyors despite anyhing the Doctors or NICE may say. This guarantees het my BP will be something in he region of 200/190 whenever I see her although the hospital can confirm my home readings of 120ish over 60ish.
The doctor's are happy to accept my readings . SHE is not.
At my last annual review a month ago my total cholesterol appeared to have risen qute a bit. There were two students conducting the proceedings under supervision aand the discussion turned o my statins which had been causing me problems
wih muscle pain. The doctor changed my statims and ordered a fasting cholesterol test. Diabetics in th epractice are never asked to fast. I also requested my 3 monthly HBA1cs as ordered by the diabetes consultant be resumed and the Dr agreed. I have previously had major problems because the Practice nurse disagreed with the consultant about the necessity for them.

When I rang up to make he appointments. the recepionist just could not cope. Although the Doctor had ordered the tests she took 20 minutes o consult colleagues. eventually she offered to send the file o the Practice Nurse to ask if the tets were necessary! Eventually I manged to threaten her into giving me a date for the blood est. The HBA1C was impossible. I decided to wait until the fasing cholesterol est was done and hen go back to the doctor.

this morning I awent for the blood test. The nurse couldnt get any blood and asked the sister to see me. this is deputy DSN .
I was a bit puzzled abou the two vials of blood she etracted and amazed to be told it was the choleserol test and another HBA1c. A month to the day after the last!
I can only assume hat the recepionist wanted to cover her back by pushing this test in with the other.

I was then amazed to be leured about my supidity in following the doctor's orders to fast! Diabeics don't need o fast.
Chollesterol could be ested without fasting. I pointed out that this had been done for the annual review and as my total cholesterol had risen the doctor must have wanted to check with a fasting test. She still insisted I shouldn't have fased.
i then asked her for details of he choleserol readings. She had he otal and the HDLs but not the LDLs. She said that they were not available because ITWAS NOT A FASTIBG test. I wondered if this was perhaps, why the Dr had requesed a fasting test.
I hen asked for the triglyceride figure but she asked me to leave because she had "fitted me in " at the reques of the nurse
and had other patients waiting. She again instructed me to always call and check with the practice nurses if an doctor asked for a fasing blood test. i aske d if she really included the doctor asking for it at the Diabetes Annnual Review.
She replied that i should call one of the pracice Nurses to check when I go home if a docor suggested such a thing!

Just when i thought I had heard everything too
I suppose in a way , its the logical result of the drs abdicating any responsibility for diabetic patients - o rmaybe its a takeover bid!
I shall be having a long conversation with the doctor. Enough is enough

 

[Anonymous]

It is extremely frustrating when (some) staff at a practice try and act above their experience level. On my last HBA1C test the receptionist tried to to fob me off with two word - "No Action" is what she said.. er, no - I need the numbers - all of the numbers.

You have to stand your ground and ask for your results - I think others have demanded a printout of theirs by right. It's supposed to be a good thing to take an interest in your condition, but many many HCPs see it as a comment on their experience.

S

ps. is there a problem with the letter T on your keyboard Unbeliever?

 

[Paul_c]

When I request my test results electronically via our practice test results service, I just get "satisfactory". I challenged them on this and they replied that they aren't allowed to give the details out and I had to get them from the DSN at my next appointment.

I stopped there as my blood was boiling and I didn't want to lose it. After all, what is the point of having a test results service if they aren't allowed to give the actual results of the test?

If you raise your voice with them, they promptly start calling the police!!! I have witnessed this myself when someone else couldn't comprehend why he was being messed around appointment wise and it was costing him time off work...

 

[Sid Bonkers]

You are entitled to your results Paul but I can see why some GP's may not want unqualified receptionists to give them out, explain to your doctor that you are trying to be proactive in your care (they like that) and ask if the receptionist could either be allowed to tell you the breakdown or arrange to have a print out left at reception for you to pick up :thumbup: Must be worth a try.

 

[))Denise((]

My surgery won't give out numbers over the phone and will say things like 'normal', but if I go in I can get a printout.

They also won't do repeat prescriptions over the phone.

 

[noblehead]

The nurse is wrong about not having to fast before a full lipid cholesterol test, if it's just for a total cholesterol test then I believe you don't have to fast but a TC test is as much use as a chocolate frying pan.

 

[xyzzy]

I am always told to fast for a full lipids test. At one point the surgery had arranged an hBA1c test and I asked for a full lipids test to be added. They phoned to say that was fine and told me I would now need to fast because of the addition of the lipids test.

 

[Unbeliever]

I am not concerned about not getting my results . I did not get them at the ime of my annual review because the mediical student conducting it was already in some difficulties. I knew I would have to see the doctor about the new statins soon and was intending o ask her then.
I would not even hink of asking a receptionis for results. I have been given the wrong results in he pas by receptionists and I do think its a little unfair to expect them to interpret quite complicated resukllts for many diffferent conditions.

My poin was that the Diabetes Nurses are overriding he Doctor's sinstructions .Both with patients and with receptionists.

I was surprised last year when the DSN refused o accept the Dr's instructions about the BP home monitors. The GP was not pleased and
and inended o speak to her. Then the receptionist refused to book me in for a fasing cholesterol test and a 3monthly HBA1C without first referring it to the Diabetes Nurse.! hese ests were ordered by the GP following my annual Diabetes review four weeks ago.
I prevailed about the cholesterol test but eventually told hem to forget about the HBA1C unil I had a word with the Dr.
I turned up for the blood est yesterday but the "blood clinic " nurse couldn't manage to take the blood.
She asked one of the Practice Nurses -i happened o be one who has been "trained in diabetes".
She manged to get the blood but it was two vials which surprised me. After aking it she informed me i was the cholesterol test and an HBA!C which had been ordered by the Dr. I knew it hadn't. The receptionist had obviously booked it at the same time because she thought I was going to complain to the Doctor. That was four weeks after my last HBA1C . The last result was 6.
Totallu unnecessary and hardly a sunsitute for a 3 monhly test.

Theen she started to lecure me about having a fasting test.. It was not necessary! I told her that I had had the non-fasting test
before the annual review and that he non-fasting test gave insufficient information. She disputed this and so I asked her to show me the screen and for the HDL figures.etc. When it became obvious that the non-fasting figures were inadequate she scrolled down . She was still insisting that I should not have fasting tests and if I was asked to I should ring and check it with the Practice Nurse!
I pointed out that the test had been requested by the Doctor at my annual diabees review who was obviously fully aware i was diabetic. Also that since diagnosis I had had many fasting tests and that diabetics in other Practices also had them all the time.
She still insisted that I should ring one of the nurses to check !
As if! I have no intention of doing this and every intention of telling the dr all about it but in my Practice the Drs leave it all to the nurses ,{diabetic care}. I have complained in the past about their full ime DSN trying to give me a drug which could have blinded me but noone wanted to know. I oped they would have a word beghind the scenes.
Now I thi nk it is getting totally out of hand..

I stated at my review when I was asked about depression that I was depressed at being treated by these nurses who onbviously didnt know what they were talking about and were in a position to do a great deal of harm.
The dr protested that I only saw them once a year. I ponted out that by interfering wih the quarterly HBA1Cs i am supposed to have , and getting the admin wrong I actually see them far more often ! Every doctor in the Practice will refuse o answer questions about diabetes and point you in the direction of these incompeients.

I am no shrinking violet and will always argue my case but they appear to have very short memories and the sane case has o be argued over and over again. Far from helping hey just waste my ime and wind me up.

Now it apppears they are claiming some sort of ownership over diabetics , her parting words were that they would see me again in August. I asked why. She replied that that would be my 6monthly check. I ponted out that as my annual reiew was in may a 6 monthly check and review would be due in Nvember . As shown on my prescription form and he screen before her.
She then said I shuld come in anaywat to get it all in "sync " again. I refused point blank . How would that help.? She said tha someone had pushed the wrong button and the screen was wrog! I just looked at her. She then said shwe would sort it out!

I will sort it out. I have quite enough to worry about and already spend a great deal of ime in the hospital without having my ime wasted in this way.
Its not just one incident its the whole culture. Who are they to ell patients to check the octor's instructions?
tail wagging the dog? maybe lunatics running he asylum - although that would make more sense.

I shall visi the doctor when the results are in. I resent the necessity.

 

[viviennem]

I would certainly tell the doctor that the nurse is over-riding her instructions. I shouldn't think she'll be pleased!

Viv 8)

 

[Truffle]

My GP insists on fasting for the HBA1C tests but now as I am 'well controlled' (their words) I am only allowed one test a year. Last year I was contacted by the nurse and asked to have the test redone as there was a problem with my results - she would not say what the problem was. I had them redone and a week later phoned for the results to be told I would have to see the GP as he would have to give them to me. A week later (when I could get an appointment) I saw my GP - thinking the worst - he wondered why I needed to see him rather than be just given the results! Apparently the problem was that my results were too good (in their eyes).
My GP was really cross that they had wasted my mine - 3 trips and three weeks - just because I was looking after myself. I explained to the nurse that if she stopped giving such **** advice then more people at the practice would have good results!

 

[hanadr]

These things are always happening. I don't think that GP practices know the rules. I'm pretty sure you are ENTITLED to blood test results in detail. I always get a print-out.
I find the best way to get what I need is to stand quietly by the reception desk until I get it.
Hana

 

[SouthernGeneral6512]

My GP insists on fasting for the HBA1C tests but now as I am 'well controlled' (their words) I am only allowed one test a year. Last year I was contacted by the nurse and asked to have the test redone as there was a problem with my results - she would not say what the problem was. I had them redone and a week later phoned for the results to be told I would have to see the GP as he would have to give them to me. A week later (when I could get an appointment) I saw my GP - thinking the worst - he wondered why I needed to see him rather than be just given the results! Apparently the problem was that my results were too good (in their eyes).
My GP was really cross that they had wasted my mine - 3 trips and three weeks - just because I was looking after myself. I explained to the nurse that if she stopped giving such **** advice then more people at the practice would have good results!

That is one of the most ridiculous things I've ever heard surely stress is to be avoided wherever possible since it puts the BS up

 

[xyzzy]

Why don't you try a formal complaint to the practice manager saying the nurse is overriding the doctor it would appear you have little to lose. http://www.nhs.uk/chq/Pages/1083.aspx?CategoryID=68&SubCategoryID=158.

If you go see the GP point out under the GMC rules they are responsible for the action of the nurse they have delegated to look after you so it's in their interest to get this resolved.

 

[Unbeliever]

I am waiting for the results to be in amd then I will make an appointment with the doctor. She was not pleased at the annual review when I pointed out that although she had acceped my home blood pressure monitor reaadings at the previous annual review
the Practice DSN would not. She said she obviously needed to speak to her and point out that she had to consifder the individual patient. It was obvious that my BP was fine in the hospital and in any event my eye cnsultant would be fully aware of any problems as BP problems show first in the eyes. I have frequenly tolfd her that SHE is the prolem with my BP in the surgery.
Friday's nurse was a differnt one . it was she who very highhandedly cancelled a blood test at the last minute for me at Christmas .
I had planned a series of appontments flu jab after HBA1C ,and before hospital visit, obtaining prni out of results , discussion anbooout medication with DSN - all to be done in time for my hospital visit. Because of her interference all this which could have been done in five days took weeks and was too late for my hospital visit . As was the flu jab. I had been anxious about that because a month before the nurse carrying out an OCT scan for me colllapsed in front of me with flu so I knew there was a risk.her only reason was because she felt the diabetes clinic was being by passed. I had been doing the same thing for years.
On that occasion I was absolutely livid. I was on the point of complaining to the Practice Manager but it was shortly before Christmas and I felt everything would be dalayed. I complained very strongly o her and also to the DSN when I saw her. The latter, to do her justice, seemed quite concerned and tried to help but it was too late. She knew her deputy had exceeded her authority.

It is a large practice involving two surgeries and diffficult to see the same doctor twice. I went o some pains to ry to have the same Dr a t my annual review his year just to point out the mater of the BP monitor. No Viv, she was not best pleased. She will be even less so wih the latest events. I think I am best o speak to the DR on this occasion as she has been involved and can corroborate what I say.

I have never had any intenion of taking the slightest notice of the Nurses . They do not and have never done anything for me
I have no weight issues no bp isssues {except when I see them} and my control is good no thanks to them. I would never dream odf consulting them under any circumasances as one know s nothing and the other is not interested.

I just wonder how many patients are told not to fast for fasing tests or have the reasts ordered by Ps cancelled as unecessary by the nurses.
friday's woman informed me that I did not need 3 monthly HBA1Cs as i was now "controlled". The consultant ordered them in order o be sure my bg levels were not creeping up at any time in order to keep my eye condition stable. I didnt bother to argue.
That is something the doctor can cope with. I am inclined to agree that I dont wan hem oo. Seeeing the nurses is really bad for me!

 

[Squire Fulwood]

I didn't realise that I was so lucky. I just phone the receptionist and ask for a print out of my (insert date) blood test result and tell her will call in shortly. They are handed to me as I walk in.

How the other half live eh.

 

[jopar]

You are entitled to print outs of your results, which you either request from reception or at the appointment, but most surgeries mine included, the only staff who have the authorisation on the computer to print off test results is the GP (my surgery)

Over the phone, Data Protection plays a bit part here and who phoned who? As they have to ensure that they are speaking and giving information to the right person..

As to the home monitor, don't understand as all you have to do is take your monitor to an appointment, so the nurse can check the accuracy of it against hers!

We are pretty lucky with our surgery, one of the GP's is actually T1, but our DSN is totally on the ball, and the GP respect her opinion and knowledge.. Hence why we about the only surgery in town where T2's are prescribed Test Strips, she's stood her ground on this one, even the prescription manager is held at bay..

We too have part of a two surgery set up, but only a couple of the GP's work between the two surgeries, but all have specific surgeries times. The other surgery is actually a lot nearer to me, but I won't use it.... My hubby transferred from their to my surgery... Due to it's chronic there, receptionists were a nightmare but what finally made my hubbies mind up about transferring was a run in with a receptionist..

On a weekend he came down with flu like symptoms, flu was doing the rounds so thought no difference, but Sunday night Hubby sussed he actually had a nasty UTI, so Monday he phoned up for an emergency appointment explaining he's was T1 diabetic, with a nasty UTI etc... After a lot of hassle her best offer was an emergency appointment for a week Thursday :shock: And when she said 'who you like me to book you in' Hubby's reply was 'Just book me into the morgue I be dead by then!' And another round of hassle over this, she finally caved and said, he could come into the surgery, and would have to wait around maybe for a long time to see if a doctor could fit him in.. Which turned out, he was seen within 10 minutes of getting there, shocked doctor that he was still standing, and strong 10 day course of antibiotics prescribed...

 

[anna29]

I didn't realise that I was so lucky. I just phone the receptionist and ask for a print out of my (insert date) blood test result and tell her will call in shortly. They are handed to me as I walk in.

How the other half live eh.

You lucky guy!!!!
Where do you live?
Any house's for sale near you?
We can come and live near you, and then get this fantastic service you recieve too!
My GP's/DSN are great too, but I 'do' feel for others who DONT get same quality of service.
Anna.

 

[Osidge]

Hi all

There seems to be a range of practice regarding fasting blood tests. HbA1c is never a fasting test as it measures blood sugar over a period of time but a fasting glucose test, as the name suggests, is always done fasting. Lipid profile (cholesterol and triglycerides) are always fasting.
For info: http://www.livestrong.com/article/27728 ... uirements/

Any problems with getting access to information that your GP holds on you should be reported to your PCT if you have no joy with the Practice Manager or your GP.

Hope this helps

Doug

 

[Unbeliever]

Hi all

There seems to be a range of practice regarding fasting blood tests. HbA1c is never a fasting test as it measures blood sugar over a period of time but a fasting glucose test, as the name suggests, is always done fasting. Lipid profile (cholesterol and triglycerides) are always fasting.
For info: http://www.livestrong.com/article/27728 ... uirements/

Any problems with getting access to information that your GP holds on you should be reported to your PCT if you have no joy with the Practice Manager or your GP.

Hope this helps

Doug[/quote

The fundamental problem is with the Practice Nurses . They now think that they should have the last word on how diabetes patients are reated although, as demonstrated their knowledge and understanding is limited.

This is a fairly logical consequence of Drs allowing them too uch freedom and perhaps overestimaing the value of the training they have received in diabetes - or of their overall capability. Many patients may not even realise it is a problem.
It is a fairly diffficult political situation to ddeal with. Were a diabetic to approach a doctor on anything o do with diabetes in my Practice the usual response is for them to refuse o deal with it and for the patient to be redirected to the nurse.
"Their knowledge of diabetes is more up o date - they go on more courses"is he usual response. I think the DRs do feel that they are unqualified and untrained in up to date mehosds of treatment etc.

Although the annual review is caried out by the Dr - in most cases any issues arising are referred to the nurse. There are fundamental flaws in the whole system I believe. I understand that nurses have been involved in chronic care in he practices for many years but this was generally under the supervision of the drs and were not able to prescribe etc.
The consultant in the hospital said that leaving everything to he nurses was fairly commmon but not universal.
Now in my practice this is out of hand, with nurses instructing patients to "check with them " about procedures about which their knowledge is incomplete. I wonder how many patients are not fasting on the instructions of the nurse when the Dr thinks that a fasting tet has been dne?