How to talk so your GP will listen - in this instance knees/arthritis

I have multi-joint O/A so I have great sympathy with you Azie09 its pretty painful. I do have a good GP but I'm afraid you have to be quite forthright to get action, usually they work their way through a list of treatment, pain relief, anti-inflammatories then physio or pain management if nothing really helps then you have to tell them that you are at the end of your rope with the pain and that the quality of your life is being affected seriously.
I'm awaiting my second hip replacement and went through this list with my GP although I bypassed the physio wait by paying privately an Osteopath.

If your life is being seriously affected then you deserve to be treated for your pain make yourself heard and try not to let them fob you off. Could you see a different GP perhaps?

I forgot to answer your last question, stress/weather don't affect my pain levels.

I don't know if your local GP is a training practice. If possible I always ask to see the GP registrar (trainee GP) as it seems to me that they have a bit more time and try harder. Also more recent training so well up to date. I've always been lucky so far.

Thank you for that Tanith. I've been pretty tough with myself up until now but the pain on the recent holiday was shocking. I'm a bit frightened about being fobbed off with high dose painkillers, perhaps because I can be my own worst enemy and I just try to get on with it.
How long have you had your OA, did it start gradually or appear suddenly? I too recently paid for some private physio, I put my name down on a physio self referral system in September and still haven't heard!

I've have worked with a lot of GPs as a District Nurse and what irrites them the most is when people are not specific about the purpose of their visit. The consultation time is very short and they want you to get to the point about why you have come straight away. The other thing they don't like is lists e,g, Oh and another thing doctor etc etc. I do not suggest for a moment that you do this Azie09 but would I would suggest is that you open the conversation straight away with what you want. A couple of examples here for you.
1) Good Morning Doctor I've come to see you today because I really think its time I saw a consultant about my knees (you have a right to this under the NHS so just firmly and politely stand your ground).
2)Good Morning Doctor My pain control is insufficient I am not sleeping, the pain is worse when I walk and I fear becoming immobile etc etc.

So be direct, be clear and polite.

I hope this was helpful. I've certainly found that the people who get what they want from GPs clearly express it.

Good Luck and I hope you get some relief from the pain.

Hello Azie09 if you feel that you need to see an orthopaedic consultant re your knees it would be better to do your homework first. Ask around and see if any of your friends have had knee surgery. Choose a surgeon who specialises in knee replacements. Maybe google your local hospital and see who works there. I think it is better to go to your GP saying that you would like to have a letter of referral to Mr.X at Y hospital the reason being that he may be able to help whereas the drugs you have been taking have not.

I've been the same Azie09 put off the GP for ages, I've had my O/A for over 20 yrs and it started gradually first in my thumbs then fingers, spine and wrists then my hips and now my shoulder.
I take Naproxen 500mgX2 each day and have for a long time its an anti-inflammatory and also a painkiller that works well for me. For this second hip-replacement as I have already gone down the list of pain relief and had 3 series of physio treatments as I know how long I would wait on the NHS, It didn't help so my GP referred me for xrays which showed how bad my hip had got and referred me straight away to a surgeon who put me on the waiting list. Have they actually diagnosed O/A or R/A?

Thank you very much for your helpful replies everyone and Teetime for that suggested script, brilliant!
I think I partly struggle with knowing when bad is bad enough. I've been able to rest the last couple of days and things have improved but when I popped out to the shops at lunchtime, pretty quickly I was limping slightly on one leg and ouching to myself and the other was painful but not horribly so. Foot just grumbling.
I once read a NICE criteria for knee replacement and I'm sure it said you wouldn't be considered unless you couldn't walk as far as across the room. I suppose I can at least ask to be referred for a consultation, there'll probably be a wait anyway. Deep sympathies tanith and anyone else who suffers, the pain is indeed like knives or hot pokers, horrible!

If your knee is painful in bed and the pain wakens you, that is one criteria for doing a knee replacement. It also sounds as though a walking stick may help you when out and about.

Could you take someone to the GP with you for support?

Pain and the ability to bear it differs from one person to another. I wouldn't believe the criteria for knee replacement you have quoted. A member of my Tai-chi class has just had ner 2nd replacement, she was walking but apparently there was very little cartilage left in her knee joint. Tell your doctor you want to see a consultant and you want an MRI scan. I think since the reorganisation GPs are trying to save money by not referring patients.

Azie I saw your post on another thread.

Can I ask if you have a problem being assertive and I mean this question genuinely.

"Being assertive means being able to stand up for your own or other people's rights in a calm and positive way, without being either aggressive, or passively accepting 'wrong'."

If the answer is yes, then you might want to do some reading and practise being more assertive in everyday life and this will help in situations with awkward people like your GPs.

Teetime great advice. My GP surgery is fantastic though and you always get to see the same Doctor which i think helps, so when i said "i have had enough" without a smile he was straight on the phone to the Gynae dept and i left his room with an appointment and a smile

Surely GPs should be trained to recognise reticent patients who find it difficult to be assertive? Some peolple find it hard to articulate their concerns, maybe through embarrassment or a fear of wasting the doctor's time.
I would agree with chelseababy that it might help to take someone along with you.

I have found, twice (two different doctors in two different places) that looking or speaking my shock at their dismissive attitude worked wonders both times. The first time I simply gave a dropped jaw look. I was genuinely shocked. There was an immediate step change in her attitude. The second time I felt my GP was presuming things about me. I told him straight out that he didn't know "what I am like". He has been a model of politeness and caringness since then.

In a perfect world Lilllie

Azie the comment "no further action" is one of those standard (unhelpful) phrases that the GPs click on from a limited pick list when viewing results or letters. It does not mean that there is nothing further that they can do, but just that on reading that particular result in the huge pile of results and letters that they are working through, (so without your particulars in front of them at that moment) he/she has seen that it has not revealed anything that they need to do immediately such as refer you to a consultant or ask you to come in to see them because they need to discuss something that the result has shown up, or book you for a further blood test etc. These pick list comments are just notes for the secretary or receptionist to take further action on, so as I say, very unhelpful for you as the patient. In my role as a receptionist, I will always explain this to the patient when reading out the doctor's comments. The receptionist you spoke to doesn't seem to have been thinking from your perspective unfortunately. Doctors have to rule out stuff in their diagnosis so these particular tests giving the all clear on that route just means that the doctor now has to have another rethink as where next to look.

So you must go back and say that ok those tests were clear but I am still in a lot of pain so where do we go next and keep pushing for an answer.

If it's a while since you had them X rayed ask to have them done again. They can deteriorate quite quickly. 8 paracetamol a
day is the limit. My MIL lived happily on that many for years. I never found they did anything for my arthritis though.

When I first had my knees X rayed they weren't bad enough for a replacement. I carried on for a couple of years or so and then moaned at my GP until he sent me back to see the surgeon again. This time he looked at the new X rays and said "Hmm these have really deteriorated" and I was in for the first replacement three months later.

Thank you very much everyone again for a set of very useful responses. Funnily enough I did look at some walking sticks in a charity shop yesterday. I feel I've been given permission to try one!
I'm not a person who pushes herself forward but I'm reasonably assertive in everyday situations. However, it's a good question to ask Anya and it made me realise that actually I find the whole consultation process uncomfortable. Our family hardly ever visit the GP so it's unfamiliar and I don't know what I can ask for or expect. Your answers have given me some clues. Thanks charleybaby and lillie for the suggestion of taking someone with me, though in my present situation that would be DH and he's too meek by half!

I was really taken aback when the GP I saw seemed to be embarking on a response suggesting I'd brought the arthritis on myself by being so silly as to move house!

So I'm going to get a grip, make another appointment and be more assertive. Teetime and Granaby that kind of insider knowledge was exactly what I was after! I feel much better prepared now, thanks again.

Just another small word if I may. I know a number of golfing ladies who have still be golfing admittedly with an electric trolley who have had new hips and new knees so the 'cant walk across a room rule' is being applied very flexibly. what I would say is that these ladies are very assertive and probably pester the life out of the GP until they get what they want.
Good Luck.