We should adopt "American attitudes" with our GPs

Oops forgot to blue the link www.telegraph.co.uk/health/nhs/10595806/NHS-patients-should-be-pushy-with-GPs-about-treatment-and-drugs-says-health-chief.html

Easier said than done. In America drug manufacturers advertise direct to patients and as the bills will be paid by the insurance company the US GP will, more or less prescribe what the customer, sorry patient, wants. We work to a different system with NICE having to approve prescription drugs and their uses and doctors worrying about their budgets.

With the onset of the internet, patients have been getting more assertive, googling their symptoms or their diagnosed problem and looking for treatments. All the doctors do is complain.

They cannot have it both ways, complain if we use google to get information on our medical problems and bring this information to consultations then complain, as this article does, that we are not assertive enough.

I think he is making a good point. NICE only approve drugs if they are financially appropriate, as well as safe and effective for a particular condition. Maybe some doctors are just too set in their ways to think any further than what they have been prescribing for years.

It's your body and we now have the means of researching. So why not?

yes, but then the GPs complain if we do question them about our treatments and drugs.

I can't see why GPs have to spend all those years at university and then in hospitals when they have google to provide an instant diagnosis and advise the most appropriate treatment. Same with these damn pharmacists – they're just pill counters after all.

Morning Absent

Hello there absent, and thanks for your comments, we need a bit of irony to cheer us up (well I do, difficult afternoon at dog training, with my scallywag young dog..)
I appreciate I'm a bit of a rarity, but I feel very fortunate to be with a good GP practice. I usually see the young GP who has a special interest in rheumatology, as she understands my health and is always up to date on the latest research. My rheumatology consultant is a joy, as is my specialist nurse. I have joined up care. The cuts are impacting in areas like podiatry, chiropody and physio. I am fortunate in being prescribed an expensive disease modifier. I haven't found any of our GP's, or my consultant resistant to my questions, fears and worries about the costs and benefits of the drugs I'm prescribed. I've been given written information, sent away to read up and come back in a couple of weeks, to further discuss the treatment options. I know I'm lucky - my sister has the same disease, and her experience, 10 miles away, has been much less positive. I do believe though, we benefit if we have the resources to be active in our own treatments.

100% with absent. We will get the doctors we deserve at the end of the day (:

It's a tricky one. I'm no scientist and I can only judge the quality of the advice I receive on the somewhat unrelated areas of how good the communication is. I was recently asked by the consultant I saw about osteoporosis what my thoughts were about the merits of two alternative treatments. I said I had no idea. I don't understand the science and was happy to rely on the fact that she did and was familiar with the effects on the body and the outcomes of the different drugs.

I have to rely on the professionalism of the expert. In just the same way that I trust the driver of the bus to have an PSV licence and a sales assistant to know their stock. How can any lay person can possibly be expected to know even a small percentage of what professionals know? We really have to rely on their communication skills to make complex science or other matters understandable to the lay person.

Not sure about that granjura. Doctors come with varying levels of competence, as in any profession or job, and have their prejudices and preferences like other people. It is not always possible to ascertain what these are nor to change doctors if you do not like the doctor you are assigned.

In our quite large practice we can shift around and DH avoids at all costs the GP that I prefer to see.

Since DH has been ill I have been in touch with a lot of patients in the USA through Facebook and they all seem to have a very different attitude. Many of them go to great lengths to see specific specialists, often travelling huge distances, and demanding all sorts of specialised tests and treatments. To be honest I'm not certain that this approach is making much difference to their survival rates but they seem to like feeling in control. The down side of course is that the people who don't have good enough insurance are left waiting for essential tests and procedures and are often refused the newest drugs.
Fortunately with DD's medical and scientific contacts we are able to come up with suggestions which aren't just "Something I saw on the internet" and our GP's and the consultant are always quite happy to discuss the options.

Agreed Flickety- but our 'likes and dislikes' for doctors are also linked to our own 'prejudices' and lots of other factors. A friend of mine told me she hated her GP because he always told her that her bronchitis was linked to her heavy smoking, and that he could not keep prescribing antibiotics. Another hated hers because he repeatedly told her that the new 'magic' medication she wanted to be prescribed would not be a great help to her knees if she did not try and accept help to lose weight- etc.

Sadly, a lot of our health problems are caused by lifestyle choices which no amount of modern (expensive) and magic cures will make disappear. American drug adverts actually tell patients to 'request' said drugs- at a huge cost and very little improvement, and even harm.

Doctors do come with varying levels of talents, of course- but after 9+ yearsof training, will have plenty more than me, with none. Active and intelligent part of treatment is of course really normal and good. Not sure what you mean by 'the doctor allocated to you'- you do have the choice of doctor and can change if you do not trust or get on with yours, don't you?

When it comes to surgeons, I'd say that often the best in surgery, are actually not the best communicators. I'd like to have both, if possible- but if not I'd rather choose a brilliant surgeon, than a good communicator.

I was not talking about 'hating' GPs. DH didn't find my GP difficult to get on with because he 'hated' her for refusing him anything. It was just that she has quite a brisk manner and he found it intimidating so found it difficult to be insistent if he had problems he was concerned about. A move to another GP who has a more relaxed manner meant that he found it easier to talk and this led to his diabetes being diagnosed.

Now I find her brisk manner welcoming because I find a too empathetic doctor difficult to deal with because I tend to be brisk and to the point myself. The result is that our relationship succeeds where her relationship with DH didn't

I find your absolute confidence in doctors knowing best quite frightening. Every year there is a trail of doctors, all with 9 years training, often more because they are hospital consultants, before the GMC accused of poor, bad and malpractice. There are thousands, possibly 10,000s of people in the UK whose health has been permanently damaged by incompetent, well-trained doctors and almost every week there is an inquest reported where the cause of death, or a contributory cause, is medical negligence.

Personally I have never googled a medical problem before visiting a GP but I have found it immensely useful after a diagnosis to find more information. Finding the discitis my DF was diagnosed with at the age of 92 was 'primarily a disease of the under 8s' was a source of much amusement and that itself had therapeutic effects, at a time of much worry.

One major difference between England and the USA is that prescription drugs are advertised on TV so public awareness is greater

Pulsetoday website has an article where a GP trainer is suggesting that GPs in this country should learn to say no more often to patients who ask for drugs.
Bit of a dilemma there. Who do you go along with? Who has a vested interest in us asking for more drugs?
After I'd come out of hospital with a prescription two pages long after having an aortic dissection, my GP told me I didn't have to take any drugs if I did not want to. He's also the one who told my husband he was being greedy when he was dying of brain cancer.
Needless to say, I go to see someone more sympathetic now.

I've heard that, in the US, doctors are quite keen to carry out unnecessary tests and treatments because obviously that way they make more money.

Just because a drug is advertised on TV, doesn't necessarily mean it is the most effective or best value treatment. If patients demanded a particular drug on that basis, it would be the drug company with the highest marketing budget that would be the winner.

I'd like to know how chemists choose what drugs to buy in from which manufacturer. One of the drugs I have changes colour every month. The chemist says it does not matter, but it does to me. The orange one has three different e-number additives, and I try to avoid those in my diet.
It's as bad as them giving you a gelatine capsule when you've avoided gelatine for 35 years as you are vegetarian. At least I speak up for myself as far as gelatine is concerned. GP knows I do not take gelatine.

My DD2 is a micro biologist and I am always surprised how open her GP and other consultants are with her. They open up and discuss the pros and cons of treatment etc. In her preganancies she got up to date information, and was even asked what she thought.

I decided if I ever move house and need another GP I shall register myself as Dr XX and perhaps get some relevant information instead of being pushed into the little old lady corner.

When I told my GP my medication didn't last 24 hours he said it did, it was stated in his files. So I told him that DD2 had told me that to get that 24 hours lasting period in the trials 15 % were less than 24 hours and 15% were over that.
After that he accepted it but I wish he had just believed me.
Still we don't really want the American system. I prefer the German one anyday but can't speak for the NHS.

I do not understand all this fuss about doctors refusing drugs where they are not necessary. The first time a doctor saw me and said he would not prescribe drugs because my recovery was well underway was 40 years ago and a variety of doctors since at three different surgeries have decided not to prescribe drugs for me on various occasions. I can only think of one occasion when I queried this and after further discussion I was given a further five days prescription for antibiotics. Other friends and relatives tell me their GPs are equally slow to prescribe so I assume most doctors must do it.

Eloethan, an excellent post. Over testing, over prescribing- is very lucrative in private system. And so is over operating! If your GP or specialist tells you it is best to wait and see- rather than go in with invasive surgery- it is usually because it makes total medical sense. But there is no money in it, is there? All the GPs I know agree totally that mixing payments for certain treatments, etc, has totally destroyed faith and trust in the NHS- and that it is totally tragic. My OH grieves for the NHS he left behind- and although totally and absolutely dedicated to it for all his life- is really, really glad he has now retired and left this total mess behind. It is so sad, and much worse.

When the DSs were little, we had an Egyptian GP, trained in the US, who liked to prescribe antibiotics for every sniffle. I eventually decided to ask for another of the GPs in the practice who were less cavalier in their approach to prescribing.

It takes a lot lot longer to explain to a patient why it is NOT a good idea to prescribe antibiotics (or other medication, tranquilisers, etc), or why it is best to wait and see and NOT to jump in and operate- and some patients will always take NO as BAD- rather than see that NOT doing something is often the very best treatment, and NOT just to save money.

Germany leads Europe in Operations for knees and backs. Most slipped discs get better by themselves but it takes many weeks. They would rather you had a MRI or CT scan than take the time to ask a few questions.
if you are a private patient here, you get far more treatments, most of which are unnecessary. DH was offered magnetic treatment for his shoulder - to pay for himself of course. He asked our GP for his opinion. He said 'you can either have the treatent or throw 300 Euros in the bin. its your choice' and then both laughed.

Thank you Margaret- same here in Switzerland. Operating pays- waiting and seeing if it gets better by itself, without the invasion and dangers of surgery- does NOT. Another reason why the good old NHS as was was so much better. But to explain why it is better to wait, why it is better not to have antbiotics, why vaccination for Measles makes sense, etc, etc- takes a lot more time and dedication- and brings no money in. If your GP or Consultant advises waiting and not over medicating, or over-treating- it mya well be, in most cases- because they know from study and experience that it IS THE BEST solution- and nothing to save money for NHS or threshholds, or whatever.

A lot more operations and investigations done in private systems- and not always for the best, that is for sure. One of the best (or worst) examples of this is prostate cancer in the elderly- where aggressive treatment and operation often make things much worse rather than better.