Medical farce

[simont]

Two weeks ago I tried to make an appointment with my GP. Since it was tedious administrative routine (renewing my prescription for gluten-free pasta, which I still can't bring myself to believe is worth wasting a medical professional's time for in the first place), I didn't think it was worth booking an urgent same-day appointment, and instead tried to book in advance. It turned out they didn't have any advance appointments earlier than a week later – you can have today, or next week, and nothing in between.

When I arrived for my appointment they said I didn't have one.

I was not best pleased, but the receptionist was utterly unwilling to do anything to compensate, so the best I could do was to walk away with an appointment card promising me an appointment in another week's time.

This morning I turned up for that one, and this time I got to see a doctor. However, I still didn't walk away with a prescription in my hand – because all their printers, or at least all the ones they tried, were broken!

Comments

[lnr]

Can they not do a handwritten one any more? How hopeless!

[simont]

My theory is that doctors' handwriting has now progressed from "notoriously hard to read" to "actually completely illegible" now that they rely on printers nearly all the time :-)

[crazyscot]

I think they still have to hand-write scrips for controlled drugs. However that might conceivably involve different stationery to regular scrips.

Can they not put a scrip request into the system so you can some back to collect it in a few days' time?

[hilarita]

I presume it's now easy for Simon to get the prescription once the printers are working, as the tedious administrativa about seeing a GP has been done.

[simont]

Actually, it should be even easier than that: they promised to print my prescription out later today and stick it in the post. But based on their recent level of organisation I won't put my money on that actually happening...

[kaberett]

I have only ever received hospital-pharmacy-only hand-written scrips, and by a consultant, at that.

[pvaneynd]

There was an item on the news a few days ago that the increased use of printed prescriptions was the most likely cause for a huge rise in fake prescriptions.

Turns out that the unreadable handwriting of a doctor is pretty difficult to fake and easy to recognize (due to the extensive training required) by the pharmacist.

So now we will probably go to use pki to solve this problem :(.

[damerell]

I got a handwritten one in Whitby this March...

[rmc28]

I'm sorry you had tedious administrivia, but reading your post prompted me to book the non-urgent GP appointments I've not been getting round to for the last few weeks.

Thank you (assuming they don't get lost between now and next week, of course).

[gerald_duck]

I sometimes think I should get a smartphone with a moderately sized memory card in it simply so I can record every phone call I ever make as a mediator in disputes like that one. I assume smartphones can be configured to record all calls? (Preferably with a subsequent secure-delete feature for sensitive ones…)

Had all the practice's pens broken too, or have they forgotten that prescriptions can be written by hand?

[simont]

My theory is that doctors' handwriting has now progressed from "notoriously hard to read" to "actually completely illegible" now that they rely on printers nearly all the time :-)

[samholloway.livejournal.com]

I saw a consultant privately recently, and he wrote out the prescription (quite a complex one, too, involving varying doses over times). It was, to my eyes, completely illegible, but the pharmacist had no problems decoding. :-)

[gerald_duck]

Not wishing to make you paranoid, but how can you tell the pharmacist had no problems decoding? What indications are there that you've been given the right thing? (I assume your head hasn't turned purple and fallen off, but is there not a risk of it being more subtly wrong?)

I'm on a long-term drug where careful modulation has demonstrated that the correct dose for me is about 23mg daily (and it has significant side effects, so you don't want to take any more of it than necessary). It's available in 10mg and 25mg capsules, so I take two 10mg capsules five days a week, 30mg capsules two days a week.

I worked this regime out for myself having established that 25mg was ample and 20mg was insufficient. The registrar didn't fancy trying to describe it on the prescription, so did a script for 20mg/30mg in strict alternation. The hospital dispensary got that one wrong. Now, they just write me a script for more months of 20mg daily, which seems to have worked so far (though the pharmacist seems to think there are 356 days in a year not 365, judging from how many capsules I got last time).

[samholloway.livejournal.com]

In this specific case, because the consultant explained the prescription to me verbally, and while I was walking round to the hospital pharmacy, I worked out in my head what the net result should be from the pharmacy - it matched!

Agree that in general, though, there is a difficulty in ensuring prescriptions match the doctor's wishes. Even in printed ones - e.g. I've had problems where my GP has picked the right drug but the wrong form (suspension instead of tablet, for example) - and it's not always easy to get that changed without going back to the GP.

[feanelwa.livejournal.com]

Oh, that's exactly the systematic error that I need! Every time I get an antibiotic that isn't flucloxacillin I end up with big round tablets that I can't swallow and sometimes end up ringing NHS direct to get another prescription for the same thing in liquid form so I can actually take it.

[samholloway.livejournal.com]

The irony here is that, until quite recently, I couldn't bring myself to swallow tablets. It was after having a course of flucloxacillin last year, taking as 'medicine', and having to keep the bottles in the fridge, back and forth to work etc, that I realised I really needed to try to learn to take tablets!

The big round ones do seem to be the hardest pills to swallow; still not really comfortable with those.

[pjc50.livejournal.com]

Note that if you record everything with intent to disclose you are legally obliged to tell your interlocutor.

[gerald_duck]

Well, yes. But playing it back to the person you spoke to is legal. As is submitting it to a court in evidence. You couldn't play it to the person's boss, though.

[cartesiandaemon.livejournal.com]

That would almost be better -- it would be kind of insulting to say it at the start of every phone call, but it might get people to get it right the FIRST time :)

[samholloway.livejournal.com]

Although quite often when you speak to a call centre, you are told that "calls may be recorded" - in absence of further specification about who may record the call, I've always thought that could be taken as an open invitation by either party.

[beckyc.livejournal.com]

When I arrived for my appointment they said I didn't have one.

Is this NR? They did that to me a couple of weeks ago :-(. In my case, it turned out that I misheard a time of X fifteen as X fifty.

[simont]

No, I'm still with Bridge Street in the town centre (where I originally registered in 1994 because it was convenient for Trinity!).

Last week they said they couldn't find any appointment for me, not even one for a different time or doctor. I'm more inclined to suspect that whoever I spoke to on the phone just failed to hit Save, or equivalent.

[sphyg.livejournal.com]

Sounds like my surgery. I just have to remember to book the next monthly appointment shortly after the last one. BTW, I saw frozen gluten-free pizza in Waitrose.

[simont]

Don't suppose you noticed the brand? Sainsbury's have the Dietary Specials ones, which are OK for a zero-effort fast meal (but not a patch on making my own). If Waitrose have a different kind, it might be worth an investigatory trip, but if I slog all the way across town to find it's exactly the same one again then that would be a shame :-)

[lnr]

FWIW Ocado.com have those ones, in cheese or pepperoni. Waitrose.com seem to only have pizza bases and pizza base mix. Your guess is as good as mine what they'll have in the actual shop!

[1ngi.livejournal.com]

The last time I looked it was Dietary specials - but that would be back in Feb now. Only product on the market that is worth the money at the I think is Genius bread - started having sandwiches again.

[numberland.livejournal.com]

The Proceli bases were quite nice IIRC but I don't know for sure where would stock them https://www.waitrose.com/shop/ProductView-10317-10001-81786-Proceli+pizza+bases.

[sphyg.livejournal.com]

I had a look at the DS website and the packaging seems familiar. But I'll try and remember to check next time at Waitrose.

[samholloway.livejournal.com]

My surgery used to *only* let you have same-day appointments, there was no such thing as a book-ahead. (This was in the days when surgeries were measured by the %age of appointments that were seen-to within 48 hours.)

The current system sounds like yours. You can't go in person to request an appointment; you have to phone up. You tell the receptionist (yes) what's wrong. Then one of two things will happen : either a GP or nurse will phone you back (telephone triage), or you'll be offered an appointment for >1wk from now.

The telephone triage system can work quite well - if you know what's wrong with you (e.g. require prescription of specific drug) then you just quickly discuss it over the phone and a prescription is left for you at the surgery to collect. Otherwise you'll be invited to come to the surgery in the next 48 hours.

As for the prescriptions, why couldn't they do you a handwritten one, I wonder?

[simont]

if you know what's wrong with you (e.g. require prescription of specific drug) then you just quickly discuss it over the phone and a prescription is left for you at the surgery to collect

It actually hadn't even occurred to me to try that. That would be ideal for me! I should try it next time. (Or this time, if their current intention to post me the prescription doesn't pan out...)

[samholloway.livejournal.com]

It's worth a go - particularly if it's something you've had before.

We don't have an 'assigned' GP at my surgery (you can try requesting a specific GP for a book-ahead appointment but you could wait much longer if you do) so IME they just look at your medical history and will prescribe if they see someone else has already done the diagnosis. :-)

[lnr]

IME for things on repeat you can request a repeat by ticking the box on the form and leaving the form at the practice. Some practices will also let you do this on the web, different ones have different systems. None of mine have ever let me do it by phone but it's worth asking - they may also take faxes or emails. My current practice then send the prescription direct to the local chemist, or I can arrange to collect from the surgery if I prefer to get it filled out elsewhere.

But repeats usually have an annual or similar review date, and you have to go in and talk to a doctor and nurse if you're past the review date before they'll issue more repeats.

For things not on repeat I've never tried getting them to re-prescribe over the phone mind.

[simont]

Yes, the annual review date is what usually bites me: I just don't eat pasta fast enough (and I get enough prescribed in one go) to be able to get many repeat prescriptions without finding I've already hit the "review required" stage. Hence, re-involving a doctor every time.

I'm actively considering solutions to this problem (e.g. pretend I've finished the pasta a couple of times this year, so I can have a few repeats which will put off having to do this again for aaaaages; alternatively, experiment with a pasta-making machine and do my own fresh at home).

[gerald_duck]

Once, when my hay fever medication was up for review, I got a nasal spray with a "medication review required before next prescription" note by it.

When I was running low, I dropped off the repeat prescription form with the tickybox tickied, that note circled and "Please review" scribbled beside it. It came back with "Reviewed — date, doctor's initials" scribbed beside that. I got my new nasal spray.

At least with my surgery, it seems that long-standing patients who are known not to be stupid can fairly easily bend the system in ways that save hassle for all concerned. After all, they don't want to give me an appointment any more than I want to turn up for one. (It doesn't help that the surgery, although within crawling distance of my house, is twenty miles from the office.)

[aldabra]

I do my repeat prescriptions through Boots, and they tend to let me have one when I'm over the review period, with instructions to go see the doctor before I get another. I recommend this because when you go in they've counted it all out already and you don't have to hang around for fifteen minutes.

What they aren't set up to do is e-mail me when I'm due for another, so I tend to forget, which breaks the system.

Pasta keeps for years, maybe decades. Get your doctor to prescribe two months' worth; iterate it through Boots for a year; keep it in an airtight box and think of it as your apocalypse stash.

[hilarityallen.livejournal.com]

This won't work for repeat prescriptions where you haven't seen a dr within the requisite timespan. Also, some surgeries will not allow you to ask for repeats over the phone. If you ask to find out whether they do, they will often give you a bollocking for trying to get a repeat prescription over the phone.

[uitlander]

Are they not capable of writing a prescription by hand?

[k425.livejournal.com]

I had the "prescription review" problem when my GP retired and we were all shuffled to a health centre. It's taken two years for them to fully understand that while drugs do, definitely, need regular reviews, I'm not going to stop needing to eat.

[simont]

<yorkshiremen count="4"> Two years? Lucky. My surgery still hasn't got its collective head round that one in six... </yorkshiremen>

[gerald_duck]

It seems that, in the last few years, the NHS has tightened up and GPs are no longer supposed to prescribe more than a month's supply of a drug.

My practice has ralented over the daily tablets that come in tubs of sixty, but is still refusing to give me more than four at a time of the weekly pills.

Apparently, it's to avoid waste. It strikes me they could easily finesse the policy and save everyone some hassle by letting people have three month's supply of stuff they've been taking for literally years.

[hilarityallen.livejournal.com]

Yes - mine do that too. It's really bloody annoying, particularly as I can't do any of the 'get repeats delivered to a given pharmacy' tricks because I don't always use the same pharmacy.

[gerald_duck]

I live in a village. I like living in a village; it's quiet and peaceful.

However, it has bugger all infrastructure.

One of the very few infrastructural perks is that, because there's no pharmacist in a five mile radius my GP has its own dispensary tacked on the side. The computer systems are linked so prescriptions get transmitted digitally. When I drop off a repeat prescription request, I go back a day or two later and the drugs are waiting.

Even then, having to get stuff a month at a time is pointless and infuriating; I can well imagine it's much worse if you have to visit GP twice then visit pharmacy twice. (Some of the stuff I need tends not to be routinely stocked.)

[arundelo.livejournal.com]

Let me just say: You need a prescription to get gluten-free pasta?! Sheesh!

[simont]

Yes and no. I don't need a prescription, in the sense of not being able to get it any other way. It isn't a controlled substance: I could just buy it with my own money if I really wanted to. However, I don't want to, because the brand in question costs an absurd amount – something like a factor of ten or twenty more than normal pasta. (It's made by a process of extracting the gluten from wheat, which is presumably hellishly fiddly and expensive.) So getting it on prescription essentially means the NHS subsidises most of the cost of that.

Alternatively, I could just go to the supermarket and buy any of a number of brands of more reasonably priced gluten-free pasta. That's what I ended up doing with flour. But the difference is that the sensibly priced flour is nice, and the sensibly priced pasta is horrible. So I go through the prescription rigmarole, and try to arrange to get as much as I can at a time when I do.

[arundelo.livejournal.com]

Ah, my faith in the British government is restored!