(No 2) THE ROLE OF THE GP!
So, you have joined the ranks of the chronic back pain sufferers? Welcome!!!
If so, you have a severe, disabling and persistent back problem, which may have developed slowly over many months (or years) and you may have first noticed these issues when ironing, washing up and lifting children, OR, you may have arrived at this pitiful state, by having these problem ‘thrust’ upon you, after a catastrophic event!
Either way, your initial treatment options for these life limiting, and sometimes, life altering back pain issues, is usually to self administer pain killing and anti-inflammatory tablets, lotions and creams. You may also use hot baths, ice packs and bed rest. But eventually, as a chronic back sufferer, you will come to the inevitable realization, that none of your brave efforts are having the desired effects of returning you to your former good health and fitness! You are still getting worse in spite of all!
It is at this point that most of us seek the help of our GP’s. Just like me and many others I’m sure, believe that GPs are the font of all knowledge! The Doctor will surely know what to do?? The GP will have the answers????
This was for me and might be for you, your first, fundamental and fatal mistake!
I sincerely hope that I can help you avoid the same mistakes as me, wasting years of your life, £25,000, your dignity and a good quality family and social life!
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My epiphany came when, after three and a half years of ‘misdiagnosis’ and ‘mistreatment’ by my GPs & Orthopedic Consultants, I started to self research my symptoms, possible diagnosis and treatments. After just 8 months of my untrained ‘part time’ research, I went to see my GP to touch base and asked for clarification about some of the things I found out, only to be ‘stopped in mid sentence’ by the GP, and told that he, the GP, did not know much about spinal issues!! As he had not followed that particular training pathway!!!!
He ‘did not understand’ the simple medical questions I was asking him, nor could he offer me answers regarding specific spinal physiological anatomy questions!! WHY? Because the questions were about chronic back pain and associated severe spinal physiological disorders!!!
He explained to me, that as part of his Doctor’s training program, the ‘training pathway’ he took during his ‘rotational assignments’ did not include any ‘significant lessons’ from practicing Spinal Surgeons! He did carry out training rotations with an Orthopedic Surgeon and Neurosurgeon, as this is a compulsory part of the ‘core’ Doctor training curriculum, Spinal Surgery is not!! It is a ‘sub-specialty’ and as such, is often, not compulsory learning for Trainee/Junior Doctors!!
[url]What kind of surgeon do I want to be? — Surgical Careers | The Royal College of Surgeons of England[/url]
'''This is not only a British/NHS issue, but this problem is a world wide scandal.'''
[url]Orthopaedists' and family practitioner... [Spine (Phila Pa 1976). 2009] - PubMed - NCBI[/url]
[url]Doctors with a special interest in bac... [Spine (Phila Pa 1976). 2009] - PubMed - NCBI[/url]
[url]BMC Musculoskeletal Disorders | Full text | Staying at work with back pain: patients' experiences of work-related help received from GPs and other clinicians. A qualitative study[/url]
It is therefore, highly likely, that your GP has gained very little (if any) detailed knowledge regarding ‘state of the art’ and ‘cutting edge’ spinal diagnostics, treatments or after care! Unless spinal/back pain is the GP’s special interest ‘or’ as a Trainee Doctor, he was taught extensively about spinal issues by a Consultant Orthopaedic or Neurosurgeon ‘who were themselves’ experienced and practicing Spine Surgeons.
To correct this knowledge shortfall, there are many GP training courses available!
[DLMURL] http://www.medical.theconferencewebsite.com/conference-info/NSpine-2013 [/DLMURL]
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There are 2 main reasons for this chronic shortfall in their knowledge:
1)
((((((((Spinal Surgery is a sub-specialty! This means that it is ‘not a core subject’ that Junior Doctors ‘must’ learn! Orthopaedic Surgery and Neurosurgery are!!))))))
Whilst Junior Doctors will inevitably pick up knowledge regarding Neurological matters such as autonomic and peripheral nervous systems, and whilst they will also learn about issues regarding basic bone, joint and cartilage issues during their Orthopaedic rotation, Spinal Surgery, I believe, is regarded as a ‘low priority’ in the early learning pathway of a Junior Doctor!!
2)
(((((((I believe, that the incentive for ‘Junior Doctors’ to request specialization in spinal surgery during their early rotation, is very low!))))))
Because, in order for a Doctor to become a Spinal Surgeon, a Doctor must have first gained their full Doctor status (5 years, plus), then must qualify and have worked as a Consultant Orthopaedic ‘or’ Neurosurgeon, for up to 7 years or more, before ‘retraining’ for around 2 years, before qualifying as a Spinal Surgeon some 14 years or so later!
I fully understand a Trainee Doctors ‘reluctance’ to prioritize a sub specialty, what would be the point in training early in their careers, in a discipline that a Doctor must wait for up to ‘14 years or more’ before earning a living from? This outdated training regime, I believe, is also why there is a shortfall in UK Spinal Surgeons overall.
[url]BMA - How to become a doctor[/url]
[url]How many years does it take to become a spine surgeon[/url]
Here is my thought, if we, the back pain/spinal pain sufferers (80% of the population) are wasting tax payer’s money, why aren’t all Trainee Doctors trained in spinal condition diagnosis, treatment including surgery???
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Because of the above, it is now my strongly held belief, that we, the chronically ill, must regard GPs, and to a lesser extent, General Orthopedic Surgeons, as being ‘nothing more’ than mere Gatekeepers! Someone who simply holds the ‘pass key’ to the next ‘appropriate’ level of back pain care, the Spinal Surgeons!!!
The quicker you can get ‘past’ these GP and Orthopedic Gatekeepers, and consult with experienced and highly rated Spinal Surgeons, the better and faster your recovery and clinical outcome will be!
But even here, you must be careful! GPs and Consultants have, over the years, developed ‘patient treatment protocols’ designed to ‘slowly channel’ us sufferers, steadily and cheaply, through the NHS spinal care service system, irrespective of the sufferer’s true need for urgent surgical intervention!!!
There are different protocol models, like these for example:
[DLMURL] http://www.nice.org.uk/media/94d/be/referraladvice.pdf [/DLMURL]
[url]Referral Guidelines[/url]
[url]Plymouth Hospitals[/url]
[DLMURL] http://www.gmneurosciences.nhs.uk/Back%20Pain%20GP%20Survey.pdf [/DLMURL]
[url]referral criteria from primary care - acute low back pain - General Practice Notebook[/url]
[url]management of nerve root pain - General Practice Notebook[/url]
To underline my point, I recently met a fellow sufferer at an Osteopathic appointment, who told me that, along with his lower lumber pain and spasms, he was ‘presenting’ to his GP with ‘bowel and bladder’ control problems and rectal pain, he was leaking urine and faeces with regularity and with increasing frequency! (Condition confirmed by Osteopath) The GP’s response was to send our fellow sufferer to the ‘pain management clinic’ and secondly, was to offer him a nerve route block injection!!
In 2-3 months!!!
NOW, I’m sure, that those symptoms are instantly recognizable to regular Healthy Page (back pain forum) Members, as true ‘Red Flag’ issues, issues that would suggest the involvement of the very serious Caudia Equine Syndrome, and I’m equally sure, that there are a lot of ‘consternation and expletives’ that are going along with the HP Members moment of realization!!
How could this clear misdiagnosis and mistreatment be taken place in 2013!!!
[url]Slipped disc - Symptoms - NHS Choices[/url]
See:
[url]Cauda Equina Syndrome | Doctor | Patient.co.uk[/url]
[url]Cauda equina syndrome: symptoms, treatment, surgery and more[/url]
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During my time in the system, although my condition was chronic, acute and I was more severely disabled than anyone I met on the system’s courses, I was ‘lumped together’ with other back pain patients, who had simply pulled muscles, who were experiencing their first pain episode, who were simply improving cardiac activity and fitness levels and others who were ‘milking’ the benefits system by showing the DWP that they actually needed back therapy, and benefits!! (This last one is not my prejudiced view by the way, they themselves told me!!)
In spite of this, our treatments, therapies and training, were exactly the same! No matter what was wrong with the patient!! The NHS approach was one size fits all!!!!
They made my condition worse! No 1 on this advice sheet ‘below’ nearly rendered me paraplegic!!!!
[DLMURL] http://www.croydonhealthservices.nhs.uk/Downloads/GP_resources/Referral_information/Therapies%20exercise%20leaflets/Acute%20Back%20pain%20leaflet2011.pdf [/DLMURL]
FYI to the Medics of British Back Pain Units, Back Pain Sufferer’s Conditions ‘are not’ all the same!!!
One ‘back pain’ size does not fit all!!!
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SPINELF’s recommendations:
Armed with the information resources gleaned from your online researches (No 1), and having assured yourself of the correctness of the ‘probable causes and/or areas’ of your spinal/back pain, I would strongly recommend that you ‘march’ into your GP’s surgery and respectfully, but firmly ‘demand’ an urgent consultation with an experienced and respected Spinal Surgeon, based at your local NHS Spinal Unit!
Don’t let yourself be put off or put down, if the GP tries to fob you off with an Orthopaedic Consultant or redirect you to other therapies, simply read out your gathered information and explain with your new found knowledge and confidence, and tell him to reconsider his views!
He will be unsettled at you new found knowledge and will resist your request, but don’t back down!! If you do, like me, will regret it in the long run!
I don’t encourage looking for a fight with or to seek out resistance from your Doctors, but don’t worry, rest assured, that fight and that resistance, will look for you!!
Best wishes and best back care health to you all
SPINELF
Thank-you
Not sure if we are meant to reply or not, but I read these three 'State of Play' posts with more and more tears in my eyes, I am not alone anymore.
I really hope that people here at HP will take them in the spirit they are intended which is so obviously to help people help themselves. What better way than to use the brilliant forum of HP and share our experiences and resources and findings?
The trouble is even I am guilty of just saying I have a bad back (lol bit of an understatement and better than the long clinical spinal diagnoses) it is just far easier. Even that NHS page linked talks about slipped discs. Discs don't slip! They protrude, bulge, herniate or eventually burst but they don't slip out and then in.
I am really glad these threads have been pinned so that they are there clearly for reference, a little bit away from the day to day pain and suffering of our friends here, that can be so painful and shocking to read. Sending all good wishes to every one of them.
With respect I hope we can do some good so if you have a 'bad back' read them all and take note 🙂
Having had back problems and subsequent surgery I know only too well the NHS is NOT good with bad backs. But in defence of the GP may I point out the clue is in the word 'general' they are NOT specialists. they CANNOT have a detailed knowledge of EVERY problem that may be presented to them.
I actually had a very understanding and helpful GP .
Not sure if we are meant to reply or not, but I read these three 'State of Play' posts with more and more tears in my eyes, I am not alone anymore.
)
Yes Cassie, my posts are all about the dialog, discussions and revelations and all are welcome to reply!!
Hugs and stuff!!
SPINELF
But in defence of the GP may I point out the clue is in the word 'general' they are NOT specialists. they CANNOT have a detailed knowledge of EVERY problem that may be presented to them.
I actually had a very understanding and helpful GP .
I take your point Tashanie, General indeed.
But sadly, as is my point, their grip and control on the 'early treatment pathway' for a chronic back pain sufferer, is very often, too far outside of their diagnostic skill set and/or clinical experience, for the sufferers own good.
This almost inevitably means a slowing down of the speed delivery of urgent diagnostics and therapeutic treatments.
All the best.
SPINELF
I take your point Tashanie, General indeed.
But sadly, as is my point, their grip and control on the 'early treatment pathway' for a chronic back pain sufferer, is very often, too far outside of their diagnostic skill set and/or clinical experience, for the sufferers own good.
This almost inevitably means a slowing down of the speed delivery of urgent diagnostics and therapeutic treatments.
All the best.
SPINELF
The problem is very often there is no diagnostic system available. Even MRI's will often come back showing no obvious cause of the pain. This if course doesn't mean nothing is wrong..far from it!
I can only speak of what happens in my area. I had a flare up of back pain - bad enough to send me to my GP because I knew I needed stronger pain killers than I could buy. She was very understanding, wrote me out appropriate prescriptions and gave me a form to refer myself to a physio class at the local orthopedic hospital. I decided to find an osteopath while I waited and she worked her magic on me, The physio referral came through much quicker than I anticipated tho.
Should osteopathy be available on ther NHS? (I had to pay to go privately) very probably. Had I waited for the physio referral maybe that is the treatment I would have been offered. But the problem was the delay in being seen a physio. If the GP could have got me into see a physio the day I went to her I might have been saved about 150.00. The sad truth is there are not enough physios so there is a delay in patients being seem. Just as in mental health there are not enough CBT specialists so it can take months for a patient with depression to receive appropriate treatment,
The sad truth is the NHS is not good in ANY chronic condition - ask any suffer from depression, bipolar disease, endometriosis, menorrhagia, ulcerative colitis, IBS, Diverticulitis...............I could go on.
The problem with back pain is often there is no obvious cause - and no obvious treatment option. I have NO idea what caused my flare up earlier this year - and had I been sent for an MRI there would almost certainly have been nothing to see (and the waiting time for MRI scans is also another factor outside the GP's control- too few machines and too few staff to run them) If I hadn't got to the osteopath I would probably have had 3 or 4 moths of pain instead of the 3 weeks or less I actually had. I stopped taking painkillers in less than a month.
But had I had to wait, that would not have been the GP's fault - but the fault of the creaky NHs. I worked in the NHS for over 30 years...so I know how creaky it is and it is probably worse at the moment than at any other time. Too few staff trying to care for too many patients.
But I sense we will just have to agree to differ on this point . ....
But I sense we will just have to agree to differ on this point . ....
Hiya Tashanie!
With regard to your last line (above), nothing could be further from the truth!
I 'totally agree' with everything you said!
I also freely acknowledge that there are excellent GP's, Orthopaeds, Neuros and NHS Spinal Surgeons who 'do go the extra mile' for our fellow sufferers, and I'm very glad that you found one of them!
My issue is, that they are 'few and far between' and 'access to them' is a post code lottery.
In the last 9 years, I (and I know, other forum buddies) could not find a single medic would go 'off scrip' or 'break rank' from ridged ineffective treatment protocols.
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In my next post Tashanie (No 3), I will address the issues that you raised regarding MRI and X-Ray scan deficiencies! Here again, the reasons for poor diagnostic outcomes are known, but there is no ambition amongst the medical establishment to improve the availability or quality of correctly targeted and cutting edge scans and tests. Watch this space! LOL!!!
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I will also be posting soon (No 4 or 5) on the marvelous work done by 'Therapists' of all kinds, in the critical role of reducing disabling pains and holding back the 'inexorable tide' of morbidity.
With regards to you question, Tashanie about whether the NHS should carry out Osteopathy and so on, there is presently a 'big debate' amongst Osteopathic organisations, as to this very question, i'll get more info on that by then.
There have been recent trials of 'NHS funded osteopathic therapies' here in Wales, carried out by 'Extended Scope Physiotherapists' who essentially did the same work as Osteopaths, but there has been no further 'permanent' developments since.
My view is, that they should 'not' be absorbed into the NHS, there should just be funded 'private' treatments available for us! As you rightly say, The NHS is no good for any chronic condition, and as I'm sure you know, having worked in the NHS for so long, once absorbed in to the poorly managed chronic care system, private osteopathic services will suffer the same fate as the other NHS services you mentioned in your post.
Speak more soon Tashanie.
Best wishes.
SPINELF
I know this is an old topic but It is still upsetting to read as not just with back pain, our GPs don't appear to be on the ball with anything, they even resort to looking up information on the web while you are in the surgery, scary stuff for sure.
I reluctantly went to the Docs recently and for both (what I would call simple matters) she is wanting to refer me to hospital.
No confidence in them, not a jot! Just one of my experiences and there are many -When I was grossly underweight, suffering severe stomach pains I was told to go away and eat a couple of steaks a week, not long after I had peritonitis of the bowel ending up with a colostomy.
I know this is an old topic but It is still upsetting to read as not just with back pain, our GPs don't appear to be on the ball with anything, they even resort to looking up information on the web while you are in the surgery, scary stuff for sure.
Much better to look something up than guess and guess wrong. NO-ONE can carry al the information in their head. I often find myself having to tell people that I will have to go and look up the answer to their drug query. The key thing is of curse I know where to look, which sites are trusted, and more importantly how to interpret the information so I can give an accurate and relevant answer to the question.
Much better to look something up than guess and guess wrong. NO-ONE can carry al the information in their head. I often find myself having to tell people that I will have to go and look up the answer to their drug query. The key thing is of curse I know where to look, which sites are trusted, and more importantly how to interpret the information so I can give an accurate and relevant answer to the question.
Hi there Sally, I know what you mean but after a Doc has been practicing for possibly 20 years or so you would think they would not misdiagnose so much and most importantly they need to learn to listen more.
I would like to mention a fantastic book while on here today, I have not looked at it for a long time and forgot just how valuable it is...The Natural Health Book by Dorothy Hall. It truly is amazing.
x
Hi there Sally, I know what you mean but after a Doc has been practicing for possibly 20 years or so you would think they would not misdiagnose so much and most importantly they need to learn to listen more.
x
Not when medical knowledge advances and changes as much as it does. I have been a pharmacist for over 30 years....and what happens now bears NO resemblance to what happened when I qualified.
Diagnosis is not simple - and I sometimes think patients have very unrealistic expectations of what doctors should be able to do. It is very rare that symptom a b and c will lead direct to a diagnosis of x. Sometimes all they can do is terat the symptoms....
I do however totally agree that some need t listen better!!!
Hi everyone! Sorry to have been absent from the cause for so long! My rehab, sudden and multiple family deaths (including Mam!) and long standing marital problems, have just left me with a total lack any kind of clear focus.
I'll be back soon!
The very best to all
SPINELF
So sorry to hear about your losses and problems. Sending you lots of good wishes Elfie, hurry back it's so quiet without you xxx
Hi everyone! Sorry to have been absent from the cause for so long! My rehab, sudden and multiple family deaths (including Mam!) and long standing marital problems, have just left me with a total lack any kind of clear focus.
I'll be back soon!
The very best to all
SPINELF
So sorry to hear of your problems Spinelf. Sending you Love, Light and Healing in the hope it will help a little. know the HP community are here to listen if needs be. (Hugs)
Thank you so much for all the information posted above - as a relatively new back sufferer it is wonderful to know there are others who have been through the mill who are willing to help and advise.
Cassie, I got Sarah Key's The Back Sufferer's Bible and am about to read through it - thanks for the suggestion.
Caroline, it is a real eye opener, let us know what you think won't you please 🙂