Showing posts with label GPs. Show all posts
Showing posts with label GPs. Show all posts
Wednesday, 13 February 2013
'Flu Jab!
Well, I also heard back from endocrinology yesterday; turns out that they too managed to bugger up my appointments. So the pituitary clinic appointment I was given for the 21st February was cancelled; instead, I'm going in to see the nurses for blood tests on the 28th and am being sent an appointment for early March by post. The lady at the end of the telephone thanked me for calling and alerting them to the fact I hadn't received a "clinical investigations" (what they insist on calling blood tests) appointment, as otherwise they would have booked me in for the 28th anyway and I'd have turned up on the 21st to meet a confused endocrinologist wondering why no blood test results were on the system for me.
Sigh.
So of the three disciplines who are chiefly in charge of my post pituitary surgery aftercare (endocrinology, ENT and neurosurgery), only neurosurgery managed to arrange my appointments without messing it up - although given that they epically messed up my pre-surgery appointments, they don't exactly get any gloating rights as a result.
ANYWAY.
I went to the GPs yesterday to get a new hydrocortisone prescription and get all my info up to date and get my letter signing me off work. The GP was new to me - since joining the new GP's practice last year, I've been pick'n'mixing which doctors I see, I don't really have a regular GP there - and he was very nice. He even suggested I have a 'flu jab - it's kind of late in the season now but it would definitely not be fun to have the 'flu at present. So I did! He warned that I might feel a few 'flu-y symptoms for the next day or two, but actually last night I felt really good. My boyfriend and I made pancakes for pancake day (first course: ham cheese & chive pancakes; second course: oak smoked bacon and maple syrup pancakes; third course: lemon and sugar pancakes), which were delicious. I had more energy than I have had most evenings since my surgery, which was greatly appreciated. Fingers crossed my energy levels start going up from now on!
Tuesday, 7 August 2012
Please Sir, Can I Have My Medication?
Regular readers will remember that earlier in the year I was lamenting the fact that my stupid GP's forced me to change GP surgery after I moved a few minutes down the road, due to their weird practice boundaries. At first I thought this was just Massively Inconvenient And Stupid, but in fact it's gone on to have far more serious ramifications.
At present I am thyrotoxic; I have way too much thyroid hormone sloshing around my body, because my pituitary tumour is producing a hormone which is overstimulating my thyroid gland. It has been getting noticeably worse recently; over the past few weeks I have had to up my dose of the beta blockers I take to control my excessively fast heartbeat from 1 - 2 per day to 2 or more frequently 3 per day. I'm noticeably more jittery, I get shaky hands sometimes, I'm getting much more tired more easily. I feel pretty rubbish right now.
The medical universe strongly agree that I need to go on lanreotide injections to stop the tumour producing thyroid stimulating hormone immediately. Like right now. Like actually we should probably have put you back on them at the start of July.
They do not agree on who should pay for it.
My injections are expensive; they cost about £750 a pop (one injection lasts for four weeks, so they cost about £27 a day). My old GP noted that they were more expensive than uranium, but he went on and prescribed them anyway.
My new GP noted that they were more expensive than uranium, and that they are now on our PCT Red List.
The Red List is a list of drugs that should only be prescribed by a specialist, not a general practitioner. It has been suggested that more PCTs are red-listing more drugs to make savings cuts. I could not possibly comment on that. What I do know is that despite the fact that my specialist endocrinologist requested my new GP prescribe them, this is apparently not enough, and after consulting with the PCT (primary care trust) she was unable to do so. The problem is complicated by the fact that the long-acting form of the drug I need (Somatuline Autogel) is not technically licensed for my condition (TSHoma). The older, short-acting form is licensed, but it only lasts ten days, and who wants injections every ten days? Essentially this is just wrangling, but my GP doesn't want to be held responsible for prescribing an unlicensed drug for me, should anything go wrong. She is playing by the book, which is a stance I can sympathise with.
Fortunately the day after I first found out about this issue, I went into the hospital for an appointment and informed my various endocrinologists of the problem. They immediately requested that the specialist nurses order in the first dose of the drug for me so that I could have it administered as soon as possible.
The nurses already have the syringe full of delicious lanreotide. It came in yesterday.
I could have had the injection yesterday. I could have had it today. I could even have it tomorrow, but I don't know if I will - because even though the first dose has been bought and paid for and is SITTING IN A FRIDGE WAITING FOR ME, they are wrangling about who should pay for the next dose.
The next dose.
WHICH I DON'T NEED TO HAVE FOR FOUR WEEKS.
The nurse was super apologetic when I called up to find out what the heck was going on (as I had been told I would probably have it yesterday or today but hadn't heard anything) and she's basically spent the whole afternoon trying to find out if she can just give me the damn injection already and work out where the next one is coming from afterwards.
There is no question that the NHS wants me to have this drug. It's the drug I need, I've had it before, plenty of other patients with my condition have had it before, it works, the licensing issue is really just a wrangle and they reckon the drug company is hoping to get it licensed for TSHoma soon anyway. All the people actually involved in my care want me to have this drug as soon as possible because being this thyrotoxic is Not A Good Thing. But no-one wants to pay for it. Which is ridiculous because it's public damn money. If the hospital pays for it, if my GP's pay for it, it doesn't matter - the net effect on the public purse is exactly the same.*
So please can I just have the damn injection already?
________________________________________________
*Although in fact, it would probably be cheaper to the NHS overall for me to have it administered by a nurse at my GP's practice rather than an expensive and specialist endocrine nurse at the hospital whose time is probably more valuable.**
** And more expensive if my thyroid gland goes into overdrive while I'm hanging around waiting and sends me into a coma.***
***Very unlikely but actually not entirely impossible.
At present I am thyrotoxic; I have way too much thyroid hormone sloshing around my body, because my pituitary tumour is producing a hormone which is overstimulating my thyroid gland. It has been getting noticeably worse recently; over the past few weeks I have had to up my dose of the beta blockers I take to control my excessively fast heartbeat from 1 - 2 per day to 2 or more frequently 3 per day. I'm noticeably more jittery, I get shaky hands sometimes, I'm getting much more tired more easily. I feel pretty rubbish right now.
The medical universe strongly agree that I need to go on lanreotide injections to stop the tumour producing thyroid stimulating hormone immediately. Like right now. Like actually we should probably have put you back on them at the start of July.
They do not agree on who should pay for it.
My injections are expensive; they cost about £750 a pop (one injection lasts for four weeks, so they cost about £27 a day). My old GP noted that they were more expensive than uranium, but he went on and prescribed them anyway.
My new GP noted that they were more expensive than uranium, and that they are now on our PCT Red List.
The Red List is a list of drugs that should only be prescribed by a specialist, not a general practitioner. It has been suggested that more PCTs are red-listing more drugs to make savings cuts. I could not possibly comment on that. What I do know is that despite the fact that my specialist endocrinologist requested my new GP prescribe them, this is apparently not enough, and after consulting with the PCT (primary care trust) she was unable to do so. The problem is complicated by the fact that the long-acting form of the drug I need (Somatuline Autogel) is not technically licensed for my condition (TSHoma). The older, short-acting form is licensed, but it only lasts ten days, and who wants injections every ten days? Essentially this is just wrangling, but my GP doesn't want to be held responsible for prescribing an unlicensed drug for me, should anything go wrong. She is playing by the book, which is a stance I can sympathise with.
Fortunately the day after I first found out about this issue, I went into the hospital for an appointment and informed my various endocrinologists of the problem. They immediately requested that the specialist nurses order in the first dose of the drug for me so that I could have it administered as soon as possible.
The nurses already have the syringe full of delicious lanreotide. It came in yesterday.
I could have had the injection yesterday. I could have had it today. I could even have it tomorrow, but I don't know if I will - because even though the first dose has been bought and paid for and is SITTING IN A FRIDGE WAITING FOR ME, they are wrangling about who should pay for the next dose.
The next dose.
WHICH I DON'T NEED TO HAVE FOR FOUR WEEKS.
The nurse was super apologetic when I called up to find out what the heck was going on (as I had been told I would probably have it yesterday or today but hadn't heard anything) and she's basically spent the whole afternoon trying to find out if she can just give me the damn injection already and work out where the next one is coming from afterwards.
There is no question that the NHS wants me to have this drug. It's the drug I need, I've had it before, plenty of other patients with my condition have had it before, it works, the licensing issue is really just a wrangle and they reckon the drug company is hoping to get it licensed for TSHoma soon anyway. All the people actually involved in my care want me to have this drug as soon as possible because being this thyrotoxic is Not A Good Thing. But no-one wants to pay for it. Which is ridiculous because it's public damn money. If the hospital pays for it, if my GP's pay for it, it doesn't matter - the net effect on the public purse is exactly the same.*
So please can I just have the damn injection already?
________________________________________________
*Although in fact, it would probably be cheaper to the NHS overall for me to have it administered by a nurse at my GP's practice rather than an expensive and specialist endocrine nurse at the hospital whose time is probably more valuable.**
** And more expensive if my thyroid gland goes into overdrive while I'm hanging around waiting and sends me into a coma.***
***Very unlikely but actually not entirely impossible.
Wednesday, 18 April 2012
Belated Bad Luck
...and, I'm back again. Apologies for my absence, this time I wasn't ill, just busy with work. Last Wednesday I had a whole day of medical bad luck, however, which I propose to tell you about right now. I know, I know. You can hardly contain your excitement.
So, I set off into town, to visit my GP's surgery, to find out whether my new address means that I'm out of their catchment area and consequently would need to find a new doctor. My local GP's would appear to have the world's most illogical catchment area; I used to live a forty-five minute walk away and had no problem staying on their books, but when I moved much closer (a fifteen minute walk away) they warned me that I was "only just" still inside their boundaries. W, I hear you cry, TF.
Anyway, I moved house basically down the road, so I'm still just as close but in a slightly different direction. My new house is nice, by the way. It's painted yellow on the inside, which is cheery, and there is both a gardener and a dishwasher. Decadence, thy name is me. Or moi, probably. I hear Decadence is French.
When I arrived at the doctor's surgery, a bad omen was pinned on the door. No, not a dead raven - a notice that my long term GP, Dr Boris (who I have previously written about here) had left the surgery and was working at another one nearby. Now, Dr Boris isn't so much of a legend that I would weep tears of watery saline solution from my lachrimal glands at his departure, but still, this could be inconvenient.
I went in to the surgery and asked the receptionist if my new address was still in their area. She looked up my postcode on their computer system -
Haha, no.
She looked up the name of my road in a tatty folder which contained an alphabetical list of all the road names in my city. Apparently only people living in a road underlined in yellow highlighter are allowed to register at the surgery and, alas, my new road is not highlighted.
I point out to the receptionist that I live absurdly nearby and need to have a fairly unusual injection once every month and that there are three nurses at this practice who are trained to give them and potentially may be none at another GP's practice. "You have to go register at another GP's," she says.
Ok, fine. I ask the receptionist what other GPs are nearby. She looks at me like I'm insane and responds that she "doesn't know the area".
Fortunately, I asked mainly out of curiosity. I know there is one other GP's in the town centre, which my boyfriend used to be registered at, so I head there to ask about registering.
In the window is a sign "GP's closed 23rd March - 19th April". Ah, the joys of the NHS.
So currently I'm still registered at my old practice (I cunningly told them I "would be moving shortly" because I am a deeply suspicious person by nature) but I have to find a new one. Ho hum!
I have to say, I cannot for the life of me understand having a GP's practice boundary which extends less than a mile to the north and east but several miles to the south. And if you're going to have such a strange and arbitrary boundary, surely keeping a list of other GPs with less mental regulations is only common sense?
So, I set off into town, to visit my GP's surgery, to find out whether my new address means that I'm out of their catchment area and consequently would need to find a new doctor. My local GP's would appear to have the world's most illogical catchment area; I used to live a forty-five minute walk away and had no problem staying on their books, but when I moved much closer (a fifteen minute walk away) they warned me that I was "only just" still inside their boundaries. W, I hear you cry, TF.
Anyway, I moved house basically down the road, so I'm still just as close but in a slightly different direction. My new house is nice, by the way. It's painted yellow on the inside, which is cheery, and there is both a gardener and a dishwasher. Decadence, thy name is me. Or moi, probably. I hear Decadence is French.
When I arrived at the doctor's surgery, a bad omen was pinned on the door. No, not a dead raven - a notice that my long term GP, Dr Boris (who I have previously written about here) had left the surgery and was working at another one nearby. Now, Dr Boris isn't so much of a legend that I would weep tears of watery saline solution from my lachrimal glands at his departure, but still, this could be inconvenient.
I went in to the surgery and asked the receptionist if my new address was still in their area. She looked up my postcode on their computer system -
Haha, no.
She looked up the name of my road in a tatty folder which contained an alphabetical list of all the road names in my city. Apparently only people living in a road underlined in yellow highlighter are allowed to register at the surgery and, alas, my new road is not highlighted.
I point out to the receptionist that I live absurdly nearby and need to have a fairly unusual injection once every month and that there are three nurses at this practice who are trained to give them and potentially may be none at another GP's practice. "You have to go register at another GP's," she says.
Ok, fine. I ask the receptionist what other GPs are nearby. She looks at me like I'm insane and responds that she "doesn't know the area".
Fortunately, I asked mainly out of curiosity. I know there is one other GP's in the town centre, which my boyfriend used to be registered at, so I head there to ask about registering.
In the window is a sign "GP's closed 23rd March - 19th April". Ah, the joys of the NHS.
So currently I'm still registered at my old practice (I cunningly told them I "would be moving shortly" because I am a deeply suspicious person by nature) but I have to find a new one. Ho hum!
I have to say, I cannot for the life of me understand having a GP's practice boundary which extends less than a mile to the north and east but several miles to the south. And if you're going to have such a strange and arbitrary boundary, surely keeping a list of other GPs with less mental regulations is only common sense?
Wednesday, 11 January 2012
More Expensive Than Uranium
I have two GPs who I see on a semi-regular basis; both excellent medical men in their way, but both with certain personal quirks that turn my regular visits from dull routine into amusing interludes. The first,* Dr. Ken, has a curious habit of continually saying "mmhm, mmhm, mmhm, mmhm" whilst you speak to him (I have actually discussed this with another patient, so I know it's not just me).
Initially, I assumed he must have gorged on peanut butter before letting me in to his office, and the curious masticating noise was the sound of him trying to detach it from the roof of his mouth. I have since been forced to revise this view, however, and now my best guess is that at some point as a medical student he must have gone on some kind of "relating to patients" course and believes that frequent low-level humming noises are a soothing way of indicating his interest and concern, and not just extremely irritating.
My other GP, Boris, has never made any unexpected murmurs, susurrations, sighs, soughs or rumbles - which is to his credit. However, he does have a somewhat quirky sense of humour; last year, when receiving my regular blood test results, he gravely informed me I was pregnant and then burst into hysterical peals of laughter. Fortunately, due to a) being used to him and b) being extremely sure I was not, I did actually find it funny, but I imagine he needs to be careful precisely who he pulls that joke on.
Today I visited Dr. Boris to get my prescription for Somatuline Autogel injections, as agreed with my endocrinologist. He looked it up in his little dictionary of medicines, looked up at me and said, "Did you know this is more expensive than uranium?"***
Never having previously considered the price of uranium (as I am neither a nuclear scientist nor intent on causing mass terror) - and slightly concerned that my GP knew the exact cost of uranium yet had to look up my medication in a book - I asked him how he knew. Apparently the food critic, Giles Coren, recently wrote a bit of a rant about Pizza Express, in which he calculated that the price they charge for extra olives makes the olives, gram for gram, more expensive than uranium - which, I imagine, means that my lanreotide injections are significantly more expensive than uranium.
I can't guarantee that this story is true, and I foolishly didn't think to ask whether this valuation applied to enriched, depleted or farm-fresh newly-mined uranium. I can't look it up now, of course; I imagine that researching current uranium prices may well attract The Wrong Kind Of Attention. Probably just using the word "uranium" six times in one blog post is bad enough.
Anyway, I got my prescription and Dr. Boris instructed me that, should I be mugged whilst transferring the lanreotide injection from the pharmacy to the GP's surgery, I may hand over my purse and phone - but I have to fight them for the syringe.
_________________________________________________________________
*I won't name them, obviously, as I have no wish to get sued. Let's call them Ken and Boris, for no reason other than that they are excellent names and that both my doctors have extreme political views at opposing ends of the spectrum.**
**N.B. this is a lie.
***I have cost the NHS an awful lot more than I've ever paid in taxes >.>
Initially, I assumed he must have gorged on peanut butter before letting me in to his office, and the curious masticating noise was the sound of him trying to detach it from the roof of his mouth. I have since been forced to revise this view, however, and now my best guess is that at some point as a medical student he must have gone on some kind of "relating to patients" course and believes that frequent low-level humming noises are a soothing way of indicating his interest and concern, and not just extremely irritating.
My other GP, Boris, has never made any unexpected murmurs, susurrations, sighs, soughs or rumbles - which is to his credit. However, he does have a somewhat quirky sense of humour; last year, when receiving my regular blood test results, he gravely informed me I was pregnant and then burst into hysterical peals of laughter. Fortunately, due to a) being used to him and b) being extremely sure I was not, I did actually find it funny, but I imagine he needs to be careful precisely who he pulls that joke on.
Today I visited Dr. Boris to get my prescription for Somatuline Autogel injections, as agreed with my endocrinologist. He looked it up in his little dictionary of medicines, looked up at me and said, "Did you know this is more expensive than uranium?"***
Never having previously considered the price of uranium (as I am neither a nuclear scientist nor intent on causing mass terror) - and slightly concerned that my GP knew the exact cost of uranium yet had to look up my medication in a book - I asked him how he knew. Apparently the food critic, Giles Coren, recently wrote a bit of a rant about Pizza Express, in which he calculated that the price they charge for extra olives makes the olives, gram for gram, more expensive than uranium - which, I imagine, means that my lanreotide injections are significantly more expensive than uranium.
I can't guarantee that this story is true, and I foolishly didn't think to ask whether this valuation applied to enriched, depleted or farm-fresh newly-mined uranium. I can't look it up now, of course; I imagine that researching current uranium prices may well attract The Wrong Kind Of Attention. Probably just using the word "uranium" six times in one blog post is bad enough.
Anyway, I got my prescription and Dr. Boris instructed me that, should I be mugged whilst transferring the lanreotide injection from the pharmacy to the GP's surgery, I may hand over my purse and phone - but I have to fight them for the syringe.
_________________________________________________________________
*I won't name them, obviously, as I have no wish to get sued. Let's call them Ken and Boris, for no reason other than that they are excellent names and that both my doctors have extreme political views at opposing ends of the spectrum.**
**N.B. this is a lie.
***I have cost the NHS an awful lot more than I've ever paid in taxes >.>
Subscribe to:
Posts (Atom)