a locum as thats how afternoon surgery is run at the clinic I go to no practice doctors work in the afternoon.

Really?! Sh1t! How many partners are at the practice? Are you prepared to name and shame it?

That’s good, 250 sometimes seems to be used – normally not enough IME. I give a 10 day course though for tonsillitis as it often seems to need it.

Something doesn’t quite add up here… either the doctor you saw is seriously deficient or something has been lost in translation. Are you sure they were a locum and not an F2 (junior doctor)?

Hmmm… sounds odd.

She wouldn’t be fresh out of medical school as a locum, she’d have to be a fully qualified GP and therefore an absolute minimum of 4 years out of medical school.

If she didn’t examine you, said you can’t catch tonsillitis twice and completely dismissed you then she was wrong on 3 counts.

What dose of erythromycin did you get the first time?

P.S. I always hesitate to encourage complaints as they’re such a ball ache for both parties yet seem to achieve so little but it might be worth it here. If you do complain then I’d stick to the facts and not make it personal. Also, keep the letter short – it’s well known that the length of complaint letter is inversely proportional to the validity of the complaint!

If its your only household income then you do not have childcare costs unless you are a single parent

Only if said stay at home parent sits in an unheated house with their child all day and doesn’t go anywhere / do anything with them. Childcare costs even if you DIY.

I think Garstang is the most horribly named place I’ve heard of in Britain.
Always makes me think of a concentration camp for some reason.

Yes. Enough to put me off just a little! There seem to be a few places with funny names ’round there.

Thanks – sounds promising then. Looked good when we had a drive about at the weekend but often difficult to tell just by doing that. Moving from the northern end of the north yorks moors.

Depends. Is he a higher rate taxpayer? 😆

There is no straightforward way.

Depending on the nature of your job you may be able to employ her to do some (e.g. admin, book-keeping) work for you. The work has to be done, it has to be at a commercial rate and the money has to actually be paid from you to her. You can do this up to her tax free allowance. However, be very careful and make sure you keep excellent records as it’s a good way of getting HMRC’s attention so it must be absolutely legit, if it’s not then HMRC will be on you like a ton of bricks! Is there any work you currently pay someone else to do for you that you could pay her to do instead?

bwaarp – the NHS does not pay for you to become a doctor as far as I know??
If they do … then i guess my son is fleecing me & his mother!

No it doesn’t. The NHS pays bursaries for some courses (e.g. nursing) but never has done and still does not for medicine AFAIK.

My main objection to the proposals is that it’s one person over the 40% threshold. I’m just over but my wife is unemployed. We can’t use her tax allowance at all, she can’t claim benefits and we’ve lost child tax credits. In January we’ll lose child benefit too.

Also, wealth isn’t solely about income – my wage is good now but the costs I’ve incurred getting here are high and are still being repaid. They weren’t tax deductible either (in the main).

Is it tennis, Golfers or both?

Cortisone injections work short term but there’s a high recurrence rate and some evidence they make things worse longer term. They also carry various short term risks…

Have you tried the velcro strap thingies that go just below the elbow? Splinting the wrist (in a futura splint) overnight and when doing activities that exacerbate it can help too (the problem is with the wrist extensors (tennis) or flexors (Golfers) rather than the elbow which is why this works). Physio useful too.

Rydster:

😀

Always sounds good! Good luck.

Yes rydster!

That doesn’t sound great flow – hope things do pick up.

When I first got the rotator cuff tendonitis the Doc game me some blood test for something like this but they were ‘ok’ (whatever that means exactly). I did tell my urologist I had some undiagnosed inflammatory-tendonitis thing going on recently, so when I see him again I may raise it again.

May well just have done ESR and CRP though – you could do with having various autoantibodies checked as they’re much more specific and reliable. Even if all bloods normal I’d have referred you to a rheumatologist. The relevance of a diagnosis is that some of these conditions are progressive and treatment with disease modifying drugs is important.

I don’t really have a GP I really trust to be honest, especially after that guy told me to just do some swimming. One issue I have with the NHS GP is that I feel like a charity case going in, it is very dis-empowering. My urologist is private and I find it easier to talk as one educated person to the other with him, with the NHS I am just another plebeian in the queue so to speak rendered a kind of passive passenger through the system. I know GP’s see a lot of ‘undeserving ill’ and hypochondriacs etc I can see how they develop a hard skin.

Sorry that’s how you feel – you really shouldn’t though. The NHS might be free at the point of (ab!)use but we do pay for it.

Yep, they’re currently gunning again for an ‘alternative’ doctor despite him having been cleared several months ago and receiving a huge amount of support from his patients. Why would the GMC be doing this? Are they not confident of their recommendations? Perhaps this person is right and they are wrong?

See their role as ‘upholding the reputation of the profession’ and it makes a little more sense. It’s a fine line between pioneer and nutcase… I think it’s fair to say that the profession continues to lose confidence in the GMC.

I’m saddened to read you’re considering your options and presumably you feel that the proposed reforms won’t improve things?

Even if you take the proposed reforms at face value, why would you put a group of generalist clinicians in charge of commissioning (a highly specialist non-clinical skill) and take them away from clinical work? Doesn’t make sense.

The NHS reforms are a poisoned chalice for GPs that a very small minority (of the usual suspects) will do very well from but that will ruin the NHS and lay the blame for that at GPs’ door – perfect headline material for the Mail etc! Care for people like those on this thread, who don’t fit nicely into a (profitable) category will undoubtedly get worse (imagine that!!) and may start to be subject to top up payments not immediately but eventually.

IMO GPs get completely worn down by the constant flow of work-shy p-takers, and eventually see us all like that. Every interaction I’ve had with GPs over the age of about 35 has been unsatisfactory. It’s entirely understandable, but very difficult to know how to fix the system as currently constructed.

Interesting you say that, I find a similar problem with police!

I’m a 32 year old GP trying hard not to tar everyone with the same brush, perhaps when I reach 35 I’ll give in! One option I’m seriously considering (and many of others of my generation are too) is emigrating because it’s things almost unique to the uk like the social rubbish (e.g. sick notes), bureaucracy, constant changes and lack of independence that really grind you down. Helping decent (ill!) people get better and live their lives and doing the difficult medical stuff (especially diagnosis) are the enjoyable bits of the job for me but the system isn’t set up for this really.

In my case, my argument has been that the result of a blood test is treated as gospel and how I actually feel doesn’t come into it! Notwithstanding guidelines from the Royal College of Physicians needing looking at, compared to other countries.

I think regarding thyroid problems it would take a very brave (?foolhardy) GP / endocrinologist to deviate too far from those guidelines. They’re very prescriptive and have been written for a particular purpose. The GMC show plenty of interest in doctors who don’t toe the party line on thyroid conditions and that means that for most doctors the risk isn’t one we’d be happy to take. I try to be open-minded but on this it is very difficult to practise with an open-mind without attracting unwanted attention.

Out of curiosity jb79, seeing as these days GPs have far too many patients, how do GPs actually find time to read up on new medical developments, research etc.?

In short – with great difficulty (and I suspect in a few cases, not at all). There are very good courses (GP Update / Hot Topics) that cover a vast amount of new research in a day and give a thick summary book for future reference. Part of being a professional is knowing when you’re out of your depth – most of my learning is based around when I’ve not done or known something as well I should, I go and read it up and practice it (case-based learning). Patients teach me a lot too. In fact, most medical degrees are now based on the principle that to know it all and stay up to date is impossible, but to know how to find the information you need and deal with the immediate need when you don’t know is possible. I think most sensible and reasonable people accept that some things we don’t know and some things aren’t known, but there are some who get really angry about it (a personal bugbear) and some doctors who try to hide or are blissfully unaware of their ignorance (another bugbear).

There was a research paper a few years ago that reckoned a super-specialist (e.g. a proctologist specialising in anal cancers!) would need 26 hours per day of reading to stay up to date in his field.

My own thoughts are that after I hurt my back in early 2007 I was taking tons of ibuprofen every day, then about 6 months later I got really painful bursitis in my shoulder, kept on taking ibuprofen, then 6 months later got tendonitis in rotator cuff, then over the next 6 months it was just pain everywhere and through this period what seems like minor injuries would just not heal rather inflame up and stay like that. I quit the ibuprofen thinking (because of long term use) maybe my body was fighting against it by making more inflammatory chemicals??

Doesn’t sound like the ibuprofen’s fault though NSAIDs can impair tendon healing. Tendonitis is actually a misnomer since it isn’t actually an inflammatory process.

Doesn’t sound much like fibromyalgia – sounds autoimmune to me (as rydster himself says). The epididymitis could be related, being caused by the same underlying process. In this case (the correct) blood tests are likely to be very helpful though may be falsely negative, especially if not currently ‘flared up’.

You folks really seem to be meeting some crummy doctors… depressing.

I had a similar problem and it was that the sprung bit of metal between the pads had bent slightly and fallen off the edge of the pad.

You could get the Hope bit linked above and a spare crown race to fit your headset.

That’s a thought, probably have highest chance compatibility that way.

I presume the second fork you wish to swap is a taper steerer.

Correct.

Thanks very much all.

I was confused as to whether the things linked to were replacement crown races (for 1 1/8 forks in a tapered headset) or adaptors to fit a tapered crown race to a 1 1/8 fork.

I’ve already got a cane creek headset so makes sense to go for that one and hope my headset is compatible with it.

Cheers.

I am confused what are the two sets of fork steerer sizes?
I assumed you have one taper set and one 1.125

Yes that’s right, sorry I’m being confusing!

I’m getting confused as to what the on one reducer does compared to the cane creek thing I linked to and whether I can use the on one reducer with a cane creek headset. Does the on one thing just make the 1 1/8 steerer = 1.5 so that you can fit a taper headset crown race to it? Is the cane creek thing I linked to a replacement crown race that fits 1 1/8 forks into a taper headset or does it do exactly what the on one does?

As a rule of thumb 6 weeks is about right but it’s really very dependent on how badly you’ve damaged your ligaments. 12 weeks certainly not unheard of but I’d have thought early May would be ok. Get well soon!

Thanks – that’s great!

I’ve got a cane creek headset, so does that mean I can get one of these and leave it on the 1 1/8 forks? Or could I get one of the on one reducers junkyard has linked to above and then swap the crown race between the forks whenever I change them?

No problem with charging for it but there is no way he can be sued for someone dying unless he misses anything obvious. Ie all he has to do is act as any competent doctor would do in that situation.

Whilst you’d hope that’d be the case, there are 2 problems with this line of argument:

1. What should a competent doctor do? This is controversial, even (especially?) among sport and exercise medicine specialists. Pre-exercise screening is full of pitfalls. If event organisers want these forms signed they need to move away from catch all phrases and ask specific and definitive questions.

2. Even if there is no way I can be sued it doesn’t stop some folk from trying. The process is stressful, lengthy, time-consuming (taking away from NHS work) and can adversely affect things like getting a job, moving overseas, etc (most ask ‘do you have any outstanding complaints against you).

From a payout point of view I’d worry more about someone having a stroke or MI and ending up disabled but not dead…

Thanks, I’m just gonna fake it

That really is the most appropriate response as far as I’m concerned, give it the contempt it deserves.

Don’t confuse your GP with the NHS – if he signs this form and something goes wrong it’s on him, the NHS won’t help.

I can understand your frustration though, I personally find the NHS massively frustrating and unfair at times and that’s one of the reasons I tend to sign these forms, but you shouldn’t expect it, it’s a favour. As a rule those who pay most get least from it (apparently 25% are net contributors to the NHS, 75% net takers) – that’s life!

metters, DrP et al, see above, and also NHS (i,e, taxes) pays doctors, solicitors charge for their work.

Taxes pay for the contract your GP holds to provide you with medical services. Those medical services are well defined in that contract and do not include insurance forms for example. Some forms, for example fit notes, various dwp forms, etc are in the contract and are therefore ‘free’.

Edit: as it happens I frequently sign these for free but I feel under absolutely no obligation to sign them at all, let alone for free.

Why should a doctor not charge for signing these?

Part of the £6000 per annum professional indemnity insurance I personally pay covers me if/when things go wrong after I sign one of these. Consider that they’re only ‘necessary’ because the organisation asking you to get it signed is trying to save themselves a similarly large bill. It isn’t an NHS service.

I suspect something you said or did pissed the gp off for some reason – probably more about them (or the patient they saw before you) than you. Somedays it feels like everyone comes in for a bit of an argument!

Absolutely no financial incentive for a GP prescribe (unless they own the pharmacy). Quite the opposite in fact – no financial incentive to not prescribe but lots of hassle if you prescribe more / more expensive drugs than your colleagues.

He’s probably haing anxiety attacks but 3 days post op + complicated (re-admitted for 2nd op) + high pulse + anxiety is sepsis until proven otherwise. I certainly wouldn’t want to rule it out over the Internet! A settling pulse rate is reassuring though, especially if he feels well and not like he has flu.

If I was his GP I’d want to make certain he didn’t have an abdominal abscess before putting all his symptoms down to anxiety. I hope you get to see someone who at least listens to him!

3 days post op with a heart rate of 120 is cause for concern (even if it is settling – to what rate BTW?).

Whilst he might ‘just’ be having an anxiety attack he could have sepsis (and sepsis itself can make you feel anxious) so I’d get him seen in A+E tonight – needs check of bp, resp rate, temp and preferably a blood test too.

Edit: I’m a doctor.

Get thee to a GP!

I was considering emigrating there last year. I know one thing that might be of use – you’ll get permanent residency quicker if you apply for it from outside the country than if you go out on a temporary visa and then want to convert it. HTH.

In answer to the OP, I wouldn’t worry about taking amitriptyline long-term, especially if at low dose.

As an aside – why would Amitriptyline be prescribed as opposed to Gabapentin?

It’s cheap and it’s once daily and it’s been around for ages.

It can work very well, but for pain I never use it above 30mg. The dose you’d give a depressed hamster.

Gabapentin and Pregabalin (rather better -simpler dosage regime) have been been strongly promoted by drug companies, but I haven’t found them that useful.

I wouldn’t go above 50mg for pain. Gabapentin almost never seems to help if amitriptyline hasn’t but some patients tolerate its side effects better. Have had some good results with pregabalin (especially if there’s anxiety stuff going on too) but it costs a fortune and has side effects too. Gabapentin and pregabalin are both potentially abused.