Have you ever left your doctors surgery/office and wanted to cry, feeling in despair or writing in frustration?
Yeah, me too. The thing is, there is so much we can do to get what we want, but no one teaches us how to work the woman on reception or get a GP that actually ‘gets it’. This is why I was so keen to chat to GP Dan Maggs. In this episode, he gives us a blueprint we can use to get an appointment with the right GP, at a time that suits us.
About Dr. Dan Maggs M.D
Dr Dan Maggs is a GP living in Warwickshire. His specialist interest is in Diabetes and the effective management of weight and insulin levels.
You can find him talking about low carb living over on YouTube and at CarbDodging.
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[1.00] The role of the GP[3.30] GP dermatology specialists
[3.30] GP dermatology specialists
[4.30] Visiting different doctors
[6.40] How to get an appointment with your GP
[11.00] Why your GP is more useful than you think
[26.00] Your GP can find the answers
[27.48] How medicine availability works in the UK
One more thing!
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nd in the system that I use in the GP surgery, there’s a button actually it says my consultations. So, you can really easily click on that and actually see if you’ve seen that patient before. And sometimes, you don’t even need to click on that, because you’re familiar with the name and you know this patient in advance. But actually, it’s very, very quick to say I’m not required with names, to be honest, this very great quick click to say to click and say that you’ve seen this patient before and you know just quickly looking through your notes will judge your memory. And actually you do build an understanding of people over time and actually, that’s one of the great things about general practice is we do see people again and again. And you know you might not be coming in with your psoriasis all the time, you might be just to accompany your children in when you’re you know taking them in for something and actually. We do build up a picture of people over time and that helps us understand that person as an individual in the context of their family and I do believe that that is really, really helpful and one of the great things about general practice is that we get to build up a relationship over time.
Gemma: Yeah, suppose that’s really handy for other things like identifying things like depression or mental health challenges if you’ve got that relationship and you can see something changing in a patient. You’re more likely to ask the right questions on you know if you’ve got that relationship.
Dr. Dan: Absolutely, and whilst we are you know everybody has their own confidentiality. It’s very, very important to recognize that we do see people in the context of their families. So, actually it’s quite easy for us to say when you know if you’ve been seeing you know for example; husband lost his job and you’ve seen him about the stress that goes along with that. You also know when you also realize that when the parliament may come in and you know be having problems that you can actually put those things together.
Dr. Dan: And actually say some…you can say someone has stress in the family may be, the stress level in the family may have gone up at that time and that may be having an influence on people’s mood problems maybe have been in an influence on their skin problems.
Gemma: Okay, right. so, would you advise that people who get psoriases for example; who know they’re going to need to see their GP on a regular basis, to book appointments months in advance, just to make sure that they see the same GP on a regular basis?
Dr. Dan: I think if there’s a genuine need to have a…you know if you need to be reviewed at that point, I wouldn’t advise people to just book an appointment in case they need them at that time. But I would definitely stay if you’ve got a genuine need to have a periodic review of your psoriases control, on your medications and I think that’s very reasonable to be booking an appointment in several months time. And actually, that’s something you can discuss with your doctor when at the end of the consultation. And it’s usual for us to be arranging some sort of follow-ups, though you know that the conversation might say you’ve come in for something. You know like a chest infections, and just for an example; you know it to be reasonable to say; okay, look if things aren’t getting better off you know you aren’t responding to the treatment in the way you expect to, you know if you’re getting more short of breath, your temperatures aren’t getting under control, then we really want to see back on an urgent basis. You know if things haven’t improved with your symptoms you know, if after a week things are completely better, you now be a reasonable comeback. So, we do try to organize follow up as part of the consultation. and I think if you’re coming in about your psoriasis you could be said you know when should we be reviewing the situation? Should I book an appointment for three months with you and we can have a look at the situation now? That might be reasonable. I think allow your own doctor to guide you. a good doctor should guide you with that.
Gemma: Okay, and there’s nothing wrong with going in and initiating the conversation yourself either if an appointment did not come up, it’s well within your rights to start that conversation is now.
Dr. Dan: Absolutely, I don’t really think there’s anything that’s off the table in terms of asking questions of your GP, I would really encourage anybody if they’ve got a query to just ask. I tell you we can ask the strangest stuff. So, I can promise you that asking questions about getting asked a question about when should I come back to see you. It really isn’t something that’s off the table.
Gemma: What about asking about other things because I know that living within incurable disease people’s psoriases is quite often end up on the internet, reading things in the newspaper. And I know I’ve had several bad experiences where I’ve spoken to a medical practitioner and they’ve been and very negative and found it very difficult to talk to them about…what you are saying your GP should be open to talking about things that you’ve read in the newspaper, you should be taking things that you’ve seen before testing among yourself and talking about those with the doctor you know. If I’ve read like a psoriasis diet in the newspaper it’s well within a normal consultation for me to talk that through with you. You’re not going to laugh at me or tell me to go away or…
Dr. Dan: I know from previous conversations with you that you’ve had a very bad experience in this department. So, I think…can you just tell us a little bit about that experience will that be okay?
Gemma: That’s fine. So, I visited a dermatologist and discussed some information I had read and he laughed at me and said where did you get that information from? Was it the Daily Mail? You’re going to be asking me whether we should be [inaudible, 22:58] skins on the skin and then just continued to wait and the consultation prescribing me the same old stuff. And it wasn’t until tenth rounds and wheeled off my academic qualifications where he actually stopped writing ten rounds and start to listen twice to him.
Dr. Dan: It’s really sad to hear that. It’s really is. I just think it’s really unhelpful. I don’t really think that anybody could ever consider that good medical practice really. we get people coming in with clippings from the newspaper, stuff from online all the time. I think it’s very…it’s part of modern life. And even if someone’s not coming in and showing you [inaudible, 23:42] cool, it’s very reasonable that they probably read something and got an idea in their head about that…about what they’ve read. And I think it’s an important part of the modern medical consultation to be able to say you know what do you think about what’s going on here? Have you had you done any research yourself? Have you come up with anything? When you know have you looked on the Internet? Have you read anything? And I think that’s normal to expect that as part of a consultation in this day and age. And yeah, there is a lot in the media and I don’t think it’s reasonable that a doctor should speak to you like that. And I don’t think you should have to realize the number of academic qualifications to get respect in that consultation. So, yeah I’m really sorry that you’ve had that experience. It won’t be something I’d want for any of my patients. Yes. So, but going back to what we spoke about at the beginning, we are generalist okay? So, actually, it’s not as part of our train…as part of our ongoing professional development, we have to do at least 50 hours a year of basically, at least an hour a week of reading, attending conferences, reading medical papers, basically continuing our professional development. But it’s very reasonable and most we try to get that across a range of different areas within our medical practice. it may be that a doctor hasn’t been updated on the latest in a particular dermatological condition for several years. and actually, new medications do come out on a regular basis and new…and there’s a very often reports in the media about some sort of new treatment for or whatever condition is that people have got questions about. But it’s also not reasonable to expect your doctor necessary to read that. But I think if you coming in with you know some thoughts about a new treatment, there are a few things you’ve got to remember; yet your doctor might not have come across. But I think it’s also reasonable that a doctor should go away and try and find out some more information on something okay. You know we’ve all got [inaudible, 26:07] our surgeries these days. there’s nothing wrong with pulling up Google and having a look and trying to find an article and actually going through it with somebody while they’re in the surgery is a good time to do that. And you know doctors even if you have come across that, it may not be on the tip of our tongues. It’s reasonable that we should be able to go and look things up. We know we live in an age where it’s not possible to know everything about everything these days. And it’s actually very reasonable for your doctor to be looking on the internet to try and find something out. And also, sometimes it will be a case of do you know what? I haven’t got I actually haven’t heard of that, but I will go and have a look up. And at sometimes say to patients, you know I’m going to go away, I’m going to have a look at what you’ve said here and I’ll give you a call later. And then you know what I find out and then you know that that’s a really good way of going about that. And I think you know you should expect…you know if it’s something the doctor has an off, then it’s something that is reasonable to say yeah I’ll go and have a look at that. The second thing is medications that have just come out. Very often what happens is…so, let me tell you a bit about how you know prescribing of medications work. Each area have their own area prescribing committee okay and they will assess new medications and assess whether they can be prescribed by a specialist, by a GP or whoever it is okay so, new medication or not at all. So, new medication comes out and it will be…it should be assessed on in a fairly timely manner by that area prescribing committee. So, you know if the sum, the cream or whatever comes out for a particular condition, it may not be that your doctor can prescribe that medication, your GP may not be able to prescribe that medication okay. And that may vary by area as well. So, you may be reading somebody in a different part of the country, may be able to get that medication from that GP. That’s not going to be the case across the whole country.
Dr. Dan: Some medications can only be prescribed by specialists. And typically if it’s a new medication now that’s often where things start. So, it may only be able to be described by a specialist dermatologist. So, that may be something you need to [inaudible, 28:51] your dermatologist if you’ve got an ongoing relationship with a dermatologist or you might need to be referred for consideration of that condition…sorry for that prescription. So, I think that’s something that people should know. Not all GP’s can prescribe all medications. Some medications may need to be initiated by a specialist. But then can be continued by a GP and general practice. Things like me to track say another medication which alters the immune system and might need regular blood tests for example; they will be done on what’s called a shared agreement between the GP and the specialist. So, you know it’s quite a complicated system of actually just getting medications what was it might seem you can just go and request a certain medication from your doctor, that’s not always the case. And just bear in mind that we actually have to work within a set of guidelines and actually those guidelines are; you can actually Google your local area prescribing committee stuff and it’s all online. But just bear in mind actually, you and GP might not be able to prescribe you know the latest medication that you just read about. You know in whatever literature it may have been okay so, and actually things at different internationally as well. So, whilst a medication may be widely available in the US it may not be available at all in the UK because it might not have been through the UK screening process for the medication yet.
Gemma: Right. With the shared agreement, so we talked earlier about someone having quite complex health situation so that might be on [inaudible, 30:39], psoriasis, they might be on another drug for arthritis, they might be on another drug for their heart. You’re the one who’s monitoring all the blood tests, to check you know the liver function and kidney function. How does that weigh that if there’s something going skew if with the drugs that someone is taking for the heart for example; do you call the dermatologist and have a chat or is there like an online system you’re kind of the hope on you essentially?
Dr. Dan: Absolutely, so when somebody is started on something like [inaudible, 31:12] says something like that, in order to…they usually started within secondary care. So, that would be secondary care; I mean in hospital. So, the dermatologist and their team would start their medication or the mythologist in the team would start that medication and then it would be a case of…once they’re stabilized on that medication; they’ve got the dose right. Then the GP would take over that regular monitoring and must not be on a monthly six week on a case by case basis depending on the medication. So, if something then…if we started to pick up a problem with those blood tests, we would then start to make some phone calls okay. and that would be…you know for example if it was arthritis in an [inaudible, 32:00] condition, which used, to begin with [inaudible, 32:03] specialist nurses like a hospital or the you know the link nurses who are looking after that, because very often it will be…it won’t be the specialist themselves who is actually been monitoring that medication. It will be the link nurses who are looking after those patients who are being started on a medication. And that’s just a good point of contact generally. I mean I’m sure it varies across the country in terms of the exact setup. And that’s a pretty common set up in my experience. So, yeah we would be having a chat with the specialist nurses and actually, they will be people who will be having regular contact with those specialists with the mythologist or the dermatologists. And actually would be a case of them just have a conversation saying patient such and such is having this and then they would get back to us. And I’ll say well actually, you know I think we should change the dose or I think we should continue on the same dose, but increase the frequency of the monitoring. And yeah, that’s how this whole process works. Yeah, we are going to link between the hospital and the patient.
Gemma: And when it comes to leftover question and at sometimes, especially when I’ve been introduced to a new medication, and I’ve been a little bit overwhelmed in the appointment with my dermatologist [inaudible, 33:28] and really process myself, because there are another twenty questions I wish I’d asked. Who…could I make an appointment with my GP and ask him or her or would I call the dermatologist nurses or I mean how to get [inaudible, 33:45]?
Dr. Dan: Okay, so a couple of ways you could go about that. it depends so certainly had the question would have you got to follow up with that patient. that specialist could those questions wait or are those questions that you need to be answered that on [inaudible, 34:00]? I would encourage you to get them written down so that you can take them off because that’s a really good way of just structuring your thoughts actually. Yeah, I think it’s very reasonable to be able to go to the GP, but I think it’s also reasonable if it’s a very highly specialized medication that can only be prescribed by a dermatologist. That actually may not know the answer to your questions, but we should be able to help find those answer okay. So, that might be looking at The British National Formulary. It’s a book which has a lot of guidance about all medications that are available to be prescribed in the UK. looking at specialist’s websites to be able to potentially tease out the information from those and you know as doctors we generally know which websites are more trustworthy and official than the other ones. So, that can be really, really useful. And finally, we may be able to actually…if you’ve got a very specific question that we don’t know the answer to; just fire off an email or any mail or a letter or a fax…yeah; we still use fax in the [inaudible, 35:13] to that consultant said; our patient surgeon has got this question about medication he started them on and get the necessary…they need to necessarily come back and see you in an appointment to get this question and said Would you mind answering it by email, via letter, via a message, and actually that’s an entirely reasonable way of getting a response.
Gemma: Will a GP be crossed if you tell him…I feel like when you go to a GP need like a specific problem, will they cross if you turn up and ask 20 questions left over from another medical appointment?
Dr. Dan: I think it’s very reasonable too…I think you have to consider what the way our GP surgeries work. We have 10 minutes appointments pretty much just under across the UK, very rarely do the surgery is that vary from that. And actually, most surgeries will say that’s one problem with that appointment. It can be very, very difficult, it can make an entire morning surgery run late if somebody comes in with various problems. It’s just not reasonable to expect all of those to be done in one surgery, one 10 minute appointment. And so, no, but also you can also try booking a double appointment if you’ve got you to know a question about a hearing infection and a problem with your psoriasis; it is reasonable to book two appointments. And you can ask for a double appointment in order to discuss those two different things. And actually, that’s really, really helpful for us, because we are you know we can properly deal with those problems. I think we’re very aware…you know we live in an increasingly litigious society unfortunately, we’re also with very aware of not doing a proper job as doctors. You know I…you know somebody comes in and says right…you know somebody comes in about you know what may turn out to be a minor problem and at the end of their consultation goes actually you know I’m also I got a bit of chest pain. Then you know it can be…it can strike the whole thing off and you think well, why didn’t you leave with that? And maybe it’s and that’s probably good reasons why they didn’t leave it that maybe that kind of sounding you out as a doctor before they actually come in with what they really wanted to talk about. And you know that’s just something we have to deal with at the time. But very often I would say to someone, who comes have actually just got this one he’s patient he says or I should just go with one problem of the problem. I wouldn’t be offended if that doctor turns around and says what I often say which is; look I really don’t want to just answer your question quickly and you not get a proper answer or you know to get the wrong answer because we haven’t had time to talk about this properly. But we really don’t have time to talk about that problem at the moment, could you please book for another appointment?
Dr, Dan: Okay
Gemma: If I had an ear infection and 20 questions about [inaudible, 38:31] would I need two appointments?
Dr. Dan: It’s Yeah. I think it’s…yeah, I think you should aim to book two appointments for the operation. Because you know an ear infection might seem like a minor thing. We do have to you know do a proper job; which includes taking a history, you know looking at your notes which is something we’ve done before you’ve got in. we also have to write the notes that after you’ve left as well and that does take up a couple of minutes at least. And then we have to do an examination. So, you know even a simple ear infection you know even if it’s done quickly can take six, seven minutes, of actual face to face contact at times. And before you’ve come in, we’ve actually had to look at your notes after you leave we have to write those notes. So, you know you’re pretty much approaching a ten-minute consultation just with what might seem simple ear infection.
Dr. Dan: And actually, then we’ve also got to potentially delve into the cycle spore issues, I think that’s you know in of itself very complicated, to be honest.
Dr. Dan: Book two appointments.
Gemma: Book two appointments. So, that has been very informative. Do you have any top tips that we could take away?
Dr. Dan: I think my main…I think we’ve got three areas that are really important. I think the first is, have a realistic expectation of what your GP is…who your GP is and what their skill level is. Now, I’m not saying you should have no expectations of your GP, but don’t expect them to know the latest and greatest treatments. But similarly, I would expect my GP to be going in looking at those things and potentially referring me on to a specialist who could actually help me with those things. The second thing I think is; find the right GP for you. It’s great to hear from you Gemma that you’ve found a GP that you’ve got a good relationship with over a long period of time and that’s really, really powerful. And I think you should, even if you don’t have that relationship with your GP at the moment, I think it should be something you endeavour to develop over a period of time. And it doesn’t happen overnight. It does happen over months, years actually, but yeah that’s realistic to expect to have the ongoing relationship with your GP, but it does take a bit of work to develop that. And I think finally, don’t be concerned about being educated patient, by the nature of the fact that you’re listening to a podcast about psoriasis at the moment, you are obviously somebody who is you know expects to educate themselves about their long-term condition. And I think a good doctor will embrace that. And a doctor will want to have conversations; we spend a lot of time learning from our patients. It’s not possible for us to read every piece of literature that comes out about every condition as a doctor, you know that you know if you’re a specialist dermatologist that might you know and you own specialized psoriasis and you probably going to be a lot more up to date than your GP. But actually, as an educated patient have a good expectation of where your GP skill level is, and actually a good doctor should be able to work with you If you’re bringing in that latest information that you feel might help you.
Gemma: Alight okay. Thank you very much.
Dr. Dan: Thank you.
Gemma: I hope you enjoy today’s interview? If you have any questions, I would love to hear from you. Simply head on to Instagram and let me know. You can find me @Gemma_boak.