Gp Prescribing Ethics

[Iamcazzy]

Our 21 year old daughter is a second year midwifery student at a Scottish university. For some time, she's suffered heavy periods which have been a puzzle to diagnose by her GP and hospital consultants. She's also suffered from virtually constant abdominal pain during her periods. She's tried The Pill but it hasn't helped.

The consultant advised fitting a Mirena coil to try to solve the problem. This was done by general surgery under full anaesthetic about a month ago. It hasn't helped and the pain is now virtually constant.

She recently saw her GP and was in tears in the consulting room at the time. She pointed out that she's not keen on taking the consultant prescribed codeine due to its potential addictive properties. The GP has failed to bring the 6 week follow-up appointment forward. He also seems to have ruled out IBS as the cause of the pain.

The GP prescribed Amitryptyline 10mg at night for her without explaining his decision. On getting home, our daughter hit the roof as the patient information leaflet states that the drug is only used to treat depression. My internet searches show that it's also used for something called neuropathic pain but our daughter feels her pain was not taken seriously by the GP because of his choice of drug.

I've tried to reassure her and told her to give the Amitryptyline a chance but can anyone provide any further advice. Thank you.

[ladyalex]

I have to agree with theprof about the importance of good communication between Gps (and other medical professionals) and their patients.
An explanation that the amytriptiline was being prescribed, perfectly properly and customarily, for pain would hopefully have avoided this young lady's distress.
I often think that because GPs et al are so involved within their world that they forget that it can still be a very mysterious world to their patients and what they, the medics, consider common knowledge is anything but.

[wolf63]

I was given a booklet (A5ish size) for my Priadel - I told the pharmacist that I didn't want it, he was quite insistent that I take it.

[anneasquith]

it would appear lack of communication between patient/gp. re PIL . I take numerous medication and would never start treatment without first reading the information.

[Sqad]

It would appear, in retrospect, that the GP faced with two options, chose the wrong one.........a poor decision.

Now, there is no medical practitioner alive today that hasn't made poor decisions in his lifetime and that includes sqad and Mrs prof and given a second chance might well have opted for the alternative decision.

i feel that AB has treated this GP harshly, at the same time I feel compassion and understanding for the patient.

A situation that every medical practitioner hates and tries to avoid.

[theprof]

I wholeheartedly agree with you Sqad.

[lcg]

as for squad and the prof above.....no gp in the land has enough time to fully explain every detail and eventuality to all patients that darken their door. those who work for the nhs at the moment cannot do right for doing wrong! his decision was absolutely correct and the patient reaction not common.....at the end of the day he isn't a mind reader and the patient is quite within their rights to ring the surgery and ask the dr for a quick fone call for an explanation (for future reference).

[theprof]

Fascinating lcg. So you are of the opinion that patients darken a GP's door? I'm sure Sqad would agree that any doctor with such an opinion wouldn't last long in the NHS with an attitude like that. If a patient is unwelcome or is too much trouble for the GP, the GP shouldn't be doing the job.

Neither GP nor patient are expected to be mind-readers. However, when a drug is prescribed for an off-licence application the GP should have thought of the possible implications of misinterpreting the contents of the PIL. Who knows whether the patient will read the PIL or not? Clearly some posters on here do so before beginning treatment. Clarifying issues with a GP over the phone should not be necessary. Clearly, you have no personal experience of situations such as this.

Neither I nor the OP were discussing the need to discuss every eventuality and detail with the patient. It was confined to disclosing the reason for an off licence use of amitryptyline with the patient. The PIL is "intended " to do the rest.