Diabetes Review - In Absentia

[MikeyBikey]

You may recall about six weeks ago I had clashing appointments and felt that the Podiatry one was more important than the Diabetes Review. However they stubbornly refused to change the date and did it In Absentia. Tonight I found the write up under Patient Access.

History :

• Diabetes self-management plan agreed, - type 1 diabetes - HBA1c stable - renal function, BP and lipids good
• Under endocrinology and will be reviewed by vascular - severe PVD - revascularisation likely to be too high risk
• Palliative care not currently clinically indicated

Social :

• Ex-smoker, - long term

Examination :

• O/E - Right diabetic foot - ulcerated
• Amputated left lower limb
• O/E - Right diabetic foot at high risk

Comment :

• Patient unsuitable for foot pulse check, - left above knee amputation
• Diabetic annual review
• Structured medication review

Additional :

• Frail elderly assessment
• Falls assessment
• Medication review done

Assessment :

• Severe frailty

Obviously they discussed the "self management plan" amongst themselves as nobody has spoken with me. And of course they have added the togs "ex-smoker, long term" which is meaningless in isolation and "severe frailty". I actually last smoked on the 1st November 1975! There is a recant amputee of my age at amputee physio who has been given the "severe frailty" tag and he hates it! We dish out "moron" tags! Well I suppose they got Type 1 right for a change as many notes say Type 2, but mine is a "below knee" amputation!!! I also would have liked a mention of "phantom pain" which is more relevant than the smoking and frailty issues!!!

 

[Merluza]

For them, box ticked, for you, worthless.

 

[Alan44]

I recently had a meeting (yes a meeting) with my Doctor to up-date my medical records, because so much of it was wrong/incorrect. I do home measuring on BP and peak flow readings which had all improved dramatically. they had my weight 3st heaver than I am and had me down as non diabetic.

I took the time and trouble to re-write my records and also asked why "non diabetic".

He explained the "non diabetic bit which I was happy with and thanked me for up-dating my records which he was happy to include on my file.
We also reduced my BP meds, which was a first.

I checked my records yesterday and it had all been up-dated and correct.

Sometimes you just have to tell the doctors

I will say that I do have a good relationship with my doc and we do discuss my health together, including any medical treatment

 

[Sharron1]

You may recall about six weeks ago I had clashing appointments and felt that the Podiatry one was more important than the Diabetes Review. However they stubbornly refused to change the date and did it In Absentia. Tonight I found the write up under Patient Access.

History :

• Diabetes self-management plan agreed, - type 1 diabetes - HBA1c stable - renal function, BP and lipids good
• Under endocrinology and will be reviewed by vascular - severe PVD - revascularisation likely to be too high risk
• Palliative care not currently clinically indicated

Social :

• Ex-smoker, - long term

Examination :

• O/E - Right diabetic foot - ulcerated
• Amputated left lower limb
• O/E - Right diabetic foot at high risk

Comment :

• Patient unsuitable for foot pulse check, - left above knee amputation
• Diabetic annual review
• Structured medication review

Additional :

• Frail elderly assessment
• Falls assessment
• Medication review done

Assessment :

• Severe frailty

Obviously they discussed the "self management plan" amongst themselves as nobody has spoken with me. And of course they have added the togs "ex-smoker, long term" which is meaningless in isolation and "severe frailty". I actually last smoked on the 1st November 1975! There is a recant amputee of my age at amputee physio who has been given the "severe frailty" tag and he hates it! We dish out "moron" tags! Well I suppose they got Type 1 right for a change as many notes say Type 2, but mine is a "below knee" amputation!!! I also would have liked a mention of "phantom pain" which is more relevant than the smoking and frailty issues!!!

Ah, the 'tick box ' exercise. I never see the GP whio is responsible for Diabetics in the clinic, I always see a nurse who is great but if I ask any questions, always tells me she doesn't know but I can make an appointment to see the Clinician. This year I met with the new Clinical Pharmacolgist, who again couldn't answer my regular query why am I still taking metformin without giving a reduction a try? She was very loathe to give a response and I received the usual response to make an appointment with Clinician. Plus,the additional 'I am sorry but I haven't got alot of time, there are other patients I need to see' I wanted to respond, well why am I wasting my time here? Anyway, I managed to persuade her to reduce it by one, of course she gave me the subtle theaat that my Hba1c would increase and I would need to go back to metformin x3.

I told my fab dentist this story who after some eyeball rolling, told me I was a 'tick box' patient. They just needed see I am still alive, GP can't be bothered so I am passed along/down the medical food chain. Job done. Dentist also advisrd me to request access to my medical records that don't appear on NHS app, as she is certain I wouldn't recognise how they are portraying me! Not sure I have the energy for that particular battle.
Heigh ho...

 

[Alan44]

@Sharron1 you should be able to see your records via patient access, that said each area will be different and may use a different system.
Once you have set it up you can see all your records and results and any doctors comments.

You may need a medical degree to understand all the results and what they mean though lol.

My wife is a senior medical secretary, so lucky me, she does have a better understanding of my results than I do and what they mean.
Most of my results say normal, but when you look closer, they are only on the cusp of normal, but from a tick box exercise, "normal" that said, I'm also on the cusp of "abnormal" depending how you read them, I guess.

 

[Sharron1]

@Sharron1 you should be able to see your records via patient access, that said each area will be different and may use a different system.
Once you have set it up you can see all your records and results and any doctors comments.

You may need a medical degree to understand all the results and what they mean though lol.

My wife is a senior medical secretary, so lucky me, she does have a better understanding of my results than I do and what they mean.
Most of my results say normal, but when you look closer, they are only on the cusp of normal, but from a tick box exercise, "normal" that said, I'm also on the cusp of "abnormal" depending how you read them, I guess.

Thank.you, I also have PatientAccrss, but the surgery restricts what can be viewed by patients All my tests and results are there. But I would like.to read the notes!!

 

[silver minion]

@Sharron1 you should be able to see your records via patient access, that said each area will be different and may use a different system.
Once you have set it up you can see all your records and results and any doctors comments.

You may need a medical degree to understand all the results and what they mean though lol.

My wife is a senior medical secretary, so lucky me, she does have a better understanding of my results than I do and what they mean.
Most of my results say normal, but when you look closer, they are only on the cusp of normal, but from a tick box exercise, "normal" that said, I'm also on the cusp of "abnormal" depending how you read them, I guess.

I can also view my records on NHS app. A few of my test results are borderline but I suppose that is my increasing age and general decrepititus as I call it. Things don't function as well as they used to. Not going to worry about it as the diabetes related checks are all improving. Shocking to hear the tone of your diabetes review @MikeyBikey . At the very least they should have noted that you were unable to attend. Maybe you should insist on a telephone review appointment so your comments and input can be added to your notes. Would be nice if they treated you as a person rather than a collection of medical issues.😡

 

[Robin]

Thank.you, I also have PatientAccrss, but the surgery restricts what can be viewed by patients All my tests and results are there. But I would like.to read the notes!!

There’s definitely more in my notes than appears on Patient Access. I cracked ribs falling off a horse a few years ago, and the Gp typed a whole paragraph into the computer, yet my online notes just say 'Horse rider. Fall of horse' and a prescription for Codeine, so nobody seeing those would glean anything about what I'd injured.

 

[Eddy Edson]

I have kind of the opposite story with my cardiologist. He prints off a copy of his notes and they are like four-page essays on the subject of my heart.

They actually don't seem very interesting & I can't imagine many people reading the whole thing.

 

[Drummer]

I was told that I'd had annual reviews of my health since the age of 40.
Don't think so, I said.
It's the policy here.
I have my diaries just here on the shelf, can you tell me the date of one of those appointments and I'll check.
clickerty click click I hear.
We don't seem to have the dates recorded.
I suspect they might never have happened. My memory isn't all that good but my record keeping is impeccable.
Ah.
I've had annual health reviews since then.

 

[medidia]

Ah, the 'tick box ' exercise. I never see the GP whio is responsible for Diabetics in the clinic, I always see a nurse who is great but if I ask any questions, always tells me she doesn't know but I can make an appointment to see the Clinician. This year I met with the new Clinical Pharmacolgist, who again couldn't answer my regular query why am I still taking metformin without giving a reduction a try? She was very loathe to give a response and I received the usual response to make an appointment with Clinician. Plus,the additional 'I am sorry but I haven't got alot of time, there are other patients I need to see' I wanted to respond, well why am I wasting my time here? Anyway, I managed to persuade her to reduce it by one, of course she gave me the subtle theaat that my Hba1c would increase and I would need to go back to metformin x3.

I told my fab dentist this story who after some eyeball rolling, told me I was a 'tick box' patient. They just needed see I am still alive, GP can't be bothered so I am passed along/down the medical food chain. Job done. Dentist also advisrd me to request access to my medical records that don't appear on NHS app, as she is certain I wouldn't recognise how they are portraying me! Not sure I have the energy for that particular battle.
Heigh ho...

do you have more than one practice available to you? maybe changing GP might be a good idea as you have so many problems with them, and might be easier than battling with them all.

 

[JimmyBlue]

You may need a medical degree to understand all the results and what they mean though lol.

Hi @Alan44 I was intrigued by your comment about understanding the results. I use the NHS app to access my medical records and in particular the results of my blood tests, retinopathy and the rest. For the blood tests, I get an option to click on which takes me to a web page that explains the test, the purpose, the results and other information. I thought that was standard for these types of things, but I am now wondering if it is because of the way my local GP practice provides the information to the NHS app.

 

[helli]

Hi @Alan44 I was intrigued by your comment about understanding the results. I use the NHS app to access my medical records and in particular the results of my blood tests, retinopathy and the rest. For the blood tests, I get an option to click on which takes me to a web page that explains the test, the purpose, the results and other information. I thought that was standard for these types of things, but I am now wondering if it is because of the way my local GP practice provides the information to the NHS app.

Sadly different surgeries present the data in different ways even though they use the same app.
For example, my friend was showing me a graph of his hba1c results over time whereas mine are just shown in unformatted text as part of the full set of blood tests done on a specific date. There are no hyperlinks - the only help with understanding the result is the acceptable range in brackets after my results.

 

[JimmyBlue]

@helli the results I received earlier this week (and my previous ones last October) provide links to the test information on the following website: labtestsonline.org.uk. The site menu has a link to an index of tests so you could look up the ones you have had to get more information. The links cover pretty much all the elements of my blood tests and I would presume it captures yours.

I must admit I am sometimes shocked by the lack of support/information some people receive from their local GP practices. At times I think I must be a bit of an exception as I have always found my local practice near Milton Keynes to be really good although issues around getting appointments are sometimes a problem. In the main however I cannot fault the way they have treated me nor their willingness to discuss treatment approaches and provision of additional information.

As a big supporter of the NHS I would like to think that poor practice is an exception and not the norm but there are times when I think it is the other way around. Although, having a niece and nephew who are GPs, I also get to hear the other side of the problem and some patients really do not want to help themselves.

 

[Alan44]

Sadly different surgeries present the data in different ways even though they use the same app.
For example, my friend was showing me a graph of his hba1c results over time whereas mine are just shown in unformatted text as part of the full set of blood tests done on a specific date. There are no hyperlinks - the only help with understanding the result is the acceptable range in brackets after my results.

All I get is the bare minimum, normal or abnormal, action or no action required and some numbers, sometimes, defiantly no links, hyperlinks, super hyperlinks or mega super hyperlinks, that said when I went to the docs the other day, the doc did show me a graph of my hba1c which I can't see when I log on via the app

 

[everydayupsanddowns]

Sadly different surgeries present the data in different ways even though they use the same app.
For example, my friend was showing me a graph of his hba1c results over time whereas mine are just shown in unformatted text as part of the full set of blood tests done on a specific date. There are no hyperlinks - the only help with understanding the result is the acceptable range in brackets after my results.

Mine too @helli

Perhaps that’s the cheaper option and other surgeries pay for the ‘Premium’ features

Sorry to hear about the way your review was handled @MikeyBikey

Sounds quite frustrating for you.