Before COVID-19, our clients were people who had injured themselves, but hadn’t gone to the doctors for (generally) two reasons – they didn’t have time to wait for an appointment, or they didn’t “like the doctors”.
It’s pretty easy to understand not wanting to wait for a GP appointment. Most appointments are either booked a long way in advance (for routine matters) or have to be booked on the day – which can lead to frustrating recorded messages at 8AM and waiting hours for a call back before maybe getting an appointment.
If you’re young, or older and male, the idea of not “liking” the doctor might seem odd. For older (and I’m going with thirty plus here as “older”) women, it can be a very different experience, especially in more provincial areas where doctors are “well established in professional practice” (aka graduated a long time ago and have dated knowledge that they’ve not bothered to refresh). Some of the accounts we have heard at State 11 are simply frightening – ignorance about pelvic pain, massively outdated opinions on mental health, denial of recognised chronic health conditions, a lack of understanding about the menopause and a definite lack of open-mindedness when it comes to solutions that don’t involve taking tablets made from horse urine. (Read more about Premarin here).
Since many of our clients come to us with long term injuries, we find referrals to “the pain clinic” are a particularly contentious matter…but that’s a topic for another blog post.
Since we were allowed to re-open in July 2020, we’re hearing very different accounts about doctor’s appointments. On the whole – people simply can’t get them. Appointments for musculoskeletal issues are generally short, and telephone based, and while it’s perfectly possible to explain issues with (for example) a shoulder hurting when you lie down, it’s much harder to have someone palpate (poke, prod and touch) the shoulder and neck when the appointment is over the phone. This is an issue because (in our experience) it’s leading to potentially much more serious issues being missed.
We can’t legally diagnose a condition but we can (generally) tell when something is wrong. Since the advent of telephone appointments, we’ve seen a large number of people who have “talked to the doctor on the phone and they said to take some painkillers from the chemist”. Sometimes, those painkillers work…although there is a huge issue with the routine suggestion of anti-inflammatories for issues with musculoskeletal problems (this has been reported several times in the BJSM as it can negatively affect healing – read more about it here -but this comes back to doctors having dated knowledge).
More often than not, though, the fact the client is sat on our couch means the “take a couple of painkillers” approach hasn’t worked, and the poor client has been struggling on with increasing pain and increasing disability, finding themselves unable to sleep due to pain, having difficulty at work due to pain…but not knowing what to do because they’ve already spoken to the doctor once.
We helped our clients sorted out their shoulder pain, neck pain, sciatic pain…but we’ve also found ourselves confronted with fractured and broken bones, severe muscle tears and at least one client we’ve had to urgently rush to A&E ourselves.
As mentioned, we can’t legally diagnose – and we don’t have x-ray eyes – so whilst I can be pretty sure that I’m dealing with a fracture, or a break, or a tear, we can only tell people that there is a real issue and they need to go to A&E or speak to their GP because they need more extensive help than we can give them.
We’re advising our clients, in these situations, to say that they have seen a soft tissue therapist, and they have said that the problem needs to be seen and assessed by a doctor. Sometimes its listened to, and sometimes it’s not – but at least it shows to the doctor or the receptionist that the client hasn’t just visited “Dr Google” and is being over-dramatic. We’ve found that here – far more than in other places we’ve lived, there is a real sense of reverence towards doctors, and that clients daren’t challenge, or ask for a second opinion. But they are just people – and you know your body better than anyone else, even if you don’t know all the names for the different bits that might be causing you pain. My personal advice is that if you find you have an unpleasant doctor, you should use Pohwer – a charity patients’ advocacy service – to make a complaint (complaints made to the surgery generally get brushed under the carpet) – and never go to an appointment alone, always take someone else with you. That tends to stop doctors with god-complexes in their tracks.)
We’re not sure what the solution is. Those clients who have got in to see a GP in person report that the surgeries are empty. We absolutely understand there is a pandemic emergency, and that doctors seeing multiple patients a day are putting themselves at risk (although the science about viral load and COVID-19 is confusing at best – read more about that here). And there is a lot of noise (especially from our glorious Health Secretary, Mr Hancock) that virtual GP appointments are the way to go (read more about that here, but maybe not if you have high blood pressure) because it means that “people who really need to see their doctor can get appointments”. That might be the case but the clients walking through our door suggest that the balance isn’t being managed properly yet at all.