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    (Original post by MJK91)

    Speaking as an outsider, obviously :P
    Definitely as an outsider!

    You don't learn doses, you just learn when certain drugs are useful.

    Different drugs within a class have very different roles sometimes - I know you said 'except for antibiotics and painkillers', but they make easy examples so...

    For example, opiates - diamorphine, vs morphine, vs tramadol, vs codeine, it's not a case of **** it I'll give everyone tramadol.

    Or penicillins - amoxicillin vs benzylpenicillin vs penV vs piperacillin - only one is active against pseudomonas, which would you like if you have that particular bug? Which would you like if you have tonsillitis (one risks giving you a pretty nasty rash if it turns out to be viral)?
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    I remember i was young a naive, i said to my cousin ( who's a gp) that all GP's do is hand out prescriptions!

    But if i think about it, the vast majority of times ive gone to a GP with problems, like tonsilitis and etc, its been, heres a prescription of penicillin, and some painkillers, have a nice day.

    Being a GP is probably alot harder than that though.
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    (Original post by hslt)
    Definitely as an outsider!

    You don't learn doses, you just learn when certain drugs are useful.

    Different drugs within a class have very different roles sometimes - I know you said 'except for antibiotics and painkillers', but they make easy examples so...

    For example, opiates - diamorphine, vs morphine, vs tramadol, vs codeine, it's not a case of **** it I'll give everyone tramadol.

    Or penicillins - amoxicillin vs benzylpenicillin vs penV vs piperacillin - only one is active against pseudomonas, which would you like if you have that particular bug? Which would you like if you have tonsillitis (one risks giving you a pretty nasty rash if it turns out to be viral)?
    Ehh I may not have expressed myself properly, since that's definitely not what I was implying!

    I may have set the bar too widely at analgesia, but I still meant learning mechanisms rather than dosages. That includes, obviously, when they're appropriate. I wouldn't suggest giving everyone Tramadol...

    Opiates may be too wide a bar, too. Rather, why not learn mu receptor opiates versus delta receptor opiates? All drugs within their class should act similarly, with the only other differences being tolerance (i.e. metabolism) and potency (i.e. receptor affinity)
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    (Original post by MENDACIUM)
    NOTE: I HAVE IMMENSE RESPECT FOR DOCTORS - THE ONES THAT DO IT RIGHT. I FEEL WE SHOULD HOLD DOCTORS ACCOUNTABLE AND NOT TAKE THEIR WORD AS ABSOLUTE TRUTH. MY CONCERNS ARE ALSO RE EXPRESSED BY HEALTH-CARE GOVERNING BODIES, BBC DOCUMENTARIES, AND INNUMERABLE UNSATISFIED PATIENTS.

    Unfortunately, i have had many G.P's who have been quite terrible, through there were some who were good. I have a place at medical school and i have tried to do in-depth study of what a doctor does, and i just can not fathom how some G.P's are allowed to operate like this. Perhaps my comments will be mixed with a little anger, because of what i and many have gone through.

    I have been misdiagnoised so many times.

    The G.P's answer to every ilness is 'anti-biotics' or 'anxiety', which led to a gross misdiagnosis for me.

    I was diagnosed with a condition which the G.P's should have known about, and they had no idea. I may as well tell it to you: SVT, POTS, and a few other ilnesses. They had no idea, were rude to me, misdiagnosed me ect

    I asked them "What is SVT"?
    They STILL did not know what that meant!(they only told me they saw cases of it before, but could not tell me what it was? )The consultants offered me no support whatsoever, gave me a medication and said 'use it'.

    I've always wanted to be G.P as i wanted to really learn about a myriad of illnesses be more community based, forge long-term relationships with my patients, and the more balanced working hours was attractive as well.

    I hope to make money and go private.(as in, pay for my own private doctor as they probably care more (Or have to care/be competent as i'm paying them!).

    I admire the G.P's who do it right, and i understand the complexities with diagnosis, but this does not mean there should be a shield barring any medical professional from accountability.

    GP misses signs of cancer in Dispatches investigation

    2 Oct 2011 00:00
    A DOCTOR told a “patient” with classic signs of bowel cancer he had constipation and said: “Get yourself some mangoes.

    http://www.mirror.co.uk/3am/celebrit...spatches-82596

    http://www.dailymail.co.uk/health/ar...-watchdog.html

    That is just your experience you cannot apply it to the world of medicine!
    My Gp has been amazing in fact they saved my life.
    When I was younger I has Cancer, I was seriously ill beforehand, and had been prescribed many antibotics for my "flu" like symptoms, than after going to A&E after 5 hours of waiting we were told it was a bee sting. My GP that pulled her contacts to get me an emergency x-ray, which resulted in me being transported across london to Great Ormond Street Hosp. and being treated with open chest surgery and numerous surgeries as well as chemotherapy over a year.

    If that GP had not gone out of her way to help us, who knows what could of happened....
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    (Original post by Lakesx)
    That is just your experience you cannot apply it to the world of medicine!
    My Gp has been amazing in fact they saved my life.
    When I was younger I has Cancer, I was seriously ill beforehand, and had been prescribed many antibotics for my "flu" like symptoms, than after going to A&E after 5 hours of waiting we were told it was a bee sting. My GP that pulled her contacts to get me an emergency x-ray, which resulted in me being transported across london to Great Ormond Street Hosp. and being treated with open chest surgery and numerous surgeries as well as chemotherapy over a year.

    If that GP had not gone out of her way to help us, who knows what could of happened....
    I am so glad to hear the good news with respect to what happened to you. I do say that the majority of G.P's are indeed competent, and you do get gems like your G.P. However, not all G.P's are like this. There are so many unfortunate cases where people have been misdiagnosed and left alone - like my friend recently, and have as a result, really suffered. I am trying to speak on behalf of these people, against the minority

    Again, i am really happy for you! And it makes me smile when i hear about true doctors like that.
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    (Original post by MJK91)

    Opiates may be too wide a bar, too. Rather, why not learn mu receptor opiates versus delta receptor opiates? All drugs within their class should act similarly, with the only other differences being tolerance (i.e. metabolism) and potency (i.e. receptor affinity)
    But potency isn't just receptor affinity - things that bind strongly to receptors don't necessarily activate them (i.e. agonists, vs partial agonists, vs competitive inhibition). Another example would be cox inhibitors - there are various cox2 selective inhibitors, they have different side-effect profiles. Then you could take SSRIs (antidepressants) which have different indications, side-effect profiles etc. but all masquerade under the same title.

    Anyway, I was under the impression that morphine and tramadol are both u receptor agonists. As is codeine since its active metabolite is morphine.

    Is it not much much easier to learn the clinical application of drugs via a clinical tool like the WHO analgesia ladder - this way you know what to do with the drugs..?!

    And different drugs don't act the same in different people (in certain cases, perfect example = warfarin, another perfect example of course being morphine/diamorphine, where people can tolerate enormous doses after long periods of uses which would kill a room of opiate naive people).

    Much more sensible to learn individual drugs, their class if relevant, and their clinical utility and contraindications - which are different for individual drugs within classes.
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    I had a doctor who just finished his fy2 see me instead of a full fledged gp. I saw him (was 17 then) about chicken pox boils that had appeared on me. He thought it was hand foot and mouth disease which is something that affects toddlers.
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    (Original post by MENDACIUM)
    NOTE: I HAVE IMMENSE RESPECT FOR DOCTORS - THE ONES THAT DO IT RIGHT. I FEEL WE SHOULD HOLD DOCTORS ACCOUNTABLE AND NOT TAKE THEIR WORD AS ABSOLUTE TRUTH. MY CONCERNS ARE ALSO RE EXPRESSED BY HEALTH-CARE GOVERNING BODIES, BBC DOCUMENTARIES, AND INNUMERABLE UNSATISFIED PATIENTS.

    Unfortunately, i have had many G.P's who have been quite terrible, through there were some who were good. I have a place at medical school and i have tried to do in-depth study of what a doctor does, and i just can not fathom how some G.P's are allowed to operate like this. Perhaps my comments will be mixed with a little anger, because of what i and many have gone through.

    I have been misdiagnoised so many times.

    The G.P's answer to every ilness is 'anti-biotics' or 'anxiety', which led to a gross misdiagnosis for me.

    I was diagnosed with a condition which the G.P's should have known about, and they had no idea. I may as well tell it to you: SVT, POTS, and a few other ilnesses. They had no idea, were rude to me, misdiagnosed me ect

    I asked them "What is SVT"?
    They STILL did not know what that meant!(they only told me they saw cases of it before, but could not tell me what it was? )The consultants offered me no support whatsoever, gave me a medication and said 'use it'.

    I've always wanted to be G.P as i wanted to really learn about a myriad of illnesses be more community based, forge long-term relationships with my patients, and the more balanced working hours was attractive as well.

    I hope to make money and go private.(as in, pay for my own private doctor as they probably care more (Or have to care/be competent as i'm paying them!).

    I admire the G.P's who do it right, and i understand the complexities with diagnosis, but this does not mean there should be a shield barring any medical professional from accountability.

    GP misses signs of cancer in Dispatches investigation

    2 Oct 2011 00:00
    A DOCTOR told a “patient” with classic signs of bowel cancer he had constipation and said: “Get yourself some mangoes.

    http://www.mirror.co.uk/3am/celebrit...spatches-82596

    http://www.dailymail.co.uk/health/ar...-watchdog.html

    Maybe I'll be unpopular for saying I don't think you're arrogant. I haven't had a very unpleasant time with GPS at home

    - I had lyphoid hyperplasia of the appendix (basically chronic appendicitis). First time round I got told without an abdominal examination, my tummy pain probabaly 'woman's problems' and put on a contraceptive pill. Second time round, still no abdominal examination I got told I was throwing up due to stress and the tummy pain would be pulling my muscles from throwing up and got given anti sickness pills. After six months of throwing up 3 or 4 days a week and having really bad pain my dad decided to go over the GP's and take me to A and E and they sorted me out.

    - I had recurring tonsillitus,My GP I didn't have tonsillitus often enough to get them taken out... the surgeon said they lied to me about how often and that I would have more than qualified on the NHS but my GP had refused to refer me and so my parents forked several thousands of pounds. Oh yeah and there were two small tumours on my tonsils... they weren't cancerous but still shouldn't have really been left there. During one infection I had GP's try and tell me I didn't have tonsilitis but had just sprained my voice from shouting or singing... which really explained why I was so feverish etc and I really needed a letter for my exams. Luckily my mum's a nurse and we went back and insisted a swab be taken and it showed a heavy growth of bacteria.

    - I had a frozen shoulder and my GP said that she wouldn't refer me to physio because she thought it was self inflicted due to lack of an active lifestyle so said the nhs shouldn't have to pay for it (I am disabled it is NOT my choice to be inactive, prior to the disability I did eight dance classes a week). Luckily another GP in the practice, was a lot nicer and got me physio for my shoulder (this was the same GP who thought my appendix problem was my periods...)

    This is what happened in the last 2 years. At student health at uni, I found the GP's to really listen to me and be very thorough... so I thought maybe it was just the doctors in that one practice at home. However, I had to suspend my studies because I wasn't well enough to carry on with my degree... I changed GP surgeries and unfortunately the GP i'm under now seems to be one of those that see the label chronic fatigue syndrome and presume you're faking everything

    I'm not saying all GP's are awful. The one at student health was truly wonderful to me. However, I really wish they would weed out uncaring people who are in it for the money before they entered the medical proffession and have really strict ongoing professional development - not just attending headache courses but have senior GP's from other practices come observe and monitor for x amount of time, every year to make sure standards were being met. I know GP's have a touch time having to know about so many different disease, and limiting funding but I feel like if my parents were poor then I really would be a right state without their money going over GP's heads.
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    (Original post by xfirekittyx)
    Maybe I'll be unpopular for saying I don't think you're arrogant. I haven't had a very unpleasant time with GPS at home

    - I had lyphoid hyperplasia of the appendix (basically chronic appendicitis). First time round I got told without an abdominal examination, my tummy pain probabaly 'woman's problems' and put on a contraceptive pill. Second time round, still no abdominal examination I got told I was throwing up due to stress and the tummy pain would be pulling my muscles from throwing up and got given anti sickness pills. After six months of throwing up 3 or 4 days a week and having really bad pain my dad decided to go over the GP's and take me to A and E and they sorted me out.

    - I had recurring tonsillitus,My GP I didn't have tonsillitus often enough to get them taken out... the surgeon said they lied to me about how often and that I would have more than qualified on the NHS but my GP had refused to refer me and so my parents forked several thousands of pounds. Oh yeah and there were two small tumours on my tonsils... they weren't cancerous but still shouldn't have really been left there. During one infection I had GP's try and tell me I didn't have tonsilitis but had just sprained my voice from shouting or singing... which really explained why I was so feverish etc and I really needed a letter for my exams. Luckily my mum's a nurse and we went back and insisted a swab be taken and it showed a heavy growth of bacteria.

    - I had a frozen shoulder and my GP said that she wouldn't refer me to physio because she thought it was self inflicted due to lack of an active lifestyle so said the nhs shouldn't have to pay for it (I am disabled it is NOT my choice to be inactive, prior to the disability I did eight dance classes a week). Luckily another GP in the practice, was a lot nicer and got me physio for my shoulder (this was the same GP who thought my appendix problem was my periods...)

    This is what happened in the last 2 years. At student health at uni, I found the GP's to really listen to me and be very thorough... so I thought maybe it was just the doctors in that one practice at home. However, I had to suspend my studies because I wasn't well enough to carry on with my degree... I changed GP surgeries and unfortunately the GP i'm under now seems to be one of those that see the label chronic fatigue syndrome and presume you're faking everything

    I'm not saying all GP's are awful. The one at student health was truly wonderful to me. However, I really wish they would weed out uncaring people who are in it for the money before they entered the medical proffession and have really strict ongoing professional development - not just attending headache courses but have senior GP's from other practices come observe and monitor for x amount of time, every year to make sure standards were being met. I know GP's have a touch time having to know about so many different disease, and limiting funding but I feel like if my parents were poor then I really would be a right state without their money going over GP's heads.
    I am truly glad you're ok now. Stories like these are why i made this thread. I'm not here to slate G.P's or claim i know it all when i know little. I just want the dangerous G.P's, or even the 'normal' G.P's who often do mistakes like this to just step up and be more accountable.

    When a G.P is good, it makes your day - i have had a good one too.

    When their bad, the effects are serious, mentally and physically.

    Reading through what you were misdiagnosed/not referred to on time, is exactly what i was saying in my OP. How can a G.P be that negligent ? Do they have to wait until something gets life threatning before they refer? Can they not spot the early signs ect.

    If they are unsure, surely they should say 'we will monitor you because your condition could be an array of things, even some unlikely ones, here are things you should watch out for'.
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    (Original post by xfirekittyx)
    M- I had a frozen shoulder and my GP said that she wouldn't refer me to physio because she thought it was self inflicted due to lack of an active lifestyle so said the nhs shouldn't have to pay for it (I am disabled it is NOT my choice to be inactive, prior to the disability I did eight dance classes a week). Luckily another GP in the practice, was a lot nicer and got me physio for my shoulder (this was the same GP who thought my appendix problem was my periods...)
    How rude.:mad: Even if it was self inflicted, you have as much right to be treated as anyone else.

    I once had a CPN tell me that my stomach problems are "all in my head". Um, my records regarding stomach issues go back to when I was a baby.

    If they are unsure, surely they should say 'we will monitor you because your condition could be an array of things, even some unlikely ones, here are things you should watch out for'.
    Agreed. When I was at uni, I had pityrausis rosea, went to see the GP who gave me some cream and medication. I went back a few weeks later because the skin on my hands had cracked and was bleeding. He then said he doesn't really know what to do with me; so will send me to another doctor. I was given more medication and it was finally went away a few weeks later.

    Last year, I went to see my GP because I was having trouble with my hearing. She looked in my ears, said they were blocked, gave me some ear drops and told me I need to come back in 2 weeks time to get them syringed. I had them syringed and was still having the same problem a month later. (I was told it would go down) I went to see another GP who told me to just wait another 2 months and then come back. I'd already had 2 months of sensitive hearing, which is quite painful. I then saw another GP a week later who moaned at me for not waiting. I'm sorry; but most noises are physically painful. I can't really be expected to wait 2-3 months for my ears to possibly sort themselves out. They're still the same now.
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    (Original post by OU Student)
    How rude.:mad: Even if it was self inflicted, you have as much right to be treated as anyone else.

    I once had a CPN tell me that my stomach problems are "all in my head". Um, my records regarding stomach issues go back to when I was a baby.
    Did you tell her you had stomach issues from when you were a baby? I should point out it is not the job of a doctor or nurse to be a historical scribe; yes they should take aspects of history very seriously, but a lot of that needs to come from you. They are not mind readers, and there is no magical list of relevant historical diagnoses on the screen before them.

    Agreed. When I was at uni, I had pityrausis rosea, went to see the GP who gave me some cream and medication. I went back a few weeks later because the skin on my hands had cracked and was bleeding. He then said he doesn't really know what to do with me; so will send me to another doctor. I was given more medication and it was finally went away a few weeks later.
    Why would they keep you under observation for pityrausis rosea, a condition which is by all accounts fairly self-resolving and very unlikely to cause any further issues.

    It sounds by your account that the medic did the right thing -- they referred you to a specialist as they weren't sure how to deal with you. Now we have a situation where this thread contains people complaining because doctors have referred you, and others complaining that doctors didn't refer them. Excellent.

    Last year, I went to see my GP because I was having trouble with my hearing. She looked in my ears, said they were blocked, gave me some ear drops and told me I need to come back in 2 weeks time to get them syringed. I had them syringed and was still having the same problem a month later. (I was told it would go down) I went to see another GP who told me to just wait another 2 months and then come back. I'd already had 2 months of sensitive hearing, which is quite painful. I then saw another GP a week later who moaned at me for not waiting. I'm sorry; but most noises are physically painful. I can't really be expected to wait 2-3 months for my ears to possibly sort themselves out. They're still the same now.
    So, you're complaining because you didn't follow their advice? Regardless of how they are now, you should have waiting the two months as suggested. If they aren't better, then yes go back, but GPs can only do so much.
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    (Original post by MENDACIUM)
    If they are unsure, surely they should say 'we will monitor you because your condition could be an array of things, even some unlikely ones, here are things you should watch out for'.
    That would be lovely in theory, but entirely impractical. Where do you suppose they put up the hundreds of people under observation? How do they ensure each one is monitored by what is essentially a very small healthcare team? How do they afford the increase in costs under the very strict budgetary constraints they're under?

    Not practical.
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    Mine was a perv, i ended up changing GPs because i felt really uncomfortable around him.

    Sore toe? drop the trousers :rolleyes:
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    (Original post by MJK91)
    Did you tell her you had stomach issues from when you were a baby? I should point out it is not the job of a doctor or nurse to be a historical scribe; yes they should take aspects of history very seriously, but a lot of that needs to come from you. They are not mind readers, and there is no magical list of relevant historical diagnoses on the screen before them.
    Yes I did tell her. Either way, there was no reason for her to be so rude about it.:mad:

    So, you're complaining because you didn't follow their advice? Regardless of how they are now, you should have waiting the two months as suggested. If they aren't better, then yes go back, but GPs can only do so much.
    I'd already waited over 2 months. There was very little change from the first week. You have no idea what my hearing was like. Most noises (such as the clock) are painful to hear. Hence why I had to go back and ask to see someone else. Or is it really reasonable for me have to stay inside (oh hold on, I can't due to the noise the neighbours make) because the majority of everyday noises are painful?

    And don't get me started on the GP who prescribed me medication he shouldn't have done and decided after 6 months of me saying "that medication isn't working" to send me for tests to see what was actually going on.:rolleyes:
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    (Original post by MJK91)
    You clearly do not understand the budgetary constraints GPs are under, either. They cannot refer every single case to a specialist.
    You have in a nutshell, answered 2 questions with your statement,. one. it is all about money and cost over the health and well being of a patient, to which being a private sector tax payer myself, Should I be bothered about how much my treatment will cost since I pay for it, whilst a GP is earning in some cases £180K a year and secondly, Any so called doctor that has to refer anyone to a specialist after going through all the drugs that they can dispense, surely is not trained adequately as a " General Practitioner "

    The fact is that anyone with a little bit of knowledge can do the same job as a GP using the technology available and handing out the drugs that may or may not alleviate the symptoms..

    I have done some research into how easy it is to obtain prescription drugs from a GP and believe me, you can try this tomorrow with positive results...No Examination required!

    Go see your GP, give them a symptom, lets say, back, arm, leg or any other pain..
    Just inform them that the pain is unbearable.. Guaranteed result is whatever you want such as Co Codomol, Gabapentin, Amytriptylene, whatever, because GP's do not treat the cause of any ailment, they treat the symptoms...Which in reality, anyone can...Not rocket science!
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    (Original post by MJK91)
    How do they ensure each one is monitored by what is essentially a very small healthcare team? How do they afford the increase in costs under the very strict budgetary constraints they're under?

    Not practical.
    I see that your main concern regarding the medical profession are the " strict budgetary constraints " however, the biggest expense that the NHS has is in effect the prescription of drugs which last year cost the taxpayer over £10 Billion pounds.. https://catalogue.ic.nhs.uk/publicat...g-2012-rep.pdf

    With a complete rundown of which drugs were prescribed shows that GP's are good at two things.. moaning about constraints whilst pushing the drugs where in most cases, A change in diet for the patient would cost little but for some unknown reason..Whoops,, Money.. no one is treating the cause again..Statins are the latest craze which are not needed by anyone should they change their diet & the same goes for so many other drugs administered that could be avoided if the patient were informed of what they have, what they can do to rectify the problem and how to achieve it without giving them a pill to pop.
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    (Original post by SADF)

    Go see your GP, give them a symptom, lets say, back, arm, leg or any other pain..
    Just inform them that the pain is unbearable.. Guaranteed result is whatever you want such as Co Codomol, Gabapentin, Amytriptylene, whatever, because GP's do not treat the cause of any ailment, they treat the symptoms...Which in reality, anyone can...Not rocket science!
    Not all GPs are like this.
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    (Original post by OU Student)
    Not all GPs are like this.

    True, but finding the ones that aren't complacent are very few and far between unless one is fortunate enough to see a young GP who is still fresh from Uni' and wanting to do a thorough examination of the patient rather than just take a BP for the extra cash.
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    (Original post by SADF)
    True, but finding the ones that aren't complacent are very few and far between unless one is fortunate enough to see a young GP who is still fresh from Uni' and wanting to do a thorough examination of the patient rather than just take a BP for the extra cash.
    I usually end up seeing the student GP (he's left now ) or a much older GP. Neither just throw drugs at people instead of investigating the problem.
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    I think a lot of people are having a go at the OP for the way he's phrased his post and are actually missing the point somewhat.

    Yes, he's generalising and yes, he shouldn't be doing that but that is not his fundamental point. Not all doctors are incompetent and a majority will be very good at their jobs. However, one must acknowledge that there will be some doctors that display a large amount of negligence. The OP seems to have been treated by one of a minority of negligent doctors and a lot of you are attacking him, saying maybe it is he who is wrong, despite the fact that the GP would not give the correct diagnoses for 2 years, despite his persistence. The OP is then saying that these doctors who are incompetent and show negligence, should be held more accountable for their actions.

    This is a perfectly reasonable thing to say. If a doctor is showing negligence, such as not referring patients when they should be, misdiagnosing etc then they should be held accountable for their actions and there should be an investigation into their practices to ensure that patients are being treated in an acceptable manner. If it is found not to be the case, then the doctor should be fired, as they are not correctly doing their job and patients are suffering as a result. This would only ever lead to higher standards of practice and a higher level of trust in our doctors.

    Whether or not this would be feasible due to the large number of GPs, as well as needing to find replacements to those that are performing badly, remains to be seen. Perhaps so, perhaps not, but there should at least be an avenue to turn to when one wishes to complain about malpractice within the clinic. These are the topics which should be being discussed, not just blindly attacking the OP for having a bad experience and giving the doctors the benefit of the doubt. Now more than ever we should be questioning the quality of our health care in light of a number of very disturbing scandals, we shouldn't just blindly assume that all doctors will be doing the best job possible while assuming that the patient is in the wrong.
 
 
 
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