Doctor writing irrelevant stuff on referral

[poppy]

So, after I keep telling myself I have given up on my eyes/doctors etc... I decided to get another referral and am kicking myself again.

Just wanted to get my thousands and thousands of ever worsening floaters finally checked out with a thorough dilated eye exam by an ophthalmoligist, and to have a discussion about possibility of surgery given the extreme nature of my floaters.

Wasn't even really expecting my GP to give me a referral. He wasn't concerned about my floaters, but to my surprise he did give me the referral, and I was quite happy until I got home and read it.

It was brief (fair enough) just stated that I wanted to discuss my floaters with (retinal specialist). Doc then basically stated that he thought that I was a complete nut job. Not that I was being over anxious or whatever made it clear that I was nuts. I don't want to repeat the exact words.

Whether true or not, how is this fair? It seems like discrimination to me. I know people will say that the doc needs to provide the complete medical history, in this case why didn't the doc include other stuff that was much more relevant to an eye doc (ie, severe dry eye, eye pain etc, he didn't mention this AT ALL). It is also obviously very embarrassing for me to have to show this referral to reception staff as well as the eye doc.

So straight up there is no way this eye doc will even consider doing surgery for floaters on someone who is labelled as nuts in the referral. Now, I wasn't really expecting the eye doc to agree to the surgery in any case... but I had hoped he would at least do a thorough examination of inside my eyes and take my concerns seriously. But with the referral that's been provided, the eye doc is just going to consider me a nut case and at best do a pretend glance at the inside of my eyes to try to pacify me, whilst never really looking or considering there could be a real problem.

What are patients supposed to do? You guys will say go see another doc... I've seen many... how many am I supposed to see before I get someone to perform the simple task of actually examining inside my eyes. It doesn't matter what I say, they won't check out the inside of my eyes. At this point I am so exhausted with seeing so many doctors and optometrists and I just don't have the strength to try to find another GP or optometrist who will actually give me a referral to an ophthalmologist to examine severe floaters. Should I go to this retinal eye doc with the "crazy" referral or just give up? I feel I will be truly happier when I actually "give up" seeing doctors but I am like a gambler returning for one last punt hoping that this time it will be different and it never is. Does anyone else feel like this?

[DCRdryeye]

Poppy that is terribe, but not uncommon. When they can't help us, rather than admit that, they dismiss us as nut jobs. I saw the most disgusting ophthalmologist a few weeks ago who tried to tell me my eye pain is all in my head and I need counselling for it. He was arrogant and rude.

You should confront your doctor about the referral or report him to the medical board. I agree the referral won't do much for you and the eye doc will just take a quick glance to keep you happy. Absolutely unacceptable.

[wagnermid]

Poppy I really feel frustrated for you. I realise changing Drs is difficult but if your GP is going to write a referral like that then you can't have faith that they will provide you with the care you need in other circumstances. If they didn't think you needed the referral they should have at least discussed it with you, not given you a letter they knew would just lead to a wasted appointment. I guess if you have a Ophthalmologist in mind you could get a referral from a medical centre but it sounds like you need to find a more empathetic GP for long term care. Maybe you need to be seen at one of the large teaching hospitals in Sydney or Melbourne, there are good Dr's out there. Good luck.

[bakunin]

Poppy that is terribe, but not uncommon. When they can't help us, rather than admit that, they dismiss us as nut jobs. I saw the most disgusting ophthalmologist a few weeks ago who tried to tell me my eye pain is all in my head and I need counselling for it. He was arrogant and rude.

You should confront your doctor about the referral or report him to the medical board. I agree the referral won't do much for you and the eye doc will just take a quick glance to keep you happy. Absolutely unacceptable.

I agree. I would confront him. He is not being paid to act like that.

[littlemermaid]

Well, Poppy love, that sounds like a rubbish assessment if he did not observe your eye symptoms. However, if that's the view, as a doctor he should help you by referring for counselling support and putting you on the path of recovery and progress. At this stage, maybe, like us, you are expecting all the docs to be like your first bad experiences. It would be nice to find someone you like to work with on treatments and getting comfortable - as Wagnermid says, what about Sydney?

[Aussierose]

Hi Poppy,
I couldn't agree more with the previous posters. I think it is time to find a new GP, perhaps on recommendation of friends, or family or co workers. If he really thinks it is 'in your head' he should be spending time counselling you or perhaps even referring you for counselling, not writing a referral to get you out of his office. He obviously has no interest in treating what he sees as your problem.
It was also thoughtless (at best) to hand you that referral. Most referral letters in Aust are brief - he could a written something non-committal and then contacted the specialist privately if he thought that was necessary to add.
He obviously has no problem in wasting your time and money, as well as the specialist's time as that referral is unlikely to result in a proper consultation. Having said that any specialist ( or GP ) who is any good should take each case on it's merits - make their own assessment after taking their own history and a thorough exam and not be swayed by the assessments of others.

In regards to seeing opthalmologists - I have read some of your previous posts and can't understand why they refuse to dilate your eyes. The opthalmologist myself and other members of my family see in Sydney uses the dilating drops in almost every single exam. Her assistant puts them in even before she sets eyes on us (no pun intended). Amongst us we have all sorts of diagnoses so that should not make a difference -dry eye from ss, cataracts, glaucoma, macular degeneration, pterygium, corneal damage fron shingles, even my 6 year old daughter who needed merely vision correction for short sightedness had her eyes dilated - unless you mean something more and I have misunderstood.

Perhaps a way to get a completely fresh view from an opthalmologist is to present yourself to the emergency dept at Sydney Eye Hospital. That way you can bypass a referral althogether.

Good luck - I hope you finally manage to find the care you deserve.

[poppy]

Thanks for everyone's replies. I feel that my GPs attitude has been caused by some very horrible ophthalmologists who chose to write back to him not with helpful information but to simply state that I had "dry eye/bleph" and it was chronic, nothing could be done and he shouldn't refer me back to what is basically the only major provider of eye services in our city. These hateful doctors never mentioned corneal involvement/inflammation, scarring of the surface of the eye, corneal erosions, etc (this I've learned from other eye docs). Thus my GP feels that my problem is trivial.

The eye doc I had asked him to refer me to is in Sydney, as yes I know there really aren't any decent ones where I live. AussieRose - yes I mean that none of the eye docs I've seen have ever done a dilated eye exam. I have tried everything to get them to do so. Aussie Rose - have you presented to Sydney emergency eye hospital before? Do they always allow people walking in to see an ophthalmoligist? Where I live the ER eye clinic requires seeing a GP first and they won't necessarily allow you to see an eye doc, unless it is an emergency. Our public hospital eye clinic here, also is pretty much not taking new patients and there are some conditions that they just refuse to see.

[littlemermaid]

Poppy ~ watch Dr Phelps's AMA YouTube video first, hope the links work in Au x

www.cmaj.ca/content/184/14/1559.full
Canadian Medical Assocation - “Self-regulation was originally instituted at the request of the medical profession because the body of knowledge in the profession was esoteric and unknown to the average citizen, and it would be difficult for external regulation to be as effective,” says Dr. Richard Cruess, a professor of surgery at McGill University’s Centre for Medical Education in Montréal, Quebec. “But it was linked to the belief that the medical profession was altruistic.”

www.gmc-uk.org/news/13722.asp General Medical Council - England set for revalidation. 'Over time this system will not only provide greater assurance to patients about the competence of their doctors, it has the potential to enhance patient safety and improve the quality of medical care in the UK – and those are prizes worth striving for.’

Australian Medical Association, National Conference June 2012, Dr Grant Phelps 'Professionalism in the Workplace' and recertification and revalidation www.youtube.com/watch?v=ZqBNwAWxAuM

Patient tracking is successful for change. Also feedback without formal complaint is needed that doesn't jeopardise treatment for patients and helps docs. It is difficult to understand why the first tenet for everyone concerned is not 'do no harm' and eliminating error, and that there is not a professional requirement to help people access treatment by referring on for conditions identified, and to report known medical history accurately. Maybe airline procedures for pilots and staff are a good model.

The body of knowledge is no longer 'esoteric and unknown to the average citizen' worldwide now we have the internet. What a relief when docs confer and look things up while we're in the room and we have complete patient access to medical records.

...

You should have a big file of doctor's opinion letters and optometrist assessments by now, Poppy love, to take to the next ophthalmologist, so it doesn't really matter what rubbish the GP writes. This letter reflects more on GP's lack of knowledge and effort on eyes, which any ophth is already professionally fuming about.

If you haven't got the patient copies of hospital consultant letters, the GP must copy them all off for you to take to Sydney. Or I get them from the consultant's secretary. After phoning 3x in 4wk 'it's in the post', I went to the hospital this week and forced them to do it. I've also bought hospital medical records with a medico-legal application for data access. Empowerment x

[wagnermid]

Hi Poppy,

Hope you are OK.

I agree with Aussierose about Sydney Eye Hospital but would probably organise an appointment at the outpatient department rather than emergency. My son has had many a visit to emergency at Sydney Children's Hospital for his eyes and while we have always been seen at Prince of Wales eye clinic any time of the day or night, they extremely busy and then we have to come to eye clinic the next day for follow up. We go to the eye clinic regularly and get co-ordinated treatment when seeing the same Dr rather than the one who happens to be on that day.

Ring the outpatients department and enquire.

If you GP won't refer you, go to a walk -in medical centre, often the Dr's at a big medical centre will refer you to who you want as they only see you once. You could also use this option for the Dr you are wanting to see. There are advantages and disadvantages to both private and public systems, we have seen the 2 Opthalmologists he sees through both systems and we currently see one privately and the other through the clinic. I have found the Drs a bit less rushed in private practise, but then at the clinic the "eye registrars" can do some of the assesment, all the equipment is there and it is free, the big disadvantage can be the waiting times, and waiting at clinic.

Hope you get to see someone good soon, PM me if you want any information.

[soaps]

Yep don't go to eye hospital emergency . went there in agony had a rude tired Dr who said to deal with it. very upsetting. but u might get a better Dr. i would recommend private as outpatient has a long waiting list i think.

Hi Poppy,

Hope you are OK.

I agree with Aussierose about Sydney Eye Hospital but would probably organise an appointment at the outpatient department rather than emergency. My son has had many a visit to emergency at Sydney Children's Hospital for his eyes and while we have always been seen at Prince of Wales eye clinic any time of the day or night, they extremely busy and then we have to come to eye clinic the next day for follow up. We go to the eye clinic regularly and get co-ordinated treatment when seeing the same Dr rather than the one who happens to be on that day.

Ring the outpatients department and enquire.

If you GP won't refer you, go to a walk -in medical centre, often the Dr's at a big medical centre will refer you to who you want as they only see you once. You could also use this option for the Dr you are wanting to see. There are advantages and disadvantages to both private and public systems, we have seen the 2 Opthalmologists he sees through both systems and we currently see one privately and the other through the clinic. I have found the Drs a bit less rushed in private practise, but then at the clinic the "eye registrars" can do some of the assesment, all the equipment is there and it is free, the big disadvantage can be the waiting times, and waiting at clinic.

Hope you get to see someone good soon, PM me if you want any information.

[littlemermaid]

Do people still like http://www.visioneyeinstitute.com.au...of-colin-chan/ or is he too expensive?

Are Sydney Eye Clinic available in private practice? then maybe back-up and long-term follow-up in public hospital. Does that work in Oz?

Poppy, with the knowledge, experience and effort you've put in kindly sharing your experience with us and talking about treatment problems, you deserve a good ophthalmologist to work with that you actually like, and a decent easy-going counsellor near home (I've got one now and my God it helps to talk about this stuff otherwise it eats you up from within - and I was brought up not to talk about feelings, stiff upper lip, what will people think, your father's reputation comes first, and all that). They are out there. Eyes on the prize. This is the only life we've got

[poppy]

Thanks for everyone's replies... my googling tells me that unfortunately Sydney eye hospital is only for residents of NSW If anyone knows differently please advise... Our local public hospital eye clinic I have already tried, and in any case are in the news recently as they are overwhelmed with demand and basically rejecting patients left right and center.

[littlemermaid]

It's trite but I've still got that stupid L'Oreal commercial in my head (lucky if you haven't seen it) - 'because you're worth it'. Your eyes are worth it. Have you got anti-depressants to help you cope with this?

How do your eyes feel at the moment? Would you say that they are under control? Have you ever seen an ophth you like long-term? Can the optometrist see all the floaters and check the retinas and IOP? How's the vision? And the meibomian gland maintenance treatments for rosacea?

What's helped me most is to put preconceptions about professional services aside, and to focus entirely on what we need to get comfortable. Would it help you to think this way?

www.ahwo.gov.au/./ophthalmology workforce projections LM and I are seriously looking at continued schooling based on who's working in which Eye Clinics, and what medical fees and travel we can afford to keep her eyes good ongoing, plus emergency care access.

There must be patient lobbying going on. Have you heard of any active groups? We have Patient Liaison in the hospital, regional LINKs (Local Involvement Networks), national lobbying patient interest groups like Patients Association, also eye charities and lobbying for rare conditions. All fighting on policy, practice, funding. Worth getting involved if we're well enough. Channels the anger and grief for good, empowering.

Got a good one from a random paediatrician last week after virtually having to give a * Powerpoint presentation to him about LM's various conditions (none of which he'd heard of or knew anything about) ~ 'reading the notes, I'm sensing some dissatisfaction here'. Sweet guy, but really... Left him with some journal articles and the current clinical guidelines. Looking forward to minimum clinical standards and professional recertification exams.

I'm not getting the regional thing. Surely if someone has something unusual or untreatable locally or unsuccessfully treated and worsening, they can go to a national centre of expertise? Does anyone know?

Does anyone else feel like this?

Yes. Mostly it's been about finding docs to work with regularly, no matter where. Tbh our GPs can't be bothered to read the consultants' letters or look up the conditions to diagnose the next poor soul, even when a state-of-the-art consultant sends refs. GPs (7 so far) are telling me they don't know the conditions or where to refer but this leaves the field open for me. You could get counselling based on what he said.

As Aussierose says, GP should keep it short and absolutely non-committal 'Poppy has had red eyes for x years' without any attempt at diagnosis. But then your retinal ophth needs access to the anterior segment history so put it together and take it along yourself. These guys presumably have no access to shared notes.

GPs respond best if I give them Medscape or journal articles about the exact conditions and current Clinical Guidelines (in your case, implication of severe keratitis due to chronic inflammation with corneal erosions - you need possession of all the diagnosis letters for your file). No, I don't respect them because of this but I am perfectly pleasant. LM says 'I don't want to go any more because they always make me feel like I'm wasting their time'. Currently our GP practice, in their ignorance, is refusing referrals to local hospital consultants for investigation requested by the tertiary hospital consultants, and says if we want autoimmune and allergy testing we must self-refer and pay private.

Optometrists have been better - they say they are happy to refer but are 'out of their depth' and don't know where to refer outside region.

This is why we've toughened up, made a file of our consultant opinion letters, and hired the best, but the trust has gone - this is not entirely a bad thing, quite liberating. I am talking about this not to depress Poppy and everyone, but because I think Poppy is right in airing her doc problems honestly and there's strength in that. Here in UK NHS we've had to let go of a lot of assumptions, especially in the paediatric 'provision'.

We've wasted years seeing docs who actually weren't interested and didn't have the knowledge, and I didn't realise they were faking it and not treating to current standards, and, most importantly, not referring on according to the guidelines. And they thought that was good enough. If you have a doc who does not think that way and is interested and forward-thinking, it is a revelation, and someone to work with - that is good enough.

It's good to be open about patients' experiences, especially in Patients and Pros section x

[wagnermid]

Hi Poppy,

Do you live in the ACT? It's just I know from my professional life that children from the ACT access the specialist medical clinics at the Children's hospitals here in Sydney, so residents of the ACT might be able to access NSW for medical purposes. I also know of people who live on the far south coast who access health services in the ACT so it can't be a hard and fast rule.

[Aussierose]

Hi Poppy,
Firstly sorry about the delay in replying -life gets in the way. Secondly my own experience with Sydney Eye Hospital was as a private day surgery patient. I have accompanied my grandfather in law to emergency there (some years ago). He had a corneal ulcer and was admitted as an inpatient for treatment. I think the admission was because at the time he lived alone in an aged care unit and they did not think he could reliably treat himself for the first intensive stage. We were very impressed with the care he received. From memory he saw a junior doctor ( perhaps an opth in training) and then a specialist.
However being a public hospital emergency dept waiting times may be excruciating and as soaps said it may be luck of the draw whom you see and how good they are. I don't think the ED could turn you away because you are from the ACT - if you were in Sydney and had an asthma attack,say, you would be accepted in an ordinary ED. However the outpatients clinics may be different and I have no experience with them. I'm sure their website would have a number you could ring and ask, they may accept out of area referrals especially if it is well known the problems being seen at the ACT eye clinics.
Good luck however you decide to proceed.