Can anyone review this letter of complaint for me?

[Energize]

Problem sorted.

 

[Energize]

I wouldn't bother to send it. What's the point?

To improve future medical practice as I had stated if you bothered to read it properly?

Personally as someone who had a very serious car accident a few years ago I can understand the point of the GP. If you want to write a complaint then write it just based on their attitude if thats what you have beef with, because your letter just makes out like you are a hypochondriac wanting more drugs.

A hypochondriac is someone who fears they have a serious health problem.

Isn't it you that's been self-medicating with whatever combination of prescription drugs you feel like at the time for years?

I've never self prescribed opiates or other pain killers. Nor is that relevant. If you want to troll this isn't the place for it.

 

[Energize]

torn ligaments, a friend for life. sport as you know it will not be the same again :/

Not great to hear.

People become addicted to strong pain-killers, they are probably withholding them for a good reason, your letter comes across as someone addicted to strong medication demanding more.

Clinical guidelines specifically state that treatment should not be refused based on possibility of addiction.

 

[Energize]

How will dosing up on pain killers help?

Because physio aggravates pain for a period afterwards and during the treatment session itself.

Kind of is relevant though isn't it?

Man who self-medicates in thinking he knows better than his GP shocker

I'm not claiming to know more than the GP's. Nor am I medicating with painkillers.

 

[Energize]

Why are you taking that amount daily!

That was what the doctor said was a safe amount to take regularly.

The whole letter reeks of paranoia, hyperbole, and hypochondriac exaggeration. You seem very dependent on painkillers.

I've never used strong opioids outside of a prescription, so that is unfounded.

 

[Energize]

Regardless of everything, that letter sounds like it is written by someone who is trying to play the system to get his hands on as much in the way of strong painkillers as possible.

You felt fobbed off with codeine and diazepam for whiplash?

I had been prescribed codeine which failed to work.

This may help:

http://www.nhs.uk/ServiceDirectories/Pages/ServiceSearchAdditional.aspx?ServiceType=DrugAddictionSupport

Likewise.

http://oxforddictionaries.com/definition/english/naivety?q=naivety or http://oxforddictionaries.com/definition/english/ignorance?q=ignorance this.

 

[Energize]

What did you want that was stronger than DHC? Out of interest

I was in severe pain like I said and codeine didn't work.

 

[Energize]

What have you self medicated?

Anyway to your letter, you speak of collapsing due to shock in an early paragragh! How much blood had you lost? Layman definition of shock and medical definition are somewhat different.

Is there a reason you want opoids and not anti inflmmatories?
What is the source of your pain?

Shock as in anxiety not hypovolemic shock.

Well if you are taking drugs that you can form a tolerance too then I would imagine off the shelf pain killers may not work.

It doesn't work like that. The drugs act completely differently.

 

[Energize]

No, though the other professionals said she was rude.

 

[Energize]

i'm guessing by now you're long term substance abuse and prescription history combined with your metal state has persuaded your doctor not to take risks with you and your drug seeking behavior.

I haven't been abusing substances, nor have I been illegitimately seeking drugs.

 

[Energize]

Quit moaning, if you had a issue with what the GPs were telling you it's perfectly acceptable AND normal for the patient to request a referral to a consultant/specialist.

I did, doctor she wouldn't refer me for an MRI/imaging due to guidelines, whereas the physio recommended it and has referred me for one.

Do you think you should tell them about the ibuprofen you take etc?

They said it was perfectly fine to take ib and para at those doses, some patients take twice as much ib as I do for pain for years. It's standard practice and GP's are fine with it.

 

[Energize]

This is what i dont get op
What drug were you hoping to get? If dhc wasnt working, what do you think might?

Dihydrocodeine is a weak pain killer, even some non opioids are stronger.

Nefopam or tramadol I would try if it weren't for my existing medications. Flupirtine is a non-opioid that I would try but isn't licensed as far as I can see. There are also other less addictive drugs like cannibinoids and NMDA channel blockers but they aren't available either.

So the only option in the UK is strong opioids, preferably buprenorphine because it's the least addictive and actually produces ratings of "dislike" in humans unlike other opioids and because it contains naloxone so it reduces constipation, and from a doctors point of view can't be abused intravenously, half a dozen of those pills would last a month for the small amount I need for physio sessions. Morphine and oxycodone have greater addictive potential and so I would prefer not to use them. Though my friend in the crash is prescribed morphine and seems ok on them.

CHANGE IT TO CAPITALS THROUGHOUT FOR GREATER IMPACT!

On a more serious note "the depression I'm currently being treated for" and "someone addicted to strong medication demanding more" says it all really. GPs have never had a very positive attitude to the NHS supporting addicts and in the current climate are getting less enthusiastic about it by the day.

You can't get addicted to paracetamol and ibuprofen you know...

This has gone way past helping you with the letter..

WTF happened to "No drugs talk" and "No medical threads" ??

Tell me about it, I wanted advice on my letter of complaint like many other posters ask for advice on letters and cv's and I get ignorant people who think I'm addicted to drugs because I want some pain killers after being in a car crash. They are either "The Hysterical Masses" or trolls I guess, and probably binge drink every weekend as well to add some hypocrisy about drug use.

 

[Energize]

or the more common powerful NSAIDs but they don't have a high which is why you've so conveniently forgotten them.

I said I tried naproxen and take ibuprofen good lord. Do you only want to see the worst in people Tefal?

Exactly my thinking tefal, he is referncing drugs that are not licenced due to their dodgy effects, yet hasnt mentioned nsaids at any stage, truely odd. One might almost think that killing pain isnt the goal.

I've been taking max GSL dose of ib and paracetamol from day one! Many drugs are not licensed due to economic reasons like patents expiring, eg bupropion for depression, not necessarily because of deadly side effects.

Do why would you not try volterol instead of the ibuprofen you are regularly taking?
Or something similar in nsaids design rather than opoid?

I tried naproxen, but like my driver friend who is prescribed it, ended up throwing up while trying to swallow the chalky things and gave them back to the pharmacy, reading the bnf I was sure there was an enteric coated version but doctor says he couldn't find one so I don't know.

In any case it didn't seem to offer additional help, and the efficacy seems the same as high dose ibuprofen looking at studies. NSAID's and paracetamol seem to be effective for me at least for the background pain, but those severe episodes of achy type pain which are brought on by seemingly nothing (I am guessing spasms or cramp), they aren't effective, nor would you really expect them to be I guess because of how they work.

Really now most of the background pain has died down I just need something for physio, I was just so angry they wouldn't give me anything strong when I was in agony a week ago, which is why I'm writing the complaint letter, I feel it was unethical, even if they did think there was a possibility I could abuse it.

Wiki says Buprenorphine can't be taken orally.

It's sub lingual technically, IE dissolves under the tongue, you can also get weekly patches. But I don't need 24/7 opioids.

 

[Energize]

Since you asked people to review the letter I'll do just that.

Having read the entire letter, the only thing I would point out is the unnecessary melodramatics. From what I understand you're trying to highlight the 'faults' that were made whilst you were being treated and hopefully achieve a remedy to the mistakes. Right now it sounds a little too "poor-me" and in parts rather facetious, particularly with lines such as "considering it's modern day England it's scarily reminiscent of the prospect of surgery in the Victorian era".

If it were me, I'd simply lay out the course of events and then explain why you were disappointed with the service, finishing by asking what can be done to resolve the situation.

Good luck!

Thank you, I had already taken some of that out, I tend to get a little carried away when writing letters of complaint, you should see the one I wrote to moonpig! I think part of it is trying to add a little humour though, but given the subject matter I'd probably be better off without it.

So you illegally self-medicate for your anxiety AND take all the drugs your doctor gives you for the same thing because he doesn't know you're medicating yourself?

And this has been going on for years.

But you don't have any dependency on drugs, no?

And you wonder why you just can't shake that anxiety?

Open your eyes mate.

Don't have generalised anxiety problems any more like I used to, just specific situations, and panic attacks happening due to traumas like a crash are normal as the A&E doctor said. I'm prescribed too little of any one particular anxiety medication to become addicted to it either, I use them for sleep now with my doctors knowledge. I just have social anxiety, which doesn't respond to those meds anyway.

Maybe you should talk to the Doctor about the illegal drug use. It's a random thought as I have no qualification to offer drug advice but perhaps there is something you ought to address that isn't about not getting enough drugs for whiplash.

In any case I am not sure what your letter would achieve.

I've never used opioids like that and would prefer not to use them at all because they are so addictive, same as nearly everyone else who is prescribed them for pain. If I drank alcohol instead on occasion which is a legal drug would you suggest that I was asking for opioids for abuse purposes or is that different somehow because of an arbitrary legal classification?

As to your question the letter would achieve a better quality of care for other patients in my situation, ie severe pain due to acute muscular skeletal injuries.

Hmm angry they dont resort to the super strong stuff because you tell them you are sore.

Should severe pain not be treated then? Let's send those cancer patients home with paracetamol and codeine yeah!

How long have you been taking the medication for?

Since, the car crash, nearly 3 weeks.

What about acupuncture? Have you tried that to help relieve you of pain etc? Failing that, what about a visit to A&E and complain about how much pain you are in.

Physio suggested it, but questionable efficacy, risks and I don't like needles!

Pain is episodic, by the time I got to see a doctor it may have stopped. And it is a waste of resources for A&E do be doing that, that's what GP's are supposed to be for.

 

[Energize]

Thanks for that, looking at my calendar app I had gone two weeks backwards because of the July-August change. Yes there is an element of ranting as I'm sure you would understand if you had been in such severe pain and doctors dismissing it.

I was actually not very adamant at all when talking to the GP's despite my melodramaticism in the letter, more hinting than anything, ie "is there anything stronger" or "physio says treatment is limited by weak analgesia" which is entirely true btw. I think I only once asked directly a "stronger opioid" in general because the pain was so bad at that point, that I was getting annoyed at having to convince the doctor I was a genuine patient and not a drug seeker which with my history he should have known by now. In years of seeing him I have never once requested opioids for anything other than this one time for a car crash which I think is fairly justifiable. The hospital pharmacist said that I would probably be prescribed oxycodone if my whiplash pain got bad, alas. The fact that he and the physio both suggested strong opioids leads me to believe that the issue is more with those specific gp's than the drugs being wrong for the situation.

 

[Energize]

Just re: paracetamol,

http://www.bbc.co.uk/news/health-15837468

Thanks a lot, that really makes me feel better.

Does highlight what I was saying earlier about alternative pain killers needing to be available though, lots of non-opioids and even non-psychoactives that can be used to treat pain these days that are not licensed in this country. The use of non-opioid psychoactive analgesics like cannabinoids, ketamine and flupirtine should be investigated further for break-through pain if nothing else, if dependence and side effects are a concern, they can even reduce the reliable on opioids.

 

[Energize]

Is the social anxiety is only mild?

At least you have a friend unlike those with severe social anxiety.

It was very severe to the point of reclusiveness, and not even being able to make phone calls, but after leaving uni and with the help of local mental health meet up groups and possibly cbt, alongside the use of pro-social substances I have made very big improvements to the point of looking for work, but the funding combined with the poor sourcing of medications in the NHS and UK pharmacy sector makes normal antidepressant treatment not much of an option; for treatment refractory depression/anxiety, MAOI's are used and often they must be used in very high doses (you can't do this with many 1st like safer drugs because they manifest dangerous side effects), in the range of 6x the dose I'm on anyway and that could cost up to £1,000 per month for a generic medication. If the NHS infrastructure were altered so that they manufactured their own generics huge savings could be made, drug costs could be massively reduced, but they don't for some reason.

What version of the BNF are you referring to?

The online version.

Isn't it amazing how you know better than these qualified medical professionals.

Not really, they're GP's.

Letter updated anyway with a more toned down version. Thanks very much for the ~3 of you that bothered to read it with proper consideration and didn't spout hysterical nonsense or troll.

 

[Energize]

Next time I need some drugs advice, I will need to speak to Enegize first since he knows more about drugs then GP's do and all from his "personal" experience and "wiki"

LOL

Actually I prefer Rang and Dales textbook for general drugs, "Neuropsychopharmacology: 5th generation of Progress" also makes for good reading. Wiki is ok in a pinch though.

 

[Energize]

Who pays £500 for an MRI to score a few buprenorphine patches though?

The physio has only done relatively light therapy like massage type stuff for <20mins, she hasn't been walking on my back, how much less can she do?

She didn't specifically allude to any ligament as I recall, I think what she said was more based on her experience of treating victims of such severe impacts as myself, maybe as a precautionary measure.

I will probably end up sending the letter after MRI results are back anyway due to my compulsive editing. Or I may see the practice manager in person because I can explain things better.

You have brought up about an important issue though about GP and physio communication that I forgot to bring up in the letter, the GP should be liaising with other professionals treating me after my requests to him.

 

[Energize]

So what is your end game to all of this?

Are you looking for compensation? if so do you have a number in mind?

Compensation for what, not being prescribed strong enough painkillers? No.

An apology would be nice, along with an explanation of why they decided to leave a car accident victim in severe pain effectively untreated for 2 weeks, and hopefully measures put in place to stop another poor soul being put in my position.

A couple of key points I read regarding NHS analgesia protocols that seemed relevant here though.

It is vital that in the absence of a diagnosis analgesia is not withheld
Treat according to pain score not your perception of how bad the pain should be.

It certainly seems that protocol was not followed, if they aren't following their own guidelines what good is that?