Can anyone review this letter of complaint for me?

[Xordium]

A physio is a physio though right? Same medical training regardless of employer?

Yes.

But did the solicitor who sent you to the physio know of your underlying conditions and how the physio may affect it?
Is a solicitor qualified to make that decision?
Does that physio have you full medical history?
Is the physio fully trained, accredited and insured?
Is there a conflict of interest between the solicitor and the physio?
etc

If your solicitor sent you on to a surgeon would you have blindly followed that - it is the same in principle if not degree.

 

[Vanquish-Storm]

Codeine needs to be activated in the liver to its active form. However, we now know a percentage of people are incapable of performing this therefore meaning codeine is ineffective for them. The activation potential matures with age so you have the likes of Cincinnati, Toronto, Melbourne and GOSH now removing it from their formularies as it doesn't really work in kids. Likewise the inability is highly prevalent in people of Mediterranean descent. For the average white person you looking at it being ineffective in around 1 in 10 people. Now when dealing with pain why take the chance you are dealing with what is quite a frequent occurrence when you have plenty of other options.

Children under 12 should not use co-codomol anyhow so I do not see this strange that are removing it from formularies for children use. Within the UK it is still usually prescribed for backache. This may be under the name of co-codomol or even under the company name. (Kapake being one)

Everyone is different however. In the case of the OP i do not see the problem in the GP prescribing them (Not sure if the dosage has been stated?) as a starting point. Then moving up in strength depending on effectiveness.

 

[Energize]

Yes.

But did the solicitor who sent you to the physio know of your underlying conditions and how the physio may affect it?
Is a solicitor qualified to make that decision?
Does that physio have you full medical history?
Is the physio fully trained, accredited and insured?
Is there a conflict of interest between the solicitor and the physio?
etc

If your solicitor sent you on to a surgeon would you have blindly followed that - it is the same in principle if not degree.

The guy on the phone asking about my injuries relating to the accident was not medically qualified but said a medically qualified person was responsible for the referrals.

The only potential underlying physical condition I had is the previous back pain which I mentioned to the physio when she was taking a history from me, and the GP I saw said it was probably nothing to worry about. According to him lower back pain sometimes involving a shooting sensation is normal in the general population, how true that is I haven't investigated yet.

I checked out the physio practice before going and they are full qualified and insured I know that much.

As for surgery, sure I would have seen the consultant but without diagnostic tests I wouldn't have had treatment, but the intensity of the intervention is of a different magnitude surely?

 

[Xordium]

The guy on the phone asking about my injuries relating to the accident was not medically qualified but said a medically qualified person was responsible for the referrals.

The only potential underlying physical condition I had is the previous back pain which I mentioned to the physio when she was taking a history from me, and the GP I saw said it was probably nothing to worry about. According to him lower back pain sometimes involving a shooting sensation is normal in the general population, how true that is I haven't investigated yet.

I checked out the physio practice before going and they are full qualified and insured I know that much.

As for surgery, sure I would have seen the consultant but without diagnostic tests I wouldn't have had treatment, but the intensity of the intervention is of a different magnitude surely?

So you had a highly relevant history in the exact same region with the exact same overall symptom and the medical referrer never saw you to base a referral on etc. I am sure you can see why I am scratching my head here and keep coming back to this as not seeming correct or right.

 

[AndyT]

SOURCE: Personal experience

I'm afraid mate, for an anxiety problem - Therapists state that benzos are really not the way forward. Treating an acute anxiety attack with what are basically tranquilisers is said to just compound the problem. Many people believe that the only way to truly defeat anxiety disorders is to tackle the problem head on and accept the feelings of anxiety. Otherwise you just become habituated to running away from the feelings, which just makes them come back harder and stronger. Relapse is also generally worse and more common. Maybe consider seeking CBT through the NHS.

Sounds like you have almost no threshold for unpleasant feelings/pain and will immediately seek something to turn these feelings off. I'm guessing that this is a fairly slippy slope. God forbid something really bad ever happens to you.

I hadn't purchased drugs overseas, I've used certain substances sporadically (mostly legal, never highly addictive ones compared to alcohol) to medicate my social phobia much in the way the average person uses alcohol at social gatherings, because the prescribed medications were ineffective and many other drugs used in other countries like the USA that I was willing to try are not licensed here.

Physio is for the whiplash injuries to my upper body, she documented that I have a degree of limited movement, muscle weakness in my back, and pain, said I have possibly torn ligaments (not sure on her ability to diagnose it, but I guess that's what the MRI is for) and she is trying to work to aid the healing of my body with methods of a low enough intensity that I can tolerate at the moment.

For pain I have taken paracetamol and ibuprofen for 3 weeks since the accident, I'm not taking anything else, I handed the codeine back to the pharmacy to be disposed of because I felt it was not being effective, and was just making me constipated.

I have been taking my current medication for depression for a few weeks and have not yet found it to have any effect, after mentioning that much higher doses are often used in resistant patients, the GP liaised with a consultant who confirmed that and I have been referred to one. I am also prescribed a few clonazepam and pregabalin pills a month for episodes of anxiety and insomnia that may arise, although my anxiety is much better now, despite a brief exacerbation by the car crash which was promptly intensely treated with pregabalin.

 

[Xordium]

Children under 12 should not use co-codomol anyhow so I do not see this strange that are removing it from formularies for children use. Within the UK it is still usually prescribed for backache. This may be under the name of co-codomol or even under the company name. (Kapake being one)

Everyone is different however. In the case of the OP i do not see the problem in the GP prescribing them (Not sure if the dosage has been stated?) as a starting point. Then moving up in strength depending on effectiveness.

Co-codomol is codeine and paracetamol that is why it is not given to children because paediatric dosages are based upon weight and surface area (in this case weight) and the tablets would be wholly unsuitable in dosage.

I mentioned codeine as being phased out which is a different thing and for a different reason. If you don't believe me then fair enough but I think you will find the literature backs how ineffective codeine is now seen. The OPs first post does not mention co-codomol but paracetamol and codeine being prescribed on different dates. Forgive me for being blunt but like a few more on here you are saying this is fine and this is the way it should be when you quite obviously are not sure what you are on about.

 

[ince]

come on is all this so you can upgrade your rig

 

[Xordium]

As for surgery, sure I would have seen the consultant but without diagnostic tests I wouldn't have had treatment, but the intensity of the intervention is of a different magnitude surely?

Most likely like I alluded to - unless the physio knackers your back up because they have insufficient information on you etc in that case then the magnitude may well be not that different.

 

[Vanquish-Storm]

Co-codomol is codeine and paracetamol that is why it is not given to children because paediatric dosages are based upon weight and surface area (in this case weight) and the tablets would be wholly unsuitable in dosage.

I mentioned codeine as being phased out which is a different thing and for a different reason. If you don't believe me then fair enough but I think you will find the literature backs how ineffective codeine is now seen. The OPs first post does not mention co-codomol but paracetamol and codeine being prescribed on different dates. Forgive me for being blunt but like a few more on here you are saying this is fine and this is the way it should be when you quite obviously are not sure what you are on about.

Please show me where anything i have stated is wrong? Unless the OP is 12 then the fact that its not suitable for children does not matter.

In regards to phasing it out maybe they are phasing it out to reduce the amount of people becoming addicted to it and prescribing codine and paracetamol separatly so they can moderate the use depending on the pain but other than that its not been noted anywhere to phase it out.

The GP told him to take paracetomol fair enough, as the OP stated this appeared to work for a while. Then a doctor prescribed codeine, not sure if this is the same doctor and not sure what dosage was given. So far all is okay the GP (or GPs) have done nothing wrong.

The GP also prescribed Naproxen and would have later prescribed Tramadol if it was suitable for the OP.

I am failing to see where the GP have let the OP down?

 

[Xordium]

Please show me where anything i have stated is wrong? Unless the OP is 12 then the fact that its not suitable for children does not matter.

In regards to phasing it out maybe they are phasing it out to reduce the amount of people becoming addicted to it and prescribing codine and paracetamol separatly so they can moderate the use depending on the pain but other than that its not been noted anywhere to phase it out.

I am failing to see where the GP have let the OP down?

1) The age part came in as part of this:

Codeine needs to be activated in the liver to its active form. However, we now know a percentage of people are incapable of performing this therefore meaning codeine is ineffective for them. The activation potential matures with age so you have the likes of Cincinnati, Toronto, Melbourne (kids hospitals) and GOSH now removing it from their formularies as it doesn't really work in kids. Likewise the inability is highly prevalent in people of Mediterranean descent. For the average white person you're looking at it being ineffective in around 1 in 10 people - give or take. Now when dealing with pain why take the chance you are dealing with what is quite a frequent occurrence when you have plenty of other options.

The pertinent part you seem to have missed ie it's efficacy is poor across populations.

2) They are not phasing it out for that reason they are stopping using it because it is shown not to be that effective.

3) Me too bar the non-referral.

 

[Vanquish-Storm]

1) The age part came in as part of this:




The pertinent part you seem to have missed ie it's efficacy is poor across populations.

2) They are not phasing it out for that reason they are stopping using it because it is shown not to be that effective.

3) Me too.

I am sorry i think i am confusing myself now. Are you saying they are stopping using co-codomol or codeine on its own? I do not want to argue with you about it sir (although it seems i am) but as far as i am aware it is still widely used to this day within the UK and I personally have not seen or read anything to say otherwise. But thats by the by anyway thats not the issue at point.

The fact is that i do not believe the GP has done anything wrong, which i think you agree with me on that?

 

[Xordium]

I am sorry i think i am confusing myself now. Are you saying they are stopping using co-codomol or codeine on its own? I do not want to argue with you about it sir (although it seems i am) but as far as i am aware it is still widely used to this day within the UK and I personally have not seen or read anything to say otherwise. But thats by the by anyway thats not the issue at point.

The fact is that i do not believe the GP has done anything wrong, which i think you agree with me on that?

Well sidetracked but - yes expect codeine and therefore co-codomol to be phased out once people catch up with their practice. Yes it is still readily used, even in paediatrics, and most likely will be for some time - incorrectly. Do you think it acceptable a drug is readily given when we know it will be effective in roughly 10% of the general population when there are suitable alternatives? Or maybe even not at all in young kids?

I am not sure the GP has done anything wrong really bar the non-referral which will also have been decided on with the chap's medical history which we don't have and is only partly alluded to.

Like I keep saying I am more concerned the OP has gone to this physio through what seems a rather unusual route. That is the stand out part for me. If physio was warranted then this should have come from the GP not someone with no medical training on a telephone who got it signed off by a supposed qualified person who never even saw the OP.

 

[Destination]

The guy on the phone asking about my injuries relating to the accident was not medically qualified but said a medically qualified person was responsible for the referrals.

The only potential underlying physical condition I had is the previous back pain which I mentioned to the physio when she was taking a history from me, and the GP I saw said it was probably nothing to worry about. According to him lower back pain sometimes involving a shooting sensation is normal in the general population, how true that is I haven't investigated yet.

I checked out the physio practice before going and they are full qualified and insured I know that much.

As for surgery, sure I would have seen the consultant but without diagnostic tests I wouldn't have had treatment, but the intensity of the intervention is of a different magnitude surely?

Did you pick the physio, or did your solicitor?

 

[Vanquish-Storm]

Well sidetracked but - yes expect codeine and therefore co-codomol to be phased out once people catch up with their practice. Yes it is still readily used, even in paediatrics, and most likely will be for some time - incorrectly. Do you think it acceptable a drug is readily given when we know it will be effective in roughly 10% of the general population when there are suitable alternatives? Or maybe even not at all in young kids?

I am not sure the GP has done anything wrong really bar the non-referral which will also have been decided on with the chap's medical history which we don't have and is only partly alluded to.

Like I keep saying I am more concerned the OP has gone to this physio through what seems a rather unusual route. That is the stand out part for me. If physio was warranted then this should have come from the GP not someone with no medical training on a telephone who got it signed off by a supposed qualified person who never even saw the OP.

The problem i have is i have not read any research to say it is not effective. The latest BNF still has it down. If as you say it is not effective then i agree that alternatives could be used.

As you say the physio is the strange part that i can not get my head around. It is prob one of those low life scum claims lawyers that do not follow the rules that has set that up though?

 

[Xordium]

The problem i have is i have not read any research to say it is not effective. The latest BNF still has it down. If as you say it is not effective then i agree that alternatives could be used.

As you say the physio is the strange part that i can not get my head around. It is prob one of those low life scum claims lawyers that do not follow the rules that has set that up though?

Are you a 'gasman' or a 'pain-control nurse'? If not then why would be reading such literature! But google takes 1 sec to return ...

http://www.australianprescriber.com/magazine/34/5/133/5/

and the paediatric slant

http://aapnews.aappublications.org/content/32/9/18.citation

 

[Xordium]

Did you pick the physio, or did your solicitor?

This is the thing - said physio then guiding OP towards an MRI.

 

[Vanquish-Storm]

Are you a 'gasman' or a 'pain-control nurse'? If not then why would be reading such literature! But google takes 1 sec to return ...

http://www.australianprescriber.com/magazine/34/5/133/5/

and the paediatric slant

http://aapnews.aappublications.org/content/32/9/18.citation

My missus is a pharmacist, her mother is a nurse Personally i just find it all interesting and read a fair bit about it.

EDIT: Would a physio have the required training to be able to guide towards an MRI?

 

[Energize]

So you had a highly relevant history in the exact same region with the exact same overall symptom and the medical referrer never saw you to base a referral on etc. I am sure you can see why I am scratching my head here and keep coming back to this as not seeming correct or right.

I had never mentioned my previous lower back pain to a doctor before because of it's lack of chronicity and intensity.

When I did see a doctor he said it was normal and nothing to worry about, is there something I am missing here? When I mentioned to another doctor about possible exacerbation of the pain from the crash she replied with a nonchalant "maybe" and took no further action.

SOURCE: Personal experience
I'm afraid mate, for an anxiety problem - Therapists state that benzos are really not the way forward. Treating an acute anxiety attack with what are basically tranquilisers is said to just compound the problem. Many people believe that the only way to truly defeat anxiety disorders is to tackle the problem head on and accept the feelings of anxiety. Otherwise you just become habituated to running away from the feelings, which just makes them come back harder and stronger. Relapse is also generally worse and more common. Maybe consider seeking CBT through the NHS.

A therapist is not a consultant medical doctor though (which is who initiated my prescription), the medication has been very helpful and is 100% effective for insomnia and panic, unlike CBT which I am currently undergoing and takes a long time to work. Therapists are biased towards one particular model of treatment which for many is not effective. There is no reason to suffer for the sake of philosophy, same as with the painkillers.

 

[Vanquish-Storm]

I had never mentioned my previous lower back pain to a doctor before because of it's lack of chronicity and intensity.

When I did see a doctor he said it was normal and nothing to worry about, is there something I am missing here? When I mentioned to another doctor about possible exacerbation of the pain from the crash she replied with a nonchalant "maybe" and took no further action.

If the other side were to find you have previous history of back pain they would have a field day.

 

[Energize]

If the other side were to find you have previous history of back pain they would have a field day.

Exacerbation of a pre-existing injury does not go well for the opposing party. I had severe pain as a result of the accident before any physiotherapy treatment anyway, so it can hardly be attributed to that, and she was working primarily on my shoulders and neck.