Rowan

Brief Outline: Rowan has seen the GP for a number of illnesses. This includes pneumonia and severe stomach pains that led to a diagnosis of lactose intolerance. This is when the body is unable to digest lactose, a type of sugar mainly found in milk and dairy products.

Background: Rowan is at school. He lives with his parents and younger brother. Ethnic background / nationality: White British.

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Rowan has had a few illnesses that he had to see a GP (local doctor) about and occasionally had to go to hospital for. At the age of 11 he went to see his GP who told him he had the winter flu and that ‘it’ll go away’. When the symptoms persisted, though, he eventually ended up going to A&E (Accident and Emergency) and was diagnosed with pneumonia. 

At the age of 13 Rowan started having severe stomach pains and saw a number of GPs about these. He recalls that he must have seen around 10 different doctors, few of whom came up with the same diagnosis. Some of these GPs suggested he should go to A&E so that he could get a quicker referral to see a gastroenterologist (a specialist doctor who diagnoses and treats diseases affecting the stomach and intestines). The GPs were unsure what was causing the pain. 

One of Rowan’s GPs phoned the hospital that he was admitted to through A&E to try and follow up on his case. Rowan didn’t hear anything from the hospital about his gastroenterology appointment, so he went back to see a GP. He was advised to go back to A&E again, but this time to a larger hospital as a way of ‘playing the system’ and getting seen quicker. Rowan made sure he kept a print out of all his notes from every consultation to avoid having the same tests and treatments. Six months after he first saw a GP about stomach pain, he was diagnosed as being lactose intolerant. This is when the body is unable to digest lactose, a type of sugar mainly found in milk and dairy products.

To get a same-day appointment at Rowan’s local surgery, patients need to phone up at 8.30am. Rowan usually dials himself and then passes the phone to his mum or dad, although he has also made appointments himself. As lines tend to get very busy at these times, he has to phone again and again until someone answers. He usually goes to the appointments with his mum or dad. 

Rowan feels that doctors’ surgeries would run more efficiently if patients could see a GP with expertise in the problem that the patient wants to discuss. He suggests that being seen by the same GP rather than a different one about the same issue would be helpful, although he also sees the value in getting a second opinion. 

Rowan would like it if his local surgery offered telephone consultations or a live-chat option for people with minor health problems. He finds it frustrating that the waiting room at the local surgery has WIFI connection but patients find it impossible to access. 

For Rowan a good GP is ‘someone who expects the unexpected’ by making sure they are thorough in their medical examination, covering every eventuality and taking the time to explain their decisions in plain English. He also thinks that doctors should be approachable and experienced, and usually finds that younger GPs are more approachable while older ones are more experienced. 

Rowan believes that receptionists should be welcoming as they are the first person a patient sees at their local surgery and they have the potential to influence someone’s entire experience. Rowan’s message to all health professionals is that ‘a smile costs nothing but means absolutely everything’.

Rowan advises young people to get involved in youth organisations that are active in making health services more youth-friendly. He would also like young people to know that ‘there is no such a thing as a stupid question’ and that it’s better to speak to someone than worry about it. He feels that young people should be taught how to help each other, and that there should be more awareness of their right to see a GP alone and have access to their medical records.

Rowan saw lots of GPs when he was having severe stomach pains. It would have been helpful to see just two who knew about his tests and hospital appointments.

So, you mentioned that you saw lots of different doctors?

Yeah.

Maybe up to about ten. Did you ever see the same one twice during that time?

I'd say probably a couple of times I saw the same one twice. But even then because sometimes they were at large intervals when they couldn’t always remember because obviously they see lots of different patients every day.

So would it have been helpful at all to have seen the same on every time?

I think it really would have been. Or maybe, because of course you sometimes need the second opinion, then maybe a couple, but just someone who knew what was going on. And, because of course it was quite complicated the places I was going, and the different reasons why and everything, it would have been good to have something like a plan drawn up of what their aims were.

Yeah. And you mentioned you kept the notes?

Yeah.

Were you able to get the notes from the GP or your mum and dad were able to get them, how did that work?

The notes were just…after they had done their appointment, then I just asked for…if they happened to be typing away at the time or something, then I'd ask just for a print-out of what they'd written or something, and they were more than happy to give that to me.

So you asked yourself did you?

Yeah. And it really helped because then you could give that to the other doctors, and they could have a quick scan through and see what they thought. 
And I think within the practice, though, they're quite good at looking through people's kind of recent appointments and things. But the appointment system happened to be all changing at the time, and so it was always good to have a hard copy to hand.

So you always asked every time, "Could I have a copy of that?"

Yeah.

A couple of days after seeing the GP, Rowan went to A&E again. It was late at night and the pain was very severe. He hoped that he’d get tests done quickly.

I was just in so much pain and after, as I say, when they did the ultrasound, I got taken down to A&E and I went…I ended up having to go back a couple of weeks later actually. It was the GP that advised me to go back.

To go back to the hospital through A&E?

Through A&E. And I ended up being admitted, and because they still weren't sure what it was. But they said, "Look, if we admit you, then you're going to get a faster… you're going to get a closer appointment with the other hospital," which they had to transfer me to, the larger hospital in the partnership, where they had a specialist gastroenterologist. 

Well, in-between times, because we hadn’t heard anything from the smaller or the bigger hospital, then I went back to the GP. And the GP actually at, during the consultation rang up, I can't remember who she rang up – someone from the Trust, and said, "Look, I've got a patient here whose inflammatory markers have been raised, and you’ve not…you’ve said you'll do something, and you’ve not given them any follow-up." And she said, "Look if it gets…" this is the GP, said, "Look if it gets any worse, then go down to the A&E at the bigger hospital, and because we might…if you're admitted there, then you're likely to be seen quicker." 

It's again this kind of idea of playing the system. And so in fact we did a couple of days later when it just…it got so bad, and they…I think this must have been about, I can't remember what time of night it was, it was about ten or eleven o'clock at night. And I was in there, and they were…they did blood tests on me but the blood tests they seemed to do there, they did a lot more of them, and they were far more thorough than at the other hospital I'd been to.
And also because they were open – they had a twenty four hour paediatric A&E, and they also had a twenty four hour pathology lab, and so they were able to get my blood test results back to me there and then. Kind of it was either…"Stay here for a couple of hours, and we'll see what we can do," or, "because we don’t want you going home like that." 

School nurses should be involved and approachable. Pupils should be able to contact them by email and phone so it could be more private.

I think it's really important that, despite only having kind of one thousand… I think it's one thousand two hundred school nurses for the nineteen thousand schools in England, that the school nurses really get involved in the schools and kind of… make themselves approachable for people. 

So whether that may be…I think sometimes people find if they're coming in to do like a weekly slot, then that becomes a bit stigmatised and people find it a bit difficult to go along to the school nurse. But if you're able to kind of contact them as well, kind of by email or by phone or something in your own time.

The school nurse?

Yeah. Then they might be able to play a bigger part, but obviously are limited people and limited hours, which is always limiting in these situations.

So are you aware if there's a school nurse at your school or?

There is, and I know her mainly because she used to be a teaching assistant at my primary school. She has come into assembly to do her kind of school nurse presentations. "I am a school nurse, this is what I do," about three or four years ago. And of course I've seen her doing vaccinations and things every year. But, apart from that, there is very little support. In fact I'm not quite sure if she's actually still there, but she used to be quite active, and she used to pop into school every now and again. But I've not seen her recently.

Did you know her to be approachable or?

She was hardly ever around. So, apart from doing vaccinations, and I think she was going to start a kind of school nurse surgery once a month, but I didn’t actually hear what came of that.

Rowan rarely sees his named GP. He’d like to be able to see a doctor who has expertise in the problem he wants an appointment for.

And you mentioned that what you would like is, if you were phoning to have to make an appointment, to explain what the problem is, so that a doctor in the practice who's more specialised in that particular problem could…you could then see that....

Yeah, because I know lots of the…and in fact I think it's now on the practice website now – lots of the doctors have extra qualifications in certain areas. Or have a particular interest in certain areas, or they provide additional services, or do minor surgery in certain areas. I think that would be really helpful.

Yeah. So you would prefer to see a particular doctor who's more specialised in what's wrong, instead of the same one every time, or how would you think?

I think that would be logical because I know you have a family doctor, you have your named GP but it's…very few are the times when I've actually seen my named GP.

If young people were given good health education, they could talk to help each other rather than going to the GP with ‘a silly question’.

I think sometimes, and I think it…I really saw it at one of the conferences I went to recently. Doctors get so absorbed in their kind of primary care/secondary care/tertiary care, that actually they don’t always see the benefits of peer support. And when you are…if they are going in to schools and talking to young people, and if they have a good health education, then they can support each other too.

Young people?

Yeah. And I think it's important that when they do have a silly question that actually they won't need to go to the GP, they won't need to ring up, they won't need to Skype a GP because it might be answered by their friend. They might say, "Oh I've had that, it's just a bug going round" or something, or whatever it might be.

So young people talking to each other as well?

Yeah.

Telephone consultations are ‘really useful’ for minor issues that are hard to explain over the phone. Rowan wondered if a live chat with the GP would be quicker.

I think telephone consultations are really useful for if you’ve got a smaller issue and you could explain it over the phone. But I've not needed to use that yet. But I think dad had to make an appointment, and there weren't any slots free, and so he said, "Is there any telephone slots free?" And actually there weren't any either, so it all seems to be booked up pretty quickly.

I think something like a live chat with your GP could also work. I don’t know if that would be quicker for them than doing it all over the phone, or if that would take longer or how that would work, but I think that could be helpful.