The crisis in general practice

The current recruitment crisis in general practice is of great concern to doctors and patients alike.  Doctors are over-worked and patients cannot easily get an appointment.   Having spent many years studying medical workforce planning in NHS Scotland, these concerns are not new but perhaps they are more acute than ever at the present time.  It seems general practice remains unattractive to many young doctors for many reasons.  And many of those who are attracted will not work full-time.  Older GPs will choose to retire early, exacerbating the problem.

I have spent much of my adult life (40 years) attending the same GP practice.  I knew my doctors well and they knew me.  They prescribed Nitrazepam for myoclonic epilepsy and a variety of antidepressants during those 40 years.  It was suggested in 1981 by a neurologist that these drugs could be making my “depression” worse.  I briefly tried to come off the Nitrazepam but my symptoms increased and I quickly went back onto the drug.  There was never any discussion about the immense  difficulties associated with benzodiazepine withdrawal.  For the next 30 odd years  I diligently consumed my drugs.  I regularly saw a psychiatrist for review.  I had few other health problems.   Some back pain for which I was given painkillers.  An osteopath was able to fix it.  Ten years of IBS symptoms, very disabling and contributing to early retirement on health grounds, fixed in six weeks by a chiropractor.   I regularly told my doctors about the exhaustion I experienced on a daily basis, the utter debilitating exhaustion but I doubt they really understood what I meant.  I thought it was a symptom of “depression”, it was how I had to live or so I thought.  My life was dreadful, but no one knew that.  I would simply tell people I was tired.  Half my life has probably been spent in bed.  Going to work was all I could manage, outside of that I had little pleasure.   I was denied the ability to feel my emotions, to be what makes us all human.  I covered it up, I certainly did not talk about it.

After retiring, I changed my GP practice.  At the very first consultation I was advised to stop taking Nitrazepam as it was no longer a recognised treatment for myoclonic epilepsy. My question about alternative drugs was ignored as were my concerns about my mental health.  The failure to respond to my questions led me to taper off Nitrazepam myself.  The consequences have been life-changing.  I have lived through 3.5 years of hell I would not wish on anyone.  I was too sick to visit my GP practice for the most part.  When I did I was referred back to psychiatry and diagnosed with ME/CFS.  My only source of information and help was from an online support group, Benzobuddies.  They were able to tell me about the drug binding to the GABA receptors and the damage done when the drug was withdrawn.  Strangely enough, no doctor is prepared to discuss this subject with me.

Earlier this year I found myself once again able to visit my GP practice.  The consultations have been the most dreadful I have ever experienced.  The GP who advised me to withdraw from Nitrazepam now tells me he has no expertise to diagnose my symptoms.  But he had the expertise to advice me to withdraw?  His partner does not want to get involved and he has no idea what is wrong with me.  However, he seemed to become quite enthusiastic when telling me I may have cancer in my eye, despite my already distressed state.  His insensitivity astounded me.  Thankfully, I had already been assured by an ophthalmologist that cancer was unlikely, so my distress was not increased.  Talking to an 80 year old neighbour she has been similarly distressed by the same GP announcing out of the blue that she might have a cancerous tumour.

I spend my days online.  I listen to all the similar stories from patients struggling with prescribed drug dependence and withdrawal.  What do I find?  Patients being told their withdrawal symptoms are nothing to do with their drugs.  Patients being told they need more drugs even though this would only make matters worse. Patients being labelled with a psychiatric diagnosis because they do not comply with the advice given.  Doctors who assume they know far better than their patients what their patients are experiencing and what they know to be true.  Patients so damaged by benzodiazepines and antidepressants that there seems little hope of recovery.   I now know that my ill-health over the past 40 years was due to a benzodiazepine and that was something antidepressants could not fix.   I wonder why my doctors never realised this or if they did why they did not share their insight with me.

Our numbers are growing by the day.  This is hardly surprising given the ever-increasing rates of antidepressant prescribing.   Yet we are regularly assured in the media how safe and effective these drugs are.  There seems to be a reluctance to engage in a public discussion about the many harmful effects of these drugs, the inability of patients to get off them and the many patients consigned to taking them for life.  Services are provided for those addicted to illegal drugs but not for patients made chemically dependent on prescription drugs.  The Chair of the RCGP recently announced that mental health therapists would be employed in every GP practice in England and this would somehow assist patients to get off their drugs of dependence.  Yet, those of us who have withdrawn and who spend our days online talking to others in withdrawal know full well that this is a biochemical problem and nothing to do with mental health.  Therapy is of little use during withdrawal and often makes patients feel worse.

We have spent two years liaising with the BMA, supplying relevant information and personal experiences.  The BMA seems to be listening.   Meetings have been held wth the Dept of Health.  Patients believe a 24-hour helpline is needed.   After all our GPs do not seem to understand the problems associated with withdrawal and the RCGP Chair likewise.  The Dept of Health clearly does not want to fund any such service.  It suggests we instead go to the NHS Choices website or other UK equivalent or phone the out of hours services.  Of course these websites have no relevant information and the OOH services can do nothing for us.   It seems rather odd to all of us that so much help and information is provided for those addicted to alcohol and drugs.  We wonder what the next excuse will be as the DoH continues to avoid addressing what has become a major public health issue.

It is 4 years and 3 months since I stopped taking Nitrazepam.  I have seen 5 GPs and consulted with a psychiatrist and a neurologist.  I have not had one conversation about the effect of Nitrazepam on the GABA receptors of the nerve cells and the impact of withdrawal on those receptors.   The information is widely available on the internet.  The Ashton manual is the most widely used resource for those withdrawing from benzodiazepines.  Professor Heather Ashton and Professor Malcolm Lader were and still are the best-known experts on this subject.  They seemed to listen to patients and believe their accounts  Professor David Healy is now well known for his expertise in the harms caused by SSRIs.  He seems to share this ability to listen to patients.  These doctors are admired for their honesty and willingness to stand out from the crowd.

I wonder why patients who have become unwittingly dependent on prescription drugs are being treated so badly by the doctors who prescribed those drugs in the first place.  Patients are of course very angry about their situation, but doctors seem to only compound this anger by denying the reality of what has happened.   We do not wish to be treated as addicts nor do we wish to attend drug addiction clinics.  We want an honest discussion about what has happened to us and appropriate help for our ongoing symptoms and distress.   We imagined that the medical profession would wish to help us but instead we find that mostly they seem to be against us.  Perhaps the issue of prescribed drug dependence shines a light on why general practice is no longer a satisfying career.   I cannot comment for other patient groups of course but it truly makes me wonder whether a fundamental change of purpose is needed.  I have not benefited in any meaningful way from a lifetime of visiting many, many GPs.  For the most part I have only been made very sick indeed.  There are many others like me.

The diagnosis of “Medically Unexplained Physical Symptoms” has been heavily promoted recently in the medical journals and conferences.  I have been offered a referral to psychiatry to discuss my MUS which are in fact neurological symptoms resulting from benzodiazepines withdrawal.  The advice to doctors is to acknowledge patients’ symptoms so that they will they have been listened to even though no particular cause can be found for those symptoms.  I am sure that on many occasions the causes may well be unknown  However, for patients harmed by prescription drugs, the cause is abundantly clear and to treat us as if it were otherwise is downright patronising and utterly dishonest and only serves to further destroy any vestiges of a doctor-patient relationship that may remain.

And so my question is:  “Why would a young doctor choose to become a GP?”  I really am beginning to wonder.  The government is not investing sufficient funding to sustain general practice and patients are seriously questioning what GPs have to offer them.  It is a very sad state of affairs.   Perhaps some fundamental questions need to be addressed so that doctors and patients can find a way forward that would be satisfactory for both groups.   Perhaps it is too late.  Many of those seriously harmed by prescription drugs simply avoid any further consultations and are left to cope alone and with no medical support.  It does not need to be this way.  For me an honest acknowledgement of what has happened to me would have gone a long way to restore some semblance of trust or at least the possibility of future consultations.  As things stand, a GP surgery is now the last place I would ever wish to set foot in unless absolutely necessary.


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