Predicting GP visits: A multinomial logistic regression investigating GP visits amongst a cohort of UK patients living with ME: Walsh et al June 2020

[Sly Saint]

Predicting GP visits: A multinomial logistic regression investigating GP visits amongst a cohort of UK patients living with Myalgic encephalomyelitis

Abstract
Background

Myalgic Encephalomyelitis (ME) is a chronic condition whose status within medicine is the subject of on-going debate. Some medical professionals regard it as a contentious illness. Others report a lack of confidence with diagnosis and management of the condition. The genesis of this paper was a complaint, made by an ME patient, about their treatment by a general practitioner. In response to the complaint, Healthwatch Trafford ran a patient experience-gathering project.

Method
Data was collected from 476 participants (411 women and 65 men), living with ME from across the UK. Multinomial logistic regression investigated the predictive utility of length of time with ME; geographic location (i.e. Manchester vs. rest of UK); trust in GP; whether the patient had received a formal diagnosis; time taken to diagnosis; and gender. The outcome variable was number of GP visits per year.

Results
All variables, with the exception of whether the patient had received a formal diagnosis, were significant predictors.

Conclusions
Relationships between ME patients and their GPs are discussed and argued to be key to the effective delivery of care to this patient cohort. Identifying potential barriers to doctor patient interactions in the context of ME is crucial.

https://bmcfampract.biomedcentral.com/articles/10.1186/s12875-020-01160-7

 

[Hoopoe]

People don't trust their GP because their GP is told a lot of false/dubious things about ME/CFS or MUS, leading to immediate alienation, repeated treatment failures or unhelpful advice.

The problem isn't really solvable at the GP level. The BPS junk science causing confusion is half of the problem, the other half is lack of basic research into ME/CFS leading to an inability to treat it effectively.

 

[rvallee]

Relationships between ME patients and their GPs are discussed and argued to be key to the effective delivery of care

Some medical professionals regard it as a contentious illness

Not really hard to see the problem here. Discriminate against a disease? Bad for patients. It's a fairly simple cause and effect. MS patients fared just as poorly as we did before MS was adequately explained and formalized in medical practice along with a dedicated specialty that simply began to work on the problem. Now they don't. AIDS patients fared very poorly while under active discrimination. Then they didn't. Fibromyalgia patients are just as discriminated as us and they fare just as poorly as us. Weird how this always plays out the same way, where discrimination = bad.

And yeah as strategist says, this will never be a GP issue, far too complex. Chronic illness needs to be a significant specialty in itself, free from discrimination and bullying by medical peers who see it as a waste of their valuable superior intellect telling them the secrets of the universe which assure them this is absolutely conversion disorder and the fact that they can't prove it doesn't matter, you can't prove it isn't, which is exactly not how science works at all.

I did not have a GP for years. My GP from birth told me to GTFO. My current GP, whom I don't see because it's pointless, is the one who proposed it could be CFS. I have a better relationship with her than with all the other GPs I saw, and despite this I get nothing out of it other than having signed disability years after it should have, at the point at which I was fully disabled for having not received adequate care and advice in the first place. Medicine isn't an individual thing, it's a systemic process. One GP can't make a difference, nothing works like this.

Discrimination = bad. We know this. Why are we still doing this, then? We know it's bad. It's demonstrated to be bad and it always ends the same way: lift the discrimination and good things happen. Let's try it again, it literally works every time.

Identifying potential barriers to doctor patient interactions in the context of ME is crucial.

Medicine IS the problem. It is also responsible for the solution. It denies the problem exists. It has a legal monopoly over health care. When the solution IS the problem you have two problems and no solution in sight.

 

[Hoopoe]

And yeah as strategist says, this will never be a GP issue, far too complex.

I meant that it's not a problem of the GP lacking good bedside manner. Some might do because they are frustrated, just like the patients.

You're right that it would need a specialist. GPs just aren't meant to take on difficult problems like these.

So I feel that this article is unfair on GPs.

 

[Esther12]

In total 476 (411 women and 65 men) individuals with ME took part in this study, with 463 participants reporting a formal diagnosis of ME.

That's quite a divide.

For length of time with ME, there appeared to be a general trend supporting the notion that the longer participants suffered from ME, the less frequently they visited the GP. For example, 8.2 and 43.3% of those in the highest category (20 years plus) visited monthly and 1–2 times a year respectively, whereas 25 and 12.5% of those in lowest category (1–2 years) visited monthly and 1–2 times a year respectively.

A significant proportion of ME suffers reported unsatisfactory relationships with their GP. This finding indicated that ME patients experience a troubled relationship with their primary health contact. Indeed, approximately half of the surveyed participants did not trust their GP. Trust was only evident within the monthly GP visit group.

 

[NelliePledge]

Apart from needing repeat visits when you’re trying to get a diagnosis I’m surprised by people having monthly contact with a GP.

 

[Sean]

I don't have monthly contact with my GP, but it is a few times a year, mainly for routine stuff like renewing prescriptions, or common things to do with ageing (e.g. osteoarthritis), etc.

 

[Peter T]

It must be over three years since I have been able to get a visit from my GP.

Before lockdown I was working up to a visit to the surgery as the amount of time I can spend upright has improved, so will need to start to thinking about that again.

I don’t know that after the first six months or so following my acute EBV onset, if in nearly thirty years, I ever had monthly contact with my GP. I suspect the average is likely to be between once and twice a year, with after the initial acute episode the frequency of seeing my GP inversely proportional to my health. My experience is that you need to be relatively well to maintain contact with your doctor.

 

[Milo]

What other disease that is given life sentence receives only GP care? In which way should it be acceptable? In Canada, GP’s are the gatekeepers to health care. They get to decide what is worthy and what is not worthy of further investigation and transfer of care/shared care. Most GP’s would not deal with HIV care. Most GP’s do not do cancer care, when the patient is under the care of an oncologist. Rheumatoid arthritis? Nope. Kidney disease? Nope. Diabetes?

To be assigned GP care is a condemnation to lower care, where all requests for investigations get squashed and where the disease is simply not addressed but they will insist you still get your prevention screenings every single year. Family doctors are not prepared, nor are they supported to provide care for patients living with ME.

 

[Ebb Tide]

In the UK, if you in are employment but unable to work after becoming sick, you will have to have regular contact with your GP in order to get 'Fit Notes' which say you are not fit for work so that you can receive Statutory Sick Pay.

For the first 4 months I was ill, these only covered a 2 week period, then increased to monthly, and after 8 months, for 2 month intervals, until I 'officially' left work a year after first going off sick.

I think I had about 14 appointments in that 1st year, after the first 3, mostly phone appointments, although I still had to come in to the surgery to pick up the note.

Only 2 later face to face appointments were about anything other than being signed off work, when I was trying to get my tachycardia investigated. This did get me my first routine blood tests and an ECG 7 months after onset, but nothing else. I had to go down the private route to see a specialist consultant.

I've not seen a GP for nearly 2 years since I left work.

I've always felt the notion of being frequent attenders at GPs is skewed by what the system requires you to do when you can't work in order to be paid.