"Unsatisfactory consultation with endocrinologist"

About: Manchester Royal Infirmary / Endocrinology

(as the patient),

I had agreed to a student sitting in on the “consultation”. The endocrinologist then introduced themself, but not the student.

They immediately accused me of forgetting to take Levothyroxine diligently (which is untrue, I doubt I’ve forgotten more than a couple of times in the three and a half years I have been prescribed it – I use an alarm!). Once I had denied the assertion that I regularly missed taking Levo, they then launched into a monologue about how endocrinologists do not normally deal with thyroid patients as this was a GP's job. They then turned to the student and smirked, before looking at the papers in front of them.

Having noted that I had been referred by the consultant at the Eye Hospital and not my GP, they asked me to explain. I was allowed enough time to say that the Eye Hospital consultant had been very concerned that I had never seen an endocrinologist and, since that referral, an ultrasound scan had given a diagnosis of thyroiditis.

They suddenly said “And I’ll just stop you there” and turned to the student, raising their eyebrows. I was not allowed to continue and they refused to look at the ultrasound report. They then launched into another monologue where they apologised for seeming “callous” but told me that I had to understand that an immune system attack on my thyroid which had destroyed it and, as I had hypothyroidism, then they would fully expect me to have thyroiditis, which was not a problem as my T4 level, which was “crucial”, was “perfect”. Ending with another smirk to the student.

I started to explain that my throat felt uncomfortable but was swiftly interrupted and asked if I had seen anyone about this. I was given enough time to say I had been to ENT who had noted inflammation but no infection and had suggested it was possibly bile that was inflaming my throat and prescribed Gaviscon Advance. I was not able to add that this had made me vomit each time I had used it, as the doctor quickly said "Ah, so it's been dealt with" and the subject was then changed to my blood results, some of which had apparently been supplied, and they said they were "perfect" and I must be on “the perfect dose of Levothyroxine” again stating that my T4 level was “perfect”.

I said I had all my blood results with me and they looked at these, swiftly glanced at them, again stating all was “perfect”. And again there was a quick smirk to the student as they again stated my dose of Levothyroxine must be perfect for me, and also as my TSH was now suppressed, if they raised or lowered the dose I risked “a heart attack and probably death”.

I was then told that I could have a blood test done if I wished but they felt it was a waste of time. I said I did want a blood test done, admittedly mainly because they did not want me to have one, and was given a hospital label. I managed to mention my weight gain since being on Levothyroxine. This was quickly dismissed as either not enough exercise and eating too much or because “some people just get fat”.

I then tried to speak about the lingering symptoms I had, and those which I had only exhibited since being on Levothyroxine. I never got to say what these symptoms were. The doctor laughed, looked knowingly at the student and calmly got up and walked to the door. They told me, as they opened the door and gestured for me to leave, that they were sorry to be callous but I could not blame my thyroid for everything, my thyroid was fine, working well and “these symptoms” were nothing to do with my thyroid. As I had not said what the symptoms were, how could that statement be true?

The doctor continued to hold the door open with one hand, using the other to gesture I should leave. I tried a quick last ditch attempt to gain something from the appointment and said I had never been happy on Levothyroxine and would ideally like to stop taking it. The reply was that they were sorry to be callous but I could not stop taking it as I risked a heart attack and/or death. Ushering me out of the room, they said they would write to the Eye Hospital and my GP, and send a copy to me on which they would “scribble” the blood test results as they would not need to see me again. The doctor then walked over to another desk, pulled out a form for bloods, and showed me the seating area for blood tests, turned away and called the next patient.

The whole episode took less than 10 minutes. No personal or family history had been taken. No record of any other medication I was taking was noted. No opportunity to discuss either adding T3 or changing to NDT, although I would not have expected to get anywhere with those subjects. However, I would have thought that there might have been some discussion about what I could do to help myself with any Vitamin and Mineral supplements.

I felt I suffered a piece of performance art by a person for the benefit of the medical student but no regard for the patient.

Uncharacteristically, my GP (who has never shown any empathy with me regarding my thyroid problems) was so annoyed when I told her what had happened, particularly as the results of the ultrasound scan had surprised her and she had finally recommended seeing an Endocrinologist, she referred me elsewhere.

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Response from Eve Koutidou, Patient Experience & Quality Project Officer , Patient Experience & Quality, Patient Partnership Department, Central Manchester University Hospitals NHS Foundation Trust We are preparing to make a change

Thank you for your feedback. I was very sorry to hear of your experience and that it was not as positive as we would hope. It is important to us that comments are heard and are seen as an opportunity provided to the service to make changes and improvements wherever possible.

In response to your comments, I can tell you that your concerns have been raised directly with the staff in the department involved so that they can look into them and ensure that others don't experience the same issues as you did.

It is difficult to respond to your concerns in a full way without compromising your right to confidentiality, therefore, if you would like to discuss this with us in more detail, please feel free to contact our Patient Advice and Liaison Service on 0161 276 8686 or by e-mailing pals@cmft.nhs.uk

Eve Koutidou

Patient Experience & Quality Project Officer

Central Manchester University Hospitals, NHS Foundation Trust

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