A couple of days ago I got a meds delivery, accompanied by – these days – a not unusual terse note from the prescribing GP (who is becoming a total pain in the butt, frankly). I’d love to go down there and dish out the bollocking he deserves, and I’m sure that’s what he’s hoping for, as he can then dump an expensive patient for “verbal violence”.
Among the meds I’d asked for was codeine linctus, and it was the one which generated the snotty note which said:-
“I’m not happy to give MORE strong opiates alongside high-dose morphine AND Tramadol.”
This struck me as perverse, not least because Tramadol had been discontinued some weeks previously as it’s not a happy combination with morphine. It also pisses me off when people don’t have the basic courtesy to put their name on stuff like this. So I replied:-
“I don’t know who wrote the note, directly above, to which I’m responding, but please be advised that the only opiate analgesic I am currently taking is morphine, as Zomorph, 60mg b.d., and Oramorph, 10ml, every 6 to 8 hours.
The reference to Tramadol mystifies me, it having been discontinued some weeks ago. To eliminate any further confusion, Gabapentin and DHC were also withdrawn, but more recently, as Dr. Xxxxx can confirm.
While the BNF has a reference for the use of morphine in terminal care cough suppression, it seems like overkill in my case, unless there is information to which I am not privy? I rather doubt it but APH communication skills are not the best…”
And sat back to wait for a shirty phone call. Nothing yesterday, and today – a bottle of codeine linctus arrived!
Chalk another one up to the good guys!
Which is all very well but I’m getting tired of this bugger making my life difficult – the more so when it’s based on his error or, as last time, an out-of-date blood test from APH, which should have been picked up on, not left for me to challenge, and how many patients are having their health compromised because they can’t – or won’t – stand up to their GPs?
There was, to be fair, a possibility that this originated in APH, and that it wasn’t, in fact, an error, but that seems not to have been the case or, if it is…
Aaaargh!!! No! That way madness lies…
Let’s just call it a win for common sense and hope this marks the passing of his urge to interfere with my meds (which has been going on for far too long and is why I threw Gaba and DHC into the mix – get them out of the way now!).
My morphine, by the way, is mid-range, not high (the range runs from 10mg caps to 200mg – I’m taking 60mg, which is right in the middle. Even factoring in Oramorph, which appears to be stabilising at one 10ml dose a day – two if I spend much time on my feet – doesn’t change it much. Seems reasonable as I wanted it for breakthrough pain (I could, in fairness, use more, but no point in getting used to it until I see how reliable supplies are going to be).
It doesn’t kick in as fast as I’d like – takes a good hour, sometimes longer. The nurses say it should take only a fraction of that time – anyone out there have personal experience?
Now if I can just stay on morphine long enough to stabilise properly before some other bugger gets the urge to mess with my pain meds, I’ll be happy.
PS: I accept that GPs are under a lot of pressure right now but, whoever is responsible – and GPs themselves have to accept some responsibility for not standing up to the government – it should NEVER become the patients’ problem. That is entirely inexcusable.