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Seeing the GP: Advice and tips for young people

Being referred to hospital by the GP

Health services such as Accident and Emergency (A&E), sexual health clinics, walk-in centres, and out of hours services don’t need a GP referral. When people have a health problem that can't be dealt with by the GP because it needs more specialised knowledge, skill or equipment than the GP has, they are often referred to hospital. The GP decides what kind of specialist the patient needs to see and contacts them on the patient’s behalf to get them an appointment – this is called a ‘referral’. GPs can also refer patients to other health care services that aren’t hospital-based, such as physiotherapists. People can also be referred for counselling.

When Emma had been feeling tired and run down for several weeks, she went to see the GP. After taking a urine sample, the doctor diagnosed her with type 1 diabetes and referred her to hospital that very day. Although it was shocking for Emma to learn that she had a long-term condition, she felt that it was good to be referred to hospital straight away. Isaac was also referred to hospital quickly when he went to see the GP about a mole on his arm. The doctor was reassuring in what could have been a very worrying situation.
 

Emma’s GP phoned the hospital so that she could go there straight away and get the treatment she needed. Hospital staff were expecting her.

Emma’s GP phoned the hospital so that she could go there straight away and get the treatment she needed. Hospital staff were expecting her.

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So how quickly were you referred to the hospital then?

It was, I was seen the next, like on that day.

The same day?

Yeah, the same day, yeah.

And was it your GP who made the referral for you?

I can only assume so, yeah. Cos I think in those scenarios obviously because they need to get your blood sugar back within a, say a typically normal range as quickly as possible. You know, she obviously made the right phone calls that once I got to the hospital they were expecting me. So it was like, yeah, you know. But they knew who I was and my records had been obvious-, well, obviously they’re available to the health professionals anyway. But I guess she’d made the right calls that I would need to be seen that day. So I guess that’s a good thing.

And since then, have you, you said you regularly use your GP as the first point of contact?

Sure.
 

The GP told Isaac that the mole on his arm would have to be removed in hospital later that week. He phoned Isaac at home with the appointment details.

The GP told Isaac that the mole on his arm would have to be removed in hospital later that week. He phoned Isaac at home with the appointment details.

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He [GP] had a look at it and heard what I'd said, and to my stress said, "You're going to have to go to hospital and get that removed like almost immediately." And within the week I was in hospital having it removed, so I was. Yeah, immediately when he was like, "Oh you're going to have to go to hospital", I was like ah, so it's a bit more serious. He's like, "But you're fine, this is why we take you there, it's fine." But when you get told you need to go to hospital, you don’t immediately start going, "Oh, I'm fine, that’s yeah."

Could he have said that in a better way or were there not many ways to…?

There aren't many ways to say to someone you need to get something cut off your arm in a hospital. And I suppose you need to be told, and once you're told you just sort of have to deal with the slight stress it causes and get it done, yeah.

And did he say…give you much information…what is it, what's going on there?

He didn’t really. He just sort of said, "Well, you have got a mole that is slightly abnormal; you are going to have to have it removed; we will have to get you to a hospital." And that was really the information I had. But at the time I'm like, "OK so get it…get off…get it ridden…get rid of it," you know. At the time I didn’t really need more information than, "Right, when am I going?" like you know, because if it needs to go, let's get it done, that was more my frame of thinking than, yeah.

So you wanted to get rid of it and that’s what he said.

Yeah, once the doctor said, "Well it needs to go." I'm like, "Well, get it done then, it's…yeah."

Would you have liked any information or do you think he gave you enough?

I think he gave me enough and I suppose it…yeah I think the information I needed was given, and the facts were there that I had something, it wasn’t right, it needed to be gone. I'm quite a straight forward sort of person. It's like, well if it needs…this needs to happen, get it done, let's you know get it over with, that’s more of…yeah.

Did he say how long it would take? Did you know that it would happen that quickly, within the week?

No, they rang up my house a few hours later when I got home, and they stated that’s where my appointment was, that’s where I was to go, and yeah, so yeah.

So that was quite quick.

It was, yes.

Did you expect them to ring that day?

Considering the doctor's reaction to the mole, I was expecting it to be rather quick. I was expecting the reaction to be rather quick considering his reaction to seeing it and hearing what I said was rather quick of, "We're getting rid of that, you're going to hospital", so yeah.

Did that worry you at all or did you just think, well at least I'm getting it seen to or.....

At least I'm getting it seen to; at least it's going to be gone, it's not…and he did reassure me because I did mention seeing the poster in the waiting room. He did assure me, "You haven’t got cancer, it just needs to be gone to make sure nothing happens." So that was fine, yeah.
Amy saw the GP twice about ongoing stomach pain and feeling gassy and bloated She was referred to hospital for tests and diagnosed with IBS. Later she was referred by the GP to see a hospital dietician. Other people, like Simon, were also diagnosed with a long-term condition after being referred for tests by the GP.

Sometimes a referral can take what feels like a long time because it may not be obvious what is wrong and whether it needs further investigation. Minor conditions will often get better on their own. Jalé saw several GPs over a few months because of tiredness and stomach pain, and doctors felt that the most likely cause was stress. At one appointment, though, the GP diagnosed her with a muscular back pain and also found a walnut sized lump in her neck. The doctor referred Jalé for an ultrasound scan. After the scan, Jalé went back to the GP and was told that she had several nodules on her thyroid. Because of these, the thyroid would need to be removed. A few months after surgery, when Jalé was still feeling very tired and had pain in her stomach, arms and legs, she was referred to hospital again:
 

Because of Jalé’s symptoms and the fact that her sister had had cancer before, Jalé felt that the GP referred her to hospital quickly. She had several tests.

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Because of Jalé’s symptoms and the fact that her sister had had cancer before, Jalé felt that the GP referred her to hospital quickly. She had several tests.

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I went back again [to the GP] and they upped it again [medication dosage], and I went…But then as I started to notice is the more they were upping it, actually the more tired I was feeling. And it was getting more and more.... So I was thinking, 'OK that’s, you know, that’s a bit bizarre, that doesn’t make sense.' 

And so I was fine for about six months after I got on to a hundred micrograms; that was fine. And then just recently it started to then build up again, that I now get more and more tired, and I get the pains in my arms, the pains in my legs and pains in my stomach. And it can reach some days where I'm really tired that I will fall asleep mid-conversation. So I'll be talking and I would just…I just can't…and would just shut down. 

And so I went and I spoke to the GP and I'm like, "You know, I'm really worried." And I was having really severe abdominal pains, so I was really worried you know, after my sister's history and after everything that’s going on, what's going on. So they said, you know, "Considering your sister's history, we will go and give you an urgent referral."

How old was your sister when she was diagnosed [with ovarian cancer]?

She was seventeen, so yeah just before her eighteenth birthday. And I was now eighteen. So the worry starts. So, you know, they did say, "OK we'll go and get an instant referral." And so I went back to [name of hospital] again, and I was booked for a CT scan. And what else did I have that day? I had a CT scan and I had…I can't remember what it was called, but it's a gastro something, I can't remember what it's called now, but with the camera. 
Vinay was also referred for tests by the GP. When he had ongoing lower back pain, he saw doctors in his home town as well as at university. One of them referred him to see a urologist (a specialist in diseases of the urinary tract and the male reproductive system). Vinay was later diagnosed as having kidney stones, some of which had passed through his system already.
 

Vinay was confused about which GP he should see and where his medical records were held. He was referred to hospital in his home town.

Vinay was confused about which GP he should see and where his medical records were held. He was referred to hospital in his home town.

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So how come you went back to [your home town]? Was it because you happened to be there or because they said your records are there or....

So they said, “Your records are tied up in [your home town],” which I found peculiar ‘cos I thought what had happened was my records were being sent to [the university doctor] from being registered there. But apparently they said, “Oh no, your records are in [in my home town] and you have to get it sorted through them.”

Yeah. So you went back especially to get that sorted?

Yes.

So you then, did you then go back and see the same GP?

I saw a urologist.

Urologist. In the hospital?

In the hospital.

Yeah. And what happened there, can you remember the appointment?

He was quick to do the sonogram. He straightaway, because he knows, he realised that I’d had it for a period of months and I was in pain. And he kind of just said yeah, “We’re gonna do the sonogram for you.”

Yeah and did he, did you get your results from that straightaway or did you have to wait for a few days or?

Yeah I got that, the results almost straightaway. They told me, “Oh yeah there’s a few calcium deposit’s there and we think they’re indicative of stones. You might have got rid of some of them.” Yeah it was almost instantaneous. 

Yeah. Did you know at all before the point that they confirmed that it was kidney stones, that it could be kidney stones or…?

I think for a large portion of time I was just unsure about what it was. I just knew that I was having a lot of pains in my kidneys. A lot of burning feelings and I didn’t know what it was I think for a while. I kind of guessed it was kidney stones. But your mind can sort of play on it. And when it, when you’re in pain, you can sort of exaggerate and you don’t know what it is. And I think the unknown is something that can almost magnify that pain and that experience.
When Susan had ongoing headaches and couldn’t see very well, she went to the out of hours GP over the weekend. The doctor told her that she probably had a migraine and gave her painkillers. She was also advised to go to the eye hospital a few days later for a check-up and given a note. In hospital, Susan was diagnosed with a rare eye condition. Because it was quite complicated, when she later had concerns about migraines and a fungal infection, her GP advised her to contact the hospital:
 

Susan was on a high dose of steroids. She was worried when she started having migraines again. The GP suggested she phone the hospital consultant for advice.

Susan was on a high dose of steroids. She was worried when she started having migraines again. The GP suggested she phone the hospital consultant for advice.

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The only time I actually went to see my GP was when my fungal infection got really bad because I was on the steroids. And it just got to the point where I couldn’t sleep because it was so itchy, it spread to all my nails. And I went to the GP but actually they didn’t really know what to do because it was quite a complex condition and they didn’t know how to address it really. And they said that any treatments they gave me wouldn’t control it because I was on the steroids at the same time, so it was a bit disappointing [laughs].

So did they give any cream or anything at all, nothing at all?

No, they didn’t give me anything. I think they got a bit freaked out when they heard the dose of steroids I was on. And they just said, "Sorry, you’ve got to speak to the hospital." And actually I was getting episodes of headaches as well which, again, I was really worried about. And now I think back, I did go and see the GP about that as well. And again, they just told me to go back to the hospital.

Yes, did they say what it may be or might be, or just it was, "Go back to the hospital, it's best to go and speak to them?"

Yeah, they…I think they were very careful. I think they were quite scared of saying anything because they knew that it was quite a complicated condition. But yeah, they didn’t really give me anything. I felt…I think, if anything, I felt more panicked after going to see them because they told me to go to the hospital, and didn’t really, yeah....

So did you phone the hospital or go there or?

I phoned, yeah.
At the age of 13 Rowan started getting severe stomach pain. He saw a number of different GPs but it was unclear what was going on. He was advised to go to A&E if the pain got worse, where he was admitted and had tests done. Six months after Rowan 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.
 

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.

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.

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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." 
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