IT breaks my heart to have read that GP teams are seeing an increase in abuse from patients.
We are in the midst of a GP crisis which can leave people suffering, in pain and at times despair, while unable to get appointments.
Dr Zoe Williams helps a reader who is worried about their enlarged heart[/caption]
But it is not the fault of GPs, receptionists or practice managers.
The Medical and Dental Defence Union of Scotland surveyed 1,855 doctors in October 2024, and 690 responded.
Of those that took part, 84 per cent said their team had suffered verbal abuse and 28 per cent said they or someone in the team had been a victim of physical violence.
Often at the forefront of patient care are doctors’ receptionists and I am yet to meet one who doesn’t care about patients. The next time you have an interaction with one, please be kind.
If you’re not sure how to address your health problem, email me for some advice at [email protected].
Here’s a selection of what readers have asked this week…
Enlarged heart fear
Q: A CHEST X-ray found that I have an enlarged heart.
I asked if this meant I could have a heart attack at any time but was told I’d had an ECG test and the results were OK.
I am a 73-year-old woman, am overweight and have had pain from osteoarthritis since my teens.
Should I be checked regularly? Or is there nothing I can do?
You were very reassuring to a lady with heart failure a few weeks ago.
I don’t want to be a pest but it is hard to even speak to a doctor on the phone.
A:First of all, please don’t feel like you are being a pest. I’m sorry you’re finding it so hard to get an appointment but it is worth persisting and considering an e-consultation if this is the easiest way to reach a GP.
It is important to try to understand why you have an enlarged heart then any necessary treatment can be started if required. The medical term for an enlarged heart is cardio-megaly, and it can be caused by damage to the heart muscle or any condition that makes the heart pump harder than usual.
Some examples include congestive heart failure, high blood pressure, cardiomyopathy (heart- muscle disease), heart-valve disease, some autoimmune conditions, some types of lung disease or ischaemic heart disease, which would put you at an increased risk of a heart attack.
But the heart can grow larger in the absence of disease, too.
Pregnancy and elite athletes are examples of this.
It is important to try to understand why you have an enlarged heart and it may be that you would benefit from treatment, depending on the cause.
While I can’t diagnose the cause of your enlarged heart I can, however, advise you on what to do next.
The normal ECG is reassuring but check your GP did blood tests, too, especially to check kidney function, cholesterol and BNP (which increases when the heart is not working well).
Depending on these results, and any symptoms, an echo-cardiogram may help. This is a type of ultrasound scan that assesses the heart’s structure and function.
Wife can barely walk with sciatica
Q: FOR the last six weeks my wife, who is 73, has been suffering from sciatica. It’s so bad she can hardly walk.
It started in her lower back then, four weeks ago, moved down the right leg.
We are in Spain on holiday at the moment and have seen two physiotherapists, who have given her exercises. She’s also been prescribed paracetamol and ibuprofen as emergency relief, but nothing works.
It’s getting us down. She was quite active, walking and cycling daily.
A: For about three in four people who develop sciatica, their symptoms improve over the first few weeks. But as your wife has now passed six weeks, she might benefit from specialist support, which may include some investigations.
In the UK, a referral would usually go to the musculoskeletal team at your local hospital. However, as you are in Spain and presumably using a European Health Insurance Card (EHIC), your access to services there would depend on whether or not it is deemed an emergency.
You can access necessary treatment on the same basis as a Spanish citizen. See the gov.uk website for information.
If you have private travel insurance, this would allow you to access private medical services abroad. But it is worth checking with your provider first, as they may offer to cover the costs to fly you home early instead.
It’s important to be aware of the red-flag symptoms of sciatica that could suggest a rare but serious condition called cauda equina syndrome – a medical emergency as it can lead to permanent nerve damage and disability.
Symptoms include a loss of feeling/pins and needles around the inner thighs, genitals, back passage or buttocks, altered feeling when using toilet paper to wipe and changed urinary or bowel control. It may cause a loss of sensation in the genitals during sex (or a change in ability to get an erection or ejaculate).
Blocked nose driving me mad
Q: MY nose has been blocked since I had Covid in November.
In December, my doctor gave me a steroid nasal spray to use for a month but it did not work and the problem got worse. So now they have given me another one.
A reader has been struggling with a blocked nose since they had Covid – and it’s only getting worse[/caption]
I cannot breathe if my mouth is closed and I’m finding it hard to eat and drink. It’s driving me mad.
A: A persistently blocked nose, especially if on both sides, can be extremely uncomfortable, and detrimental to quality of life.
Persistent nasal symptoms following a viral infection such as Covid or the common cold are a possibility.
We would call this rhinitis, which simply means inflammation of the mucosal lining inside the nose.
Nasal polyps can also be responsible for nasal obstruction and are quite common.
These are swellings of the lining and can develop due to prolonged inflammation, or sometimes are associated with allergies.
Excessive use of over-the-counter nasal decongestant medicines, which can cause irritation and inflammation, is also a cause.
A steroid nasal spray is a sensible first step, as it can treat all of the above.
It can take up to a month for these sprays to take full effect, so I’m glad you persisted. If you didn’t use it religiously, it is worth trying again.
If no better, your next step would be to request that your GP examine the nose and consider referring you.
ENT specialists often advise patients to get into the routine of using salt water daily, either in the form of a spray or via a device which squirts the liquid through the nasal passages. These can be called neti pots, nasal douches or sinus- rinse kits.
I’ve personally witnessed this make a big difference to patients.
A week or so of taking non-sedating antihistamines such as cetirizine or loratadine could be helpful, too, and may give a clue as to whether there is an allergic element to your condition.
After that, your next step would be to request that your GP examine the nose and consider referring you.
