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DisabledAceSocialist @lemmygrad.ml

Help me write a letter to my GP

As mentioned on here before, my GP surgery has reduced the amount of meds the prescribe me, not on medical grounds, but I believe on cost-saving grounds. The pharmacist in the pharmacy that is joined on to the doctor's surgery recently complained to me about the cost of my meds, and this isn;'t the first time.

The neurologist prescribed me migraine tablets and says I can take one a day as a preventative, but the doctor will only prescribe 8 a month. This is the med the pharmacist complained about - they're £12 a tablet.

Also they recently cut the amount of eczema cream and soap substitute I'm prescribed in half. Again - no medical reason for this. It's just it costs around £20 a bottle so now I'm only allowed one bottle a month instead of two.

I'm writing to the GP to ask him to reconsider, can someone help me? What should I say and how should I phrase it? Would it be going too far to mention that the pharmacist has (publicly, in front of other patients) shamed me for the amount my meds cost the country? Would it be too emotive to say "I know I'm costing the country money but I need these things"?

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22 comments

  • In any kind of persuasive writing like this I would focus on facts and outcomes. The formula is generally linking cause and effect back to the previous prescriptions you had. You don't want to use "weasel words" or suggest that you feel the previous prescribed amount was more effective. You want to assert that it was and this downgrade has risks to your health, pointing out the causal relationships between what the medicine does for you and its absence aggravating another condition.

    So for example,

    My previous rx was 1/day of $medication for migraine prevention. This regimen worked to prevent migraines which cause me $xyz and aggravate my $abc.

    Same goes for the soap. You link to your surgical wounds and the risk of infection if you can't adequately bathe as a factual cause-effect chain and need.

    I would leave the emotive parts out. If you have a back-and-forth correspondence with the GP and have exhausted the evidence-based reason these cuts are detrimental to your health then you can use an emotional appeal. I would also leave out the pharmacist and avoid acknowledging the cost. The cost is the argumentative lever they are using to degrade your supplies and you don't want to give it any merit in your appeal.

    Feel free to post a draft here or dm, and I can offer more concrete feedback.

    • Oh, these are good ideas, thanks! I didn't even think of doing this. I will start working on a draft and try to post what I have tomorrow.

      I don't think I can use my foot surgery as a reason in this way though. I currently have to wear "LimbO boots," in the shower, waterproof foot coverings as I have to keep my surgical dressings dry. So lack of a shower wouldn't harm my surgical sites. What the lack of the soap substitute does, is mean that I have to use normal soap, which flares the eczema up badly again and then it gets infected again. Then I have to either go to hospital or be prescribed antibiotic creams.

      But yes, writing about how lack of migraine meds and eczema cream will adversely affect me is good. I've been admitted to hospital many times when my eczema gets very badly infected. I was going to use the cost of this as a reason why they should keep prescribing me the cream - it must be expensive for the NHS to keep admitting someone to hospital - what do you think?

      The cost is the argumentative lever they are using to degrade your supplies and you don’t want to give it any merit in your appeal.

      I don't have any real proof that this is why they're doing it though. The pharmacist did complain that my migraine tablets are very expensive, but the actual GP hasn't said anything about that. He just started giving me prescriptions for half the usual amount of eczema cream/soap substitute without a word about why, and has simply ignored my previous request for him to prescribe a full months worth of migraine tablets instead of the 8 a month he prescribes now.

      • What the lack of the soap substitute does, is mean that I have to use normal soap, which flares the eczema up badly again and then it gets infected again.

        You've nailed the cause-effect-outcome writing style, nice!

        I was going to use the cost of this as a reason why they should keep prescribing me the cream - it must be expensive for the NHS to keep admitting someone to hospital - what do you think?

        You're probably right, it is cheaper to give you 2x the $20 cream than $20 cream + a hospital visit and associated follow-up but imo that detracts from the focus of your healthcare outcomes. If you elect to follow my advice to ignore costs in your appeal, then noting the comparative cost to the NHS doesn't align with that line of reasoning.

        I don’t have any real proof that this is why they’re doing it though.

        I misunderstood, I thought thought the GP and pharmacist were aligned on the cost being problematic. But I would probably still avoid discussion costs. The comparative cost of giving you adequate supplies vs the cost of a potential hospital stay multiplied odds that, for example, the eczema flares up and becomes infected gives you an expected value to compare costs. And you might have noticed these are hard to quantify even if you had pricing info and it takes the argument to a weird what-if place where you probably won't win against a doctor.

        Your metaphorical high ground is the higher allocation of pills and supplies has better outcomes for you and mitigates specific health risks of yours. You want to stay within that as much as possible.

        • How about something like:

          Dear Dr R,

          I have noticed that lately I have been prescribed only half the amount of Dermol 500 cream and e45 eczema repair cream I used to receive. I was previously prescribed two bottles of each a month but now receive only one. I am unsure whether this is an oversight or intentional. I would like to ask that my future prescriptions are for two bottles each rather than just one. I need to use Dermol 500 as a soap substitute daily over my entire body, followed by e45 eczema repair cream as a mosituriser and one bottle simply doesn't last for a month. Prior to being prescribed these items, I was using ordinary soaps and body washes, and it aggravated my eczema to the point that I had open sores that regularly got infected. This resulted in frequent trips to both hospital and the GP surgery and regular treatment with both antibiotic tablets and antibiotic creams. Since switching to these items, the eczema has remained in remission and I have not had any skin infections from it nor needed antibiotic treatment for it.

          I have also previously written to the surgery about my rimegapant prescription, but have received no response. Previously I was taking rizatriptan for migraines, but since I had a stroke, the neurologist prescribed rimegapant because, rizatriptan is contraindicated in stroke patients. I have tried all the other migraine treatments including nerve blocking injections in my head, none of which worked. Rimegapant, along with topiramate, are now the only things I can take that give any relief, and rimegapant can be taken daily as a preventative. However as the GP surgery won't prescribe more than 8 tablets a month, I am unable to take it daily as a preventative, and so still suffer migraines. Migraine with aura, which I suffer from, doubles the risk of stroke, and as I have had one stroke already I would like to do everything possible to prevent another. The neurologist originally prescribed 8 tablets for me to try to see if they worked, but said I can increase them to daily if they help. They do usually work for me by ending a migraine, but as I don't receive enough to take daily I still get migraines. Would you please therefore increase the number of rimegapant tablets I am prescribed?

          I also previously wrote to the surgery about my topiramate prescription but have not received any response. I received a letter saying that all female patients taking this medication must take birth control too, as topiramate can cause birth defects. However, I am not sexually active nor have any intentions to be, and I also appear to be going through the menopause. I do not need birth control and am unwilling to take it under any circumstances. Please confirm that i will continue to receive my topiramate prescription.

          • Really good overall. A few nits.

            I am unsure whether this is an oversight or intentional.

            I would cut this. It doesn't add much value to speculate the cause of the cut and disrupts the flow of the strong argument you follow it up with.

            I have also previously written to the surgery about my rimegapant prescription, but have received no response.

            I would switch to active voice here. Try "I have also previously written to the surgery about my rimegapant prescription, but they have not responded to me."

            However as the GP surgery won’t prescribe more than 8 tablets a month, I am unable to take it daily as a preventative, and so still suffer migraines.

            You can use fewer words for the same effect here and I think make this train of thought a bit smoother. "The GP won't prescribe more than 8 tablets per month, which is insufficient for use as a daily preventative." I think you also remove the following clause of that sentence regarding how you still suffer migraines

            and so still suffer migraines.

            since the next sentence, (I've quoted w/ some suggested changes)

            I suffer from migraine with aura which doubles the risk of stroke,

            beautifully connects the consequences of lacking an effective daily preventative to take and states the risk to you.

            They do usually work for me by ending a migraine

            I would cut usually, it's a "weasel word".

            topiramate prescription but have not received any response.

            Another chance to flip passive to active voice. "... but they have not responded to me."

            Maybe as the penultimate sentence in your final paragraph acknowledge the risks to whatever unborn child the NHS is prioritizing above you, the patient. I hate it but it'll hopefully push the patient has given informed consent button in the recipient's mind.

            • Thanks for the advice, I will rewrite and repost tomorrow. The risks to the hypothetical baby are a doubled risk of autism and ADHD. It seems mad to me to make me suffer without migraine meds, or force me to take an unwanted drug, so that a baby who will never be conceived won't have ADHD. I'm not sure how to phrase that though.

              • Don't overcomplicate it. You've already stated you don't expect to become pregnant in the preceding sentences. The bone you're throwing them in their twisted bureaucrat minds is that you understand the risks of not taking contraceptives while on this medication. Something simple like, "I acknowledge and accept the increased risk of autism and ADHD of children who might be conceived while taking this medication."

                • Dear Dr R,

                  I have noticed that lately I have been prescribed only half the amount of Dermol 500 cream and e45 eczema repair cream I used to receive. I was previously prescribed two bottles of each a month but now receive only one. I would like to ask that my future prescriptions are for two bottles each rather than just one. I need to use Dermol 500 as a soap substitute daily over my entire body, followed by e45 eczema repair cream as a mosituriser and one bottle simply doesn’t last for a month. Prior to being prescribed these items, I was using ordinary soaps and body washes, and it aggravated my eczema to the point that I had open sores that regularly got infected. This resulted in frequent trips to both hospital and the GP surgery and regular treatment with both antibiotic tablets and topical antibiotics. Since switching to these items, the eczema has remained in remission and I have not had any skin infections from it nor needed antibiotic treatment for it.

                  I have also previously written to the surgery about my rimegapant prescription, but they have not responded. Previously I was taking rizatriptan for migraines, but since I had a stroke, the neurologist prescribed rimegapant because rizatriptan is contraindicated in stroke patients. I have tried all the other migraine treatments including nerve blocking injections in my head, none of which worked. Rimegapant, along with topiramate, are now the only things I can take that give any relief, and rimegapant can be taken daily as a preventative. The GP won’t prescribe more than 8 tablets per month, which is insufficient for use as a daily preventative. Migraine with aura, which I suffer from, doubles the risk of stroke, and as I have had one stroke already I would like to do everything possible to prevent another. The neurologist originally prescribed 8 tablets for me to try to see if they worked, but said I can increase them to daily if they help. They do work for me by ending a migraine, but as I don’t receive enough to take daily I still get migraines. Would you please therefore increase the number of rimegapant tablets I am prescribed?

                  I also previously wrote to the surgery about my topiramate prescription but have not received they have not responded. I received a letter saying that all female patients taking this medication must take birth control too, as topiramate can cause birth defects. However, I am not sexually active nor have any intentions to be, and I also appear to be going through the menopause. I do not need birth control and am unwilling to take it under any circumstances. I acknowledge the risks to the hypothetical unborn child that the NHS is prioritising above me. Please confirm that I will continue to receive my topiramate prescription.

                  • Looks great! Small copy paste correction before you send it off.

                    I also previously wrote to the surgery about my topiramate prescription but have not received they have not responded.

                    I also previously wrote to the surgery about my topiramate prescription but they have not responded.

                    • Oh yeah, I definitely need to give it a read through first, thanks. I think I'll drop it off on Thursday since I have to go there for a dressing change. Thanks so much for all your help, I really appreciate it. I will let you know if I get a response this time.

                    • Oh, I forgot. Should I mention that the reason I'm writing this in a letter is because it's impossible to get a GP appointment now (the receptionist always turns me away, sometimes saying they have no appointments, or trying to fob me off by telling me to go and see a chemist for a prescription instead. You can now only get practise nurse appointments.) Or would that seem too complaining/combative/passive aggressive?

                      • Or would that seem too complaining/combative/passive aggressive?

                        I would leave that out and not because of the tone of the additional information. The letter and its concerns are medical. I would keep it that way for now. You can bring other factors and circumstances in as appropriate if a back-and-forth correspondence develops. As written, your first letter is really concise and a strong plea. Don't attach awkward bits and bobs to your aerodynamic masterpiece, they'll just introduce drag. Less is more sometimes.

          • Hi, simply wanted to ask if you had also tried Valproat as prophylaxis. It off-label use status for this where I live. Sadly I don't have something, were I could ask for the medication you take - my doc prescribes me almost everything and its for free anyway - but Valproat would not be a problem at all. I could ship it to you then (sealed and not opened package)

        • OK thanks. I'll try writing up the draft tomorrow with only discussion about my health outcomes.

22 comments