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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"?

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.

  • I agree with the two other comments, it seems a safe and productive avenue for first contact. You have to make noise and become difficult if that's what it takes, otherwise they'll think they can just cut costs on you and you won't complain. It's important to be vocal and not let anything slide. You can also, but probably if this first contact fails, ask them to justify their decisions in writing, tell them you will contact the proper decision-making organs for a confirmation (and follow up of course), etc.

    Though I don't know how it works in the UK, I still find that there's a lot of leeway in bureaucracy for individual acting despite all their "reasonable" "processes". If you become "difficult", which means to assert your rights and advocate for yourself (but not threatening, yelling or harassing -- appeal to liberal values), there's a good chance they'll think it's easier to let you keep what you have rather than take it away from you. If you haven't already you should normalize asking them to justify all their decisions regarding your health to you in writing. Every time they send a decision, send back a letter/email/call asking why was this decision made and how?

    Applying just the right amount of pressure for the right thing will often yield the desired result. And I say this as someone who's normally pretty chill with bureaucracy lol. But sometimes you really have to drive the point home to make them understand how much they're fucking you over and that this isn't just numbers on a spreadsheet but has real consequences.

    So in this case I would echo the other comments and you should start by describing the outcome of the lack of medication. This will also prompt a reply. You could also point out that the neurologist -- a specialist who initially prescribed the medication -- prescribed one a day, and you don't understand why this was suddenly revised to 8 a month. At the end of the day the doctor's job is to give patients the least amount of medicine required to treat them, or at least I hope that's as low as they get. If their lower estimate is wrong then it needs to get bumped up and there's no two ways about it.

22 comments