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The consumer is a Polynesian gentleman in his thirties who resides in a residential care facility. He has an intellectual disability and feels that at times he suffers from discrimination. The following case study demonstrates how, with the right supports in place, the consumer was able to challenge this discrimination in order to get his right to good health care met.

During a recent visit to a residential care facility, the consumer explained to the advocate that he was angry because he had asked his GP for a referral to have his eyes checked. According to the consumer, the GP had asked him to read an eye chart on the wall and in spite of the fact that he couldn't read the chart, the GP advised the consumer regarding the referral "it wouldn't help".

The consumer said he did not understand why a referral would not help as the GP had not explained why. He felt he had not been listened to nor had his concerns been taken seriously. He also said the GP spoke too fast and he left the room not knowing what had been said.

The consumer identified that in future he wanted the GP to listen to what he had to say and to be taken seriously. He also wanted the GP to communicate with him in a way that he could understand.

The consumer opted for a meeting with the GP with his key worker and the advocate for support. The consumer said that he would like the GP to know of his concerns and explain why a referral to an optometrist wouldn't help.

As part of the resolution the consumer was again asked to read from the Eye Chart. Initially he experienced difficulty, however when he moved closer he was able to read some of it. The GP explained that he had assumed that the consumer had not known the alphabet and that was why he was having problems reading the eye chart. He agreed to refer the consumer to an optometrist.

The consumer also explained that he had difficulty understanding what the GP was saying because he spoke too fast and spent time on his computer instead of addressing the consumer. The GP apologised and asked the consumer to tell him to slow down in future if he started speaking too fast and that he would give his full attention to the consumer.

The consumer was happy with the outcome as he had a referral to an optometrist. He no longer felt discounted by the provider. We all learnt the importance of not making assumptions based on preconceived ideas.

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GP in a rush

GP ~ Right 5 ~ effective communication

A consumer contacted an advocate as she wanted to address her concerns with her GP. English is her second language and she felt her consultations were being rushed. After discussing the options the consumer chose to meet with the GP with advocacy support. As the advocate was also a Pacific person she requested the advocate translate her questions and the GP's responses at the meeting.

The consumer contacted the GP and advised she would like to meet with an advocate for support. The consumer was given the opportunity to discuss her concerns and ask her questions.

The GP answered each in a way that the consumer would understand or the advocate could relay in her own language. At the end of the meeting the consumer expressed satisfaction with the responses and advised she had a better understanding of why it was necessary for her to take her medication.

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Approaching the media is not always helpful

Right 1 ~ respect ~ Right 5 ~ effective communication

A consumer sought assistance from the advocacy service to resolve her concerns relating to a provider. At the time of approaching the advocate, the consumer discussed going to the media. The advocate discouraged this approach suggesting that directing her concerns to the provider was more likely to bring about resolution.

With assistance from the advocate a letter was sent to the provider clearly stating the issues and the consumer's desired outcome. A response was received advising the matter was to be investigated.

Prior to any further response being received the consumer decided to pursue the matter by telling her story to the media. The impact of this was that other consumers wrote letters to the editor about both good and bad experiences.

The provider became very defensive and took longer to investigate because of the media involvement. The consumer became very distracted because of others putting forward their views and looked at taking legal action against those whose opinions differed from her own.

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Improving systems to achieve appropriate care

GP ~ Right 1 ~ respect ~ Right 4 ~ appropriate standards ~ consistent with need

A consumer suffered a deep laceration to her finger. She sought help from a local medical centre but the receptionist, nurse and doctor all told her they were unable to assist as she was not registered at that practice. The nurse told her she needed to cover the wound as she was getting blood on the floor and the reception desk. The doctor advised her to go to A&E. She asked to be able to use their phone to call an ambulance but was refused with the comment that ambulances only come out to emergencies.

The consumer sent a letter of complaint to the medical centre who had responded and advised her of her options including contacting an advocate or the Commissioner, if she was still not happy. After discussing her concerns with an advocate, the advocate suggested that perhaps a face-to-face meeting with the provider would help. The advocate explained that the process would involve writing to the provider to request a meeting. The letter should provide information about what the consumer wanted to discuss, who she wanted present and what she was seeking as an outcome. The consumer was happy to send her own letter and advised the provider she intended having advocacy support at the meeting. The provider agreed to meet.

The consumer began by outlining her concerns as set out in her letter. Rather than respond to the issues the practice manager and doctor started debating what constituted an emergency for a non-registered person. The consumer was very empowered and said that no-one had ever looked at her finger so how could they decide whether it was or was not an emergency.

The providers apologised and conceded that the consumer should have been assessed and not just sent away. They also apologised for the comment about the ambulance saying it was not an appropriate comment to make. They agreed to put some guidelines out for staff about what to do in this type of situation.

The consumer thanked them for their apology and said she was happy with the outcome of the meeting.

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Just listen to me please

GP ~ rural hospital ~ Right 1 ~ respect ~ Right 2 ~ discrimination ~ Right 4 ~ appropriate standards ~ Right 5 ~ effective communication ~ drug seeker ~ pain relief ~ care plan

A consumer phoned saying she had been told by another provider to contact the advocacy service to discuss her concerns about her GP and the local rural hospital. She said she had a chronic condition and sometimes required opiates to relieve the pain from it.

When she presented to the medical centre she felt she was discriminated against. She said the GP never gave her a chance to speak. She said it appeared a decision had already been made about her treatment and there would be no consultation.

She felt the GP and hospital staff had formed an opinion that she was a drug seeker and treated her as such. She wanted to know why the GP wouldn't prescribe the drugs recommended by her specialists and pain clinic staff.

After discussing the advocacy process the consumer opted for a meeting with the providers and requested the advocate be present for support.

At the meeting, the consumer began by 'telling her story'. Having heard from the consumer the providers decided her plan should be changed to incorporate the suggestions of her specialist. This meant she would be given a small supply of medication to use in the first instance while waiting to see her GP. They agreed there was no documented evidence that she was abusing the prescribed medication and that opiates were in fact the most appropriate way to treat her particular illness.

The care plan also documented that she was allowed admission to the hospital at any time she felt she needed to be assessed as requiring IV medication. An additional section stated that staff would not question and treat her any differently from other service users. There was a directive made that if other service providers had issues with her treatment, they should contact her GP so the consumer would not be caught up in any debate about the appropriateness of her treatment. The care plan would be reviewed in twelve months time.

The consumer was very happy with this outcome. She said the issues had been ongoing for about six years as a result of continual changes within the GP practice. She felt no-one had listened to her or heard her story.

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Feeling intimidated by a GP

Right 1 ~ respect ~ Right 2 ~ discrimination ~ mental health

A consumer went to see his GP at the local medical centre because he needed support with mental health issues. His GP told him he was "only trying to get out of a court date" relating to a domestic dispute. The consumer says he was not attempting to get out of court rather he was seeking help with mental health issues which had resulted in the domestic dispute.

The consumer felt the comment made by the GP was disrespectful and judgemental. He shut himself away and withdrew from all interaction with others. His sister came from out of town to offer him support and it was she who initiated contact with the advocacy service.

While discussing the issue with the consumer he told the advocate he wanted a written apology and assurance from his GP that similar comments would not be made to others who sought support. The consumer stated he did not want to meet the GP as he felt intimidated by him.

Following initial contact being made by the consumer's sister the advocate met with them both. After discussing the options for progressing the matter the consumer chose to write to the GP expressing his concern and desired outcome. The advocate assisted the consumer to write his own letter.

The GP wrote a full apology to the consumer. On the next occasion he attended an appointment with another doctor at the medical centre, he was more than happy to accept a verbal apology from the GP concerned. The consumer also found the practice manager's response to his complaint to be very positive and respectful.

The consumer advised that he is happy with the outcome, and believed the GP's apology to be sincere. He would be happy to receive services from him in future.

He found that the support from the advocate had given him the confidence to raise his concerns, and as a result he understands his rights and will speak up in future without feeling intimidated.

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A misunderstanding by a locum GP

Right 4 ~ appropriate standards ~ Right 10 ~ right to make a complaint

This complaint was referred to the nationwide advocacy service by the Commissioner. Both the consumer and his wife had attended an appointment at their local medical centre. The GP they saw was not their usual GP as he was overseas at the time. The consumer had an underlying medical condition and had regular checkups for this.

However, on this occasion he was seeking medical attention for a different reason. The consumer felt that he and his wife had not been listened to, that the GP was only concerned about the underlying medical condition and that the consultation had been rushed with pain killers only prescribed to "keep him quiet".

Upon receipt of the referral from the Commissioner the advocate contacted the consumer and his wife to arrange a meeting to discuss the issues and explore options for resolution of the complaint. At the meeting with the advocate the consumer said he would like an apology and acknowledgment from the GP that he must listen to his patient's concerns and not just assume he knew why they were seeing him.

As part of the resolution process the consumer's wife suggested an education session for the GP and the practice on the Code of Rights, especially regarding respect, communication and information.

The consumer requested the advocate write to the GP advising the desired outcomes of the consumer and his wife. The GP wrote a letter directly to the Commissioner, ignoring the advocate, and also contacted the Medical Protection Society thinking he needed legal advice.

As the advocate was going to the town where the practice was, she decided it would be worth an attempt to explain to the GP and practice manager about the complaints process and role of advocacy. She phoned and arranged to meet them both.

The GP was extremely pleased and relieved when he realised that he was not facing legal action. The advocate explained in detail the complaints process and the significance of the referral from the Commissioner's Office. She also explained the role of advocacy in this process.

The GP was finally able to understand the process when it was clearly explained to him. He was pleased that the advocate had taken the time to clarify the situation to him and advise him on the next step in order to resolve the complaint. He did not realise the process was 'so easy and uncomplicated'.

As a result of his understanding of the complaint process the GP wrote an extremely sincere apology letter to the consumer. He advised the consumer that he would be incorporating the communication issue problem in his review.

The practice has also organised an education session with the advocate on the Code of Rights which the GP is keen to attend. The consumer and his wife were pleased with the outcome of their complaint and were happy for the file to be closed.

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Formal referral for missed pregnancy test

GP ~ Right 4 ~ appropriate standards ~ young high school student

This case was a formal referral to advocacy from the Commissioner. Over a period of four months the consumer (a young high school student) had been seeking medical care for constipation and a "hard" stomach. During the initial three months of consultations the doctors had done blood tests and suggested including a pregnancy test. The consumer stated this was unnecessary as she was doing pregnancy tests herself and they were showing up as "negative".

When the consumer returned during the fourth month the doctor she saw said she was going to request a pregnancy test regardless, as the medication she had given her had not worked and she wanted to know why. The pregnancy test came back "positive". The consumer and her mother were extremely angry and blamed the doctor for not doing her job properly, and as a result complained to the Commissioner.

After discussion with the consumer and her mother a meeting was arranged with the family, advocate and the doctors.

The meeting began with the young woman and her parents discussing how they felt about the situation and the effect it had had on them. The consumer's parents were angry that by the time the "positive" result came back to them, the legal timeframe to have a termination, had passed and now their teenage daughter was faced with bringing up a baby, finishing her education at high school and having to make a new life for her self, which the parents did not believe she was adequately equipped to do.

They said they were grateful for the opportunity to discuss with the doctors how their lives had changed as a result of the blood test not being done during the first three months.

The doctors talked about how they had changed their system to ensure that if a consumer is seen by another doctor, that doctor would know exactly what the other doctor had said and done. They also agreed that they should have followed their own instincts and had the pregnancy test done, regardless of the fact the daughter had been testing herself.

While the parents remained unhappy with the future picture, they were pleased to have had the opportunity to discuss their concerns with those involved.

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Manners of receptionist at medical centre

GP ~ Right 1 ~ respect & privacy ~ Right 5 ~ effective communication ~ empowering consumers

A consumer contacted an advocate to discuss her concerns about the manners of the receptionist when she attended a recent medical appointment.

The consumer said that not only had the receptionist been rude but she had been able to hear her discussing other people's private information. The consumer was seeking advice about how the advocacy service worked as she had sent her complaint to the practice manager and was not at all happy with the response.

After hearing about the role of the advocate the consumer said she would contact the practice manager and ask for a meeting and advise she would be bringing an advocate for support.

The consumer arranged the meeting herself and contacted the advocate with the date. They arranged to meet half an hour before the meeting with the provider. The plan was to go over the issues that were to be raised, the advocate's role in the meeting and the desired outcome. When the time arrived for the meeting, the consumer was confident in raising her issues.

Initially the providers did not hear what she was saying and the consumer considered their response inappropriate. The advocate encouraged the consumer to retell her story. After the retelling, the providers appeared to have heard what was said and apologised.

The consumer left the meeting feeling she had been heard. She had received an apology and wanted no further action.

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Coordination between primary and secondary care

DHB ~ GP ~ Right 4 ~ co-ordination between providers ~ continuity of care ~ Right 5 effective communication ~ Right 6 ~ fully informed ~ chemotherapy ~ radiotherapy ~ entitlements

A consumer had been having chemotherapy and radiotherapy over the previous12 months. She contacted an advocate to say she felt ill-informed about what support services were available and subsidies she may be entitled to.

She was upset about always having to explain to specialists and doctors about her condition and treatments to date and didn't understand why they did not read her medical file prior to seeing her. She said she had discussed her concerns with her oncologist particularly as she feels she was pushed from one department to another in the hospital and felt she was not being told everything.

The advocate and consumer discussed the situation, what the consumer wanted to achieve and what support she required. The consumer really just wanted confirmation that she was taking the right steps to address her concerns.

She spoke with her oncologist who had agreed to be responsible for coordinating her care in the hospital. She also spoke to her local medical centre and they had scheduled an appointment with a GP for her who would take on the role of managing her care in the community.

The advocate was able to provide contact details for other local support agencies. The consumer left feeling happy that she was in control of the situation and knowing she could approach the advocate for help at any stage in the future.

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Palliative Care Problems

Right 5 ~ Effective communication ~ Terminal illness

A consumer had been diagnosed with a terminal condition. Her GP was her primary health care professional, and apart from some respite care in hospice her husband was her primary caregiver.

The woman's husband contacted the advocacy service seeking support as his wife's health was deteriorating and she had not been seen by the GP for a period of four months. During part of that time the GP had been overseas.

The consumer's health had deteriorated to a point where she could no longer travel to the general practice. The complainant had not been able to speak with the GP by phone and was experiencing difficulty getting prescriptions for his wife. The GP had not contacted the consumer or her husband since her return to New Zealand and the complainant was feeling very isolated in his role as caregiver. He wanted to have the opportunity to speak with the GP so she would be aware of the consumer's condition and the distress caused by her lack of contact.

After considering the advocacy options, the complainant requested the advocate draft a letter to the GP requesting she phone the complainant to discuss the issues.

The advocate emailed the letter to the consumer and complainant to ensure it reflected the issues they wanted to address. Once they had confirmed they were happy with the content the advocate delivered the letter to the GP's practice.

Upon receipt of the letter the GP contacted the complainant by phone and between them they resolved the matter. The GP was surprised to hear that the complainant and his wife had expected to hear from her and was sorry to hear of the distress that had been caused to them.

The complainant was pleased with the call and communicated this to the advocate on the next working day. In this case the complaint was resolved within three days of the complainant making contact with the advocacy service.

One week later the GP sent a letter to the advocate advising that she would now be reviewing how she approached patients in palliative care to meet their needs. The letter was forwarded on to the complainant.

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GP not listening

Right 1 ~ Respect ~ Right4 ~ Appropriate standards ~ Right 5 ~ Effective communication

A consumer contacted the advocacy service after it was suggested to him by an Arthritis Fieldworker. His condition had been deteriorating over a period of three years. On one occasion the consumer had seen a locum GP who had suggested he ask for a referral to a rheumatologist. His regular GP would not action the request stating "it would be a waste of time", as the consumer had gout.

The consumer had attempted to address his pain with the GP who would only prescribe Panadol. On another occasion the GP had refused the consumer's request to have his prostate checked saying "that it would only open a can of worms".

The consumer stated all he wanted was to be referred to the appropriate services/specialists and to be as pain free as possible. The consumer wanted to discuss his issues face to face with his GP and asked for advocacy support at the meeting.

So badly arthritic and sore were his hands he was unable to hold a pen to write the letter so he dictated it to the advocate who forwarded it to the GP. The consumer received a response that the GP was happy to meet.

The advocate and the consumer met outside the Medical Centre and talked about his the consumer's role in addressing his issues. He was comfortable and confident in telling the doctor how he felt and was happy to do this.

The doctor commenced the meeting with a sincere apology for "not listening" to the consumer saying he had heard the consumer but was not listening properly. He went on to say he had made the referral to the specialist and agreed to give the consumer a prescription for different medication.

The consumer advised he was very happy with the outcome of the meeting and that he received an appointment to see a rheumatologist in the next few weeks.

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Prescription problems at a medical centre

Right 4 ~ Appropriate standards ~ Prescription ~ Right 10 ~ Timely complaint processes

An elderly gentleman called his medical centre for a repeat prescription for three months' supply of tablets. His call was directed to a recorded message on the medical centre's phone service. The medication was originally prescribed by a hospital doctor but the consumer had advised his GP of this and it was noted on his file at his last visit. The consumer left this information including his name and phone number as a message on the practice prescription phone-in system.

The consumer says he never heard back from the practice but decided to pick up his prescription three days later. When the consumed presented his prescription to the pharmacist he was told it was a one-off high dose only of the medication and a three month supply of another medication he had never taken before.

The consumer returned the prescription to the medical centre the same day to ask for it to be changed, and for an explanation. The practice nurse explained she had written the script and the doctor had signed it and there was nothing wrong with it. However, despite this he was told by the nurse that she would fix it.

The consumer called back at the end of the day to pick up a revised prescription.

The consumer contacted the advocacy service for assistance to write a letter of complaint to the Practice Manager. He had heard about our service from another consumer who had used the advocacy service to complain about the same medical practice. The advoctae explained the options to the consumer who chose to write his own letter. The advocate provided him with a copy of the `How to Format a Complaint Letter' which the consumer felt took the stress out of writing a complaint letter from scratch.

The consumer didn't get a timely response so the advocate sent a reminder to the provider outlining the required response times to complaints. The provider responded with an apology and an explanation.

Through the concerns raised by the consumer the provider was able to identify a number of issues with their procedures. Corrective action has been taken to prevent the same thing from happening again.

This includes the telephone process being under review, a new process being trialed to prevent wrong medication or dosage being put on prescriptions and the recognition of the need for better communication between all those involved.

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Communication issues at a health centre

Right 1 ~ Respect ~ Right 5 ~ Effective communication

Prior to contacting the advocacy service, a consumer said he had sent a complaint to his local health centre. When he contacted the advocate he had already received a response and felt he was being discriminated against due to his mental illness and culture.

His key concerns were in relation to

the way in which reception staff spoke to him.
not being contacted despite having requested support and leaving his contact details.
apprehension that his doctor would reprimand him at his next appointment because he had made a complaint.

He wanted to know

whether the centre had staff training and a plan for working with mental health consumers as his experience was that staff were intimidated and frightened by mental health patients in general.
whether he could have advocacy support to meet with the provider and staff involved to discuss the communication issues.

The consumer felt he had attempted self advocacy and wanted the advocate to assist with sending a letter to the provider requesting a meeting to discuss the issues.

The Centre Manager was happy to meet. The advocate accompanied the consumer to the meeting where the consumer's doctor was also present. The consumer was offered an apology which he was pleased to have. His doctor also offered to assist by writing a letter to a different agency about another issue the consumer wanted to pursue.

The consumer was very happy he had had advocacy support to resolve his concerns.

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No follow-up by GP

Right 4 ~ Appropriate standards

An advocate was contacted by rest home staff concerned about the standard of care and lack of follow-up by a medical practitioner. The staff advised that a 94-year-old resident had had an accident resulting in a suspected fracture of her foot. The staff felt that the provider had not taken the appropriate action when notified of the injury.

The advocate conferred with the consumer who also expressed concern about the delay in treatment and wanted the matter brought to the attention of the medical practice.

The key issues included the practice being notified of the injury and having sent a nurse out to check the resident's foot, none of the paperwork had been completed, and therefore no x-ray had been arranged. As a result of the paperwork not being completed the consumer waited an additional two days, in pain, before an x-ray was carried out at the local DHB.

As soon as the consumer's letter of complaint was received by the doctor, he phoned the consumer to express his regret for not having followed up the matter. He also advised her to expect a written letter in response to the complaint.

The consumer received the promised letter and was very happy with the outcome.

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Turned away from a GP Practice

Right 1 ~ Respect ~ Right 4 ~ Appropriate standards ~ Right 5 ~ Effective communication

A consumer phoned the advocacy service in distress after receiving a letter from her GP advising she would not be seen at the practice again as a result of her "aggressive behaviour". The consumer stated she was in an acute health crisis and needed a GP to obtain prescriptions that had been authorised by a specialist.

An advocate met with consumer to discuss her goals.

1. To get a new GP

The consumer self advocated with information provided by the advocate and made an urgent request for her records. The practice initially stated they had 20 working days to meet the request, however, in the end they copied the information for her.

The consumer met with the new GP who prescribed the medicine, introduced her to staff, and advised them of the acute situation of distress. The consumer felt overwhelmed with the care and understanding of the new GP.

2. Write letter of complaint to the provider

The consumer said she had unresolved feelings about how she was treated by the previous GP practice. The communication and information she received left her confused, anxious and she did not feel respected.

The issues to be included in the letter:

If the GP no longer wanted to provide care why was she not taken aside and given an explanation regarding this?
Why would the GP not prescribe medication that had been approved by a specialist?
Why had the local pharmacy been advised the medical practice was taking a restraining order against the consumer?

Why was the consumer not given the opportunity to discuss the matter with the GP instead of the administration staff advising they would no longer provide her with a prescription.

The letter of complaint was duly written and sent to the provider. The consumer received a response which she found upsetting as she said it contained untruths and her concerns were unanswered.

After discussing further options such as another letter to the provider, a meeting with the provider or going to the Commissioner the consumer decided to think about the options over the weekend and discuss them with her family.

She contacted the advocate the following Monday and requested the advocate assist with setting up a meeting with the provider. Initially reluctant the provider contacted their lawyers and after consulting with them agreed to meet.

On the day of the meeting the provider advised there would be three GPs, the Office Manager and a representative from the Medical Practitioners Board. The consumer still wanted to proceed with the meeting as she was aware of her strengths, having identified them with the advocate, and was not going to feel intimidated by the actions being taken by the provider.

At the resolution meeting the consumer expressed her concerns directly and clearly. Her original GP who was part of the meeting but had not been part of the complaint apologised to her and advised the situation could have been handled a lot better and there had been learning and processes put in place to prevent this from occurring again.

Agreement was reached on the following:

Front line staff would receive training on managing consumers with challenging behaviours.
Clinicians would be called upon if situations became difficult rather than leaving it to reception staff.
A letter would be sent to the consumer's new GP explaining her condition and medications
GPs would be reminded of the need to keep good clinical notes.
A letter would be sent to the consumer confirming the agreed actions had been taken.

The letter from the provider was received the following week. The consumer stated she was pleased with the meeting and the outcome. Despite having already moved practices she felt she needed to resolve the issues with the previous practice to enable her to move on.

On reflection the advocate felt that the consumer's strength of being resilient and courageous contributed to the resolution of the complaint by seeing it through to the end.

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GP refunds initial consultation

General practitioner ~ Right 4 ~ Appropriate standards ~ Right 5 ~ Effective communication ~ Right 6 ~ Fully informed ~ Naturopath

A consumer contacted an advocate unhappy after her last consultation with her general practitioner who she thought had not "done her job".

She felt not listened to, had no physical examination, and received a referral to a private naturopath with no explanation about why or how much the referral would cost. She was also not offered any other treatment options.

After her first complaint letter resulted in an unsatisfactory response, the advocate assisted the consumer with a second complaint letter highlighting the outstanding issues not responded to by the general practitioner.

The general practitioner's second response letter fulfilled the consumer's expectations. The GP provided a full explanation about the specialist she had referred the consumer to, including costs, and offered an alternative treatment option through the public system.

In addition she refunded the cost of her initial consultation.

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Communication problems between a consumer and receptionist

GP ~ Right 1 ~ Respect ~ Right 3 ~ Dignity ~ Right 5 ~ Effective communication

A consumer who was in New Zealand on a working visa raised concerns with the advocacy service about the way in which matters about enrolment eligibility was handled by one of the receptionists at the local medical clinic.

She had entered the clinic late in the afternoon but with enough time to see a doctor. However, when she spoke to the receptionist, she was advised that they would be closing early that day. She thought closing time was 5pm and she had arrived in the clinic at 4pm.

Unfortunately the receptionist was not able to find her registration as a clinic patient and said she would have to pay casual rates because of non registration. The consumer advised the receptionist that she had enrolled the previous year and the required documents had been sighted and photocopied by another receptionist in the practice.

When the consumer presented the documentation to the receptionist she was ignored and advised that she was not able to help as she wasn't enrolled. If she wanted to see a doctor she would have to pay the full amount and not the publicly funded amount. As far as the receptionist was concerned, she wasn't enrolled and she couldn't help her further.

The consumer decided to leave as she felt embarrassed and humiliated. The discussion had taken place in an open area of the clinic where others could hear the conversation.

After considering her options, the consumer asked the advocate to support her to write to the medical clinic about the receptionist's manner and how embarrassed she felt to have the discussion of enrolment in such a public area.

The clinic apologised on behalf of the receptionist and confirmed that she had been enrolled. Unfortunately an error had occurred that advised the receptionist she was not registered as a patient. However this was no excuse to ignore the consumer's documents.

The consumer was very happy with the outcome but is no longer with this clinic.

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Clarifying the 15-minute appointment time

GP ~ Right 6 ~ Fully informed ~ Right 10 ~ Complaints taken seriously

A consumer contacted the advocacy service because he was in a "situation he didn't know what to do about". The advocate arranged a time to meet with him to discuss his issues with the medical centre he usually visited.

He advised that he had visited his GP twice and both times the GP advised him that he could see him for no more than15 minutes. The consumer was surprised about why the GP kept telling him that. Why was it only 15 minutes and why had he not been informed about this before

He decided to talk to someone about the matter.

He asked the receptionist if there was a new policy regarding the length of time to see the doctor. She told him there was nothing new, and but did not provide any explanation or clarification about why the doctor could see him only for 15 minutes. He asked her if she could pass his concern on to the practice manager as he wanted to talk to her.

The consumer waited for months to hear from the practice but nothing happened, so he decided to contact the advocacy service.

The advocate spoke to the consumer about the Code of Rights, the advocacy service, complaint process and options available. The consumer decided to write to the provider about the communication and information he had received from the medical centre.

The consumer received a response from the GP and the clinical manager but was not satisfied with it. He asked the advocate to arrange a resolution meeting with the practice manager.

At the meeting the consumer talked about his concerns about not being fully informed about the length of time for a consultation with the GP. He also mentioned the lack of communication about his complaint.

The practice manager admitted there was a lack of the communication as she had not been informed about the consumer's concern and wish to speak to her. She apologised for that.

In relation to the length of the appointment, the manager advised that there was a notice in the waiting room for patients. She showed the consumer and advocate the notice which was very small, and on a table with some brochures for patients. The consumer advised that he couldn't see it because of its small size. He asked the manager if they could make it bigger and put it on the wall where everyone would be able to see it. She agreed to that.

In the next three days the consumer received a letter from the practice manager with a written apology. In the letter she advised that she had met with the reception team and discussed the consumer's concern that his messages were not passed on to the management staff.

They agreed to

include the 15 min consultation notice in registration packs.
increase the size of the signage in the waiting room and reception area.
continue to improve their skills with ongoing training and discussions about these events.
listen to consumer suggestions as there is always room for improvement

The consumer achieved his goals and thanked the advocate for the fantastic service provided.

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Special authority number

General practice ~ Right 4 ~ Appropriate standards ~ Chronic condition ~ Special authority number

A consumer with a chronic condition took medication which required a special authority number. Without the medication she became unwell and required hospitalisation.

When she moved to another area her GP did not tell her she would need to see a specialist before receiving a renewal of the medication authority form being completed.

She contacted the medical practice requesting they urgently address the matter and was told that due to her GP being on leave it was unlikely anything would be done before she ran out of her medication.

She contacted the advocacy service for assistance. With advocacy support the practice was again contacted which resulted in the practice manager obtaining a renewal of the medication authority from the specialist in the town where the consumer had previously resided.

The consumer was satisfied with the outcome and requested to be informed of any policy or practice changes they may adopt to prevent the same situation occurring in the future.

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GP ignores family testimonials

GP ~ Right 1 ~ Respect ~ Right 4 ~ Appropriate standards ~ Autoimmune condition

A consumer contacted an advocate because her relationship with her GP had deteriorated. The consumer said the GP did not take her seriously and seemed to be dismissive and disbelieving about the severity of her long-term autoimmune condition.

She wanted to meet with her GP, with advocacy support, to give the GP written information about her condition from medical journals and specialists' reports. She was also keen to provide testimonials from her family and friends about how the condition affected her life. The consumer advised the advocate that she was confident to gather the information and to speak up at a meeting with the GP.

She asked the advocate to organise the meeting. The GP expressed surprise but said he was open-minded about meeting with the consumer and the advocate. He said the practice manager would also attend.

At the meeting the consumer explained that her autoimmune illness resulted in her being unable to work, limited her social interactions, and caused her to feel depressed, anxious and suicidal. The consumer said that to make matters worse, her condition was invisible, which led to people doubting the veracity of her illness.

She presented the GP with the written information. He agreed to take the medical information but declined to take the family testimonials. During the meeting, the consumer mentioned financial problems and the practice manager suggested that he could support the consumer to be referred to their social services support team.

After the meeting, the consumer told the advocate that although she didn't feel the GP had really listened, she felt proud of herself for speaking up. She said she had various options to consider, including remaining at the practice but seeing another GP, changing practices, and perhaps entering their social support service.

The consumer said she was relieved and happy that she had spoken up, and that doing so had not been as daunting as she thought it might have been, thanks to having the advocate present to support her.

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A hasty GP

GP ~ Right 1 ~ respect ~ Right 4 ~ appropriate standards

A consumer phoned and asked to meet with an advocate as she had concerns about her care. When the advocate met the consumer, she explained she had been a patient at a local medical centre for twelve years and had been on a particular medication for anxiety for five years. Prior to Christmas the consumer had been given two prescriptions to ensure she did not run out of medication during the Christmas break. She filled one script at her regular pharmacy and as she had no transport, when a friend took her shopping she had the second filled at a different pharmacy in another part of the city. She believed that this action resulted in her receiving a printed email in the post from her GP stating that he could no longer provide care for her and had removed her from the practice enrolment. The consumer was very distraught as one of her medications stated it needed to be taken continuously.

After going through the options with the advocate the consumer decided she would like to have the advocate support her at a meeting with the GP as she felt that she had previously had a good rapport with her GP. Accompanied by the advocate the consumer felt able to ask the GP why he felt the relationship had broken down.

The GP explained that he had a call from one of the pharmacies where her prescription was filled, which was not her usual pharmacy. Having heard the consumer's explanation, the GP agreed he might have been a bit hasty and offered to re-enrol the consumer with the proviso she only use the one pharmacy for filling prescriptions. The consumer happily agreed and was pleased she had sought support from the advocate to resolve the matter.

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Expectations of a good GP

GP ~ Right 5 ~ Effective communication ~ ACC ~ Headaches ~ Pain ~ Neurology

A consumer initially called advocacy for support as a result of ACC declining his claim following an accident where a piece of steel penetrated his left eye. The advocate explained her role and gave the consumer contact details of an organisation who may be able to assist with the ACC claim.

Having listened to the advocate's explanation of her role, the consumer went on to say that as a result of his injury he had been left with severe headaches. There had been times when his headaches become so painful, that he fainted and fell down, and his elderly mother has been so distressed by this that she had called an ambulance.

The advocate visited the consumer and his elderly mother to discuss what was happening. The consumer felt that his GP was not listening to him or helping him and after discussing the options with the advocate for resolving his concerns decided he just wanted to change to his mother's GP.

Following the consultation with the new GP the consumer again called the advocate as he and his mother were distraught. The consumer said he had been told by the new GP that his old GP was doing everything he could and that the consumer should just go back to him. The old GP told him "the pain is not real, it is in your head", "nobody will do anything different". "and don't call the ambulance again". The consumer left the GP's practice and felt like ending it all.

Using the five column approach to assist the consumer through the process, he decided he would like assistance from the advocate to write a letter to the GP explaining how hurt he was by his comments. He said he would like to have a meeting to get an apology and be able to explain what he expected from his GP.

A meeting was held with the GP, the consumer and the advocate. The GP apologised and suggested his comments had been misunderstood.

He listened to what the consumer expected in a GP and agreed to stay on as his GP. He also agreed to review his clinical file to see if there was anything that could be done differently.

During the meeting there was discussion of a pain management plan that all services could follow in the event of the consumer becoming unwell. The consumer agreed to this plan which included an ambulance being called if the pain did not decrease.

The consumer was happy with the outcome of the meeting. He contacted the advocacy service to say the GP had referred him to a neurologist.

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An unfortunate amputation

GP ~ Right 4 ~ Appropriate standards ~ Right 5 ~ Effective communication ~ Right 6 ~ Fully informed ~ Specialist referral ~ Infected finger ~ Amputation

A consumer told an advocate that as a consequence of the actions by a medical practice he had had his finger amputated. He had seen a number of GPs at the practice for an infection and had received four different antibiotics, none of which had been effective. He said he had requested an x-ray and referral to a specialist, neither of which had been done.

When he attempted to get further follow-up he was told he was not a registered patient of the practice. As a result he enrolled with another practice and the GP he saw there had immediately referred him to a specialist, resulting in the amputation.

After discussions with the advocate, the consumer elected to have support with writing to the medical practice, outlining what had happened and requesting a meeting to discuss his concerns. The advocate supported the consumer at the meeting where his letter was used as the basis for the discussion.

He received an apology, and an assurance that in future consumers would be advised of the need to register on their first visit to the medical centre. With his permission photographs of his injury would be used for a peer review within the practice. The consumer was satisfied that he had been heard and steps would be taken to prevent anything similar happening to anyone else.

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Mismatch at the pharmacy

GP ~ Pharmacy ~ Right 5 ~ Effective communication ~ Right 6 ~ Fully informed

Following a consultation with her regular GP, a consumer went to collect prescribed medication from the pharmacy. She noted some medications had been decreased, one had been increased and the antibiotic she had been on long term had been omitted.

None of these changes had been discussed during the consultation so the consumer attempted to make contact with the GP by phone to have the prescription revised. She was advised she would need to make another appointment but it would have to be with another doctor as her GP was not available. As she required the medication the consumer agreed, and as a result incurred another $50 consultation fee.

After seeking information from a local advocate, the consumer decided to have advocacy support in writing to the GP practice requesting information about their policy on obtaining repeat prescriptions including where regular prescribed medication has been omitted. In her letter the consumer provided an outline of what had happened to her and stated that as the error had been made by the GP, not her, she felt the second consultation fee should be refunded.

The consumer received a written response containing an apology and an explanation of what the provider's investigation had revealed that had contributed to the error in the medication. The GP had received a letter from the consumer's specialist advising of the changes that needed to be made. However, as the antibiotic was not mentioned by the specialist, the GP had overlooked prescribing it. The writer advised that the practice followed the Medical Council of New Zealand's Guidelines on Good Prescribing Practice and included a copy for the consumer's perusal along with a copy of the specialist's letter. The response also contained an offer to reduce the second consultation fee to a prescription fee, which was considerably cheaper.

The consumer advised the advocate that she felt her concerns had been taken seriously and that she was satisfied with the outcome. She was pleased to have an advocate support her through the process and would recommend the advocacy service to others.

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Consumer objects to GP's home visit

GP ~ Home visit ~ Mental health assessment ~ Community Mental Health Team ~ Right 6 ~ Fully informed

A consumer contacted an advocate after the consumer's GP visited her at home and subsequently sent her a letter in which he said he would refer the consumer for an urgent mental health assessment. She was concerned that the GP had based his evaluation of her on a conversation with her daughter to which the consumer was not privy.

With the advocate's support, the consumer wrote a letter to the GP asking what the GP had discussed with her daughter and on what basis the GP concluded that the consumer was evidencing a mental health condition.

The GP replied. He said he visited her at home because it was the accepted standard of care by a GP. He explained that he based his conclusions on his assessment of the consumer, as well as his conversation with her daughter.

He didn't disclose the content of the discussion with the consumer's daughter. He said that he had discussed the matter with the Community Mental Health Team and they didn't believe the consumer needed an assessment.

The consumer wasn't satisfied with the GP's reply. With advocate support, the consumer wrote a second letter. The GP replied, reiterating what he had said in his first letter, and advising that he would not enter into further discussion.

The advocate spoke with the consumer about what the consumer wanted to do next. The consumer didn't want to meet with the GP as she didn't believe the he was a real doctor. Although the advocate informed the consumer that the GP is on the Medical Council website she remained unconvinced.

Although she was happy to know that the Community Mental Health Team would not assess her, she wanted to compel the GP to prove his comments about her being mentally unwell and to disclose what he discussed with her daughter.

She said she would self-advocate from here on using the skill she had learned from the advocate. She planned to telephone her GP, the Community Mental Health Team and the Office of the Privacy Commissioner in the hope of achieving a resolution.

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Missing x-ray referral

GP ~ Right 4 ~ Appropriate standards ~ Right 5 ~ Effective communication

Unable to speak English made the consumer feel very vulnerable while trying to communicate with his GP. The consumer said he had injured his foot. At the consultation with his GP he was told an urgent referral for x-rays and an ACC form would be completed as soon as possible. He was however worried his GP was not able to provide essential healthcare for him which would meet his needs in a timely manner. A full month passed without the consumer hearing anything. By the time he contacted the advocacy service he was very concerned that the delay might increase the risk of permanent damage. He said the prolonged period of waiting in pain had resulted in increased anxiety and frustration, and an inability to sleep at night.

The advocate spoke with him at lengthl, face to face, exploring various options. He requested the advocate support him to draft up a formal letter of complaint to be sent to his GP by urgent mail, requesting the referrals be made without any further delay. Upon receipt of the letter the referrals were made and the x-ray showed no permanent damage had been done.

The consumer said that he was relieved with the outcome. He was happy with the advocate's prompt support to overcome the communication barrier as well as the assistance to resolve the issues which had been impacting adversely on his health and quality of life.

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X-Ray Referral Service

GP ~ Diagnostics ~ X-ray

The initial call to the advocate was made by the consumer's husband, who said the GP had not referred his wife to a hospital x-ray service as discussed. The consumer then spoke with the advocate confirming she wanted to have the matter addressed. She said that at a follow-up appointment the GP asked if she had received an appointment for an x-ray. The consumer responded she hadn't, and was told this must mean the x-ray service had not been able to take her.

The consumer contacted the hospital booking office and was informed that a referral had not been received by the service. The consumer felt the GP had misled her and asked her husband to contact the GP practice to complain. The Practice Manager advised the consumer would be sent a copy of her notes detailing the action taken regarding the referral and she would be reimbursed for the last consultation with the GP as requested. It was at this point they contacted the advocate for support as they were dissatisfied with the response.

After considering the options, the consumer decided to have advocate support to both speak with the doctor and to seek an explanation for what had happened. The advocate contacted the practice to set up a meeting. The GP involved was no longer at the practice but another GP aware of the situation agreed to attend the meeting.

At the meeting the consumer expressed that she had felt misled about the referral for an x-ray particularly as at the follow-up appointment the GP had discussed whether she had received an appointment. The GP who attended the meeting explained to the consumer how the hospital x-ray referral service worked and that there had been some recent changes to the service. The consumer accepted the explanation saying if she had received the information at the first consultation she would not have felt misled. The consumer was pleased she had been given the opportunity to discuss her concerns and considered, based on the GP's explanation, that the matter was resolved.

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Evidenced-based Approach to prescribing

GPs ~ Prescribing ~ Right 4 ~ Appropriate Standards ~ evidence-based approach

Having received three enquiries over a four day period from consumers with concerns regarding pain management medication prescribing by GPs the advocate contacted the PHO. Consumers were saying that they were not given effective options or explanations for previous medications no longer being available to them. After discussing the role of the advocate and the assistance advocacy could provide none of the three chose to pursue their concerns by this avenue at this stage.

As a result the advocate decided to contact the senior clinical leader of the PHO in the region to clarify if there had been a recent policy change or directive to doctors re prescribing for those with pain related difficulties. A written response advised there had not been a new policy but there had been education over the past year and a half to doctors in this group about the prescribing of opiates "in a more evidence based manner".

The Clinical Leader advised that if consumers were willing to come forward he would be happy to review their concerns to look at the specific issues so that he could look at them from a systems wide perspective.

Evidenced-based approach to prescribing

GPs ~ Prescribing ~ Right 4 ~ Appropriate Standards ~ Evidence-based approach

Having received three enquiries over a four-day period from consumers with concerns regarding pain management medication prescribing by GPs, an advocate contacted the PHO.

Consumers were saying that they were not given effective options or explanations for previous medications no longer being available to them. After discussing the role of the advocate and the assistance advocacy could provide, none of the three chose to pursue their concerns by this avenue at this stage.

As a result the advocate decided to contact the senior clinical leader of the PHO in the region to clarify if there had been a recent policy change or directive to doctors regarding prescribing for those with pain-related difficulties. A written response advised there had not been a new policy but there had been education over the past year and a half to doctors in this group about the prescribing of opiates "in a more evidence based manner".

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Concerns about medication changes

GP ~ Right 5 ~ Effective communication ~ Subsidized medicines ~ Medication side effects

An older woman called to speak with an advocate. She was upset that her GP was not listening to her when she explained to him that she was having problems with new medication he had prescribed in place of the previous medicine. She was not happy with the side effects of the new medication and wanted to know why it had been changed.

After considering her options, the consumer decided to check with the pharmacist whether the change had been made by them due to subsidized medicine changes. It turned out that there would be an additional $17 per month to change back to her old medication.

With this information she decided to raise the matter with her GP herself as she was able to pay the additional cost to avoid the side effects.

The consumer confirmed her medication had been changed after she put her case to the GP. She felt good about the outcome and that the information she had gathered had given her confidence to speak up more in this and future consultations.

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Confused patient not wanting to be annoying

GP ~ Blood sugar test strips ~ Diabetes ~ Right 6 ~ Fully informed

A confused consumer contacted an advocate for help as he didn't know why his GP had stopped prescribing him his usual test strips which he used to test his blood sugar levels. He did not know how to approach the doctor as he did not want to be an "annoying patient".

The advocate presented a number of options including writing a letter and/or having a meeting. The consumer said he would like help to write a letter as he felt he would not be able to express his concerns fully if he wrote it himself. He said his literacy levels were not strong and he was easily confused. The consumer dictated his questions for the advocate to formatted into a letter for the consumer to check before posting.

The following week the GP replied to the consumer copying in the advocate as the consumer had requested. The advocate contacted the consumer so they could read the letter together. The GP explained that the consumer's diabetes had deteriorated so he needed to have a more advanced testing strip which would be ready soon.

The consumer said that he was very happy with this explanation. The advocate followed up with the consumer who confirmed he had picked up his new strips. The consumer is now fully aware that his diabetes has deteriorated and plans to be very vigilant about taking better care of himself.

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Effective networking gets results

General practice ~ Mental health ~ Personal safety ~ Police assistance ~ Right 4 ~ Consistent with needs

An advocate was approached by a consumer for help to get the medication she needed. She had been unable to obtain a prescription from any local medical practice in the area due to a previous incident at one of the practices. Local practice staff were concerned about their personal safety and felt they were at risk from this consumer. The consumer was in a vulnerable state and required medication for her mental health and wellbeing.

After seeking the consumer's agreement, the advocate contacted the sergeant in charge at the local police station and asked if he could provide assistance. As the local police were well aware of the consumer's situation and mental health history they immediately provided a positive response to the advocate's request.

A time was organized for the consumer to come to the local police station and two non-uniformed women police officers accompanied her to a local medical practice. The practice had agreed to provide a consultation, provided there was adequate safety precautions in place for their staff and other patients.

The consumer and police officers attended the medical practice as arranged and a successful consultation occurred between the general practitioner and the consumer.

The consumer identified this as a positive step as she was able to obtain the medication she needed. The practice eventually agreed to see the consumer without a police escort when she required a prescription for future medication.

The local police were happy to help as they often dealt with this consumer and the consequences when she was not taking her medication.

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The GP that refused to listen

GP ~ Sick baby ~ Right 2 ~ Age discrimination ~ Right 5 ~ Effective communication

A young first time mother complained to an advocate that her GP hadn't listened to her concerns. She had taken her three-week-old baby for a check by the GP as she was concerned about the baby's breathing and restlessness. The GP advised the baby was fine.

A couple of weeks later she returned to the GP with the same concerns and was again told the baby was OK. In addition she was given tips on baby care. Unhappy with her concerns being dismissed in this way, she took the baby to an after hour clinic where bronchitis was diagnosed and treatment provided.

The young woman felt the GP at her regular practice had not taken her concerns seriously and had discriminated against her on the basis of her age. After considering the options she decided to put her concerns in writing and have the letter checked by the advocate before sending it to the GP. The advocate gave her a guide to writing a letter of complaint.

The response from the GP contained an apology, an explanation and an offer to meet. Although the young woman declined a meeting as she had moved to another GP, she was happy with the outcome.

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Problems when costs are not transparent

GP Practice ~ Hidden costs ~ Right 5 ~ Effective communication ~ Self advocacy

A frustrated consumer emailed her complaint to both the advocacy service and her GP practice after a dispute over fees. The consumer had already made several attempts to resolve the matter and had collected information on a range of options including the disputes tribunal.

After meeting with the consumer to discuss the options, a meeting was organised with the GP practice to discuss the issues. The advocate supported the consumer at the meeting with the GP, the Practice Manager, and another senior staff member.

The complaint was taken very seriously and staff advised they had made changes to their charging practice so it was more transparent. They also acknowledged the challenging issues of communication with consumers with complex health needs.

The consumer was very happy with this acknowledgment and their understanding of the issues she had raised. The remedies offered by the practice included waiving contested charges as well as a new partnership approach for dealing with complex family health issues.

The advocate was contacted by other members of the consumer's family who were delighted with the outcome. The advocate was able to recognise the thorough work the consumer had already done before contacting the advocacy service which had helped to achieve such a great result.

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Self-advocacy following delays at GP Practice

GP Practice ~ Delays ~ Surgical dressings ~ Medical Records

Following a surgical procedure, a consumer was directed to his GP Practice to have the dressings changed. Following a consultation with the GP he was told to wait in the waiting room for the nurse to change his dressings. The consumer told the doctor he had another appointment at the hospital and was assured he would not miss it. He sat in the waiting room minus his shirt with the dressing hanging from the side of his neck for forty-five minutes before the nurse attended to him. As soon as the dressing was changed he left the practice in haste without paying or collecting his prescriptions as he feared he would miss his hospital appointment.

He contacted the advocate to say he had requested his medical records over a month ago and had not received them. However, when he contacted the Practice he was told the delay was due to the outstanding account. He believed he was being held to ransom and wanted support to prevent this happening to another person.

After discussing his options (including the Privacy Commissioner), the consumer said he felt able to self advocate and would contact the Practice about the matter. He was very happy the advocate had been able to provide him with information that would assist him to manage the situation.

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Abrupt GP very apologetic

GP ~ Right 1 ~ Respect ~ Written apology

A consumer complained to an advocate about a general practitioner at one of the local medical centres. She said he had treated her in a rude and abrupt manner on more than one occasion. She had changed practices but felt it was important to let the doctor know how she felt. She had no desire to meet with the doctor but wanted help to write a letter seeking an apology for the way she had been treated.

The consumer received a prompt response from the doctor offering his "sincerest apologies". The GP said he had taken note of the issues raised in her letter and was happy to meet with her and a support person of her choice to apologise in person. The consumer chose not to meet as she was happy with the written response.

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Harsh treatment of a rest home resident by a practice nurse

Rest home resident ~ Practice nurse ~ Right 1 ~ Respect ~ Right 3 ~ Dignity ~ Right 4 ~ Appropriate standards

A rest home resident spoke with an advocate about an upsetting incident she wanted to complain about. She had gone to her GP's practice to have her ears cleaned out. The practice nurse did not check the temperature of the water, which was far too hot. Then the cleaning of the first ear took longer than usual so when the resident stood up to change sides she lost her balance and knocked over a tray of instruments. The nurse was very cross and swore at her. When the procedure was over the resident was taken back to the waiting area, and "plonked" down with her walker. The nurse ignored the resident telling the staff member from the home who had accompanied her, that "they get dizzy sometimes afterwards". The resident was very distressed by this incident and felt so ill she could not eat her lunch. She felt she had been treated with little care, and the disrespect and lack of dignity made her feel powerless and humiliated.

After discussing the options, the advocate assisted her to draft a letter requesting an apology and acknowledgement that this sort of treatment was inappropriate so that it would not happen again to future patients.

Although the consumer received a letter with a written apology, she was disappointed the nurse had not acknowledged her inappropriate behaviour. She discussed other options with the advocate and decided not to pursue the matter as she felt that by having raised her concerns already, the nurse would be more careful in her treatment of elderly people in the future.

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Unwelcome drama at a general practice

GP reception ~ Right 1 ~ Respect

A woman sought the assistance of an advocate to help her with a complaint to a general practice. She had gone to the practice for an appointment with her usual GP. When the GP called her name, the receptionist rushed up to her to say she had been double booked with the GP. Then in the middle of the consultation the practice manager knocked on the GP's door to say the other patient was waiting.

When the woman was at the reception desk waiting to pay, the practice manager approached the GP and in a voice that could be easily heard by others in the waiting room told the GP off for double booking. The GP tried speaking to the practice manager in a lower voice but as they were in the reception area their comments about patients could still be heard. Although the practice manager told the GP she didn't think it was a professional thing to do, once the GP's back was turned the practice manager and reception staff all threw up their hands and rolled their eyes.

The woman was frustrated by this unwelcome drama and became angry at the staff. As she had also had her appointment interrupted she made some offensive remarks to them. The receptionist responded by telling her not to come back as she was no longer welcome at the practice.

The woman had a prescription to pick up and requested her partner to do this for her since she had been told not to come back. A friend of hers happened to be in the waiting area when the GP asked the receptionist if she had collected the prescription. The receptionist replied in a loud voice that her lesbian partner had picked it up.

The woman was very upset by the behaviour at the practice. Due to her emotional state and work commitments she did not feel able to write a letter of complaint and asked if the advocate would be able to draft a letter for her. The advocate agreed to do this and emailed it to the consumer for sending.

The woman later contacted the advocate to say she had received an apology from the receptionist for the way she had been treated.

She was also told she was able to remain with the practice, but had decided to change to a different practice. She was pleased to have had an advocate to support her at a time when she felt so upset by what had happened.

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Rude response from medical centre nurse

Medical centre ~ Right 1~ Respect ~ Warfarin levels ~ Nurse ~ Non-English speaking consumer

A son, acting as an agent for his mother, who didn't speak English, contacted an advocate for help to make a complaint about the way he was spoken to by a nurse. His mother had a medical condition requiring warfarin, the dose of which is adjusted regularly according to blood results received by a medical centre. The usual process was that someone from the medical centre phoned his mobile phone and provided the results and dosage his mother was to take.

On this particular occasion he did not answer his phone at the time. As no message was left he phoned the medical centre but it had closed. He followed up with a further call on the next business day. When he asked the nurse why she had not left a message about his mother's warfarin results, the discussion became heated and the nurse hung up on him. He believed she did this because she was unable to understand his heavily accented English.

As it was imperative for them to maintain a positive ongoing relationship with the medical centre he wanted an advocate to help resolve the matter in a way that would help preserve this relationship.

He felt the best option was for a meeting which he asked the advocate to arrange. The manager of the centre agreed to meet and listened to what had happened. After discussing the best way for notifying his mother's results, it was agreed that a file alert would be made to text the results to the son who would then pass the information to his mother. The meeting concluded with a verbal apology from the manager as well as an undertaking to send a written apology by the end of the week. The son was very happy with this outcome.

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Medical Practice GP Gets it Wrong

GP ~ Right 4 ~ sSndard of care ~ Failure to diagnose

A consumer who presented at a general practice with a very bad headache was sent home with pain relief and told there was nothing wrong with him. After a night of intense pain and no sleep his family took him to the Emergency Department the next day. He was diagnosed with internal bleeding and was admitted to hospital for four days. Over this time he received a blood transfusion to replace the blood he had lost.

The consumer contacted an advocate to support him to write to the practice and notify them about what had happened to him. He received a written response advising his complaint had been investigated. The letter contained an apology and the offer of a meeting with the doctor.

The consumer was satisfied with the apology and the acknowledgement knowing that the practice had taken his concerns seriously. and did not feel it necessary to attend a meeting.

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Medication change damages relationship with GP

Rights 2, 4 & 5 ~ Discrimination ~ Victimised ~ Care consistent with needs ~ Effective communication ~ GP ~ Mental health ~ Medication ~ Privacy

A consumer was very upset at the actions of his GP. After being prescribed the same medication for seventeen years for both pain and mental illness, he felt his new GP had made an arbitrary decision to discontinue the medication and refer him to a detox clinic. He felt he was being discriminated against and felt victimised. However he did not want to compromise his relationship with the GP and sought advocacy support to help resolve his concerns.

After considering the options the consumer chose to have advocacy support to raise his concerns in a letter to the provider. However, he was very unhappy with the provider's response. Information contained in the response was a breach of his privacy, and he took that up with the Privacy Commissioner. Although he pursued the privacy matter he decided not to pursue his complaint about the GP stopping his medication, opting to find a new GP instead.

He has since contacted the advocate to tell her that since receiving her support with his first complaint he has been able to self advocate on another matter that was of concern to him.

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Medical Centre overlooks telling a patient about the fee

Rights 6 & 7 ~ Fully informed ~ Choice ~ Payment ~ Medical practice

An 87-year-old man with a number of chronic medical conditions was discharged after being hospitalised for vertigo. Soon after discharge from hospital his arm began to swell, causing severe pain. He went to the weekend medical centre for treatment.

The consumer was triaged by a nurse and then treated by a doctor within 30 minutes of arrival. Following the consultation he was charged a fee. He was upset about this as he had been under the impression that he was being treated as an urgent patient, free of charge.

The consumer sought the help of an advocate to support him to write to the provider as he felt he had not been fully informed of the triage process.

A written response was received from the provider and a meeting arranged. The consumer expressed his concerns about not being fully informed about the triage process and that he would need to pay for the consultation and any treatment provided. These were fully acknowledged by the provider and a written apology was received. The consumer was very happy with this outcome.

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A disappointing first response to a consumer

Rights 4 & 10 ~ Appropriate standards ~ Complaint process ~ Medical Centre ~ Detached retina

A consumer contacted the advocacy service after receiving an inadequate response to her complaint about a doctor's response to her eye symptoms.

The doctor had diagnosed her with an eye infection, despite her concern that it could be a retinal detachment. He also said the red skin lump was an infected hair follicle that did not require treatment. The consumer sought a second opinion resulting in urgent surgery for a retinal detachment and removal of a small skin growth. Although the response had included an apology from the treating doctor and a copy of the medical notes from the Medical Centre's Clinical Director, she felt it had not addressed her concerns about the doctor's competence and how this was affecting his practice.

After discussing the options with the advocate, the consumer chose to send a second letter of complaint. A full response was received from the Medical Centre's Clinical Director who advised that he would have referred her to a specialist. As a result of her complaint he had notified the Medical Council so the doctor's annual practicing certificate had been changed to requiring on-site supervision. The Clinical Director also apologised for the inadequate response that left her feeling that her initial complaint was not taken seriously as well as the lack of information provided about their complaint process.

As a result of this second response, the consumer was happy to have received a full written explanation that included support for the doctor as well as an apology, and was pleased to have finally been taken seriously.

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An alarming GP response

Rights 1 & 8 ~ Respect ~ Support ~ General practice ~ GP ~ Chaperone ~ Disability

A consumer made an appointment with a GP to have a Work and Income Disability form completed. However, she felt she was spoken to in an unprofessional and inappropriate manner. The doctor said she needed to prove she was unwell and told her to remove her clothes. The consumer said she did not want to have an examination without a female nurse present. The doctor responded with a "no" and pulled the curtain to the cubicle. A few minutes later he left the room, returning with another patient and then ushered the consumer out of the cubicle closing the door behind her.

The consumer was shocked, distressed and confused by the incident and approached the receptionist to explain what had just happened. Her usual GP heard her distressed tone and took her into the office. Upon hearing the consumer's account of what had happened, the GP informed the consumer she would not be seen by the first GP again.

Unhappy with the response to her concerns, the consumer approached an advocate. After considering her options, the consumer asked the advocate to help her write a letter to the complaints manager at the practice. She wanted an apology from the doctor and a written explanation as to why he had spoken to her like he did and why he treated her so inappropriately.

In response to the letter of complaint, the complaints manager rang to ask if she would like to meet, which she agreed to. At the meeting the consumer was informed that the doctor was no longer employed by the practice. However, the practice manager tendered an apology on behalf of the clinic staff, and informed the consumer she would also receive a written apology. The consumer was happy with this outcome as the meeting had resolved her concerns about the practice.

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Problems with a medical receptionist - Right 4

A consumer contacted the advocacy service for assistance with a tricky situation where a receptionist was acting as a gatekeeper. Due to the need to stop smoking because of health issues his GP had prescribed nicotine replacements. Three days prior to his prescription running out he contacted the practice to arrange for a repeat prescription. Each time he called he was "fobbed off" by the medical receptionist who advised him that there were no GPs available to write a prescription for him.

The consumer phoned for an advocate after the receptionist refused to take any further calls from him. After discussing the options the consumer asked the advocate to phone the practice on his behalf as he was feeling stressed at the thought he would soon exhaust his supply of gum and be tempted to have a cigarette.

The advocate phoned the head office for the medical centre and asked to speak with the manager. The manager confirmed that the medical centre in question was a very busy one and that the GPs had not been available. However, she said she would phone the consumer and arrange for a GP at their other clinic to write a prescription and fax it through to the pharmacy. She also confirmed that she would speak with the receptionist at the medical centre and make her aware that in circumstances like this she should have referred the consumer to the centre manager.

The advocate phoned the consumer the following day and he confirmed that the prescription had been faxed to the pharmacy. He was very pleased with the support he had received from the advocate to resolve the situation.

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A breakdown in communication

GP ~ Right 5 ~ Effective communication

A consumer was very distressed about the way a GP had spoken to and treated her at a recent appointment. The consumer felt the GP had not listened to her, did not want to understand what she had come to talk about, and showed no interest in her illness. The consumer was very apprehensive about going to the follow-up appointment and requested the support of an advocate to help her communicate with the GP.

The advocate assisted her to document the concerns that needed to be addressed. These included comments made by the GP about the consumer being narcissistic, as well as the GP being rude. The consumer requested a copy of her file and saw that the GP had also written comments in the notes about her being a narcissist. With the support of the advocate she wrote a letter of complaint to the medical practice requesting a meeting to discuss the points in the letter with the GP and the Practice Manager.

At the meeting a verbal apology was given to the consumer. Following the meeting she received a written apology from the GP and the comment was removed from her notes.

The consumer was happy with this outcome, but decided to find a new GP.

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Disrespectful GP

A consumer contacted an advocate after being upset by information provided in a letter from his GP. The consumer said that the GP had referred to him as being beyond reform, mischievous and dishonest. Although the consumer had ongoing health issues he has refused to continue receiving treatment for these as he felt other health professionals had been influenced by the GP's comments. He felt he was being treated with disrespect by them as well.

The advocate met with the consumer to discuss his issues and what actions might help to resolve his concerns. The consumer said he had written to the GP and had not received a response. He requested the advocate write another letter on his behalf. The letter was drafted and when the consumer had approved the content it was sent to the GP.

The GP wrote back apologising for his comments. The consumer advises that he is now being treated respectfully when he visits these other health professionals and that advocacy support was very helpful with getting his concerns resolved.

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A very long wait

An advocate met with a consumer who was unhappy about the way she had been spoken to when she raised her concerns about being left in a small room on her own, at the local medical practice, for over an hour.

When she approached the locum doctor who had put her in the room, she found the response so upsetting she left without getting the prescription for the medication she needed. As a result she ended up at the local emergency department later that day.

The consumer considered the options for resolving the complaint and after initially wanting to meet with the doctor; she decided to send a letter to the practice instead.

She was happy with the response from the doctor.

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Learning from a mistake

Face-to-face resolution meeting ~ Prescribing risks ~ General practice ~ Fluconazole

A woman who saw a locum doctor for a fungal infection of her foot was prescribed an eight-week course of fluconazole (Diflucan). Several weeks later, she found out she was pregnant. Her usual GP informed her of the possible risks of the drug causing abnormalities to the developing baby and that the drug should be avoided during pregnancy unless the fungal infection was severe or potentially life-threatening.

After weeks of agonizing she and her husband concluded that the risk was too high and reluctantly decided to terminate the pregnancy. She complained to HDC:

"If I had been informed from the beginning of the risks, I would never have put myself in the position of becoming pregnant while on that drug. I am hoping something can be done to make the doctor more diligent while prescribing drugs that could possibly change people's lives forever."

The complaint was referred to an advocate who supported the consumer at a face-to-face resolution meeting. At the meeting the consumer said she accepted the doctor had not deliberately prescribed something that could harm her unborn child. However, she wanted him to understand the effect of the termination on her and her family, and her hope that others would not have to go through the same experience.

The doctor said he had prescribed fluconazole for a number of years and had not been aware of the risk during pregnancy. He provided the consumer with a copy of his revised information sheet on the use of anti-fungal treatment including the risk when pregnant, and agreed to refund her consultation fee.

During the meeting, the doctor expressed his concern about how difficult it is for GPs to stay abreast of changes in prescribing information. This was passed on to HDC who informed the Medical Council, Medsafe and the RNZCGP of the circumstances surrounding the complaint so that they could take appropriate follow-up action.

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Being taken seriously by a GP

A consumer contacted an advocate for information about her rights, as she felt her GP was not listening to her. She had requested a referral to a specialist as she felt the medication the GP had prescribed for her skin condition was not helping and he was not taking her concerns seriously. She also had a very sore wrist and although he had referred her for an X-ray he did not provide any pain relief. She attempted to contact the Practice Manager but had the feeling no-one wanted to deal with her. She said she wanted the GP and others in higher positions in the practice to know how she felt.

After considering the options the consumer asked the advocate to set up a meeting with the provider. The provider organisation advised that those attending the meeting would be the human resources manager, the business support person, and the quality assurance manager. This information was relayed to the consumer who said she was happy to meet with them.

At the meeting the consumer spoke about her concerns and how she was feeling. Those present listened, acknowledged her concerns and apologised. They also apologised for the delay in meeting with her.

At the conclusion of the meeting the consumer said she was pleased to have had the opportunity to raise her issues in a face-to-face meeting. She said she felt empowered by the process and pleased to have been treated with respect.

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A GP's lack of consumer-centred care

A woman wrote to the GP who provided care to her recently deceased father, outlining some concerns. She had attended a GP appointment with her father when he complained of decreasing mobility and ongoing vomiting. The daughter felt the GP had not taken the symptoms seriously, as her father was sent home. Four days later, when his condition worsened, both he and his wife left messages at the medical centre requesting either the GP or his nurse call back. Neither of them returned these calls. In the end the daughter called an ambulance, her father was admitted to hospital and died two days later.

When he received the complaint, the GP contacted the daughter and said he was willing to meet. He suggested she may wish to contact the advocacy service to have the support of an advocate at the meeting and gave her the contact details. She contacted the local advocate and they discussed the matters she had raised in her letter of complaint to the doctor. These included the GP's failure to:

look at her father when speaking even though he was aware of her father's significant hearing loss,
refer to the consumer's medical records, as well as his lack of knowledge about his past medical history,
take the consumer's symptoms seriously, meaning he didn't get the referral to hospital he needed,
return calls left at the medical centre despite being advised of the need for urgency in responding.

She wanted an apology from the GP as well as an investigation into the communication practices at the medical centre to see whether the calls not being returned were due to a system error.

The advocate supported the consumer's wife and his daughter at a meeting with the GP and Practice Manager. The Practice Manager confirmed the phone system had not been working that day and said the matter was being looked into to see what improvements could be made to prevent the problem happening again. The Manager apologised for the telephone failures.

The GP said he had been very busy on the day he saw the consumer. Upon reflection he acknowledged that he may not have been facing the consumer throughout the consultation so he missed seeing the extent of the consumer's pain. He also apologised and advised that he had identified ways he could improve aspects of his practice. He sought permission from the family to use this situation as a learning experience with his colleagues. Permission was given willingly.

The family was very satisfied with the outcome of the meeting and was pleased their concerns had been heard and improvements made as a result of their complaint.

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Dealing with POW grief and an ambivalent GP

A former prisoner of war complained to an advocate that his GP was not listening to him. He said the GP had dismissed requests for further referrals suggested by the specialists screening him for Veterans Affairs. It had taken this man 60 years to speak up about his days as a POW and he felt belittled by the GP's remarks about his past history.

He had suffered several severe chronic conditions, both physically and mentally, most of his life. He was keen for these conditions to be finally recognised as a result of his POW days and the information used for statistical and historical purposes.

With the support of the advocate and the knowledge of his rights, he was able to insist on further examinations which led to his conditions being recognised. He finally felt listened to and that he was getting recognition for the grief he had suffered over the last 60 years.

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Missed diagnosis

A young mother in her early twenties contacted advocacy as she had recently been diagnosed as having stage 4 bowel cancer with a prognosis of twelve months to live. She had been a patient at the same medical centre for eight years, and had repeatedly requested her general practitioner take her health concerns seriously (bloated stomach and problematic/painful bowel).

After discussing the options available, with the support of an advocate she sent a formal letter of complaint to the medical centre informing them of the recent diagnosis. She requested a copy of her full medical history. She wanted her diagnosis and treatment as managed by her GPs to be recognised as inadequate, and a formal apology.

The practice manager responded immediately providing her medical records, acknowledging the inadequacy of diagnosis and treatment, and providing a formal apology, which the consumer accepted.

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Prescription of antibiotics following surgery

Following nasal surgery, as a result of an infection, a consumer was prescribed a 14-day course of antibiotics by her GP. The GP told her that a referral would be made back to the hospital if the infection did not clear.

She returned to the medical centre ten days later, and was seen by another GP who prescribed two different antibiotics to be taken during the following two weeks, and told her to return if there was no improvement. She returned at the end of the two weeks and was again prescribed antibiotics, and told to return in three weeks.

On the fourth visit the consumer informed the GP that she had had a cold resulting in her being off work for four days, and was very mucousy and had pain below her eye. She was prescribed Rifampicin, which the GP explained is normally given to patients with tuberculosis, but can assist with deep tissue infections. He referred her for an x-ray. The consumer asked about the possibility of a CT scan but was told an x-ray would be sufficient. She was advised to return in 2-3 weeks if the matter had not resolved.

Following this consultation the consumer contacted an advocate as she felt she should have been referred back to the Hospital Ear Nose and Throat Department (ENT). After discussion of the options, the advocate supported the consumer to write to the GP asking for a referral to ENT, for a copy of medical notes made during the consultations and an explanation of why a CT was not ordered.

The GP responded that he would need to see the consumer again to complete a referral to ENT and that this visit would be free. He explained that a CT scan can only be requested by a specialist. The consumer was satisfied with the response of the provider and took up his offer.

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Regular eye tests for intellectually disabled man with diabetes

At the suggestion of an eye specialist, a complainant contacted the local advocate to discuss her concerns about the care of her intellectually disabled son. Her son had type II diabetes and over a nine-year period the GP had not checked his eyesight. The complainant had noted her son's eyesight deteriorating and within a month the consumer underwent an operation. He had a second operation a month later and vision was partially restored.

The complainant believed the failure to check the consumer's eyesight was because of her son's intellectual disability and that had appropriate action been taken by the GP her son's eyesight may have been saved. Losing his eyesight compromised the his ability to be independent.

The complainant said she wanted an explanation from the GP as to why he did not perform regular eye tests. She wanted a face-to-face meeting with the GP, preferably in her own home to minimise disruption for her son, and with the support of another of her sons. The consumer agreed he wanted his mother to raise the complaint for him.

With the support of the advocate, the complainant wrote a letter to the provider outlining her concerns, requesting a meeting in her home. The provider agreed, and advised they would have another doctor with them for support. The complainant was happy with this.

The complainant opened the hui with an explanation of how her son's blindness had impacted not only on himself, but her whole family. As she became upset, the consumer sat by her and consoled his mother. The consumer's brother took over, advising the family felt very let down by the service and wanted an explanation as to why the consumer had not had regular eye checks since his diagnosis of diabetes.

The GP was very apologetic and the senior doctor acknowledged that the service had let them down. He said they were reviewing and updating procedures as a result of receiving their letter of complaint.

The GP explained that when the original referral for the consumer was sent, the section relating to the eye test had not been completed, and as a result the referral was returned and no further action was taken. The doctor said they now had implemented a system where returned referrals would be brought to the attention of the appropriate GP to enable them to take further action. They agreed, within a week, to complete the necessary paperwork for a treatment injury claim under ACC for the consumer.

At the end of the meeting, the complainant thanked the doctors for their time, said she was now ready to move forward, and athat she accepted their apology and their mistake. She explained she did not want any other family to go through what they had had to go through.

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Charges for prescriptions

A locum saw a young woman who needed a prescription for her epilepsy. While there she asked for a prescription for her children. The doctor did three prescriptions for the children but was told to make another appointment for her epilepsy medication. She did this although her family could not afford the additional cost. When her partner picked up the medication he discovered that the epilepsy medication was incorrect and that despite all three scripts for the children being for the same thing he was to be charged $5 for each of them. He contacted the medical centre to discuss this and while speaking with the receptionist brought up the additional visit and associated cost. The receptionist said that he shouldn't complain, as the visits were subsidised.

The woman asked the advocate to contact the practice manager on the family's behalf. The practice manager said that another GP would take on the woman's care until her own GP returned, and that the correct prescription would be faxed to the chemist at no charge. The practice manager would speak to the chemist about the individual charges for the childrens' treatment as prescriptions for the same medication for the same family could be put into one prescription.

The family was impressed not only by the process but by the short time frame in which it had been achieved.

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Being listened to

A consumer felt her GP was not listening to her and that as a result of incorrect information being given to a specialist she had lost her driver's license. She decided that the best option was to obtain services from a new GP but requested advocacy support at the first consultation where she intended discussing all the medical issues she felt had not previously been addressed.

The new GP listened, completed forms and referrals to specialists as requested, then reviewed and reduced the consumer's medication. The consumer left the consultation feeling she had been heard, and that appropriate actions had been taken by the new GP.

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Providing support at a GP visit

A man visited his GP on a number of occasions for sores on various parts of his body. On two occasions surgical intervention was required to drain the sores. While the GP had given the man an explanation of the cause of the sores, it was in medical terms which consumer didn't understand. He was too embarrassed to ask for clarification, and asked for advocacy support at his next appointment.

With this support, the consumer felt able to ask for an explanation in simple terms. The GP told him how he could care for the sores himself, and the GP offered a specialist referral if necessary.

The consumer called two weeks later to say his skin was looking great and he was delighted that by simply changing towels daily and using an antiseptic soap he was able to leave the house without embarrassment. He felt he did not need specialist intervention and was grateful for the support he had received from the advocate.

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Changing to a new GP

A consumer felt that the service she was getting from her GP of twenty years was not what she desired. She had requested a change via the receptionist and this had not been acted upon. The consumer did not want to lay a complaint as she lived in a community where there were few options for medical care.

The consumer discussed the options with an advocate, and chose to write to the GP of her choice at the practice requesting she be taken on as a patient of that GP. She felt confident that her request would be met and thanked me for my assistance.

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Monthly prescriptions

A consumer advised that she lived in a rural community, had difficulty getting transport to town and was on an Invalid Benefit. Due to her circumstances her regular GP provided monthly prescriptions for the controlled medicine she took. Her GP went on leave the locum would only provide a weekly prescription. After discussing how the advocate could assist her through the complaint process, the consumer opted to put her complaint in writing, addressing her concerns to her GP and the practice manager.

She received a written apology advising that her circumstances had been noted on her file and that in the event of her GP being on leave again she would be given monthly prescriptions. The consumer was happy with the outcome.

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Improving communication at a medical practice

A consumer felt her doctor did not treat her with respect and did not explain follow-up procedures or test results to her. When she tried to make a complaint, she was not given the correct complaints procedure at the practice and had been told "to find another doctor" by the receptionist.
When discussing the options with an advocate, the woman said she did not want to meet with the doctor so the advocate supported her to write a letter outlining her. The doctor did not respond within the required timeframe and when the advocate followed up he advised he was unaware of the role of the advocacy service. After the advocate outlined the role of advocacy, and the doctor advised he would like to meet with the consumer at a neutral place and requested the advocate again discuss a meeting with the consumer.

The consumer finally agreed to meet. The doctor agreed to change the way he provided information and reimbursed the consumer for the expenses incurred in finding a new GP. He also agreed to a date the advocate could provide an education on the Code and advocacy for staff employed at the practice.

The consumer thanked the advocate for supporting her and said she felt the presence of an advocate had made a difference to the doctor's communication, and to "the way he will treat future patients".

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Availability of patient records at general practice

A whänau made an appointment with an advocate as they were concerned that their GP practice did not hold any historical notes for one of their whänau. The man had requested his notes from the practice in order make a claim through ACC, but was advised that they had none available. Despite filling out an enrolment form when he joined the practice three years previous, the notes had not been obtained from his previous practice.

They wrote to the practice expressing their concerns, requesting that the notes be obtained and that they review their systems to ensure historical medical notes were available should they be needed. They asked the advocate's advice on the layout of their letter, whether their expectations were realistic and what they should expect as a response from the provider.

The consumer was happy with the outcome, having received an apology and copies of his notes. He was advised that the practice was reviewing all patient records to ensure they contained the relevant historical information.

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A listening ear

The consumer described how, at a consultation for a back problem, the GP had directed her to the examination table to look at her back. Without informing her, the doctor attempted to "crack her back". Following this procedure she was in tears, and on exiting the consultation room she spoke to the reception staff about this.

An advocate informed the consumer of her right to complain and how the advocacy service could support her through the process. The consumer made the decision not to pursue the matter, as she just wanted someone to be aware of her concern.

She thanked the advocate for listening and said she felt heartened by the information the advocate had provided.

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Talk to the patient

A consumer contacted an advocate who assisted him with a letter of complaint to his GP about the way the GP had responded to him.

The GP apologised for making a clinical decision without consulting him about the treatment and said -

" a valuable lesson has been learned. I should have taken more time and care in discussing with you the options for pain relief. I have certainly learned a lesson and won't be doing it again."

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Family and privacy issues when visiting the GP

A woman sought the support of an advocate after an unsatisfactory visit to her GP. She did not understand why the GP had not treated the whole family at one appointment as they all had the same contagious infection. It was not until she picked up the prescription that she realised the GP had not prescribed anything for the children. When she returned to the practice to query this, the nurses embarrassed her by openly discussing the infection in front of other patients so she left.

After considering the options, she asked the advocate to help her write a letter to the Practice Manager outlining her concerns and requesting a resolution meeting. She wanted an apology from the nurses and the GP, as well as an explanation from the GP about why the whole family weren't treated in the first instance. She was also keen for the staff to receive training on the Code as she felt her rights had not been respected.

The advocate supported the consumer at the meeting where she received both an explanation and an apology from the GP. He advised he had already spoken to the nurses and reminded the team about the need to respect patients' rights and to ensure their privacy was maintained at all times.

Following the meeting, the consumer received a written apology as well as an undertaking that the practice would work with the advocacy service to provide training on the Code of Rights to the staff, to ensure they are all aware of their duties and responsibilities to patients.

The advocate subsequently arranged to go and speak to the staff at the practice. The consumer was very happy with the outcome and comfortable about continuing to attend the practice as her issues had been resolved.

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