Gatekeepers

I am not, by nature, an assertive person. I am getting better at it, but I'm still not great. As you may have gathered, I'm one of these folks who nods meekly on the outside, while seething on the inside and then rants to my other half about all the things I wish I'd said.

This is especially problematic when dealing with doctors. All doctors, especially GPs have essentially two functions :
1) To diagnose / manage conditions and do other doctor-ly things
2) To act as "gatekeepers" to other services

I used to expect my GP to telepathically know that "my joints still hurt" means "please refer me to rheumatology", because I was too afraid of seeming demanding by asking for what I wanted. I'm finding it a bit easier these days, especially since I was introduced to the Assertive Method (really well worth a read, I like to glance over it before each time I go to the GP). For example :

• Step 1 - I have been telling you about my joint pain for 2 years now, and it's been getting worse, not better.
• Step 2 - I am feeling overwhelmed by these symptoms at the moment, and I don't know how to cope.
• Step 3 - I would like you to refer me to rheumatology so that I can get a proper diagnosis, and some more help.
• Step 4 - What do you think?
• GP - I don't think that's necessary, there's no sign of inflammatory arthritis, your RF and ANA are negative, hypermobility can cause a bit of joint pain etc, etc, etc.
• Step 3 - I would like a referral anyway, so that I can get a proper diagnosis, and some more help.
• GP- OK.
  

The picture shows a green metal gate with flowers
worked into it. It is dark, and through the gaps you
can see a passing car, and a red traffic light.

It might not always work, but it is very effective. And, more importantly sometimes, if it doesn't work, you still have your dignity. When your relationship with a doctor is battered and bruised because they constantly seem to disbelieve you, your dignity is important.

I've been on the other side of this tactic - for example a student-led consultation with a gentleman who was completely insistent about getting some diazepam. He would not be talked down, over and over again "I just want my tablets". In the end my GP tutor gave him the prescription.

There is a reason doctors aren't allowed to prescribe for themselves or their nearest and dearest. Sometimes you need a bit of outside impartiality in your life. But, it's important to be educated about your health, and your condition - and sometimes that will mean that you literally do know better than your GP.

How do you guys, especially medics / expert patients, deal with your GPs in their gatekeeping role?