Twelve mistakes even good GPs make: They deal with so many illnesses they can't always keep up with the latest thinking. And our experts reveal YOU may pay the price

Our GPs act as the gatekeepers to the NHS - they decide whether they should treat you, or if you need referring for specialist attention. It is a difficult and challenging role, since a family doctor is required to have some understanding of a broad range of physical and psychological conditions.
But with even specialists overwhelmed by the rate of medical developments, are there ways GP care could be improved?
As Chris Eden, a leading urologist, explains: 'Due to the rapid pace of advancement in medicine, GPs in 2013 do a job that their predecessors could never have imagined doing in the past. I struggle to remain current with just the latest research in prostate cancer and really can't imagine trying to keep abreast of advances in all medical specialities.'
Here, we ask some of the country's leading medical specialists - whose patients are referred to them by GPs - to identify how the doctors at your local surgery could enhance the care they provide.

With even specialists overwhelmed by the rate of developments, are there ways GP care could be improved?

FAULTY HEARTBEAT

Dr Glyn Thomas, a consultant cardiologist at the Bristol Heart Institute, says: 'People who suffer with atrial fibrillation -irregular heart rhythm - are five times more likely to suffer with a stroke; what's more, the strokes triggered by this condition are also more likely to be fatal.
'So atrial fibrillation (AF) patients - who make up 2 per cent of the population - should be prescribed an anticoagulant such as warfarin or dabigatran to prevent the blood clotting and so reduce the risk of stroke.
'However, GPs often prescribe aspirin instead, shying away from drugs such as warfarin because they fear the risk of internal bleeding. But this is nonsense. Not only does aspirin carry all the same risks of bleeding, it has none of the benefits because it is not effective as an anticoagulant.
'Warfarin reduces the risk of stroke in AF patients by 64 per cent; aspirin reduces it by  0 per cent! But the bleeding risk is the same. It remains ridiculous that GPs - and even some hospital doctors - don't know this.
'Warfarin does need careful monitoring, which perhaps is why GPs might not prescribe it, but I think the main reason is they are concerned, wrongly, about excess bleeding.'

ABDOMINAL PAIN

There is a tendency among GPs to think an attack of upper abdominal pain must be to do with the stomach

Dr Peter Fairclough, Harley Street consultant gastroenterologist, says: 'I see a lot of patients needlessly referred after an attack of upper abdominal pain, which their GP has decided is gastritis - where the stomach lining becomes inflamed and irritated as a result of infection, alcohol use or medication. They recommend investigation with an endoscopy - a camera inserted down the throat.
In fact, what these patients have is gallstones - usually formed of cholesterol - in the gallbladder, which is just under the liver and the ribs on the right-hand side of the upper abdomen.
'Gallstones, which affect 10 per cent of those over 40, will not be picked up through an endoscopy. So the results will come back normal and the patient will have been through the inconvenience of a referral and a procedure they may find uncomfortable for nothing. And that's aside from the cost to the NHS.
'There is a tendency among GPs to think an attack of upper abdominal pain must be to do with the stomach and that it will require investigation this way. However, a diagnosis of gallstones can be confirmed with blood tests or ultrasound.'

BLOATED STOMACH

Professor Gordon Jayson, medical oncologist and ovarian cancer specialist at The Christie Hospital in Manchester, says:
'GPs need to listen really carefully when a women in her 50s comes in complaining of abdominal pain and bloating. It's easy to think it's IBS -and in most cases it will be.
'But the symptoms could also be those of ovarian cancer. The critical difference is that whereas IBS pain will come and go, the pain and bloating from ovarian cancer will be progressive and constant.
'If it's the latter, a GP needs to arrange for a blood test for a chemical called CA125 - this is produced by some ovarian cancer cells, though levels may also be raised in many benign conditions.
'Although ovarian cancer is among the deadliest of cancers, with only a third of the 7,000 women diagnosed each year surviving, if it's caught early, 95 per cent of cases are treatable.
'For a GP with only a few minutes to make a diagnosis, IBS is going to be faster and a far more likely diagnosis than ovarian cancer. A study by Target Ovarian Cancer found four in five GPs wrongly thought women with early-stage ovarian cancer had no symptoms.'

Patients can be given painkillers that won't have much impact on their migraine

MIGRAINE

Dr Andrew Dowson, director of headache services at King's College Hospital, London, says: 'Many GPs will miss a diagnosis of migraine as they think this type of headache has to have an aura - symptoms such as dark spots, sparkles, and zig-zag lines before the eyes, which can precede an attack.
'In fact, only one in ten patients has an aura and only 40 per cent of these will get them all of the time. So the vast majority of migraine suffers will not.
'A GP needs to recognise the other main symptoms of migraine, such as one-sided throbbing to the head, feeling sick or light and sound sensitivity.
'The problem with overlooking migraine is the patient will be given painkillers that won't have much impact on their headache.
'Migraines affect six million people in the UK - more than asthma, diabetes and epilepsy combined. Yet patients often come to my headache clinic after being referred by a GP having suffered the debilitating symptoms for years without a proper diagnosis.'

ECZEMA

Andrew Wright, professor of dermatology at the University of Bradford, says: 'When patients go to their doctors with an eczema-like rash, the routine seems to involve the GP having a quick look and then prescribing a cream such as a hydrocortisone, which will help relieve the symptoms.
'But often little direction is given about how much to use. So a 30g tube of ointment may be given with a request to come back in two weeks if there's no improvement.
'The patient thinks the cream is supposed to last two weeks, will under-treat themselves to keep the cream going, the eczema then gets worse, so they go back to their GP, who refers them to a specialist.
'If GPs could give proper direction about how to use the ointments they prescribe, rather than relying on the patient to read the small print on the leaflet, it would save us all a lot of time.
'GPs also shouldn't prescribe aqueous cream for eczema - not even to wash with. It's incredibly damaging to skin, especially children's, because it contains sodium lauryl sulphate, which is the harshest possible detergent.
'As a consequence, it breaks the skin down, making eczema worse. Very worryingly, many people are still given it as a moisturiser as it's the cheapest option.
'Research has shown more than half of children who used it suffered an immediate bad reaction, such as stinging.'

A blocked nose could be complications of a deviated septum

BLOCKED NOSE

Henry Sharpe, a consultant ear, nose and throat surgeon at East Kent Hospital, says: 'Around 5.2 million people see their GP complaining of a blocked nose and many will be given antibiotics or nasal spray on the assumption that the cause is nasal congestion.
'But a blocked nose can be anything from complications of a deviated septum - a bend in the cartilage separating the nostrils, which occurs in 75 per cent of people - to polyps, which are fleshy, non-cancerous swellings.
'Unfortunately, the GP only has a torch with which they can look up the nose - and many rarely do so anyway.
'I'd like to see referrals to an ENT department if the congestion goes on for more than a month.
'Antibiotics won't work if it isn't a bacterial infection; steroid sprays can have side-effects, from bleeding to discomfort. So rather than waste their time and their patient's time and discomfort, GPs should refer to a specialist if symptoms persist after four weeks.'

SHOULDER PAIN

Professor Tony Kochhar, consultant shoulder and upper limb surgeon at South London Healthcare NHS Trust and BMI The Sloane Hospital, says: 'GPs should refer patients with shoulder pain for an ultrasound scan before any other treatment such as anti-inflammatories or physiotherapy is suggested.
'The anatomy of the shoulder is especially complex. It's very hard for a GP to be able to tell what could be the cause of a pain in the shoulder - it's certainly difficult to tell the difference between a muscle strain and a tear.
'If there is a tear, and a GP sends the patient off for physiotherapy - where they'll often be told to work through the pain - that tear can get worse.
'So what starts out as a simple injury, perhaps necessitating a small operation, can lead to some irreparable damage or loss of function.
'Ultrasounds are fairly cheap for the NHS and in the long  term would save money on  needless physiotherapy referrals or prescriptions for anti- inflammatories, which can also upset the stomach.
'An ultrasound should be enough to locate the source of the problem. And it's also sometimes possible for treatment to take place during the scan - perhaps with an injection of anti-inflammatory steroid into the joint.'

The anatomy of the shoulder is especially complex. It's very hard for a GP to tell the cause of pain

MUCUS IN THROAT

John Rubin, a consultant ear, nose and throat surgeon at the Royal National Throat, Nose and Ear Hospital in London, says: 'I see a lot of patients who have suffered with a post-nasal drip - when excess mucus gathers in the throat or back of the nose - and whose GP has referred them to me for further tests. In fact, it could be something as simple as acid reflux - when acid splashes up from the stomach - which also creates a similar feeling, since the reflux creates a build-up of liquid in the throat.
'It's far more likely to be that since heartburn affects one in three people at some point. So rather than referring to a specialist, I'd like GPs first to try a front-line treatment, such as Gaviscon, which prevents acid in the stomach from flowing back into the gullet.'

INFLAMED,  PAINFUL JOINTS

Dr Andrew  Bamji, a consultant rheumatologist at Chelsfield Park Hospital, Orpington, says: 'Patients with rheumatoid arthritis  - which causes pain and swelling in the joints such as hands, feet and wrists and affects 2 per cent of the population - do much better if they are referred quickly, within four weeks of diagnosis. Too often they aren't seen in time and the disease becomes more established, causing greater pain and disability.
'So I'd like to see GPs do better at spotting signs of the disease at its early stages - swelling with the joint pain, early morning stiffness and generally feeling under the weather.
'And one red flag for rheumatoid arthritis, which can get missed, is anaemia - a deficiency  of iron.
'Eight out of ten sufferers have this. Unfortunately, the GP may focus on the anaemia, rather than the fact it is a symptom of a wider problem.'

SWOLLEN LEG

Eddie Chaloner, consultant vascular surgeon at Lewisham  Hospital, says: 'Patients with a swollen leg are often given antibiotics because they're told they have an infection. But it's usually superficial phlebitis - where a superficial vein becomes inflamed and a blood clot forms within  the vein.
'It commonly happens in varicose veins, but can occur as a result of an injury to any vein. Usually it goes away on its own, though it can be treated with an anti-inflammatory if painful. Antibiotics wouldn't have any effect.
'If there hasn't been any recent wound or surgery or cut and there's no pus and discharge, infection is unlikely to be the cause. I don't know why GPs don't know the difference.'

MIDDLE-AGED SPREAD

Christopher Eden, a consultant urologist and leading prostate cancer specialist at the Royal Surrey County Hospital in Guildford, says: 'Many GPs will advise overweight men in their 40s and older to have a cholesterol test. But men in this bracket - middle aged and overweight, with a BMI over 25 - are also at an increased risk of prostate cancer; and those who get it seem to develop a more aggressive form. So I wish GPs would offer them a PSA test, too.
'This measures prostate specific antigen (PSA), a protein in the blood produced by normal cells in the prostate. Raised levels could be a marker for prostate cancer.'

HEARING LOSS

Dr Myles Black, a consultant ear, nose and throat (ENT) and thyroid surgeon at East Kent University Hospital, says: 'I'm concerned that GPs sometimes dismiss sudden hearing loss as ear wax or fluid from an ear infection or cold when it could be caused by a condition known as sensorineural hearing loss, which requires immediate treatment to prevent permanent hearing loss.
'What distinguishes sensorineural hearing loss from the blocked-up feeling you get with a cold or ear wax is that the hearing suddenly disappears completely, usually in one ear, but possibly both. With a cold, that hearing may just be muffled.
'Sensorineural hearing loss - caused when a cold, virus or infection travels to the inner ear - needs speedy treatment with steroids.
'It worries me that patients could be needlessly losing their hearing because GPs don't get enough training at medical school to diagnose sensorineural hearing loss. Yet it can be picked up easily using a tuning fork.' (This is placed on the forehead and, if hearing is normal, the sound  will be heard equally in both ears.)