Where you are:
You are FY2 in GP surgery.Who the patient is:
Julia, mother of a 6 year old boy, who is diagnosed with tonsillitis, has come to you to talk about her son’s referral to ENT surgery that was rejected.
The child had previously 5 episodes of infections over 6 months.What you must do:
Talk to the mother and address her concerns. On request of the mother, GP made the referral to the ENT surgery.
Doctor: How can I help you today?
Patient: I am here for my son. He had recently been referred to ENT surgery from the GP and the referral got rejected.
D: I see. Would you mind if I ask you a few questions regarding your son to have better understanding of your son’s health?
P: OK.
(Take history)
D: Could you tell me why he had been referred to ENT surgery?
P: He had 5 episodes of tonsillitis in the last 1 year
(Explore)
D: Could you give a brief recap of the episodes?
P: The first episode was about 10 months ago. He had a sore throat and fever and was advised to have steam inhalation. The 2nd and 3rd episodes the symptoms were more severe, and he was given antibiotics.
And the last 2 episodes was like the first episode, and it got better with steam inhalation as well.
(Show sympathy)
D: I can understand it must be very tough on him and he’s only young.
P: Yes, so why did the referral get rejected? (Concern)
D: As you already know the referral was made upon your request. But to be honest with you your son doesn’t meet the criteria to have the surgery for tonsil removal.
P: What criteria are you talking about? (Explain criteria)
D: Let me explain this to you further. There are some criteria that have been set to decide which patients need tonsil removal surgery. One of those criteria is having at least 7 attacks in a year. You mentioned your son had 5 attacks. So it’s possible that that’s why the referral got rejected.
P: Doctor, forget about the criteria. I can’t see him suffer like that anymore. Please arrange the surgery for him.
D: I can really see you are worried about your son. But let me tell you the criteria are made in a way to avoid unnecessary surgery and ensure better care for the patients. And every surgery has a lot of complications.
We don’t want your son to go through the unnecessary stress of the surgery without a strong reason. Another thing is that tonsils are a very important part of the defence mechanism of our body that fights against infection. That is why we don’t want to remove them unless it’s absolutely necessary.
P: Doctor I just think the NHS is doing it for budget cutting. Don’t you think so?
D: I am really sorry you feel that way, but the NHS has planned those surgeries and set those criteria for delivering the best possible care to the patients.
P: Alright.
Management
D: For now, we will give him painkillers to relieve the pain. Please ensure he is taking
plenty of rest.
Safety netting
By any chance if your son’s condition gets worse or he develops neck stiffness or he can’t even swallow, please bring him back to us.
Indications for tonsillectomy:
You may be advised to have your tonsils removed in certain situations. In particular:
- If you have frequent and severe bouts of tonsillitis. This usually means:
– Seven or more episodes of tonsillitis in the preceding year; or
– Five or more such episodes in each of the preceding two years; or
– Three or more such episodes in each of the preceding three years. - The bouts of tonsillitis affect normal functioning. For example, they are severe enough to make you need time off from work or from school.
- If you have large tonsils that are partially obstructing your airway, this may be a contributing factor to a condition called obstructive sleep apnoea syndrome.
- If you develop cancer of the tonsil.