The General Medical Council responds to our questions

Menopause Support founder Diane Danzebrink has been pushing for answers to your questions around menopause. Based on heartfelt pleas from those of you struggling with menopause symptoms she has put your vital questions to the medical establishment – and after weeks and months of waiting, responses are starting to arrive.

Questions were asked of the General Medical Council (GMC) , who are responsible for protecting patients and improving medical education and practice in the UK by setting standards for students and doctors. Di’s take on their answers is in her three-minute video below, which we will also be posting on Facebook and Twitter.

She has also put a series of questions to the Royal College of GPs, the UK professional body for general practitioners and to The National Institute for Health and Care Excellence (NICE), which provides national guidance and advice to improve health and social care. We’ll be publishing the other responses on the website soon.

Here’s Di’s questions to the GMC, sent by letter, and their written response, which we are sure they will not mind us publishing here.

Our questions:

Good Morning

My name is Diane Danzebrink and I run Menopause Support which offers education, information, advice and emotional support to women and their families who are struggling with the symptoms of menopause. I am regularly being told by women that their doctors are refusing to prescribe HRT. Some doctors say they don’t agree with it, others say they think it doesn’t work, some say it just delays symptoms, some say their practice does not prescribe it. I have heard of women incorrectly informed that they are not eligible as they suffer from migraines or smoke etc. I have also counselled women incorrectly prescribed (oestrogen only for a woman who still has her womb) and in the last couple of weeks have spoken with women who have been shouted at and laughed at by their doctors when wanting to discuss menopause and hrt.

I realise that the NICE menopause guidelines set out very clearly to doctors what they should be doing but many are not following them and a shocking amount have never heard of them and certainly not read them. I have campaigned the RCGP to look at the curriculm and improve the depth, breadth and quality of teaching in this area to medical students and I am told a review is now going to happen. I would be very greatful for some advice on how women can talk to doctors who refuse first line treatment, far too many are suffering in silence or incorrectly prescribed antidepressants. Please advise what rights a woman has when her doctor is refusing to prescribe hrt to her in situations similar to those described above. I realise of course that there are some medical conditions that would preclude hrt but I am referring to otherwise healthy women just hoping to ease menopause symptoms. Please also advise what can be done to increase the awareness and implementation of the guidelines amongst health care professionals.

I would be very happy to discuss any of the above either via telephone or in person and if there is anything that menopause support can be involved in to further the awareness I would, of course, be very happy to help.

The GMC Response:

Dear Diane

Thank you for your enquiry requesting advice on how women can talk to their doctors who refuse to prescribe first line treatment to ease menopause symptoms. It might be helpful for me to start by explaining our role. We’re here to protect patients and improve medical education and practice across the UK. We do this by producing guidance for doctors on what good medical practice looks like. We do this in our core guidance, Good medical practice and in our other supporting statements, and we also set out in these the professional values, knowledge, skills and behaviours required of all doctors working in the UK. We expect doctors to follow this guidance, and if they fail to do so, we can take action to stop or limit their right to practice medicine.

Below I have outlined some of the key principles within our guidance which we would expect doctors to consider when discussing HRT with their patients. This may be useful for the women you help to be aware of.

One of the fundamental aspects of patient care is treating each person as an individual and with respect. Doctors should work in partnership with their patient, giving them the information they need, in a way they understand so that they can reach decisions together.

In paragraph 2 of our Consent guidance, we say doctors must:

a. listen to patients and respect their views about their health

b. discuss with patients what their diagnosis, prognosis, treatment and care involve

c. share with patients the information they want or need in order to make decisions

d. maximise patients’ opportunities, and their ability, to make decisions for themselves

e. respect patients’ decisions.

And in paragraph 5(c) of Consent we say that if the patient asks for a treatment that the doctor considers would not be clinically appropriate for them, then the doctor should discuss the issues with the patient and explore the reasons for their request. If, after discussion, the doctor still considers that the treatment would not be clinically appropriate, then doctors do not have to provide the treatment. But they should explain their reasons to the patient and explain any other options that are available, including the option to seek a second opinion or access legal representation.