Tuesday, 1 July 2014

My doctor should have known....

There was recent press coverage of a possible plan to name and shame GPs who repeatedly fail to spot the signs of cancer in their patients or patients have to make repeated visits before being referred for tests.  Here is the article that was in the Daily Telegraph

I am very ambivalent about this: I do know (anecdotally) of friends who subsequently were found to have cancer or other serious illnesses, but who had been fobbed off by their doctors. When I was involved in a medical research charity we would hear regular reports.  But no one ever told us about how good their doctor was or how quickly they were referred because that was an expectation and not news.  I am also reminded that my own GP (now retired) told me that in 20 years of practice she had only had two patients come to her with symptoms that proved to be breast cancer – she had many patients with the disease who had been picked up through the screening programme.  Also, what this doesn’t take into account are the people who delay and delay going to the doctor with a worrying symptom.

Many years ago I sat on a disciplinary panel for GP’s who had had a complaint referred.  One was from a woman who complained that when she went to the doctor with a lump in the breast, the doctor told her she couldn’t feel anything but to come back in two weeks.  When she came back the doctor said that she still couldn’t feel anything but referred her immediately. She proved to have breast cancer and the doctor had acted perfectly properly – lumps can come and go and two weeks is not a delay.

The second was from a patient who had visited the doctor with a lump.  The doctor had told her it was not cancer and to leave it. She subsequently had to undergo a medical and cancer was found.  The GP’s rationale was that he had once spent six months in a breast clinic so he “knew” so didn’t need to refer her.

Cancer is not always easy to diagnose and I would rather be safe than sorry so I do feel strongly that doctors need to eliminate the worst case first, especially with symptoms that are troublesome but perhaps not specific. We know that, for example, ovarian or pancreatic cancer can have different symptoms, not always clear cut and I would rather they were eliminated before a series of treatments were prescribed for, say, irritable bowel syndrome or constipation.

Will red-flagging a practice on a web-site help – I am not sure and the people least likely to be referred are often the ones less likely to do the online research.

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