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At the heart of general practice since 1960

In most cases, it's just another duck

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Yet again GPs are rubbish. Its hardly a surprise, rarely a week goes by when we’re not accused of failing by some armchair GP with a super-specialist interest. The most recent episode was our total failure to diagnose Motor Neurone Disease. You remember MND, right? A prevalence of around six in 100,000 in the UK, a GP may expect to see one to two cases in their whole career. MND is a catastrophic disease, but as the MND association states ‘early symptoms can be quite slight… it can be some time before someone feels it is necessary to see a GP.’ MND is a life-limiting disease, with no simple tests for diagnosis, unless of course, you’re a pathologist.

Only by doing this could he rule out something rare, and realise that no, actually, it was just another duck

It all reminds me of my childhood torture; my parents’ desire to educate their children in the world of ornithology. For some reason, they decided it would be ‘fun’ to drag their children on trips to the local RSPB sanctuary for some bird watching. Ignoring the protestations of a very bored five-year-old we would wander around marshes, forced to be ‘absorbed in the wildlife’. We would occasionally sit in a hide and watch: duck, duck, swan, duck, moorhen, duck, duck. You can tell I paid as much attention then as I do in meetings now.

But my eagle-eyed (excuse the pun) older brother would sit with his Find 50 Almost Extinct Birds book and wait. Would he find the greater-lesser-spotted-golden-tufted-purple-bellied-warbler, and be able to tick it off in his book and report it to the RSPB as a rare sighting?

He’d see a bird the right size, with a golden tuft, but the belly colour was wrong. Or he’d see one with a purple belly but no tuft. He’d wait until they came closer so he could spend more time observing them, watching to see if their appearance and behaviour matched the description. Sometimes he took several glances through the binoculars, cross-referencing with the resource. Only by doing this could he rule out something rare, and realise that no, actually, it was just another duck.

But if he had taken the advice dished out to GPs then he’d be acting on his first suspicion - ticking off 100s of birds in his book, reporting a multitude of rare sightings. He would be culpable for flooding the system and taking up precious resources. Another rarity would be neglected at the expense of this one. Maybe the RSPB officer in charge of monitoring English golden eagle nests would be reassigned to deal with the rare warbler influx. The precious eagle eggs in the nest would be ignored. Perhaps the following day the neighbourhood B&B would produce a suspiciously large omelette.

So yes, GPs will miss rare diagnoses or refer them late. We will miss them because they are rare. We will refer them late because we need to wait to have more clarity. We will miss them because if we referred every back pain to rule out cauda equina, or every cough to rule out lung cancer, the system would fail in seconds. So perhaps its time to applaud us when we miraculously pick up these vanishingly-rare conditions, not vilify us when we don’t.

Dr Susie Bayley is a GP in Derby and chair of GP Survival

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Readers' comments (3)

  • So why doesn't the NHS have specialist generalists like other countries (internists) so that GPs can refer these patients to someone who will take an interest and investigate?

    It may be a hassle for you to spot rare disease but the consequences of misdiagnosis can be fatal at worst and traumatic at best for patients.

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  • The NHS does have specialist generalists - we are called General Practitioners.

    We do refer on to someone who will take an interest and investigate when we need to or have suspicions of something rare.

    I think you've missed the point - go back and read the article again!

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  • To the anonymous, other healthcare professional.
    Please sign me up. I want to be an MND internist.
    In my town of 200.000 I can expect to have 12 New patients referred every year.
    By the way, the only thing I can offer is symptomatic treatment, not even prognosis with any high certainty.

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