Posted by: Pete Deveson26 April 2017
Another shameful hit was added to the world’s most dispiriting Google search today as the headlines splashed ‘GPs failing thousands of cancer patients’. ‘Alarming toll of victims sent away THREE TIMES without diagnosis’ is the Mail’s spin on a sensible and interesting paper in the British Journal of Literally Never Removed From Its Shrink-wrapping Until It Goes In The Recycle Bin Won’t Someone Think Of The Trees that looked at how many times patients who were confirmed to have cancer during an emergency hospital admission had seen a GP beforehand. The paper specifically states ‘It is important to note that the number of pre-referral consultations before a cancer diagnosis cannot be assumed to be a measure of diagnostic quality’ but of course such nuance is lost on the tabloid press who jumped at the chance to put the boot into primary care.
Perhaps the most annoying facet of this story is the persistent misrepresentation of a broad category of routes to inpatient diagnosis that includes direct GP referral and consultant referral from outpatients with the phrase ‘diagnosed in casualty’, as if no sooner have you crossed the emergency department threshold than the triage nurse is handing you your histology results. Of course A&E doesn’t diagnose cancer; A&E diagnoses ‘normotroponinaemia ?cause, 4-hour breach imminent’ and gets you admitted for the several days of tests which surprisingly figure out more than your GP could in ten minutes with a stethoscope.
The obvious question, unanswered by the tabloids apart from the inherent implication that it must be down to our laziness, greed and/or stupidity, is why do GPs miss cases of cancer? Cancer Research UK, somewhat predictably, says more cancer awareness is needed, but I’m not sure if this will help. We are living in an epidemic of cancer anxiety; our surgeries are already stuffed with the hyperaware, from the concerned parent of a child with deadly nosebleeds to the embarrassed young man who thinks he may have felt a lump in what is essentially a bag full of lumps to the successful dieter who’s internally reading himself the last rites after self-diagnosing a xiphisternoma. Even though the fear of missing a serious diagnosis is every GP’s constant companion, it can be increasingly hard to see the wood for the trees, and awareness campaigns simply plant more and more hectares of worried well conifers.
So maybe stories like this one, which perpetuate the media trope of the all-knowing Cas Officer saving the patient from the GP doofus, could actually end up helping. If everyone with vague symptoms and no underlying illness heads over to A&E in search of better treatment, perhaps we might stand a better chance of spotting the genuine pathology when it walks through our door. Here’s hoping.
Dr Pete Deveson is a GP in Surrey. You can follow him on Twitter @PeteDeveson