This site is intended for health professionals only

At the heart of general practice since 1960

pul jul aug2020 cover 80x101px
Read the latest issue online

Independents' Day

Sometimes it's more important to be kind

Winner of the under-35s category in Pulse’s 2016 writing competition, Dr Heather Ryan

dr heather ryan duotone 330x330px

In the early weeks of my GP registrar year, diagnostic certainty came rarely. My consultation with Alan had been an exception: as soon as he had shuffled into my room, pale and drawn, wearing the tell-tale oversized clothes of one who has unexpectedly lost weight, my antennae were twitching. When he said that he had been constipated for six months and had recently started passing blood, I mentally started writing the two week wait referral. As he lay on my couch, my gloved finger found the culprit: a hard, annular mass just inside his rectum. Once he was dressed again, I tactfully outlined my concerns, printed off the referral form, and wished him luck at the hospital.

Sometimes it is more important to be kind than it is to follow rules

The phone rang for so long that I suspected nobody was home. Eventually, in a barely audible whisper, Alan answered. He confirmed that the consultant had found a mass on sigmoidoscopy. A nurse in the endoscopy suite had advised him to phone her GP for the biopsy results. Four weeks later, after a busy morning, his name appeared on the telephone list. With a spasm of frustration, I read the accompanying note: ‘Had biopsy at hospital – told to ring GP for result.’ I knew that the responsibility for acting on a test result lay with the person who had requested it – in this case, whoever had performed Alan’s sigmoidoscopy. I decided that I would politely suggest that he ring the consultant’s secretary to arrange getting his results.

I checked the computer: no letter from the hospital yet. I explained that to him, and added that, ideally, he should receive his results from a specialist who would be able to discuss exactly how to proceed.

elderly man with mobile under 35 330x330px

‘I see,’ he said, and his voice cracked slightly. A pause, a barely audible gulp, ‘I’m seeing the consultant next week. But I want to know now. I want to know what I’m up against.’

We have a link to the hospital and can view some lab results live on their system. A few clicks later, I had the report in front of me, confirming what I’d known since he first walked into my room a month earlier: adenocarcinoma.

I gently explored his understanding and established that, although nobody at the hospital had used the word ‘cancer’, he had drawn his own conclusions. I explained that the biopsy confirmed this, and gave a rough outline of the next steps. He thanked me profusely, he was glad he would have time to get used to the diagnosis before seeing the consultant.

Other writing competition entries

(Winner) Dr Renee Hoenderkamp: ’I knew I was breaking every rule’  

(2nd place) Dr Helen Cotton: My son’s call for help saved me

(3rd place) Dr Richard Cook: ’I tried to speak, but no words came’ 

(Runner-Up) Dr Celine Inglis: Being a doctor puts you in a strange position for tragedy

The best of the other entries 

Six months later, Alan is still alive, but faltering now. The staging CT found liver metastases, and he had to stop palliative radiotherapy due to side-effects. Conversely, I have blossomed, now far more confident than the newbie who first met Alan. I still challenge inappropriate transfers of work, but I try not to forget that there is a patient caught in the middle, and that sometimes it is more important to be kind than it is to follow rules.

Dr Heather Ryan is a GP registrar in Liverpool. She receives a £50 book voucher. 

Rate this article  (4.25 average user rating)

Click to rate

  • 1 star out of 5
  • 2 stars out of 5
  • 3 stars out of 5
  • 4 stars out of 5
  • 5 stars out of 5

0 out of 5 stars

Readers' comments (11)

  • Azeem Majeed

    Thanks - very informative.

    Unsuitable or offensive? Report this comment

  • Sensitive and poignant. It's nice to know that this generation of GPs has not lost the importance of a kind and supportive attitude, even when being resilient to work dumping from secondary care. Well done Helen!

    Unsuitable or offensive? Report this comment

  • Lovely - thanks for writing this, really uplifting

    Unsuitable or offensive? Report this comment

  • Well done Heather! Great piece!

    Unsuitable or offensive? Report this comment

  • T Roscoe

    and sometimes it is important to point out to the hospital that they are shirking their responsibilities and adding to the pressures that are destroying General Practice.

    Unsuitable or offensive? Report this comment

  • All results should be available to Primary Care Services electronically at the same time as to Specialist / Secondary Care Services.

    Unsuitable or offensive? Report this comment

  • They were available, but that doesn't let the hospital service off the hook - suppose that he had wanted to know more about his possible treatment and chances of a cure? The author handled the situation very well but should not have been in that position.

    Unsuitable or offensive? Report this comment

  • A poigniant reminder that the "secondary care workload that is dumped onto GPs" is actually often frightened patients

    Unsuitable or offensive? Report this comment

  • Giving the result is fair enough and it is important to be compassionate. I would have done the same.

    But don't you think you have positively reinforced hospital's behaviour and something should have been done to prevent recurrence? I bet the specialist nurse mentioned above will continue to tell pt to "just call your GP". Not sure if the author realizes but hospital is paid for the episode of care which includes giving result.

    Persoanlly, I normally follow it up with "I have informed my patient but I expect you to convey the result in timely and compassionate manner" to the consultant.

    Unsuitable or offensive? Report this comment

  • Vinci Ho

    We call the system ICE in Liverpool to link up GP practices with local hospitals for lab results , endoscopy , X ray and histology.Still it is mainly for the two main teaching hospitals

    Unsuitable or offensive? Report this comment

View results 10 results per page20 results per page

Have your say