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CAMHS won't see you now

Where's our correction from NICE?

Refined two-week cancer referral guidelines are one thing, but hopefully it is not the clear-cut, textbook, red-flag cancer patients who get stuck in the non-urgent pile.

Delayed diagnosis is due to atypical, 'wrong age', not the threshold size or non-textbook presentations.

Patients may have other pathology and put the symptoms down as 'more of the same', eg lung cancer in COPD or heart failure, colon cancer from a history of IBS.

Organic pathology arises out of vague unexplained symptoms in the anxious.

In an ideal world everything should be audited and positive changes made.

The place of missed cancers is in 'significant event analysis' and should be explored in partnership with our local consultant colleagues.

There should be a reliable way of getting all urgent/semi-urgent referrals seen in a sensible timeframe.

We should not be discouraged from putting some atypical 'don't fit the guidelines' grey cases through the two-week wait on gut instinct and be aware of negative tests being compatible with early disease.

Meanwhile patients with chronic disease should have information about red-flag symptoms and patience is required not to write things off as psychosomatic too early.

Dr Elizabeth Howard

London

PS: A 2.5-in-a-million incidence mediasteinal lymphoma was behind my own worsening asthma.

A chest consultant missed it entirely.

I finally qualified for two-week wait ENT. Eight-month delay. Glad to be alive and well.

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