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You name and shame, I’ll open the floodgates

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Expletive deleted hell.  We’re still down from the punch in the face that was Jeremy Hunt threatening to name and shame GPs who ‘fail to spot cancer’only for the Royal College of Pathologists to wade in with a kick in the head too.

Politicians and pathologists are entitled to their opinion, I guess, so long as the public understand that one group specialises in not actually dealing with live people and the other talks as though it’s braindead.

The fact is, as anyone who’s spent even the briefest time working in general practice knows, cancer diagnosis is unbelievably complex, difficult and nuanced - but we’re so downtrodden and depressed that it’s hard to summon the energy to explain this to those who simply wish to beat us into submission. But there is one obvious point we should ram home.

Whether or not you think the politicians and pathologists are unbalanced, their argument certainly is.

Because any talk about cancer diagnosis has to factor in the opposite – non-cancer diagnosis. This is actually the larger part of our work. For every patient we see who ends up having cancer, we see at least 10 other who are worried they have it, but don’t. These patients are dealt with properly by us with the time-honoured history and examination, followed by judicious tests when necessary. We resolve patient anxiety, avoid unnecessary investigation, reduce waiting times at the hospital and save the NHS money.

This isn’t easy and is prone to human error - but we see it as our core role and we bear the associated risk as part of the job. You can’t even start to ‘judge’ cancer diagnosis without taking account of non-cancer diagnosis. If you don’t, then the obvious response (as many have already pointed out) is for GPs to refer absolutely everything. We’d never miss a cancer, so we’d never be named - but we would be shamed for destroying the NHS.

At least, that’s what I’ve always thought – that a week of action where we really do open the floodgates would be counterproductive, as it would harm patients and screw the health service. After this, though, I’m starting to think differently.

Our role is undervalued because it’s not understood. Bringing the NHS to its knees for a week would focus the minds of politicians, pathologists and headline writers – and maybe we should accept the collateral damage as an unfortunate necessity. Let’s do it. Let’s give them expletive deleted hell.

Dr Tony Copperfield is a GP in Essex. You follow him on Twitter @DocCopperfield

Readers' comments (27)

  • Vinci Ho

    I take it in a different way philosophically:
    When a regime is about to fall , all kinds of evil will surface themselves......
    Our battle goes on no matter what.....

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  • There is wide spread ignorance at all levels of what GPs actually do. I'm continually amazed at the total lack of imagination within the BMA and RCGP to rectify this. Referring everything would be akin to going on strike, we won't do this however ...because the bulk of the profession are conformist, chicken and weak and as a result we are doomed to be ignored. Drs aren't known for being outrageous ...GPs are dependable types who 'do the right thing'...we grumble but get on with it. Increasingly it's a profession without any guts ...and one I for one am losing faith in. No one will 'refer everything', no one will strike..it's a profession of chickens and in the eyes of the country at large quite frankly our views are irrelevant.

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  • Refer on the first consultation. That's what I'll be doing now, always. Then organise any investigations that you think might be necessary. The public perception is that anyone who fears they have, or actually has cancer, should be referred. So be it. When referrals increase stratospherically, it is not going to be our problem. Rising referrals is not a criticism that damages the public's trust in or respect for GPs. The public and the politicians can sort that one out together.

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  • Harry Longman

    Dear Doctor, my left foot is wet and cold all winter. I think I have cancer of the shoe. Kindly refer.

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  • Drachula

    Dear generic consultant
    This patient thinks they have cancer. There are no specific symptoms to direct me to a particular primary, so I am referring to you so that you can arrange all the tests they want that will pick up incidentalomas so that they really do have something to worry about. I am sure they will need a full body MRI as CT scans are to quick and dangerous to do any good.
    Please see tomorrow as they are going on holiday on Friday
    Yours faithfully
    A GP who would like to send sensible referrals but as the patient is always right, is now fulfilling a secretarial role.

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  • How about sending to the Plastics every skin ole that comes to" get checked out"

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  • sorry, I meant skin mole

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  • I work in a walk-in centre; without referral rights, except for suspected cancers. Everytime someone comes to me because they couldn't wait 'til 3pm for their GP, & I refer it, that's a point off the GP. Should I just do it? Should I arrange the relevant test & send them back to the GP for The Point? These are the same sort of balancing acts, from a different seat - in fact, it depends on the individual presentation, just like everybody else - but this is clearly a way that these figures can be unjustly skewed, in amongst many similar. I don't get points (other than Brownie ones) either way, The patients may benefit more if I send the form off - but only by 24 hours, probably, and won't get a letter by someone who knows them. Measure that!

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  • Everybody thinks they know how we should do our job because they've all been to the GP. We've made a rod for our own backs by making an incredibly difficult and complex job look too easy!

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  • I'm with David on this one. Watch the CT scanners, MRI, endoscopy suites fill with ME patients. But then we'll be blamed for our new crusade on avoiding missing cancer diagnoses! These bughead politicians should keep their mouths shut about things they haven't got a scooby-doo about.

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From: Copperfield

Dr Tony Copperfield is a jobbing GP in Essex with more than a few chips on his shoulder