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Shades of grey

So, this week, we GPs have been mostly ‘complacent'. Says who? About what?

You'd guess the Daily Wail, probably about the fact that patients are dying while we're in the queue at the bank waiting to deposit our fat pay cheques. But no. This was Prof Steve Field, our very own chair of our very own college, having a pop at his colleagues for needing to do better with cancer referrals.

Apparently, a new report has found that the proportion of cancers referred by GPs under the two week wait ranges from a fifth to 7%. OK, so there is some variation, but there always will be when your sample approaches 41,000. Complacency, though? I don't think so. We all live in fear of missing the Big C, but that doesn't make it any easier to sift the pathological needle from the polysymptomatic haystack.

Besides, the simple stats hide the complex truth. Politicians and journalists could be forgiven for thinking that medicine is black and white. They can't understand the nuances which we have to agonise over – the patient diagnosed with diverticular disease who presents a year later with more diarrhoea, the bloating woman whose chronic anxiety would reach breakdown point if she's investigated, the elderly patient unwilling to pursue the rectal bleed which is probably just piles anyway… Plus there's the fact that cancer doesn't always oblige with text-book symptoms because the mitotic process hates GPs too, and makes us want to look lazy and incompetent.

This is real life practice and it has the potential to screw up patient lives and our referral stats. Being a GP, Prof Field understands this. And being our figurehead, you'd like to think he'd point it out.

Of course, we could all take the easy route and refer urgently any patient with even the slightest hint of a whiff of a suspicion of something vaguely neoplastic. That way, our arses would be covered, and Prof Field and every other GP-knocker would presumably be happy. Until they discover that the two week wait is now two years - which would result in accusations of defensive medicine.

At least that makes a change from complacency.



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