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News article- Cancer mostly diagnosed in A&E, not GP visit


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http://news.sky.com/story/cancer-often-being-diagnosed-in-ae-despite-patients-seeing-gps-10849984

 

Does not surprise me. Given that it can take 3 weeks to get a GP appointment and then they only have about 8 minutes to diagnose or refer for tests, it is most likely to be a Hospital A&E that finds patients have cancer.

 

The last time i had a blood sample taken, between booking the appointment and getting the test result back, it was over a month. Two weeks before GP appointment, rebooked to see a Nurse to take sample a week later and then two weeks to get the result back.

 

The NHS has gone backwards over recent years.

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http://news.sky.com/story/cancer-often-being-diagnosed-in-ae-despite-patients-seeing-gps-10849984

 

Does not surprise me. Given that it can take 3 weeks to get a GP appointment and then they only have about 8 minutes to diagnose or refer for tests, it is most likely to be a Hospital A&E that finds patients have cancer.

 

The last time i had a blood sample taken, between booking the appointment and getting the test result back, it was over a month. Two weeks before GP appointment, rebooked to see a Nurse to take sample a week later and then two weeks to get the result back.

 

The NHS has gone backwards over recent years.

 

It says that 71% ("more than 2/3') of people diagnosed with cancer in A&E have been to see their GP with symptoms more than once.

However, that isn't the whole story, by any means, and it is wrong to say (as this thread title says) that "cancer mostly diagnosed in A&E, not GP visit".

 

It is actually also saying "29% of people diagnosed with cancer in A&E HAVEN'T been to see their GP with symptoms at least once"!.

In other words 29% of people diagnosed with cancer in A&E didn't go to their GP with symptoms.............

 

The researcher's conclusion cited is:

"These findings tell us that some patients diagnosed as an emergency might not be acting on 'red flag' symptoms which could have prompted them to visit their GP."

 

Why the discrepancy?.

Because 22% of cancers are diagnosed as an emergency.

 

So, 78% are not diagnosed as an emergency (so, presumably, by those awful, incompetent creatures, the GP's.......)

22% are diagnosed as an emergency, this 22% being split into 15.6% who had seen their GP with a symptom, and 6.4% who hadn't seen their GP with a symptom.

 

Still, 15.6% of all cancers being diagnosed as an emergency, having been seen by their GP at least once is still pretty convincing of the GP's being awful, incompetent creature, right?.

 

Except, the study (apparently) also said:

"patients diagnosed in A&E with common cancers, after seeing their GP, may have had atypical symptoms".

 

So, the symptoms may have been atypical (or even, changed between being seen by the GP and in A&E).........

 

So, the actual figure(s) that needs to be looked at, and dealt with are:

"what percentage of all cancers are diagnosed after a patient has been to see the GP with a 'red-flag' symptom, and the GP didn't recognize it as such", as well as

"what percentage of all cancers are diagnosed only as an emergency (or diagnosed by the GP but late on in the disease) where the patient hasn't gone to ANY doctor with a 'red-flag' symptom", and even (turning the problem around!)

"what percentage of all cancers are diagnosed by a GP or another A&E / hospital visit, after the patient was seen in A&E / hospital with a 'red-flag' symptom, and the first A&E/ in-patient / out-patient visit didn't recognize it as such..........."

 

It is easy to take headlines and say "something must be done!".

It is harder to actually work out what is a problem that can be fixed (symptoms being atypical doesn't mean the GP got it wrong, symptoms getting worse between visits doesn't mean the GP got it wrong, otherwise the GP's would have to refer EVERYTHING, and the hospital system would grind to a halt ...........)

 

Criticise any doctor (ok, any health care professional!) who 'misses' a cancer they should have spotted: absolutely!.

But that isn't actually what the thread title is suggesting .........

 

Accepting there are missed opportunities: why?.

Some will be lazy (and / or) incompetent doctors (GP's or others), and they should be identified, and re-trained (or sacked, if not able to improve with help).

 

Some will be able / competent practitioners, who 'just made a mistake' [with no pre-disposing factor(s)]. Pretty awful. More awful for the poor patient, sure, but still awful for the practitioner, who (because they are able and competent) will always wonder "how did I make that mistake?, and may never get an answer to that question for themselves, or to tell the patient (who deserves an explanation).

 

Some will be able / competent practitioners whose mistake came from a variety of factors. If they were burnt out / exhausted / had had the "we've (again!)added 'just one more' patient to your list to be seen today" as the "straw that broke the camel's back" : Still more awful for the patient, but potentially the final straw for an able / competent practitioner who may never work again.

Two tragedies: the tragedy for the patient whose diagnosis was delayed

The tragedy for the doctor whose career got ended (and for the patients they might have continued to help, who lost an able and competent practitioner to a bad set of circumstances).

 

So, this sort of research is VITAL. It is important to improve.

But, it isn't as simple as 'lazy, incompetent GP's"............. and I know that wasn't what UB was saying (since he acknowleged)

Given that it can take 3 weeks to get a GP appointment and then they only have about 8 minutes to diagnose or refer for tests

 

but it is the hazard of headlines such as "Cancer_often_ being diagnosed in A&E despite patients seeing GPs" which then morphs into thread titles such as "Cancer _mostly_ being diagnosed in A&E, not GP visit".

That 15.6% (of which we don't know how many are 'avoidable'!) isn't "mostly". Mostly would be more than 50%, and even then the 'non-avoidable' proportion won't be able to be avoided.......

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The article itself is online at

http://bjgp.org/content/early/2017/04/24/bjgp17X690869

 

Its conclusion is

Contrary to suggestions that emergency presentations represent missed diagnoses, about one-third of emergency presenters (particularly those in older and more deprived groups) have no prior GP consultations. Furthermore, only about one-third report multiple (three or more) consultations, which are more likely in ‘harder-to-suspect’ groups.

 

The editorial comment (on the journal's main page at http://bjgp.org/ ) asks "what causes late cancer presentations?", and notes "The answer to this question has, often inaccurately as it turns out, tended to be that GPs have missed the diagnosis."

So, sometimes it is accurate that the GP has missed the diagnosis, but 'often' that isn't accurate.

The editorial comment conclusion:

These findings underline the continuing need for public health education campaigns aimed at changing patient awareness, beliefs, and behaviour about their symptoms.

 

That isn't blaming the GP's (nor actually is it blaming the patients! - that isn't what I'm suggesting should be done, either!.), but it is saying the system needs to do better in making sure the symptoms get spotted, and dealt with, earlier.

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Bazza

 

I think all you say is fair and accurate.

 

The point i took from this was that people had presented symptons which might be cancer, but might also be something else. But given that GP assessment is often about 8 minutes and there is reluctance to refer to Hospital for tests unless the patients condition really looks bad, then early detection/treatment is not being optimised.

 

The problem is that we hear of cases where GP's have not diagnosed possible cancer earlier much more than cases where GP's have managed to pick up cancer symptons arranging urgent referral to Hospital specialists.

 

Of course media seems to always concentrate on negatives as they are not in business to print positive stories, unless it is on a subject where positive news sells advertising.

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Absolutely.

 

(For the local papers), how often have you seen the story "hospital does OK" ?

 

You'll see "the hospital was great, they deserve praise", but only on the readers' letters page.

Otherwise it'll be "local hospital : disaster story!".

These sell papers, not "hospital does OK"

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very rarely does the GP actually diagnose cancer. They suspect it, refer the patient to the hospital for tests. We don't have a CT or MRI machine here, nor are we able to carry out extensive pathological testing. No, our GP's use their clinical judgment and NICE guidance to steer their decision making and where they feel that a patient may be at risk will refer them appropriately.

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