To think the new “Jess’s rule” should be blindly obvious & it’s an embarrassment that we have to remind GPs this?

Exactly. No GP should ever be allowed to utter the words ‘you are too young for cancer’ . Full stop. It’s as though they have had zero training. Even the general public know better.

I had breast cancer at 34 with zero family history. I was fortunate that I was referred straight away by my GP.

There needs to be some penalty if they don’t do the most basic functions of their jobs properly.

That's what my mum has always said, too. If they think they can fob you off, they will. And I actually think that applies to men too - my husband has been fobbed off on occasion too. Even though he had private health insurance. But women tend to get told it's all to do with hormones.

Though I had the opposite - GP erring on the side of caution even though I thought (and think) it was hormones!

Anytime I've had anything which may or may not be serious I've been referred and put on the two week pathway. The first time I was only about 34.

GPs do get time wasters and hypochondriacs but someone presenting with what could be cancer should surely have that ruled out, whatever their age.

I've been struggling with absolutely debilitating (heavy) periods and shocking levels of bleeding to the point I can't leave the house for a week every month for 30, yes 30 years. Only in this last month have they finally started to get their act together and I have an ultrasound scan booked for a few weeks' time. I had a hysteroscopy last week which confirmed "huge" fibroids. I could have told them that. My GP won't even prescribe iron, and I was anaemic to the point I couldn't breathe. I get iron from a local pharmacy now.

But that doesn’t excuse a diagnosis of an ill fitting bra.

This is also true

There are many people who present over and over again that are not missed cancer cases. There are many patients that do actually have anxiety or long covid or IBD. There are many patients that attend a&E frequently without a serious condition

Every medic has had a patient who has one referral from the GP, something entirely different to you and a third completely different history to the consultant. (E.g. patient tells you no weight loss, suddenly they have night sweats and weight loss when the consultants there)

This isn't to excuse when cancers are missed. But GP is a hard job, you have to be able to basically diagnose everything or pick up red flags for everything. There are only so many tests and so many investigations.

You never know what history the GPS was given. What questions were answered. What examinations were undertaken and what those results were.

We cannot assume every patient has something seriously wrong just because they represent. Medicine is and should always be a clinical judgement.

I think the issue for her was (a) covid was on and (b) she was only 27.

But you'd think that if you keep going to the doctor they'd actually do something! I never understand that if you never go and then you do, they fob you off. Surely they can look at your records and think "well she's never been to see us in the last five years so clearly something is actually wrong with her".

However, I think in this case she started getting symptoms in the June and was dead by the December - maybe she wouldn't have survived anyway. But many people said at the time that it didn't matter if you died during covid, as long as it was of something other than covid.

It’s also true that if you have a chronic physical disease, every symptom is attributed to that

Took my DH to the GP as an urgent appointment, he had a high fever that kept coming and going, was unable to even keep water down and was extremely weak and fatigued, literally struggled to walk across the GP waiting room. There was a retirement celebration in the surgery (balloons, banners and cake) and I felt the GP was very distracted in the appointment. GP referred him for blood tests the following week, and advised paracetamol to keep on top of the fever.

My DH was grey, pallid skin and very weakened - we left the GP surgery and went straight to A&E where he was immediately admitted with sepsis. Had I listened to the GP he wouldn’t have made the blood test the following week.

In fairness I complained to the surgery, and their practice has improved significantly, but it could have ended very badly.

As much as they might like to think they are, doctors and consultants aren't god and they DO get it wrong sometimes.

Wow. Most of us would consider cancer with unexplained weight loss. How did they all miss this. I’ve been on cancer wards, they are full of young people.

@SoIMO also the waiting time for ENT is shocking. My son has been waiting for 2 years . My other son needed his tonsils out and the wait would have been about 3 years, so we had to go privately.

Was there a coroner’s inquest? I am guessing not, unfortunately

100% yes!!
I had 4 appointments in 3 days for horrendous constipation. None of the 3 doctors I saw managed to diagnose labour despite me being 32 weeks pregnant with twins.

Not true. Pathways are devised by secondary care. Why on earth would a generalist develop the referral pathway to a specialist?

The waiting list to see a gynaecologist where I work is over a year. We refer people, but they wait an eternity to be seen. More often than not, we just get a letter from gynae advising us to prescribe extra hormones.

It is shocking and I bet it happens a lot. My friends sister spent almost a year going to her GP because of heavy bleeding that wasn’t stopping and was fobbed of with.. You’ve just had a baby, your periods take a while to get back in sync.
She eventually collapsed, was rushed to hospital where she was diagnosed with cervical cancer and sadly passed away at 27. It’s criminal.

This tiny post seems to me to be highly pertinent.

@notatinydancer the people who need to be told are the ones who devise the referral pathways. Not GPs.

GPs can’t refer breast pain on the 2 week wait pathway. There has to be a lump or skin changes.

I work in ED the amount of people diagnosed with cancer is shocking.
Also you hear about GPs saying people are too young for cancer , this needs to be addressed immediately. Of course no one is too young.

Oh lovely, another GP bashing thread.

For those who are interested in learning something (not just ranting about how overpaid and shit GPs are)……whilst I can’t comment on the details of this case as I don’t know them, and it’s possible the GPs were negligent, it’s worth people knowing that us GPs don’t have unfettered instant access to secondary care.

2 week wait referrals are strictly governed by specific criteria, such as age of the patient, what their haemoglobin level is, if they have positive cancer markers, if the have a positive FIT etc. We can’t just refer people because we’ve run out of ideas and have got a bad feeling. Of course we can refer via the normal (not 2ww) pathway, but the waiting time can be a year.

I’ve currently got a patient with some dodgy bleeding on HRT. She doesn’t fit the urgent pathway. I’ve referred her on the “correct” pathway, and the waiting time is about 9 months. I wrote to gynaecology expressing my concern at her symptoms, and was advised to give her higher doses of hormone to suppress the bleeding while she waited for her appointment.

In the past I’ve lied on 2ww forms, in order to get a patient seen when I had a gut feeling that something was wrong, but you can’t do that regularly. And you can only really stretch the truth, not tell outright lies.

Referrals to secondary care are triaged by non clinicians much of the time, and if the specific criteria aren’t met, then our referrals are rejected.

Unfortunately nowadays many many people present many many times and are investigated many many times for the same thing. I really don't think the public (or the government) really appreciate the volume of patients GPs have contact with. For ONE week I would like every GP to refer urgently every patient that has presented 3 times. If you think its bad now, secondary care services would be done in a day.
Dont let government rhetoric and gaslighting scapegoat the front line staff.

This is why I would never go to a GP with something like anxiety or depression. I'm convinced that once that was in my medical notes any symptoms I had of anything serious would be fobbed off as mental health related.