AIBU to raise this with my GP?

[AnonymousBird]

In January, I went to my GP as I wanted a couple of moles checking. After much pushing by me, she referred me (third time of asking) to the local Skin Clinic. I saw a dermatologist (not a consultant) who said nothing to worry about, though she did hint on my asking that they don't really progress things any further unless they really think there is a problem.

For other reasons completely I saw a consultant dermatologist privately recently and I just, almost as an aside, asked her to look at a few moles. She immediately said that one needed removing without any delay and others warranted a closer look. She removed it there and then under local anaesthetic. I got the results on the one removed today, and it was "severely dysplastic" and very damaged according to the report. Short of malignant, but warranting me now having a larger area of skin removed as a precaution plus three others also removed which show similar signs though not as advanced as the one removed. Thankfully, because I am private for this treatment, it is being done on Monday.

These moles have been there for some time, they've not just popped up in the last few months, certainly since before I saw the GP/NHS dermatologist. I am seriously concerned that their tightened purse strings mean I could have slipped through the net - it is only by chance of something completely unrelated coming up which I was able to get a private consultation for has brought all this to light.

I have to see the GP again soon - AIBU to raise this with her? She did her bit (eventually) by referring me albeit reluctantly, but the skin clinic should have picked this up, surely, and referred me to the next level of treatment/consultation for possible removal in light of how serious this mole is and it could have been much worse in time.

Well done you for getting a second opinion. If you GP is part of a large practice they might have one doctor who has a particular interest in dermatology - perhaps you could ask to see this GP instead of your own?

I wld mention it, but not in a vindictive or blamey sort of way. They would like to know where they slipped up, perhaps the doctor needs to update their training in moles. Sometimes people slip through the net, because GPs need to knkow an awful lot of things and cannot be an expert in every medical category. Mostly people get referred, but it is terrible if you happen to be one of the ones who did. I'd ask your GP to complain to the skin clinic people on your behalf, as THEY were surely the ones who really messed up!

Yes, you should definitely raise this with your GP - and it would be worthwhile writing a very factual letter about it both to the GP copied to the GP practice manager, and again to the clinic that saw you (copied to the dr that saw you, the consultant head of clinic and the NHS manager in charge if the clinic). You can also copy this to PALS as information without making a formal complaint.

I'm a huge fan of the NHS but is really important that GPs and hospitals are held accountable for decision-making anx that mistakes are recorded via a clear paper trail. You could help make things better by doing this, and potentially save someone else's life in the future.

i wouldn't complain about the GP as they referred you on - the question is about the NHS dermatologist. My (quick) research and the fact is was non-cancerous suggests the NHS made the correct descision and the private doctor was too earnings orientated/risk averse to make the correct call.

*terrible if you happen to be one of the ones who did slip through

Honestly not sure a dysplastic mile is the big deal your private dermatologist is making it. And is bow making more money removing more isn't he. We remove lots of dysplastic moles and really they are not at all obvious clinically and the risk of malignant change is small. Your private seem clearly has a vested interest in removing moles doesnt he. Not sure what you want to get out of it. We cannot refer everyone.

Thanks for the replies. I too am a huge fan of the NHS, and it is pure chance this has been spotted now - obviously a private doctor doesn't have the same constraints of budget as an NHS practice, and I appreciate they can't just whip off every single mole. But both my GP and the skin clinic were so "budget obsessed" that it seems they were blinkered to adequate patient care in the interests of not incurring costs. This one that was removed was serious, really serious, thankfully found a step short of maligant and it should have been picked up.

I will give it some thought and will take it further in some form.

Why do you think they were budget obsessed did they say so? Odd turn of phrase for a doctor to use, it doesn't actually work like that, we dont get billed directly. We are just trying to do the best for the most number of patients. Your private derm has no such obligations and in fact the more work he does the more he gets paid.

I realise of course, that a private doctor doesn't have to worry about finances, however, the pathology report on this (which is prepared by NHS pathologist at Addenbrookes out of interest) has recommended immediate extra incision to remove more surrounding skin and is pretty serious in its wording, I have seen it myself in black and white.

So, if this had been removed under NHS and had been passed for analysis to the same NHS pathologist for a report, would they have not suggested immediate further incision? I don't think so. Which tells me, it is serious and should have been picked up and referred on before.

Both the GP and the Skin Clinic were very quick on "budget" and "not how it used to be" and "we only refer when we are really certain action is needed". Ie. a suspicion of further investigation being needed is not enough. They were both pretty clear about that.

The private doctor is very concerned about finance - how much extra did he charge for all the work he did? It goes in his pocket you know.

Yes, as I've said, I get the fact that a private doctor can charge etc, but what concerns me is that I have an NHS written histopathology report detailing how severely damaged this mole is/was and that a re-incision should be carried out straight away.

In this case, the private doctor has not acted primarily "for the cash", they've acted because they should. The NHS skin clinic passed this over only in April, as presumably if this had been referred by NHS then for further examination/removal, the same NHS department would have written the report and come to the same conclusion ie. this mole and a good margin of skin around it needs to be removed.

What was the actual wording of the report? Up to one in 8 people have dysplastic moles, the vast majority never become cancerous. If you wish to raise this issue, you would be better raising it with the dermatology service that you were referred to, the decision not to excise it was nothing to do with your GP.

Comments of "not how it used to be" probably means just that they dpn't take off a mole just on request.
My dm was somewhat obsessed with removing moles-I have the scars to prove it. None of the moles they removed that had any worries that they were harmful, just dm said they looked wrong/irritating place. She didn't even have to push. I remember one time I had one on my waist, that dm found me scratching vigorously. She told the GP Ihad an itchy mole, GP commented that it might tend to be itchy because it was under the waistband. It was removed the next week.
Another time I had three round my neck that I occasionally caught, and the GP looked at them and said "tell you what, we'll remove two, which two would you like?"Actually there's times that I wish all three had gone as the one left still catches, particularly on my hair, but none of them were the least bit worse than slightly irritating occasionally.

Some of the scars I have are pretty much invisible, but some are bad, and much worse than the moles they removed.

But that's what they mean by "not as it used to be". Not "we don't remove ones we think there is a problem" but "we don't remove on request without good reason".

TBH this reads like you have had a mole removed because you wanted it removed and are now trying to justify it by the slightly abnormal report (which is not cancerous anyway).

I suspect the GP and NHS doctor were right in that it didn't need removing, and besides which what exactly are you going to 'take up' with the GP? It was the skin clinic who declined to remove it.

So the moles were actually not cancerous or even precancerous. So your nhs derm was right then. Private dermatologists are renowned for removing moles that 'might' become cancerous in 30 years time. They make a lot of money from it. Unfortunately the nhs doesn't receive enough money to do this.

So, do we have to wait for things to be cancerous for them to be removed on the NHS?

The NHS prepared histopathology report has recommended a re-excision straightaway. Would they only recommend that for a private patient, and not an NHS one if they didn't think it was really necessary?

If it was the skin clinic's cock up, why raise it with your GP? What's she going to do about it?

If you think they've made an error raise it with them for an explanation or NHS Area Team.

Hmmm. Difficult to know if this is over treatment on the private sector or under treatment in the NHS. If you want to take it up with anyone, do so with the dermatologist but it is by no means clear from your post that you've been badly treated.

I think the other posters saying why raise it with your GP are wrong. You mention Addenbrookes - I don't know if your GP is in that area?

In my local area several GP practices are unhappy with poor service in cost and referral times from the local hospital skin clinic, and several practices are making a decision to outsource their derm referrals to a cheaper and more efficient private skin clinic provider (this is very much encouraged under the new private contractors system in the NHS....)

So writing to your GP and the practice manager may well have an effect in terms of where they refer derm patients in the future.

Tell her.

I know someone who's been to her GP several times over a few years about a weird mole. Eventually they agreed to remove it and its malignant. And its spread into her lymph system.

I have had melanoma. Dysplastic nevus are really really common. Ive got tens of them over my body. There is no way they would all be removed 'just in case'. I don't think your gp has done anything wrong - and i think this is proven by the fact that your moles were NAD. I say this as someone whose melanoma was missed the first time i went to my GP.

Oh sounds like its maybe not too bad then. From what you first posted the dr had said it sounded like they'd caught a cancerous mole just in time.

Anon most of us trust what the NHS spec tells us. Not keep looking for opinions until one of them agrees with your view. And in this case the NHS spec was right- your mole was not malignant. Happy's post above sums it up perfectly.

Definitely raise this as they may need to inform the skin clinic of your experience so that they can tighten up their measures.