To think that GPs are not the best people to spot cancer early enough?

[AnnaPutinoff]

This is a bit personal, hence NC and deliberate vagueness, but basically two family members have been diagnosed with cancer. One of them has something very rare which was only picked up because their spouse used to work in the field and has been bugging the GP for getting on for two years about niggly symptoms that looked trivial but turned out to be anything but. A big operation is required now and the outlook isn't brilliant but they're at the age where 5 years is a real bonus. The other family member has just been told that theirs is very advanced and likely to be terminal. This person is very definitely much too young to die. And the awful thing is that they have been taking medication for years on repeat prescription to mask symptoms that were probably a sign of the illness. No recall from the GP surgery, nothing, until other more alarming symptoms happened.

Now I know that everyone keeps saying please see the GP. But what if you get fobbed off on a regular basis? Or getting an appointment requires something approaching top-level security clearance and a four-week wait? And then when you get there, well, it may be you have something rare enough that a GP used to a regular stream of coughs and colds and jabs and diabetes checks will never have seen it and won't have a clue. Cancer is such a complicated set of diseases, how the hell can a non-specialist (albeit qualified) be able to spot the early signs when they are so vague and non-specific? (I'd be interested to know how other countries manage this as well).

It's hard. gps have a few minutes to see people. Many cancers as you say have symptoms that are pretty vague ( ovarian is a bad one for this.)

Going back repeatedly and being fobbed off isn't great though.

I don't know what he answer is - I agree that you have to be pushy sometimes. I'd been telling a relative for years he had a specific chronic condition. The GP refused to do anything so I went with him with a set of questions and requests. Lo and behold he did have the condition once it was finally tested for. Same thing happened with medication - cheap outdated treatment given until I went again and requested a specific biological antibody treatment.

Person is now back to full health but it was like pulling teeth.

I'm sorry about your loved ones

I am always shocked by how much people can be fibbed off by gps, even now.

When I was a teen I was fobbed off for years by my GP. When I lived GP they spotted my pcos symptoms straight away.

Anytime I have gone in with a concern relating to cancer, they always send you to the hospital for further tests.

They always give me the 'it's almost certainly nothing but best to double check' type explanation and that's it. Still shocked how much this doesn't happen.

I just don't know what the solution is. There is never going to be no one that doesn't slip through the net. There is never going to be anyone who is trained to a high level available in GP surgeries for appointments.

And if they had a drop clinic at the hospital it would be rammed everyday.

It's awful, but I have no idea what the answer is.

I do know part of it is that some gps need to listen to patients more though.

My aunty kept going to the GP because she was getting bad stomach cramps, she went about 5 times before they finally scanned her and found she had cancer of the pancreas.
She died about 9 months after.
Its sad because if they listened to her on her first appointment maybe she could of been saved. Who knows.

I know of someone who was constantly told by their GP over the course of a couple of years they had arthritis. It turned out to be cancer which is know terminal.
My GP reluctantly sent me for tests on a cyst which was actually a benign tumour.
I don't know how the system can be improved.

I once worked in a GP surgery where a patient came in regularly with various problems - stomach ache, loss of appetitle, nausea etc. This went on for around 18 months. The GP did send her for tests and xrays, however it seems that they were not looking in the right place. By the time they found the stomach cancer, the only treatment they could offer was palliative and she died around a year later, leaving behind a husband and three teenagers.

My Mum's throat cancer and my aunt's ovarian cancer were both missed by their GPs. A lady (I was her carer), who I took to her GP at least 5 times with red flags symptoms, had her bowel cancer missed until it was very advanced. All of them died from their cancers. Though the lady I cared for was in her late 90's, so maybe even if they had found her's when she first presented at the GP and asked for a referral, there might not have been much they could have really done at such an age. They kept putting her symptoms down to her age. Tired - well at 98 that's not surprising. Constipation and diarrhoea - sluggish bowel etc etc.

You have to push and push if you aren't happy with a diagnosis or have symptoms that just won't clear.

I forgot to add that my aunt's ovarian cancer symptoms were textbook, but GP completely misdiagnosed her time after time :(

YANBU. FIL was told he just had back trouble causing the headaches, until he collapsed and was diagnosed with brain cancer. He'd been complaining to the GP for two years but kept being fobbed off with 'aches and pains of getting older'.

The cancer was so far advanced by the time it was caught that there was nothing they could do

sadly yanbu
the attitude of (some) gp's needs to change.
I, and I assume mane others, only go when symptoms are bad and/or don't go away with the 'wait and take paracetamol' approach.
it's then pretty insulting if the gp doesn't listen and says 'come back in 2 weeks if it hasn't improved' if you have done that already.

GPs dont have a speciality so if symptoms don't fit a specific thing it's easily possible to slip through the net. As our healthcare system is free we don't do many routine tests and check ups because of cost/benefit (compared to eg USA where you may have access to a lot of diagnostic tests, but there is no corresponding increase in life expectancy).

The answer as far as I have seen is always report to a&e to get admitted if you have genuinely worrying symptoms and are being brushed off by gp. You won't be restricted to a 10 min appointment, and if symptoms are serious enough to be admitted you will be quickly referred to a specialist. Ime they will usually be very happy to quickly organise scans etc to rule out anything suspicious.

I have been a few times over what I worried was skin cancer. Two GPs told me it was scarring from a cystic spot.

I went again yesterday over a mole change and I asked for his opinion on the scar as he is an ex derm. He took one look at it and told me it was not a scar but pre-cancer and I'm now treating the area with a burning cream. If it doesn't work or it gets bigger than 1cm it will need a derm appointment. It isn't life threatening, and he said he wouldn't usually give the cream for a small area but he knows I have health anxiety so he is happy to prescribe me the cream. I still find it quite worrying that the other two didn't know the difference between pre cancer and a scar.

I probably shouldn't be reading this thread really.

The answer as far as I have seen is always report to a&e to get admitted if you have genuinely worrying symptoms and are being brushed off by gp. You won't be restricted to a 10 min appointment, and if symptoms are serious enough to be admitted you will be quickly referred to a specialist. Ime they will usually be very happy to quickly organise scans etc to rule out anything suspicious

That is complete and utter nonsense. A&E do not have access to scans etc, apart from for emergency conditions (I am a GP and A&E doctor).

YANBU
My GP missed my DD's cancer for months.

You have to push and push if you aren't happy with a diagnosis or have symptoms that just won't clear

Agree with this ^^ totally, but I think there's still unquestioning deference towards GPs amongst some, especially older, people. Also not wanting to bother the GP, because everyone knows how overworked they are.

My GP said she was "100% certain" my breast lump wasn't cancer. I expect you can guess the rest!

I think as many people have said it's incredibly difficult for a GP in ten minutes to review all of the history and work out what can be very vague symptoms to pin point a potential cancer.

For me, I'm feel very lucky, and incidental finding on a MRI scan has shown issues with my kidneys. I have now had ultra sounds, a reassuring meeting with my GP to explain what's happening and an appointment to see a urologist to make sure it's not cancer.

The systems not perfect but in the main they do an amazing job considering the time and resources available to them

Tfoot75. Think a&e not the best place as shiny points out from a professional stance. A GP referral to the appropriate specialist would be more appropriate and if I was concerned and my GP hadn't suggested one, I'd push for a referral. And if there are suspicions that something could be cancer related, I believe you have to be seen within a time frame of 2 weeks.

I think GPs are fine for the everyday common illnesses but not so good at spotting rarer conditions, especially those with diverse symptoms.

Not cancer, but my Mum was misdiagnosed before she died. She had various symptoms and it took some time before her GP diagnosed her with an auto immune condition and referred her to hospital. Problem was there are two types of this condition, one is not that serious but the other is potentially life-threatening. The GP diagnosed the first, and sent a letter to the hospital but unfortunately my mum had the second condition.

she ended up in intensive care for a week over the Christmas and New Year period but she was too sick at that stage and sadly died. The referral letter from the GP arrived the day she died in hospital. If her GP has diagnosed the second condition and sent her straight to hospital the chances are she would be alive now.

Sadly the human body isn't an exact science, and it's inevitable that some cancers will be missed, if they present in an atypical way.

I recall seeing a man who had several lumps on his back, that looked like lipomas (benign fatty swellings). I referred him for an ultrasound to check that's what they were, but the wait for an ultrasound was about 6 weeks. The scan showed that the lumps were cutaneous metastases (localised cancer spread to the skin), which turned out to have come from lung cancer. He had no respiratory symptoms at all. The whole diagnostic process took about 2 months, and he died soon after.

Ovarian and pancreatic cancer are notoriously difficult to spot. Ovarian cancer often presents with mild bloating, which most people don't even bother to see their GP about. Pancreatic cancer often goes unnoticed by the patient until they wake up one day with yellow skin.

Bladder cancer is often picked up by detecting microscopic amounts of blood in urine. If this is detected 3 times then a cystoscopy is needed. You'd be amazed at the number of people who don't bring in a repeat urine sample after they've been told there was blood in the first.

I have been a GP for 20 years and I can say, hand on heart, that I have never missed a cancer that presented in a common way. I refer every single breast lump I see, which helps.

But financial pressures make it impossible for GPs to request tests without compelling reasons.

I think this is a bit unfair to GP's. E.g. Ovarian cancer is relatively rare. Most GP's may only see one case in three years. The symptoms are v vague and much more likely to be caused by other diseases, e.g. IBS. Sadly, it's possible to be terminal without having any symptoms worth a visit to a doctor.

A bit of heartburn? Stress incontinence? An expanding waistline? Most cases are in postmenopausal women who would regard the above as par for the course at their age.

Headaches, coughs, stomach pains are all much more likely to be benign than anything else. If the GP referred them all to a specialist, there'd be no appointments for patients in genuine need.

I wish GPs wouldn't put everything down to a virus, stress or getting older. It takes such an effort to get to see a GP, many like my DH have to be nagged, so people should be listened to and taken seriously when they finally get there.

The problem is that most of the people who 'push and push' have fuck all wrong with them. I think it is difficult for a GP to differentiate between the pushers who are time wasters who have prepared from Google a list of all the medical investigations they urgently require for free on the NHS, and genuine sick people with worrying symptoms. It has been said that the biggest cost to the NHS is the 'worried well'. People who are extremely worried about various symptoms but perfectly well.

The worst thing is that the most genuinely sick people are the polite ones who will never push, they don't want to take up any time in case it turns out they're ok. But I don't think telling everyone to push GPs more is the answer. If only there was a way to get the time-wasters to pull themselves together and stop pushing, freeing up GPs to focus on the cases that need investigation.

When I was at uni a girl with TB was repeatedly sent by her GP to buy cough syrup for months and months until it became life-threatening (plus a public health hazard as TB is highly contagious). But how is the GP going to investigate further when there are so many people who will go and see them just for a cough, that he has resorted to advising cough syrup for all the coughers? He can't send all the coughers for further investigation, that would be a joke.

I don't think it's unfair on gps and ovarian cancer is not "relatively rare" unfortunately. Can you guess my mum was fobbed off and spoken to rudely by a gp? No diagnosis for 9 months until a locum sent her for a scan. Next door neighbour fobbed off for 18 months. By then it was too late for any treatment. Same for a colleague's wife. All talked down to.

GPs should err on the side of caution when a woman, who rarely went to the doctor, had bleeding, bloating and a family history of breast cancer. Not patronise her "it's your age".

I think there are some GP's who are more likely to miss things than others. There is on GP at my surgery who I avoid because no matter what symptoms you go with you either have a virus, a chest infection, eczema or need your eyes tested. He once diagnosed eczema on DD1 before she'd even taken her gloves off.

My friend has been to see him several times recently because she's had a cough since November as well as a few other symptoms including an almost constant kidney infection. She saw one of his colleagues last week and was sent to hospital and diagnosed with kidney cancer that has already spread to the lungs and lymph nodes.

Other GPs are very on the ball. When I had a breast lump I was referred straight away despite the GP being very sure that it was nothing scary. Due to DD's hospital appointment schedule she even went out of her way to ring them and ask if they could fit me in between her appointments.