Possible cancer and AIBU

[Spooksandchocolatecake]

Hi I'm new to MN so please be kind, my dd14 has had a lump in her left leg for the last 2 months(we spotted it then but thought it might just go away on its own😬) small but prominent. I noticed it again last night and was shocked at how much it'd grown.

This morning I took dd to the surgery and asked for an appointment with a doctor. She replied saying that their wasn't any this morning but at 9:30 we could see a primary nurse (wasn't best pleased but appreciate that the NHS is crippling underfunded and was reassured if their was anything more sinicall she would refer us to a Dr). We went to this nurse who gave one look at my daughter and said that she was absolutely fine (refusing to look at my daughters leg in the process).Telling me she had a lipoma:fatty lump in the muscle. It's rock hard and attached to her kneecap! I then went back to reception and asked for an appointed with the Dr, she said no because the nurse had said no further investigation was required. I made a bit of a song and dance and managed to get a appointment with the Dr at 2:30.

We got there and she took a look and said it was possible cancer. The lump was 3cm×3cm rock hard and definitely not a fatty mass, she had bloods done to check her calcium level and put down as a emergency so we'll get them tmrw.

I asked for a complaint sheet to complain about the nurse, to which the receptionist said that wouldnt be necessary and that I had caused enough trouble as it is!

AIBU and any advice to help dd

Exactly what @TwitterQueen1 said.

Completely unprofessional all round
.
I hope your dd has better news and better treatment at the hospital.

The doctor won't know at this stage

Not for definite they won't. But there are very definite differences between cancerous and benign lumps so they might have a very good idea. And if they think it's cancer then they absolutely should be honest about that for all the reasons I gave in my earlier post. Hopefully though they are wrong, which is definitely possible especially given that cancer in children is rare.

Take care OP, hope you and your dd have plenty of support and that she gets her investigations done soon so you know what, if anything, needs to be done.

@CharlotteUnaNatalieThompson

Are you saying a GP has enough experience to make an accurate visual diagnosis that a lump is probably cancer? Even if they examine it as well?

You can surely not give false hope whilst not lying either?

Complain to the practice manager you’ve received shocking treatment all round. Even if your complaint had been completely spurious and unreasonable it’s not the receptionists place to deny you the ability to make it.
Write a letter and then spend no more time of this you don’t need to be wasting your energy when you’ve got so much else to worry about at the moment. Sending love to your and your DD and hope it turns out to be nothing of any consequence.

At 14, it is extremely unlikely to be cancer. I'm all for honesty, autonomy and respect, but in this case the doctor was not reasonable to mention the C word in the presence of your daughter.

Are you saying a GP has enough experience to make an accurate visual diagnosis that a lump is probably cancer? Even if they examine it as well?

@NannyOgg they certainly can have enough experience to assess that a lump has features that suggest cancer. Remember, all patients that come to see hospital consultants have to come via their GP, who therefore has to be highly skilled at determining whether a symptom / set of symptoms is concerning based on their examination alone. Their clinical examination skills are therefore often more highly tuned than those of a hospital consultant, who has easy access to tests that will give a more definite answer, and therefore isn't so reliant on their clinical judgement.

To be clear (especially to the OP) I'm not making a judgement call as to whether the GP is right as to the diagnosis in this specific case or not - I have no idea about what the cause of the lump is because I haven't seen the OP's dd, I'm trying to explain why it's appropriate for doctors to be honest.

Cancer doesn't mean that it will be malignant though. I have a growing benign tumor. It doesn't spread to my organs and it's not damaging anything. It won't kill me, it's just not pretty. I will have it removed in future but that is more for cosmetic and comfort reasons.

On the one hand the nurse was dismissive (and wrong) and the receptionist was also in the wrong, and complaints about them are valid.

On the other hand, demanding an immediate GP appointment for something that’s been there for two months growing slowly that you had vaguely noticed but thought would go away on its own? How long would you have had to wait to get a GP appointment?

Also, for clarity, if the GP is referring a patient under the 2 week wait pathway (which is the referral pathway for all suspected cancers and is subject to strict timescales such that if it is a cancer there is minimal delay to diagnosis and treatment) then part of that referral includes indicating that the patient is aware that the referral is to investigate a possible cancer.

Patients are referred using this pathway if their symptoms or pattern of symptoms have a likelihood of 3% or more of being a cancer - so potentially up to 97 out of 100 patients referred in this way could turn out not to have cancer (in reality given that some symptoms are much more concerning than others the actual percentage will be bigger than this but will probably vary between different specialities).

It's therefore possible that the GP said something like 'I need to refer you urgently using the 2 week wait pathway to rule out possible cancer' and the OP and her DD heard only 'possible cancer'. This is also very very common, not because people don't listen but because as soon as you hear the word cancer it's pretty hard to focus on anything else.

At 14, it is extremely unlikely to be cancer. I'm all for honesty, autonomy and respect, but in this case the doctor was not reasonable to mention the C word in the presence of your daughter

The C word?!?!? Please don't call it the C word, that is making something a taboo. I spent years working in a cancer clinic who did a questionnaire and most patients felt that calling it the C word isn't helping them talking about it, far from it. They spent years educating guest via posters to talk normally about it.

At 14, it is extremely unlikely to be cancer. I'm all for honesty, autonomy and respect, but in this case the doctor was not reasonable to mention the C word in the presence of your daughter

Tell that to members like GoJetterGirl and other munsnetters with children with cancer- rare, yes, but it does happen- 1 in 300 children if I remember correctly PP

My husband was referred under the 2 week wait pathway for a lump in his arm, and cancer was mentioned during the first appointment, but it was in the "let's rule out cancer" context. He ended up having lots of scans (some of them at the carcinoma clinic, which sounded very scary) and consultant's appointments before it was decided that it was a non-cancerous mass. It was quite stressful but we appreciated the transparency.

Having said that though, I had a lump in my breast when I was about 20 and the junior GP that I saw immediately went "it's probably cancer", which scared the hell out of me. He was told off by a senior doctor shortly after. I think transparency is great but so is being mindful of your patient and their age. I hope your daughter is ok, OP.

As much as the nurse and receptionist were at fault, I think the GP saying "this could be cancer" on an initial observation of a lump is the most shocking thing here.

No competent GP would ever use that sort of language on initial appointment and unnecessarily terrify a patient, especially a youngster. Far more likely for a GP to say that it's likely to be a cyst (which it is) but that they will investigate further - blood tests, order imaging, for extra reassurance.

Charlotte I am a stage 4 ovarian cancer patient. There would be no need to 'lie' or to hide things. There are ways of talking to patients and saying anything along the lines of "it could be cancer" either in front of, or to, a 14 year old child (and the parent) on a first visit to a surgery is not acceptable. Surely you can understand what the word 'cancer' means to people? The utter fear it generates?

All that needed to be said was that the GP thinks it's highly unlikely to be anything nasty or suspicious but that he/she would refer for further test.

I think you should focus on your daughter and her health at the moment, rather than pursuing your complaint. Wait until you have a clear diagnosis and then decide whether a complaint is worth pursuing.

A relative of mine had a fatty lump on her knee which was rock hard. She had it for years before agreeing to have it removed.
I wouldn't jump the gun and assume the worst because it's far more likely to be what the nurse said it was.
I'm also shocked the GP said it might be cancer. They are usually very cautious about saying that even if they suspect it because they are not oncologists!

@twitterqueen I echo what you’ve said totally. My dh is an oncologist and he’s horrified that any GP would say that in front of child. Totally unacceptable.

Tell that to members like GoJetterGirl and other munsnetters with children with cancer- rare, yes, but it does happen- 1 in 300 children if I remember correctly PP

Seriously??? Why would I? Rare = extremely unlikely. 1 in 300 - extremely unlikely. Go and be alarmist somewhere else.

@TwitterQueen1 sorry to hear about your diagnosis.

I completely agree with you that there are ways of handling this that doesn't mean just being blunt. However, none of us know exactly how the conversation went. Indeed, precisely because of the fear the word cancer generates (and clearly you'll know this first hand better than me) it's probable that even the OP and her DD can't really recall how it went now.

It's possible that the GP handled it really badly. If they blurted out 'it's probably cancer' without a more gentle discussion exploiting the concerns of his/her patient and explaining why they are worried and what they are going to do to get her seen quickly, I'd be as horrified as anyone.

However I think we'll have to agree to disagree on this:

All that needed to be said was that the GP thinks it's highly unlikely to be anything nasty or suspicious but that he/she would refer for further test

See, this isn't being honest if the GP genuinely thinks it's cancer. It's giving reassurance that it's probably nothing.

I wouldn't actually use the word cancer in this situation, unless explicitly asked, I'd say something along the lines of 'this may turn out to be nothing, but there are some things about this lump that make me worried. So because of that, I'm going to refer you urgently for tests that will get to the bottom of this quickly and hopefully reassure us that all is fine'. So, gives a warning shot, and is honest, but not brutal. In that situation, most patients don't ask more, but a small number ask a lot of detail about what I think it is, often explicitly asking if it could be cancer. In which case I'd be honest that that was a possibility.

Hopefully this is how the GP handled it, hopefully they are wrong and the tests are reassuring.

Exploring NOT exploiting

Did the GP just say that or did you ask if it could be cancer and she said it could be but would have to do tests?
If so, then even that would surprise me because most would say they don't know until tests were completed.

I agree about complaining to the practice manager about the attitudes you've experienced.
I agree the GP should never had said what he/she did-they tend to be more cautious in how they speak.
As for the nurse, it's possible she is correct but she was very dismissive.
They should always refer for imaging in these scenarios.

You don't need a complaint sheet to make a complaint.

You just write a letter to the practice manager stating clearly what your concerns are:
Misdiagnosis by nurse - potentially life threatening
Being prevented from having second opinion by receptionist
Receptionist being unfamiliar with complaints procedure and preventing you from making complaint

Ask for them all to be dealt with as a serious incident.

Spooks - you must be feeling very worried. Concentrate on supporting your daughter.

Complain to practice manager and copy it to the CCG.
I am surprised by the GP comments too.