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AIBU?

Share your dilemmas and get honest opinions from other Mumsnetters.

Original poster

To think this gp was very dismissive and slightly inappropriate?

56 replies

whatonearth555 · 06/11/2023 19:16

NC. DD was a victim of rape when she was 15 (now 21). She had counselling after and developed ptsd and has been on sertraline for the past 2 or so years. Last week, she noticed a new lump on her breast. Today, she has an appointment with the gp (I went with her as she asked me to) he examined breast and felt the lump (about 30 seconds) said it was unlikely to be anything sinister and probably caused by stress of DD passed trauma???? DD didn't even mention that to him but guessing he read her medical records and saw she accessed counselling and of course the antidepressants. DD said to him she has never felt more content with herself and at uni etc and feels settled. To which he responded it well may be subconscious and if it doesn't settle down in a few weeks to come back???

OP posts:
GrannyAchingsShepherdsHut · 06/11/2023 21:12

CliffsofMohair · 06/11/2023 20:15

Also these days never assume you actually saw a GP. Some physician associates working in GP practices now

This is exactly where my mind went too.

Can you look at the practice website and make sure he was actually a doctor, as a first step?

If she's not happy, and I wouldn't be, I think she should ask for another appt with a female Dr.

Cece92 · 06/11/2023 21:21

That's Ridiculous!! I found a lump at 21 a few months after my daughter was born and my GP sent for for the 2 week referral to the breast clinic. It was just a fat lump but they took it quite seriously and I did think I'd be dismissed due to my age and the fact it could be like a blocked milk duct or hormonal. Definitely get a second opinion xx

Faffertea · 06/11/2023 21:38

I’ll start this by saying I’m a GP…

It’s difficult to comment on any individual case without knowing all the details but on the basis of what you’ve said it seems odd to me to attribute a breast lump to previous psychological trauma (as opposed to physical trauma to the breast which can cause tissue changes).

As a general rule of thumb, watchful waiting for the length of a menstrual cycle in women under 30 to see what happens over that time is the usual approach and what my local breast team advice. There are of course times though where that will not be the right approach and watching for a longer period of time or urgent referral without watching is needed. Which is why training to be a GP takes the time that it does.

I think what’s important here is that you and your daughter are still concerned. In which case it is completely reasonable to ask for a second opinion and to ask when you/your daughter books the appointment if the receptionist can suggest who would be best to see about a breast lump. I would also say I think it’s completely reasonable to ask the person you see to explain their rationale for what they’re suggesting as a management plan if it’s not clear why or it doesn’t reassure you or your concerns. I think it’s part of our job to ensure patients understand why we’re suggesting a certain treatment or action, why we’re worried or not and 100% what we want them to look out for and come back to us with.

Dancingonaslice · 06/11/2023 21:49

AmicableHonest · 06/11/2023 19:34

Any lump should immediately be referred to the breast clinic. I was referred even for an obviously blocked duct while breastfeeding, just to be sure.

Go back, ask for a different GP.

I disagree- in younger women with no other risk factors or abnormal signs it can be reasonable to wait for a cycle to see if a hormonal cyst settles.
A persisting lump should then be referred but age may play a part in whether it meets criteria for a two week wait for suspected cancer Or a more routine referral.

Original poster
whatonearth555 · 06/11/2023 21:51

Faffertea · 06/11/2023 21:38

I’ll start this by saying I’m a GP…

It’s difficult to comment on any individual case without knowing all the details but on the basis of what you’ve said it seems odd to me to attribute a breast lump to previous psychological trauma (as opposed to physical trauma to the breast which can cause tissue changes).

As a general rule of thumb, watchful waiting for the length of a menstrual cycle in women under 30 to see what happens over that time is the usual approach and what my local breast team advice. There are of course times though where that will not be the right approach and watching for a longer period of time or urgent referral without watching is needed. Which is why training to be a GP takes the time that it does.

I think what’s important here is that you and your daughter are still concerned. In which case it is completely reasonable to ask for a second opinion and to ask when you/your daughter books the appointment if the receptionist can suggest who would be best to see about a breast lump. I would also say I think it’s completely reasonable to ask the person you see to explain their rationale for what they’re suggesting as a management plan if it’s not clear why or it doesn’t reassure you or your concerns. I think it’s part of our job to ensure patients understand why we’re suggesting a certain treatment or action, why we’re worried or not and 100% what we want them to look out for and come back to us with.

Edited

Thank you for this comment. Really helpful to get a GP perspective. DD going to ring tomorrow tomorrow to see if she can at least get a telephone appointment to discuss it again. And ask some questions she didn't feel she could ask today.

OP posts:
Original poster
whatonearth555 · 06/11/2023 21:55

Checked the practice website, it was an advanced clinical practitioner she saw- what is it that? Is it a nurse practitioner?? I just assumed he was a dr as he had a stethoscope how ignorant of me😩

OP posts:
Original poster
whatonearth555 · 06/11/2023 21:55

CliffsofMohair · 06/11/2023 20:15

Also these days never assume you actually saw a GP. Some physician associates working in GP practices now

Checked the practice website, it was an advanced clinical practitioner she saw- what is it that? Is it a nurse practitioner?? I just assumed he was a dr as he had a stethoscope how ignorant of me😩

OP posts:
doublec · 06/11/2023 21:56

I actually have a long history of fibroadenomas - benign breast lumps. First one was at 15, and many others until my late 30s. Three of them all developed/were found by me after periods of great stress - mock GCSEs, mother's death, father's death, so actually, the GP is partially correct that they could be linked to trauma/stress, and given your DD's age, hormones too. (Mine were probably caused by oestrogen dominance, and trauma can cause stress, which in turn, can cause hormones to fluctuate. ).

How many menstrual cycles has your DD had the lump for? At the very least, watch it for another one, then go back and say that it has been present for two cycles and the GP should refer you. Often, these lumps can disappear as quickly as they appear. Either way, keep a close eye on it and if it's stlll there in a month's time, go back and insist on a breast clinic referral.

rubytubeytubes · 06/11/2023 21:58

No, it shouldn’t.
It’s accepted that, particularly in young women, that watchful waiting for a few weeks, usually until after the next period (if possible) is a sensible first step.

DrPsy · 06/11/2023 22:01

This diagnostic overshadowing is so problematic. Request another appointment with another GP as PPs have suggested

PinkDaffodil2 · 06/11/2023 22:06

I’m a GP and that sounds a very very odd rationale.
If the lump has been examined by a qualified GP then the plan to wait a month before referring is reasonable as very likely a hormonal cyst. However something doesn’t sound right about your version of events - are you absolutely sure this was a qualified GP you saw - not a trainee or physicians associate / nurse practitioner etc?
I’d double check in the morning and if not a proper GP consider being seen soon again to be examined by an experienced doctor (and feed back strongly about them not making their role clear!) apologies if that is way off the mark.

PinkDaffodil2 · 06/11/2023 22:10

Sorry just saw I cross posted while typing slowly - multitasking feeding baby.
Definitely call up tomorrow to at least speak with a doctor, and consider feeding back what you raised in the initial post and also that they didn’t make their role sufficiently clear.
There have been some very sad stories in the news about bad outcomes of patients who thought they saw a GP but actually it wasn’t a doctor they saw. Nurses, pharmacists, physicians associates are increasingly being employed to see a wider range of presentations without the capacity to oversee them safely.

theduchessofspork · 06/11/2023 22:13

That’s a bizarre remark

Get it looked at by someone less crackers and complain to practice manager

theduchessofspork · 06/11/2023 22:15

whatonearth555 · 06/11/2023 21:55

Checked the practice website, it was an advanced clinical practitioner she saw- what is it that? Is it a nurse practitioner?? I just assumed he was a dr as he had a stethoscope how ignorant of me😩

No I think that’s the same as a physician associate, rather than a nurse.

That sounds even odder, I didn’t think they were qualified to do examinations like that.. but it might slightly explain the weird remark. Do complain formally.

Mirabai · 06/11/2023 22:19

It’s basically a nurse with a masters. I’m sure they can be competent in certain situations but I’ve just had similar issue with my elderly mum, who thought she saw a doctor, but the advice was so nonsensical I ignored it and called her consultant.

disappearingfish · 06/11/2023 22:30

Are you absolutely, 100% sure he meant mental trauma from her assault? In that context it could also mean a physical injury. It seems very, very unlikely that he would have read her notes from 6 years ago before her appointment.

Original poster
whatonearth555 · 06/11/2023 23:04

disappearingfish · 06/11/2023 22:30

Are you absolutely, 100% sure he meant mental trauma from her assault? In that context it could also mean a physical injury. It seems very, very unlikely that he would have read her notes from 6 years ago before her appointment.

Yep 100%. He specifically mentioned the antidepressants when talking about trauma and dd told him how she feels very content at the minute.

OP posts:
Original poster
whatonearth555 · 06/11/2023 23:06

PinkDaffodil2 · 06/11/2023 22:10

Sorry just saw I cross posted while typing slowly - multitasking feeding baby.
Definitely call up tomorrow to at least speak with a doctor, and consider feeding back what you raised in the initial post and also that they didn’t make their role sufficiently clear.
There have been some very sad stories in the news about bad outcomes of patients who thought they saw a GP but actually it wasn’t a doctor they saw. Nurses, pharmacists, physicians associates are increasingly being employed to see a wider range of presentations without the capacity to oversee them safely.

Thank you for this! I just assumed it was a doctor!! Checked practice website earlier he's down as an ACP?! Will ring tomorrow. Very impressed on multi tasking baby feeds and typing!

OP posts:
Original poster
whatonearth555 · 06/11/2023 23:07

Mirabai · 06/11/2023 22:19

It’s basically a nurse with a masters. I’m sure they can be competent in certain situations but I’ve just had similar issue with my elderly mum, who thought she saw a doctor, but the advice was so nonsensical I ignored it and called her consultant.

I literally thought he was doctor! So confusing and dangerous. Can acp/ pa prescribe?

OP posts:
Original poster
whatonearth555 · 06/11/2023 23:08

theduchessofspork · 06/11/2023 22:13

That’s a bizarre remark

Get it looked at by someone less crackers and complain to practice manager

This made me laugh😂😂

OP posts:
Rosebud21 · 06/11/2023 23:24

Advanced nurse practitioners do prescribe if registered as a non medical prescriber. They also can refer to the breast clinic and follow/use the same referral guidance/pathways as GPs.

Carriemac · 07/11/2023 07:33

Definitely complain - that ACP was working way outside their remit to attribute a breast lump as mental trauma . My advice to anyone is to check who you are seeing is an actual GP and don't be fobbed off with a noctor.
(And I'm an allied heath professional, so it being elitist just pragmatic)

Riverlee · 07/11/2023 07:50

Saying it’s more likely to be a cyst and nothing sinister is not being dismissive. If anything, you could say he’s trying to be reassuring as he’s trying to say it’s nothing sinister.

Not sure how it links to stress though.

Universalsnail · 07/11/2023 09:08

A lump in the breast is not caused by sexual violence trauma 6 years previous.

You need to see another Dr as she needs a referral to the breast clinic.

And I would be complaining to the practice and to pals about this dr

Original poster
whatonearth555 · 07/11/2023 13:47

Little update, DD developed rash overnight- had GP appointment at 11 who said she has cellulitis and given lots of antibiotics. Also said previous acp was inappropriate and encourage her to pals it.

OP posts: