Would you complain about being told to expect a cancer diagnosis when you don’t?

[BuzzyBallz]

Context- I am a surgeon. My husband is a judge and we have a very busy life. Being tired is our default. However DH was remarkably more tired, we’re talking coming home from work early (at 5pm rather than 8) sleeping til 9, getting up having pizza and then going to bed again til 5.30)

I basically forced him to go to the drs and I wrote the e consult for him because I knew the medical words for things and how to get our gp to listen.

he submitted the e consult at 7.45 am on Monday, saw a gp at 10am. She did bloods and told him to Go home and rest.

On Tuesday morning he had a phone call from the GP saying he would hear from the national cancer centre near us, that he had an appointment for the following day, was told to not go alone and to expect ‘100% a diagnosis of lymphoma or leukaemia’

I never want to repeat those 24 hours, I saw his bloods and I knew that they were grossly abnormal so I could understand the importance of having him
seen by a haematologist.

We saw the haematologist and she said that he didn’t have cancer he had very serious glandular fever. The relief was indescribable. DH wants to send an email to the gp basically castigating them for telling him to expect a diagnosis of cancer when he didn’t have cancer? I feel like he would be a bit unreasonable to do that because his bloods were so abnormal I understand why they fast tracked him immediately, whereas his view is that he doesn’t have cancer and therefore could have been spared a horrible 24 hours where we thought he would need to re evaluate his entire career and life etc.

So am I being unreasonable to say I wouldn’t complain, because I understand why he was fast tracked whereas he thinks the emotional anguish they caused him was unreasonable. So who is being unreasonable?

Me- YANBU
DH- YABU

I’ll take it with grace if I’m unreasonable (promise)

I think the GP basically saying you have cancer, rather than there's a strong chance its cancer or bloods suggest cancer or something like that was bad but ultimately, I'd just take the win and be happy.

I remember when my youngest was about two months old she was diagnosed with some serious kidney thing and sent to hospital for a whole bunch of tests going on for about a month. Ultimately, there was nothing wrong with her and it was a combination of a misdiagnosis and contaminated sample pointing to this kidney thing.
I remember telling friends lots of whom said they'd be furious and complain to the hospital. My view was that this was actually the best news we could have possibly have been given.

Working in healthcare I would never say 100 percent expect any diagnosis, but all the other things without that comment would still have given the same amount of worry.
When my mum had a similar referral, we were not told to expect a cancer diagnosis (I knew it was), and she and my brother spent the evening before talking themselves out of a cancer diagnosis and all the other things it could be. That was also awful.

I have to disagree with you. The GP is a generalist and should not be giving a specialist opinion, it is outside of their competences. They should not have given a definitive opinion.

I've been in the same position twice, not from the GP consultation but at the hospital (breast clinic and head and neck surgeon) when I was told I almost certainly had cancer prior to any diagnostic tests being done. I was immensely relieved on both occasions that I was well, in that I didn't have cancer but needing treatment/ surgery for something else. It didn't enter my head to complain.

I was told by gp that ds had bone cancer and sent us straight to the hospital where we were met by orthopedic doctors. Things de-escalated pretty quickly and within a few days we were told the tumour was likely benign. Did gp overreact? Yes, but she reacted with the knowledge she had. There was a very obvious tumour on the mri scan. Orthopedic doctors at local hospital referred us urgently to the local orthopedic cancer centre which was the only way to identify the type of tumour. They were able to quickly downgrade the level of concern although he had to have more tests and scans to confirm. I wish gp hadn't said cancer during that awful phone call telling us to go straight to hospital but it's nor a common diagnosis and she panicked. I don't hold that against her and didn't complain.

This!. Yes of course it would have been a horrible 24 hours just having been told of the referral.
A GP telling anyone they "100%" have something the GP isn't in a position to diagnose (amd indeed something they dont have) is bombastic, arrogant and unprofessional.

Being a judge is totally fucking irrelevant.

I think I agree with you. Ultimately for him it was extremely traumatic and stressful to have that conversation and now he knows the actual diagnosis he’s very much of the opinion he shouldn’t have been told anything by the gp.

And well he shouldn't.

Your attitude of "he should just be grateful he doesnt have cancer" is massively invalidating of your husband's feelings and apologising for the GP's fuck-up. I cant quite believe your arrogance in coming here and posting. Shouldn't YOU be focused on gratitude that he doesnt have cancer, by your logic?

The fact that he was seen and diagnosed The GP hasn’t seen everything they would rather over compensate than under diagnose. Haematology is better at seeing through the readings in blood.

I am so sorry for everyone who has also experienced this and either found out the gp was wrong or correct as realistically they shouldn’t be the professionals who disclose the diagnosis. I am a surgeon who specialises in colorectal cancer and I like to be the person who explains to my patients their diagnosis because I usually at that point have first hand access to their colonoscopy/ endoscopy/ scans etc and I can give them the nuance of their diagnosis. To hear the c word means most patients stop listening after that point but I will always always explain the procedure and diagnosis properly, and as many times as needed to the patient and their loved one.

I haven’t voted because I don’t think that either of you are being unreasonable.

Being fast tracked rather than waiting was a good thing, I’d probably be feeling grateful for that. On the other hand, the anguish of being told it’s 100% cancer is terrible too.

That said, I’d wonder if the GP had instead said they were fast tracking as a precautionary measure, would your husband have been any less worried? Would his mind have gone to the exact same place anyway, without this being said, just because they knew they were being fast tracked?

He’s not wrong to feel the way he does, but maybe he can think about the future. If he says something, could it possibly make the GP hesitate to put the next patient or the one after on a fast track?

Maybe it’s something he could mention in passing next time he sees the GP, being grateful for the fast track, but how awful it was to be told something was 100% rather than a possibility. This way he gets it off his chest without making it a more formal complaint.

The GP did their job, they got him rapid evaluation and they told him to expect the worst. It wasn’t the worst. That’s great. He would be grossly unreasonable to complain . Had the GP sent him in unprepared that’s worth complaining about!

As someone with cancer, no, I’d be really bloody grateful I didn’t have cancer.

The GP who referred me said, I’m pretty sure it’s this (fairly aggressive) cancer. I saw the specialist 5 days later who said, no, I am fairly certain it’s this other much less worrisome cancer that no one dies from, you’ll be fine. Biopsy done, 8 week wait for results.

Meanwhile, it kept growing and growing and a lymph node became swollen and painful. I made myself an absolute annoyance to the consultant’s secretary. Magically, me being a right pain and flapping about over my painful lymph node put a rush on the results and they were back in 3 weeks. The GP was exactly right and the consultant was wrong. It was stage 3c by then. It was spreading so fast that I think it’s possible it would have been stage 4 and incurable had I not been such a nuisance.

I am very grateful for the GP and her guess and for telling me what she thought it was. It meant I could better advocate for myself and may ultimately have saved my life. I’m now no evidence of disease (‘cancer free’) and one month away from finishing 12 months of treatment.

Do however get those bloods repeated. I was initially fobbed off by another GP and I wish I hadn’t taken their word for it. I’d wish I’d gotten a second opinion sooner. The delay meant that I’ll likely live a long life, but still with permanent disability. I’d want to know for sure the bloods returned to normal.

I suspect that those GP made a very deliberate choice in their communication to your husband based on the fact he had been dismissive and focused on his work schedule, there was a real risk of him not going to the appointment if the urgency wasn’t emphasised to him.

Did the GP really say “100% expect” a diagnosis of haematological malignancy, though?

I’m sure that you will have had occasions where you have carefully gone through the risk:benefit ratio or prognosis, for the patient to then say “so what you’re saying basically, it’s 50:50”.

We know that it is incredibly difficult to recall consultations from the other side of the desk with perfect accuracy, as it’s such a stressful situation, even if it’s your own speciality. The mind has to simplify complicated messages to process them.

It seems extremely ill advised to be as categorical as to say “100%” at this stage of the process, without any imaging or histology. The most definite most people would get would be “I’m very sorry, but you need to prepare yourself that it is very likely that…” or “there are a few things that can cause this picture, but you need to be prepared that…”

By the time the GP had reached the stage of training to practice as a GP, they will already have had the experience of the family gathering from far and wide to say goodbye to a loved one, only to find them having confounded expectations by sitting up in bed eating toast, or indeed the expected lymphoma turning out to be sarcoid or even histiocytosis or something similarly rare. And therefore learned to be a little more circumspect with suspected differentials.

I would tell them what happened and that perhaps next time not to say 100% cancer.

Saying 100% was wrong but at least there was a swift referral. Similar happened to my DH last month - we was extremely tired then had violent diarrhea for a week and started bleeding from his behind. He was having some other health issues and had a blood test which showed incredibly low iron. A very high FIT test meant he was referred urgently for a colonoscopy and endoscopy on the 2 week cancer pathway. He asked the GP if it could be anything other than cancer and the GP said not with these numbers. The next 3 weeks were quite frankly very upsetting and stressful. Thankfully he just had a huge polyp that was removed. Honestly I wouldn't even have thought to complain. It seemed like a foregone conclusion but luckily all was fine. I think you should let it go.

I was told straight after biopsy “it looks like cancer and next time you come in you’ll be meeting the cancer team”. I then had two excruciating weeks to wait for the results; it was indeed cancer. I suspect this is not so uncommon and in my situation I think it was kinder even though there was a risk of a false positive.

I agree. When I was on the 2 week pathway a few years ago my GP kept texting my re-iterating that it may well be cancer and I must not miss the appointment. Freaked me out but knowing how many missed appts there are in the NHS I can see why they do this sort of thing.

Neither of you are being unreasonable.
However, I do think the GP could have delivered the warning shot in slightly less certain terms, e.g. the blood test are abnormal and we need to consider cancer as a possible cause.
Having been in this game a while, I have seen cases that look like barn door cancer only for it to have been something benign.

Can I be very rude and ask a bit of a tangent question ? Please ignore if you want.
If I was to receive very bad news, I would much rather receive it by email, in private on my own and not in public were I had to control my feeling and couldn't react as I needed. I've been told a bad medical diagnosis would never be given privately like this regardless of what the patient wanted or how they requested they receive the news. This worries me.

I'm a GP. I would be very surprised if the GP actually said 100% cancer. I would never say that when doing an urgent suspected cancer referral. I do say to people, I'd be more surprised if it's not cancer. And to people who are talking about going on foreign holidays, or work trips etc, I am more firm about my level of worry and the need to attend. There are a fair few patients who are quite persistent in wanting me to say oh it's nothing serious, this is just a precaution isn't it.
I'm sure you know how patients recall varies.
I once said to a lady and her adult daughter in front of me, this could be something quite serious, possibly even a tumour, including cancer, so I want you to see a specialist for more tests. And the lady turned to her daughter and asked what does she mean. Daughter said 'you've got cancer, mum, and you have to stay in hospital'. I was shocked, but daughter really believed that's what I'd said. That was a lesson for me that day.

OP, you could email the practice passing on feedback. As you will know we are all having to submit evidence of learning, portfolio etc and if you phrase it kindly it shouldn't be taken badly.

i haven’t read all the comments but note you say you heard your DH receiving the referral phone call.

One might say that if this was the first time DH was ever have to submit to a higher power and was kicking against it, I can understand the GP pulling out her last big gun to get him to go.

I understand judges are under insane pressure, that they do take their job seriously (which is good for the rest of us) and that there is considerable money involved in a judge not tuning up.

Tell DH he is being an idiot and welcome to the real world where things don’t always go to plan.

I Hope so. I’ve been having palpitations so who knows. I’ve had the ‘snapshot’ one but need to be fitted for a 24 hour one. It is shocking to me that they make you wait so long.

A few years ago I was informed by a GP that all the symptoms I had (not going into details here as it's very outing) were probably cancer. There had been no tests apart from an X ray which wasn't conclusive but she stated with some certainty that it was highly likely it was cancer. She took some blood for testing and after a horrible weekend I phoned the surgery on Monday for the results. It was a different GP and her first words to me before I even explained what I was phoning about were "You don't have cancer".
What the guilty doctor should have said is "We are doing tests to rule out cancer and other potential causes". I made a big complaint to the surgery but I didn't feel that the reply I received was satisfactory and that it was a list of excuses. The GP is still at the surgery and I always refuse appointments with her.
There is no way a doctor should suggest a patient has a horrible illness till tests have formally confirmed it.