To think the new “Jess’s rule” should be blindly obvious & it’s an embarrassment that we have to remind GPs this?

[Waitingforthesunnydays]

This new NHS initiative, “Jess’s rule” is supposed to remind GPs to “rethink” things if a patient has had 3 appointments and they haven’t been able to diagnose them with anything. AIBU to think this should be blindingly bloody obvious?! And it’s actually embarrassing that we’re putting up posters to “remind” GPs to get a second opinion or refer on for tests if someone’s had 3 appointments with severe symptoms and hasn’t got a diagnosis. The initiative is a result of the death of Jessica Brady, who was 27 & died of cancer that was missed by GPs in December 2020. She had 20 appointments with SIX different GPs at the same surgery. She was suffering from unexplained weight loss, vomiting, and night sweats which were steadily & significantly worsening. Yet she was told she had long covid (even I know these are not the symptoms of long covid) and was “too young” for cancer. She eventually paid for a private doctor who diagnosed the cancer but by that time it was too late, it had spread and she died 3 weeks later. Am I missing something by thinking these GPs are 100% personally at fault for missing this? Wouldn’t anyone in their right mind think to refer her for further tests if she’d had 20 appointments with six different GPs and her symptoms were severe and getting worse?! Apparently none of the individual GPs have been blamed or investigated at all. It’s being seen as a wider issue with the NHS in general - I really disagree that it is. I can’t imagine going to my gp 20 times and never being referred for further tests. AIBU to think this gp practice is the one at fault here and some disciplinary action needs to be going on?

The demands of the job, and in particular the insane expectation that everything can be managed safely in 10-15 minute slots means that unfortunately if you want to always see your doctor on time they will make mistakes as it is impossible to be 100% on it whilst on a day to day, minute by minute whilst having to make constant decisions all day in such quick succession.
Those who work part time recognise that they can not sustain such high intensity pressure 5 days a week and still be good doctors. Part time doctors aren’t any less committed when actually at work (and they still have the same CPD expectations as full time colleagues) - part time are more likely to be less jaded from having regular respite from such a hostile and dangerous (due to time pressures) work environment. Also part time might be likely to be a bit more “human” and have a life outside meaning they see the person…

It's always been "3 strikes and you're in" since I was training. That's more for admission. I reminded my more senior partner once of this.....he was the patient sadly. He told me the GP wanted to send him in ...I said go...24 hours later pancreatic cancer. But he was acutely unwell.

I do wonder if the practice was one that was being run by locums with lack of continuity due to different staff. But she should have been seen face to face.
In a well run group practice you discuss difficult cases with your colleagues. Medicine isn't an exact science and we've all had diagnosed that have made us sit up saying "I didn't expect that!" So you revisit the case to see where you went wrong.

It's very sad. Medicine is hard, diagnosis is hard and most of our hospital colleagues say they couldn't be a GP as it's so difficult and so varied. We need more GPs and more time.
I do read horror stories on here and cringe sometimes.

My DF’s abdominal pain was apparently ‘not in the right place’ for bowel cancer, so despite a loss of weight, too, he wasn’t sent in time for further tests, either. Yet my DM - same generation as MiL - almost worshipped that GP.

Sorry to hear this. You can’t win though - my pain apparently WAS in the correct place for bowel cancer, but I couldn’t have it, because I was too young (spoiler: I did) so it must be referred pain from somewhere else.

There is no way that a GP - or any doctor for that matter - is qualified to rule serious diagnoses in or out based on a patient’s description of pain location. It’s not credible to even try, but our system is predicated on a low-skilled medic sitting in an office with barely any medical equipment arrogantly deciding who needs investigation based on little more than feels. No wonder these terrible errors occur - it’s nuts to expect this to work.

Yes it was a difficult time but not even Covid is an excuse for doing NOTHING about a young woman presenting 20 times with severe symptoms that were getting progressively worse. She DIED 3 weeks after her appointment at the private doctor, which can’t have been very long after her last appointment at her GP, so she was weeks away from death from cancer with classic symptoms yet they couldn’t even be bothered investigating it

I agree about part time GP work being a good thing given how exhausting and stressful it is.

I also think we need to look at the system which only allows 10-15 mins appointments which include writing notes and referrals.

GPs can’t do their job to the best of their ability under such huge pressure.

I've never understood why in the case of worrying persistent clusters of symptoms they don't immediately do everything to rule out the worst case scenarios before advising "lifestyle changes" or whatever.

My Mum had what was finally diagnosed as ovarian cancer after two years of being told it was "probably" IBS and religiously following the Fodmap diet. She didn't improve and when her fatigue became unmanageable her GP decided HRT might help (She was in her early 70s) and the blood test she had to have for it showed sky high cancer markers. Treatment bought her a miserable four extra years, a second round of chemo nearly finished her off anyway, and she was on palliative care for nearly a year after that. She died a horrible death. Her sister had died of the same thing some years earlier.

To be fair, as a genetic component was suspected but couldn't be proved, my cousin and I both had our ovaries removed, but we still have a risk of omentum or peritoneal cancer as they couldn't be 100% sure of the definitive diagnosis.

Similarly my SF presented with persistent bowel changes and was persistently fobbed off by various GPs until he presented with shoulder pain. Was referred pain from liver cancer secondary to advanced bowel cancer. He was dead within 6 months.

I've always thought if the big nasties can be ruled out first, then fine, lifestyle etc can be factored in and might even be more beneficial as the stress of a potential unknown festering condition being eliminated will possibly boost a commitment to self help and wellness from a psycholigical perspective.

I think that age should be irrelevant, hearing all the stories about being too young for x,y or z - everyone's physiology is unique, and while some things may have been identified as more prevalent in certain age groups at one time, so much has changed regarding environment, what we ingest etc etc, that some diagnostic criteria being applied are probably out of date by decades.

It used to be 1 in 3 were "likely" to have cancer, it's now 1 in 2. Whatever is going on, this should be kept in mind at diagnostic level.

As for GPs who are elderly avoidant past the bare minimum, don't get me started.

Ha, that would be interesting! I took DS to A&E once with a febrile seizure and later got a GP letter telling me off for misusing emergency services (despite DH being a consultant and driving me like the clappers to the children’s hospital). I would hope the GP failures are similarly followed up.

A very good friend of mine went to the doctors dozens of times with headaches and occasional periods of absence where hours would pass without her knowing.

she was dismissed as having anxiety (she’d had a breakdown 20 years before). The doctor wouldn’t even refer her for a private test because he (of course it’s a he right?) was so convinced there was nothing wrong with her.

By the time they operated on her extremely aggressive malignant brain tumour it was too late and she died a few months later.

That was 20 years ago and I strongly suspect that this is still happening (mostly to women?) now.

RIP Debbie.

I suspect that doctors look at what was ssid at your previous appointment and just go along with that. I’d like to go somewhere that I could have a clean slate and a holistic approach.

Laziness has zero to do with any of this.

If you want to be lazy and fob someone off referral/giving antibiotics is actually the way to do it. When in actuality they're trying to diagnose and manage conditions themselves, make evidence based decisions, treat their patients symptoms and help them be well. Obviously mistakes can be made. But it's far far easier to just say oh you've got some unusual abdominal pain, not an obvious diagnosis, tell you what I've popped a referral in for you, they'll be in touch in 8months... What more do you want? Meanwhile whilst a gastro referral was made it actually turns out to be a gynae problem so that was a wasted 8months, or the problem got better on its own so you don't turn up to appointment and just served to delay someone else. Often the GP will have a lot more experience than the Dr at the end of the referral, the condition could have been managed in primary care, so you needlessly suffered for X months waiting for the referral when the GP if they hadn't been lazy and 'fobbed you off' with a referral could have worked the problem, identified a diagnosis and started a treatment plan/monitored for results and making expected improvement of not re-evaluating.

It's like the same old conversation about antibiotics, often here people saying they've been fobbed off with itll get better on its own - that assessment, documentation, conversation is so much more work than "oh you have a cough for 7 days with some sputum and you think you need abx to get better? Any allergies? Here's a script of Amoxicillin.... That would be the fob off.

Last Tuesday I went to my GP with a rash on my forehead and a fluey feeling. It was a viral rash which would disappear apparently.

I'm currently in hospital having been rushed here on Wednesday with a facial cellulitis and crp of nearly 300 (blood infection markers - usually 10) so......yep. hooray for the gp

I had this with my young son almost 20 years ago. He was eventually diagnosed with crohns, but this took two years of going back and forward to the GP before they would finally refer him to the hospital.

I think we saw every GP in the practice, as well as the nurses there. They were very dismissive. His symptoms were the same each time and getting progressively worse, but no one joined the dots to see that there was actually something going on.

No one should be going to the GP so many times with the same symptoms and nothing being done about it. I really hope this new law helps people going forward.

My sister went to the same gp repeatedly. Worsening symptoms. They fobbed her off many times over a 4 month period. By the time her husband carried her into A&E she couldn’t even walk. She died just weeks later. The only justice was that same gp having to come out to pronounce her dead and look her husband and young children in the eye.
Two other family members were also misdiagnosed by GPs resulting in death so at this point it feels like the norm for our family. I would never trust an nhs gps opinion on anything serious.

I do wonder and we'll be interested to know whether GP's are updated on patients where they have missed a diagnosis?

In my case I went 20 years going backwards and forwards to different GPs, finally being diagnosed when an optician spotted my ptosis. But looking back that ptosis was there in every GP appointment I would have gone to because it appeared every time my symptoms were flaring.

I have a condition that is perceived of as rare but I do wonder how rare it is and how much it is that there are people out there struggling on through life not even realizing that they have it.

I would be told that could be nothing wrong with me because my blood tests were normal, but of course they weren't testing from my condition so that explains why the blood tests were normal.

I actually don't mind that GPS didn't spot it in some ways I do understand that it is a rare condition. But what I would really love is to know that once I was diagnosed that all the GP's who had told me there was nothing wrong could learn from it

Not being diagnosed could have put my life at risk because lots of medication and anesthesia are very risky to use with my condition (Myasthenia).

I saw 7 Drs over 50 times in 15 years regarding a serious issue ruining my life. I was told I was "anxious" - 1 private consultation, diagnosis, surgery, my life is back. I think the GPs read the notes above in the file and parroted it, don't even bother to listen to me. Utter misogyny and neglect.

I think some GP’s fob women off in general. I am a coeliac and I had between 7-10 appointments with my GP (there were 3 different practices in total) across many years. All fobbed me off. Kept telling me nothing was wrong with me and refused to do tests. It takes around 10-15 years to be diagnosed with coeliacs disease in this country, it took me until I was in my 40’s. I had all the allergy tests when I was a child as I was so skinny and malnourished and it was never picked up. I never made the connection with coeliacs until my much younger sister who is a doctor got diagnosed with it and then got us all to test for it.

It takes longer to get pregnant with undiagnosed coeliacs disease and I was at risk of some types of cancers while being undiagnosed too.

However for other issues GP’s have tended to be excellent and I always get seen by my local practice as they tell me that since I rarely come in now it must be serious!

My mum went to her GP repeatedly with breathlessness, exhaustion and going blue around her mouth. He diagnosed anxiety and told her to try and do some relaxation exercises. She collapsed whilst out shopping one day, rushed to hospital where they found a heart defect. A pacemaker and defibrillator were implanted, she subsequently lost her driving licence because her heartbeat was so erratic.

Mum then went back to the GP a few years later with worrying symptoms of Parkinson’s disease. Believe it or not, the same GP told her it was anxiety. This went on for about four years. Her mobility got worse and eventually she fell, banging her head badly and needing stitches. The A&E doctor was concerned with her tremors and walking and she was referred for testing. Yep, she has Parkinson’s.

I feel so bitter towards that GP. He’s an arrogant bastard and as spiteful as it sounds, I hope he suffers the way he made my mum suffer.

This happens a lot. A relative of mine has been very unwell since May, she's been back and forth to the gp easily more than 20 times in this time and had various treatments for minor ailments that haven't worked, as time has gone on she's got worse and worse until just before christmas the gp did actually sent her for a blood test and it flagged something vv seriously off, she was gravely unwell by this point anyway and was told by the gp to go to a+e. She had to wait 3 days in a+e as there were no beds. We thought she was going to die in the a+e waiting room she was so ill. Eventually she was scanned etc and she found out a couple of days after christmas it was cancer. She has been symptomatic since May!! Why wasn't she taken seriously then? Granted she's 80, but it doesn't mean someone in their 80's is just suffering old age ailments and ignore sending them for diagnostic tests. Her cancer has spread and isn't curable now, all through her treatment being delayed through misdiagnosis by the GP. Not only this she has had to suffer being really unwell for a prolonged amount of time, it's awful.

I welcome that GP surgeries are doing this. It seems you are ignored if you are young, ignored if you are old, ignored if you are a women... etc etc. Assumptions seem to be made by GPs rather than referring for further tests, of course until it's too late.

We have private healthcare and almost all private GP appointments lead to a referral. Presumably most of those private GPs also work for the NHS. It would be really interesting to hear how their experiences of the two differ. It must be really difficult to switch between lots of referrals and very few.

I hope they actually let people have a GP appointment. It will be down to the person triaging the online forms as to whether they are going to get one- if the online system is open.

I agree and good practise should automatically trigger fresh eyes esp if a doc has a specialisiam.in the subject

My GP surgery tries to avoid giving appointments and just wants you out once you are there. I don’t trust them.

That just suggests that private GP's are being used in a different way though . Because often if I am seeing our GP I am not expecting or needing a referral it is for something like a prescription of steroids for my daughters asthma exacerbation or similar.

That’s crazy. I had one done simply because my bowel movements changed. I think I’ve definitely been lucky with the doctors I’ve had with any big issues. My sisters are at the same surgery and have had different experiences.

Can I please ask if you got a diagnosis and what it was?