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?

@notatinydancer the people who need to be told are the ones who devise the referral pathways. Not GPs.

This tiny post seems to me to be highly pertinent.

It is shocking and I bet it happens a lot. My friends sister spent almost a year going to her GP because of heavy bleeding that wasn’t stopping and was fobbed of with.. You’ve just had a baby, your periods take a while to get back in sync.
She eventually collapsed, was rushed to hospital where she was diagnosed with cervical cancer and sadly passed away at 27. It’s criminal.

The waiting list to see a gynaecologist where I work is over a year. We refer people, but they wait an eternity to be seen. More often than not, we just get a letter from gynae advising us to prescribe extra hormones.

Not true. Pathways are devised by secondary care. Why on earth would a generalist develop the referral pathway to a specialist?

100% yes!!
I had 4 appointments in 3 days for horrendous constipation. None of the 3 doctors I saw managed to diagnose labour despite me being 32 weeks pregnant with twins.

Was there a coroner’s inquest? I am guessing not, unfortunately

@SoIMO also the waiting time for ENT is shocking. My son has been waiting for 2 years . My other son needed his tonsils out and the wait would have been about 3 years, so we had to go privately.

Wow. Most of us would consider cancer with unexplained weight loss. How did they all miss this. I’ve been on cancer wards, they are full of young people.

As much as they might like to think they are, doctors and consultants aren't god and they DO get it wrong sometimes.

Took my DH to the GP as an urgent appointment, he had a high fever that kept coming and going, was unable to even keep water down and was extremely weak and fatigued, literally struggled to walk across the GP waiting room. There was a retirement celebration in the surgery (balloons, banners and cake) and I felt the GP was very distracted in the appointment. GP referred him for blood tests the following week, and advised paracetamol to keep on top of the fever.

My DH was grey, pallid skin and very weakened - we left the GP surgery and went straight to A&E where he was immediately admitted with sepsis. Had I listened to the GP he wouldn’t have made the blood test the following week.

In fairness I complained to the surgery, and their practice has improved significantly, but it could have ended very badly.

It’s also true that if you have a chronic physical disease, every symptom is attributed to that

I think the issue for her was (a) covid was on and (b) she was only 27.

But you'd think that if you keep going to the doctor they'd actually do something! I never understand that if you never go and then you do, they fob you off. Surely they can look at your records and think "well she's never been to see us in the last five years so clearly something is actually wrong with her".

However, I think in this case she started getting symptoms in the June and was dead by the December - maybe she wouldn't have survived anyway. But many people said at the time that it didn't matter if you died during covid, as long as it was of something other than covid.

This is also true

There are many people who present over and over again that are not missed cancer cases. There are many patients that do actually have anxiety or long covid or IBD. There are many patients that attend a&E frequently without a serious condition

Every medic has had a patient who has one referral from the GP, something entirely different to you and a third completely different history to the consultant. (E.g. patient tells you no weight loss, suddenly they have night sweats and weight loss when the consultants there)

This isn't to excuse when cancers are missed. But GP is a hard job, you have to be able to basically diagnose everything or pick up red flags for everything. There are only so many tests and so many investigations.

You never know what history the GPS was given. What questions were answered. What examinations were undertaken and what those results were.

We cannot assume every patient has something seriously wrong just because they represent. Medicine is and should always be a clinical judgement.

But that doesn’t excuse a diagnosis of an ill fitting bra.

I've been struggling with absolutely debilitating (heavy) periods and shocking levels of bleeding to the point I can't leave the house for a week every month for 30, yes 30 years. Only in this last month have they finally started to get their act together and I have an ultrasound scan booked for a few weeks' time. I had a hysteroscopy last week which confirmed "huge" fibroids. I could have told them that. My GP won't even prescribe iron, and I was anaemic to the point I couldn't breathe. I get iron from a local pharmacy now.

Anytime I've had anything which may or may not be serious I've been referred and put on the two week pathway. The first time I was only about 34.

GPs do get time wasters and hypochondriacs but someone presenting with what could be cancer should surely have that ruled out, whatever their age.

That's what my mum has always said, too. If they think they can fob you off, they will. And I actually think that applies to men too - my husband has been fobbed off on occasion too. Even though he had private health insurance. But women tend to get told it's all to do with hormones.

Though I had the opposite - GP erring on the side of caution even though I thought (and think) it was hormones!

Exactly. No GP should ever be allowed to utter the words ‘you are too young for cancer’ . Full stop. It’s as though they have had zero training. Even the general public know better.

I had breast cancer at 34 with zero family history. I was fortunate that I was referred straight away by my GP.

There needs to be some penalty if they don’t do the most basic functions of their jobs properly.

I agree with those who say women tend to get ignored. I lost a very dear friend who would still be with us if the condition she had, had not been incorrectly diagnosed. A former colleague was fobbed off until a different GP saw her and she was diagnosed with stage four cancer.

However we mustn't forget that GPs are rarely 'lazy'. They are overworked and the NHS is underfunded. GPs are under pressure not to refer. Damned if they do, damned if they don't.

They did do things though, they didn't just dismiss her, they kept treating her for things but unfortunately just the wrong things. The issue was they didn't consider cancer as an option

I think the main problem in this case was covid, she may have contacted the surgery 20x but only had 3 face to face appointments.

This happened to my friend. She was having a lot of pain in her hip and i think she went about 5 times just kept giving her stronger painkillers. She could barely walk. It went on about 4 months. Wouldn't refer her for an x ray. Where we live you cannot walk in for an x ray if you've seen a doctor about the issue you're having.
Anyway she went to a chiropractor who moved her leg and her hip just broke, obviously she was in agony and the poor practictioner was mortified.
She went to hospital by ambulance and never came out bone cancer.
If they had referred her after the 2nd time she might have lived longer and not in so much pain.

Tar and feather maybe? That sounds appropriate...

Honestly the horror stories I’ve heard (ex is a GP), I am hardly suprised. Same man lectured me for ‘overfeeding’ our 4 week old ds during the night and told me I should only be feeding him water not formula.

How on earth some of them qualify is beyond me. Having said that he failed his GP exam 6 times and still somehow practises.

One recently asked me if I thought ds (who has recurrent tonsillitis) needed antibiotics then went on her computer to check. Bear in mind I have no medical training and he had pus covered tonsils and a fever for days.

Another tried to say his non blanching petechiae was eczema, despite him being admitted to hospital for IV antibiotics for the same rash a month earlier.

There are a handful which are good (older ones) at the GP surgery we go to.