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?

Why do they think like that, it's such a bizarre attitude?

This is almost exactly the same as what happened with my FIL. He was loosing weight and being sick and the doctors kept saying it was a virus. They eventually paid to go private and it was cancer.

A scan of bowel is possible for bowel cancer. Issue is that if they see anything then you have to have colonoscopy anyway to remove the growth. I wouldn't bother (I recently moved from 3 yearly coloscopies to 5 yearly after they only found one polyp on my last test).

I agree, its almost a rule to say that GPs should listen to patients!

If you started a poll on here, asking if someone who had private medical treatment should be allowed to come back and get help on the NHS for the same issue or a complication, I think a lot of the replies would be No.

People see private medical as queue jumping (not my view but read it commonly), much the same a private education. And that if you can afford it the first time then suck it up and keep paying.

Welcome to prove me wrong 🙂I'd be happy to hear the GP is an outlier.

People often have to go private even when they can't afford it because if the state of the NHS now. I know several people on low incomes who had to go into debt to get private healthcare because they were completely failed by the NHS.

Of course paying taxes for many years entitles you to NHS treatment though, I think that still stands even if you use private for one part of treatment personally or the whole premise is unsustainable.

My dad had a skin problem. He saw several different GPs and was fobbed off, given diagnoses that were visibly wrong and prescribed topical medication that made no difference at all. After about a year of extreme discomfort he diagnosed himself using an old dermatology textbook, returned to the GP and asked for relevant tests. They agreed but told him he was definitely wrong, simply because the thing he thought he had was 'rare'. Nope, dad was right.

I don’t understand why. I assume it’s because I am effectively saying the NHS/their treatment is sub par. But surely if they have any brain cells they already know this.

Just to clarify - I wasn’t asking for treatment for the same issue it was brand new one.

And even if I had been - I pay a significant amount of tax and damn well expect to be spoken to with respect and to recieve medical treatment that I have damn well paid for.

I’m pointing out the attitude, not agreeing with it.

I think there's a big difference between eg going overseas to get your boobs done and it goes wrong and then you want the NHS to sort it out, and having a medically required procedure done privately because you can't wait for the NHS to do it (often by someone who works for the NHS anyway).

Examples would be mental health or gynaecology where the waiting lists to even see someone are massive.

I started with worsening health in my mid 30s - previously to that other than having 2 DC and a back injury following a car accident - I had never needed much in the way of medical help
I have been fobbed off for years - things got much worse in the last 5-10 years (I’m now 61) that I eventually was forced to go private - they diagnosed severe vitamin deficiencies amongst many other things but I couldn’t afford to stay in private sector so struggled to persuade the NHS to listen and even test me for things eg offering X-rays instead of CT or MRI scans, referrals being refused etc
Finally feel like im being listened to - it appears I may have a very rare connective tissue disorder plus separate neurological and immune disorders
Dread to think how many times I’ve presented with worrying symptoms and been dismissed over the last 30 years

Two men in my family were threatened with being barred/reported for being too assertive (neither was violent, shouted or swore, they just asked the surgery to correct a mistake it had made), so sometimes this doesn't work.
One of them actually had cancer. To be fair, even if the doctor had been helpful, he might not have made it, as he took a long time to seek help, but who knows? Sadly both genders, and people of all ages, can get this sort of treatment.

Weight loss without effort means illness of some sort that needs looking for.

There's a differential diagnosis book to guide you through the process of what next.

I once had a GP plead with me to go privately because she was very worried and wanted me seen as quickly as possible. This was just towards the end of the covid pandemic. Thankfully I had the means to pay for the private tests as they got the diagnosis we had both expected .
I then went back to the GP and saw a different doctor to ask to be referred into the NHS system for specialist care . the doctor was initially resistant until I explained that it was his colleague who had told me to go privately and that I also had the full support of the neurologist I have seen privately and who I would be also seeing when he referred me for NHS care.

I used my private healthcare through work for the very first time last night. I’ve been struggling with low iron for over 10 years and my recent NHS blood tests show my ferritin at 5 which is unbelievably low and my serum iron at 10 which is also under range. I feel awful. My GPs suggestion is to eat more iron rich foods as I can’t tolerate oral iron. I’ll probably die of old age before I get my levels to a decent rate using that route.

Wasn’t sure if my BUPA cover would help but I spoke to a private GP at 5.15pm and had a referral to see a haematologist by 7pm. I need to call and arrange an appointment and hopefully they will refer me for an iron infusion.

My GP surgery have been extremely unhelpful with many issues over the years and actually quite incompetent at times so I’m going to stick with my private healthcare while I have it.

People seeing private consultants and coming back to nhs care is tricky. I've done it myself, and encourage patients to do it via right to choose but it is tricky

Private medics are only looking out for you at that point, and have quicker access to follow up actions with less scrutiny.

I work in mental health for example we might see

• A private dr recommending a course of action we have zero access to eg a type of therapy when we dont have that type of therapist

• commencing a treatment we wouldn't but then patients expecting us to monitor it and prescribe it on going because they are only seeing that medic for a one off. For example something like melatonin, its a real bog standard med that you can buy over the counter in the us, but for various reasons isn't licenced in the UK for most adults. Its really common that private psychiatrists start it, then any prescriptions, side effects, changes come from the nhs but then as an nhs team would need to prove that we've tried alternatives before we could consider using it and in some areas couldnt use it at all. Patient is angry.

• Most importantly the nhs has to consider waiting lists in a way private just doesnt. I have to know for example that each consultant appointment I book, therapy list you go on, extends the wait time for everybody subsequent to you.

My private Dr was happy to start me on a medication that needed really regular review and was happy to see me for that which is just not achievable massively on the nhs with my level of severity. I had an mri for example, when I know locally theres lots of hoops to get through because the mri wait is huge and I had a condition that while an mri was of benefit, I didnt have to go through the excluding other things route. An MRI would have been a last resort because of the wait list and specialist involved and you'd have needed to try all the other routes first.

I see millions of people that would benefit from therapy for example but I only have a set number of slots a year, I have to make sure that we use them for the cases that are most urgent who have exhausted other options.

Its not that I dont think people would benefit, but its important for me to
to make sure that everyone on the wait list has to be there.

A private therapist would be able to see you for as many sessions as you need for as long as you pay, and isn't worried about the rest of your county in the way that I am.

An example of this would be I have a 100 therapy slots and 300 requests, I could justify putting every single one on the waiting list but if I do that the 50 people who really really need it might wait too long and i know that another 300 requests are coming my way soon. If you exceed your waiting lists capability then very quickly the wait grows massively quickly and everybody gets sicker and people begin to wait for something that is going to collapse before it comes round to them.

Equally if someone starts that needs 12 sessions in stead of the given 6, then it halves my capacity. If i can put some of those people in for a medication review that's a sticking plaster but requires far less sessions, if I can push some into charity services they might get quicker support at a low level rather than waiting an age, if i can push them into more available help eg groups,CBT then I can ensure that none of the people on the wait list are on their when another service might meet their needs. We require for example that people try a variety of anti depressants from each group for example because a good percentage of people feel benefit and no longer require our services after that. Its annoying hoop if you are a patient but genuinely saves us a lot of pointless appointments when a patient could have tried something without a wait, and be already feeling the benefit rather than waiting 6 months for a specialist opinion.

I know that some of those people will come back in my next set of 300 referrals but if even half of them dont need a re referrals then theres a chance that my waiting list might survive

Waiting lists are a delicate balance and the nhs is always perilously close to tipping point.

A private medic or therapist doesnt have to worry about any of that.

There should be consequences. Not for making a mistake because anyone can do that.

But it's not a mistake to repeatedly misdiagnose someone over a period of time. It's arrogance or laziness or just sheer incompetence but whatever the cause it needs dealing with.

I used to have one of those arrogant, dismissive GPs. It was a multi-doctor practice but you always ended up with an appointment with him because the other GPs were booked solid with people avoiding him. He dismissed my asthma symptoms as 'just seasonal' despite some quite alarming symptoms.

I managed to change practice to another town and they immediately pounced on the asthma symptoms at my welcome appointment. It's been under control since but they even sent me for further tests to ensure the lack of treatment hadn't caused lasting damage, which thankfully it hadn't.

The original GP is still carrying on. Despite the fact his name is mud locally and I know lots of people have made official complaints about him. Nothing seems to get done.

And even if these GPs actually kill someone with their incompetence, nothing happens. It's outrageous.

This is exactly what I said. These people are very rarely punished and seem to be able to cause harm to patients with impunity.

Im only surprised more people don’t act in the manner of that American chap that shot the head of the insurance company. If I was given a terminal diagnosis due to repeated medical errors there would be consequences that’s for sure.