To think that the NHS should phone you with a diagnosis before prescribing medication?

[illfallforward]

My mum has just been called to say that a prescription is ready for her. Turns out it’s a chemotherapy cream for skin cancer. Now fair enough it’s not the worst diagnosis to have, but surely someone should speak to her before she finds this out?! I’m just flabbergasted

It’s awful.

For her it’s the fact she doesn’t know a) what type (BCC v SCC v melanoma) b) what to look out for c) how to use the cream and d) what impact this would have on her travel insurance. I just feel awful for her!

It's the same with any prescription you get from the doctor or hospital, they don't go through any possible side effects as it would take too long and all that information will be on the leaflet.

I wouldn't use the prescription until she has spoken to dermatology. Hopefully she will be able to contact them soon.

The only time I was ever told of side effects was when I had to have chemotherapy intravenously.

You’d assume that when Google says it can cause redness, weeping, etc., they will go through that and when she needs to go back and seek further help.

I don’t know why people are so desperate to justify awful care.

It is not!! Sorry, I hadn't seen this when I suggested contacting the GP. What a dissapointing response. I would have thought it is the GPs business because your mum is also their patient!

Have Dermatology said they won't come back to her, or just haven't done so yet? Does she have a follow up appointment?

Could the pharmacy advise re how to use and side effects?

In your shoes, and if your mum consents, I'd probably contact PALS.

She’s phoned about four times today and been told each time the doctor is busy

It is awful. There is no possible justification for it.

If she can't get through to dermatology, she might try contacting the hospital PALS.

Could she leave a message asking the Dr to call her back ASAP? I get that they might not be able to talk at a particular moment, say if they're with another patient, but they do owe her some sort of communication soon!

@illfallforward I'm really sorry your mum has found out she has skin cancer via a phone call from a pharmacist about a prescription. That must be such a shock for her. Completely inappropriate.
Does she know the name of the Consultant? She could call hospital switchboard and ask to be put through to their secretary.
I would also contact PALS for help as something has gone very wrong if a diagnosis has been made of skin cancer and a prescription written, yet there's been no appointment, letter, or phone call to the patient to explain / reassure/ confirm treatment plan.

I'm not justifying the fact that your mother hasn't been told by the hospital that she has skin cancer. She should have been.

But it is normal practice not to be told of possible side effects from prescriptions because they can be numerous and doctors don't have the time to do that. That's why prescriptions come with leaflets because patients are expected to read them.

I agree it's normal practice, but it's not best or even good practice.
Unfortunately the leaflets have to contain every single side effect, even the very unlikely ones. Since learning about the nocebo effect I no longer read the side effects, although I do keep the leaflet to refer back to when prescribed something new.
I wouldn't expect or want my Dr to tell me about every single possible side effect l, but i would hope they'd tell me about the most common/likely.

No that really isn't good enough. She needs reassurance about how non-threatening this type of skin cancer is and preparing for how damaged it can make your skin look when it kills the cancerous or precancerous cells. And guidance for exactly where to put it.

My fair friend loses quite big patches of skin on his forehead and looks a bit of a mess for several weeks.

I hope you get some input for her soon.

She needs warning about the intended effects, never mind the side effects. It would honestly scare her witless to look in the mirror and see her face with was much skin gone as my friend loses.

It isn't ok at all and a complaint should be made.

Communication can be awful.

I was initially told by a surgeon that my son could have cancer, he then did the surgery and said it was something else. A week later, I was pulled into a private room at 10pm at night and told by a different surgeon that he did have cancer. He had no idea that I had been told just a week earlier that it wasn't cancer and I had no idea they still believed cancer was a possibility. It was a mess.

I’m not saying she shouldn’t also have a conversation with the doctor. I just don’t think the process of getting the medication into her hands should be delayed by that conversation. The doctor absolutely needs to call her.

when I had cancer, my doctor rang at 7pm. She found time to make the call and answer my questions.

speed still mattered though.

I totally agree and would definitely go to PALS with this one. Its not in any way a proper or caring thing to do.

How does she know where to put the medication though? It's toxic stuff and she's likely only got a small area that it should go on. Or maybe it's precancerous cells like my friend and she'll be told to almost use it as a face cream with extreme care to avoid the eyes, like he was.

It feels very wrong for it to have been doled out without explanation and if Efudix is the answer then speed of getting medication into her hands is not of the essence, because it's only used for slow things that don't normally kill you.

My mum was given the meds before she had a diagnosis because the diagnosis would take many weeks while they grew the cultures.

The meds were indicated for 80% of the outcomes and not contra-indicated in the other 20% so getting her started straight away was a pragmatic option.

Could this be the case for your mum? They aren't sure what variant of skin cancer or pre-cancerous cells she has yet, but they are getting her regime started in the mean time?

Since neither your original post, nor those you made immediately subsequent, made no mention of your familiarity with the various NHS apps and your ability to fully navigate them I fail to see how I could have been expected to be in possession of that information! 😂

I was merely trying to assist, but it appears you have taken offence. Oh well. 🤷 Moving on.

Dermatology closed without the promised call back.

I’ve told her to complain to PALS. It’s just nowhere near good enough

This is very poor. I'm assuming that the prescription was written by the consultant on receipt of the results and that they are intending to call and discuss but the pharmacy are more efficient.

Tomorrow I would contact the hospital's switchboard (number usually on their website) and ask to be put through or get the number for her consultant's secretary and they can sort a call back. They are usually much more efficient at organising these communications than the staff working in the dermatology unit managing patient appointments/procedures.