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

You’d hope not - seeing as management (and it’s not them, it’s PALS initially) don’t do anything clinically.

What are you meant to do when you can’t get in contact with anyone, the GP has said they’re staying well away because it’s not their care and it’s not their area of expertise, and you’ve got a chemotherapy cream that you don’t know how to use? Just hope you get a phone call in four weeks time?

I have worked with complaints. PALs will forward it to the manager of the clinical area and they then have to investigate and look at ways to prevent from these things happening again. It's why I always recommend going to PALs for clinical issues.

I hope you get some communication soon. Id keep calling. Did she see a Consultant, it may be worth getting their secretary's details and contacting them.

It's not really leaping. I would be very, very surprised if a complaint is not upheld in this instance. Do you think that what happened was OK? Someone learning they have cancer because they were prescribed a chemotherapy cream.
OP's first post did not mention complaining, she only brought it up on seeing her Mum upset.

I’m going to try and get in contact tomorrow

I’d say the dermatologist has dictated a letter which is now sat waiting to be typed and approved which is why it’s not on the app yet. He’s then done the prescription in line with the info in the letter which has been processed and done before the letter is typed and available. Maybe check with the secretary and if there’s a letter get them to type and send urgently so she has the info

That’s not acceptable though. You cannot be giving a diagnosis through a letter that isn’t sent immediately.

I think it’s likely exactly that. I expect the consultant has issued the prescription to the hospital pharmacy electronically to avoid delay, and the letter they’ve dictated is waiting to be checked and uploaded to the electronic system and sent out.

Nah when the word necrotising fasciitis first come
realty they switched the ward lights off early in the hope I’d go sleep quicker that night, I was rocked I’d never heard nf before.

fought 4 months to get an outpatients appointment to hear if this had been x number of years it would have been an amputation.

I was a diabetic in remission but the surgeon did not have to think so,

Which still is not okay? She has so many questions - does she have to use the cream, what happens if she doesn’t, what will happen if she does? She deserves a conversation with the doctor

It may be that the consultant put an electronic prescription request through at the same time as dictating a letter which may not have been typed yet. If you’re in Sussex this wouldn’t surprise me at all (I work in a hospital there though not in Derm). I imagine that Dr Google is responsible for scaring your mum as if it was cancer needing urgent treatment it seems surprising that no conversation was had.

But in what world is it acceptable to give a diagnosis via a letter?

Also maybe someone did try to call but couldn’t get through? Has your mum got any missed calls? Quite often they come through as ‘unknown number’. I’d get your mum to call the consultant’s secretary.

No, nobody called.

There has been no attempt to contact her. She has tried the secretaries, reception, consultant. She’s not getting anywhere.

not at all. But potentially moves the ‘blame’ from the individual clinicians and secretaries involved to a system wise problem where we are deliberately being unstaffed and expected to do more.

complaints help with things like this that highlight system errors.

Unfortunately we live in an imperfect world, and the NHS is pretty much broken. It’s not good enough and I’m sorry this happened to your mum but I think she needs to get all the information from the consultant before jumping to any conclusions/worst case scenarios.

Put in a complaint to PALS if you feel that strongly about it. They do get acted on.

I think it’s acceptable if it’s non serious and is one of a number of possibilities that have been pre-discussed at the appt eg good news your scan came back unremarkable, that means this is x, we don’t need to see you again, here is some cream that will sort the issue take it x times a day.

I do agree it’s a fuck up that the cream arrived before the letter and alarmed her. I expect it’s the kind of bad consequence of a small mistake (sending the script before the letter) that they have not considered and it’s good to complain because otherwise how will they be aware and change practice.

Community e prescribing is new to our 2nd care setting and this brave new world how quickly it arrives. I have taken to texting patients if I think the script will get there before the letter. If handled a bit better then this could have been a good outcome of her being reassured and not needing another appt. The NHS is trying to use digital solutions to be more efficient but it changes ways of working and there can be unforeseen issues.

Over the past few weeks myself and my husband have attended a couple of appointments and general health checks. We both received test results by text. My husband, diagnosed pre-diabetic, received his diagnosis by text and an advice link to google. I received a text (following certain blood tests) that showed no concerns but I was still left uncertain as to what was causing my symptoms. I can recall the days when your doctor would, as a matter of course, invite you in to discuss any test results. It’s all too easy, and very lazy, to send a diagnosis by text with no thought for the patient who may well be unable to fully understand the details. I’m 63 years old and I am watching the steady decline in patient services in favour of an impersonal ‘computer based’ system. It’s very sad.

But the issue is, even if it’s non serious, the patient still deserves a chance to discuss the condition and treatment with a doctor?

She has millions of questions that nobody can answer besides the doctor. Surely she deserves to get them answered even though it’s not life threatening?

While l’m sorry about your diagnosis, this isn’t cancer top trumps and your post is dismissive and rude. I’ve been recently treated for breast cancer and can attest, as you can, to the fact that a cancer diagnosis is terrifying.

My DH had BCC two years ago, and it was anything but a ‘nothing burger’ - it was found under a finger nail and had been there undetected until discovered by accident during treatment for an unrelated condition. It had spread, and resulted in him losing a finger and nearly his hand, after complications with the original amputation. And last time l looked they don’t ultrasound your lymph nodes checking for spread if you have ‘warts’.

There are two commonly used topical creams for skin cancer - one is an immunotherapy cream that stimulates your body's immune system to attack and destroy the cancer cells. The other is a chemotherapy cream used for more aggressive skin cancers to address rapidly dividing cancer cells - since OP has stated it’s a chemotherapy cream l think it’s likely that her mum has a form of the latter.

Even when siting in a consultants’ office, having the diagnosis explained to you, with reassurance of a treatment path and the opportunity to ask questions, being told you have cancer is a very frightening experience. I simply cannot imagine having tests and waiting for a diagnosis and then skipping straight being told you are being treated for cancer, without even the courtesy of a consultation to break the news, or explain the diagnosis and treatment, or to address the very real fears attached to the word itself. Someone has dropped the ball, and badly, and rather than being thrilled for an answer and treatment l would be wanting to know why l wasn’t afforded the normal protocols when dealing with a cancer diagnosis.

Absolutely this. The prescription for a chemotherapy cream clearly indicates that the condition is cancerous. Without a consultation to advise formal diagnosis and explain the condition, treatment and prognosis, your mum is essentially being left to cope unsupported with a cancer diagnosis, with no idea of even the type of skin cancer she has, or what to expect. The fact that it may be mild and entirely treatable/curable is irrelevant. Nobody took the time to explain it, and that’s a failure in duty of care.

Do you not think it’s understandable if Dr Google scared her - given that that was her only alternative, since she wasn’t afforded the courtesy of an actual conversation with a medic ?

It’s just made me sad, to be honest.

She was told at her initial consultation they think it’s a “mild” skin cancer but can’t say without biopsies etc.

She was then told it would take 8 weeks to come back, and it’s back in just under 3. So that makes me think it’s the wrong prescription and even more reason that she shouldn’t be using it! It’s just awful, I know the NHS is in a state but serious or not, terminal or otherwise, you should be afforded the grace of a discussion with a doctor.

It’s a chemotherapy cream, to stop cancer cells dividing and growing. The side effects can be significant and someone - even the pharmacist - should have explained how to use it, what to expect and how to get help if there are problems. Not sure why so many posters are trying to excuse awful handling of a scary condition.

If you submit a formal complaint about treatment, a clinician will be involved. You are absolutely taking up the time of a clinician that could have been treating a patient. Whilst sometimes that's needed but at this point, you have no idea what has happened so going straight to a complaint is quite possibly wasting your time and, much more importantly, a clinician's time when they could be saving lives.