Research News

Patients’ “gut feelings” about symptoms should be taken seriously, say researchers

BMJ 2016; 355 doi: https://doi.org/10.1136/bmj.i6314 (Published 23 November 2016) Cite this as: BMJ 2016;355:i6314
  1. Jacqui Wise

Some patients report not being taken seriously by doctors and this can deter them from making a repeat consultation for persistent symptoms, a qualitative analysis published in the British Journal of General Practice has found.1

The researchers analysed free text comments at the end of a recent International Cancer Benchmarking Partnership survey carried out in Wales. Of the 905 patients with newly diagnosed breast, ovarian, colorectal, or lung cancer who returned the questionnaire, 530 included comments in the free text section.

The analysis showed a range of factors that patients thought contributed to a delay in their cancer diagnosis and treatment. For example, if the patient was being treated for another condition, such as bowel problems or stress, this may have acted as a barrier to early diagnosis. One 72 year old woman went to her GP but was told that her pain was due to a pre-existing back problem, and she was not examined. She later had ovarian cancer diagnosed.

Another 43 year old woman, later given a diagnosis of colorectal cancer, was initially referred to a psychiatrist. “They even referred me to a psychiatrist with cancer anxiety as they just didn’t seem to believe how ill I felt and what was happening when I went to the toilet,” she wrote.

Some younger patients reported a sense that their GP had not taken their symptoms seriously, possibly because of their age and the low likelihood of cancer.

The researchers said that their findings highlight how important it is to take seriously a patient’s “gut feelings” about their symptoms. Some patients in the survey said that this was the only initial indicator that prompted their visit to the GP, but others had delayed seeking help until more obvious symptoms were found.

Some obvious “alarm” symptoms were not recognised by patients, the researchers added. They said that screening programmes should promote awareness that symptomatic cancers may still present soon after a negative screen and that patients may ignore symptoms if they have an upcoming screen.

And some factors may act as barriers or facilitators to diagnosis, the team noted, depending on the context. For example, although seeing the same GP is important for continuity of care, a “fresh pair of eyes” can also be positive in facilitating diagnosis. One 62 year old woman with a diagnosis of lung cancer reported that she had seen a locum doctor when her usual GP was away on holiday.

“Had I seen my normal doctor she may have thought my symptoms were due to my COPD [chronic obstructive pulmonary disease],” she wrote; “However, the locum, not knowing me, immediately sent me for an x ray and re-referred me to the chest clinic, and my diagnosis was very swift.”

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