Re: Identifying melanomas in primary care: can we do better?
I agree with Dr Cave in his response(1) that Prof Newton-Bishop and Paul Lorigan completely miss the point about Primary Care management of malignant melanoma. They also choose a ridiculous example of the correct diagnosis as a percentage of patients referred. They state that "The proportion of patients correctly referred with suspected melanoma was 11.8%, compared with 61.7% for suspected leukaemia." Leukaemia is diagnosed in primary care by the results of a full blood count taken from a patient with a history or symptoms that raise the suspicion of the disease. GPs very rarely refer people with a suspected diagnosis of leukaemia without doing a blood count. Indeed I would suspect that their unreferenced figure of 61.7% is inaccurate as it should surely be much closer to 100%. What diagnosis did the over one third of patients referred with possible leukaemia actually have?
The article was not peer reviewed, perhaps a peer review from a primary care physician with an interest would have been sensible.
As Dr Cave states, this is another example of secondary care blaming primary care for poor care from a position of ignorance. At a time of increasing criticism of the medical profession from the media, perhaps they should be more supportive, and seek advice from their GP colleagues before pointing fingers
Rapid Response:
Re: Identifying melanomas in primary care: can we do better?
I agree with Dr Cave in his response(1) that Prof Newton-Bishop and Paul Lorigan completely miss the point about Primary Care management of malignant melanoma. They also choose a ridiculous example of the correct diagnosis as a percentage of patients referred. They state that "The proportion of patients correctly referred with suspected melanoma was 11.8%, compared with 61.7% for suspected leukaemia." Leukaemia is diagnosed in primary care by the results of a full blood count taken from a patient with a history or symptoms that raise the suspicion of the disease. GPs very rarely refer people with a suspected diagnosis of leukaemia without doing a blood count. Indeed I would suspect that their unreferenced figure of 61.7% is inaccurate as it should surely be much closer to 100%. What diagnosis did the over one third of patients referred with possible leukaemia actually have?
The article was not peer reviewed, perhaps a peer review from a primary care physician with an interest would have been sensible.
As Dr Cave states, this is another example of secondary care blaming primary care for poor care from a position of ignorance. At a time of increasing criticism of the medical profession from the media, perhaps they should be more supportive, and seek advice from their GP colleagues before pointing fingers
1. http://www.bmj.com/content/345/bmj.e4244?tab=responses
Competing interests: I am a GP with an interest in Dermatology