Margaret McCartney: Patients and professionals: all in this together?BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h1331 (Published 09 March 2015) Cite this as: BMJ 2015;350:h1331
All rapid responses
Dear Dr McCartney
Thankyou for saying this. Pathways / screening / protocols are great for the people who benefit. Screening is really good for those who are found to have cancer and operated on etc. But if you are found to have diverticular disease instead - treatment / investigation takes a back seat. You may struggle to get urgent surgery within 2 weeks because you don't have cancer - even though the symptoms could be life threatening (sepsis or bleeding or stricture). You may not get the same notice of surgery date - you will be slotted in around the cancer cases.
Treatment gets skewed by all sorts of things. 'Awareness campaigns' skew the referrals. Screening may falsely reassure people (I had a test so I can't have cancer ie any form of cancer), and clinical prioritisation is inferior to meeting targets - because that is where the money is. So the A+E breach for a person who is intoxicated is more important than the fact that the team saved the life of a person with a cardiac arrest.
No Dr wants to miss any patient with any serious diagnosis. Cancer isn't the only thing that can kill you - in fact some cancers probably won't kill you (eg some skin cancers, breast / prostate cancer in the very elderly, any cancer where you have another very serious illness). But the patient with recurrent sepsis from diverticular disease / renal tract stones / severe peripheral vascular disease - may well need their treatment every bit as urgently.
Let Drs of any description deal with those who are seriously ill first, screen appropriately and tell the truth with regard to risk for each person inc risk relative to their stage of cancer. And lets work for a system where everyone needing urgent treatment is treated urgently - not just those with a 'cancer' diagnosis. And everyone gets the treatment they want / need - not just what the protocol says.
Competing interests: No competing interests