The results of Cornford et al's1 qualitative study effectively highlighted the stark contrast in priorities between patients wanting an urgent appointment to reassure them that they don't have cancer, and the specialists who wish to diagnose as high a proportion of cancer cases as possible. With a commitment to the patient's biopsychosocial wellbeing we are as GPs, once again, somewhere in the middle.
We initially wondered if patient recruitment was biased by self-selection. Those who responded may have been the most anxious, harbouring the strongest feelings about a timely diagnosis, hence effectively being an unrepresentative sample. This observation however, leads to a new hypothesis.
Are those patients who are found to not have cancer on the 2-week wait system, on the whole, better educated, more health motivated, more aware of their rights, more empowered in the GP consultation setting, and more anxious? If this is the case, then have we unwittingly created a two-tier system in which, apart from cases with obvious cancers, we are facilitating a service that reassures the worried well at the expense of all cases that are presenting outside the 2-week wait criteria,2 and whose outcomes may be adversely affected by a longer wait.
Given the above hypothesis, the quotation from one GP who admitted using the 2-week wait system for patients who didn't fit the criteria, ‘in case they go to the back of a long queue’1 may prove particularly ironic — it may well be this type of behaviour that is turning the ‘fast track’ into a traffic jam.
Cronford et al make a strong case for reviewing cases where patients are ‘inappropriately’ fast tracked, and for a greater focus on the characteristics of patients who persuade their doctor to use the fast track. We look forward to presenting some data in due course.
- © British Journal of General Practice, 2004.