This month’s BJGP includes a study by Abel et al, who used data from the English Cancer Patient Experience Survey to examine prior general practice contacts of patients presenting in accident and emergency departments with a newly-diagnosed cancer. The results showed that, contrary to previous assertions, the majority of patients had not had numerous consultations with GPs, and one-third of them had not seen a GP at all. The sample included patients with cancers that often present as an emergency, such as seizures in patients with brain cancer, and bleeding in patients with renal and genital tract cancers. Older and poorer patients were also more likely to be diagnosed in casualty. Cancers which typically produce non-specific symptoms, such as myeloma, lesukaemia, and pancreatic and ovarian cancer, were more likely to come to light as emergencies.
Following online publication last month, three national daily newspapers carried reports of this research which, instead of making the valid and helpful point that the majority of cancers are not being ‘missed’ by GPs, interpreted the data as showing that GPs are ‘failing’ to diagnose thousands of cancers. One headline described cancer patients as being ‘repeatedly rejected by their GPs’ and another described GPs as ‘failing thousands of cancer patients’ and ‘victims being sent away’ by their GPs. Inevitably, experts were found, to describe the results as ‘extremely worrying’.
At a time when the whole NHS, and general practice in particular, is facing serious existential threats, this is less than helpful. Newspapers don’t sell on the basis of good news stories, and no one should expect poor clinical practice to go unremarked, but there are better ways for the press to show concern for the health service and for the public health. There must also be better ways for researchers, publishers, and editors to get important research reported and disseminated accurately, without spin, and in ways which recognise the challenges and unsolved problems involved in making early, accurate diagnoses of serious disease.
Over a century ago, and with considerable foresight, Oscar Wilde described the Fourth Estate — the press — as: ‘ ... the only estate. It has eaten up the other three. The Lords Temporal say nothing, the Lords Spiritual have nothing to say, and the House of Commons has nothing to say, and says it. We are dominated by Journalism’.
The print and digital media are potentially enormous forces for good. If I were the editor of a national daily, I would sleep more soundly if I thought that my newspaper had contributed to GP morale and recruitment by enhancing the image of the profession, rather than denigrating GPs trying their best to do a good job under very difficult circumstances. Newspapers are keen on ‘watchdogs’, and it is worth pointing out that the health watchdog, the Care Quality Commission, has recently rated 88% of all general practices as either good or outstanding. And GPs still have the highest approval ratings in the NHS.
Cancer is the theme of this month’s BJGP, with articles on consultation skills for patients with potential cancer symptoms, predictive models for lung cancer, the diagnostic significance of thrombocytosis, and knowledge and attitudes concerning prescribing tamoxifen for the prevention of breast cancer. Debate & Analysis articles look specifically at the early diagnosis question. Morgan and Wilkes take a broad look at strategies to promote early diagnosis in general practice, and wonder whether we should be casting the net wider to look for risk factors in non-consulting patients. Clarissa Penfold and colleagues focus on the diagnosis of adult brain tumours, where early diagnosis is currently thought likely to improve quality of life and morbidity. In the absence of useful biomarkers, the emphasis needs to be on early investigation, faster access to investigative facilities, and an awareness that patients with brain tumours may present to other healthcare professionals, including opticians and pharmacists.
We hope that you are enjoying the new Life & Times section. If you need something to remind you that general practice is a terrific profession, please read Sandy Taylor’s magical article.
- © British Journal of General Practice 2017
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