EMBARRASSING GPs

Nicky Pellegrino ( Health, February 9) describes three encounters between general practitioners and patients with bowel signs and symptoms. “The Aucklander saw a GP, who thought he had haemorrhoids, so didn’t send him for tests.” “One patient had

been told not to worry about stomach pain, as they were too young for cancer.” “A woman with a family history of bowel cancer was told by her GP not to be concerned, as it ran in the male line. This couldn’t be further from the truth.”

There is no way one can verify these stories, but each seems to me to be something of an embarrassment to the doctors, and they cast the teachers who instructed those doctors about bowel symptoms, and the association between bleeding and cancer, in a curious light.

Never has the training for general practice been more protracted and more expensive. Six years of medical school, two years of hospital residencies, then two or three years satisfying the requirement of the Royal College of General Practitioners. That’s not all. After that, they sit an annual test of competence called Bpac. When that began a few years ago, it was to cost each doctor $1200 a year plus GST. Toss in an annual recertification of your practice. Last year, that cost a solo GP of my acquaintance a stunning $7000. A rip-off? Well, I would say so. You have to wonder what a few unlucky patients get for all this.

And, yes, there are difficulties with the bowel-screening campaign. In a recent publicised case, a locum doctor who suspected piles in a patient sent a letter to the large local hospital, asking that she be seen. While awaiting the call, the patient went on bleeding for 12 months, the referral having been lost within the hospital. Back in town again, the locum swiftly sorted things out, but it was too late. The patient died of cancer.

Many years ago, I told a patient that her symptoms

concerned me. I gave her a letter of referral to a leading surgeon. The surgeon rang me in some perplexity. He wondered why I had got the date wrong on my letter. I had not. The patient had carried the letter around from the previous year. She showed up late, placing herself at risk.

Having taken a history that suggested a bowel disorder, I gave a wealthy businessman a request form for the appropriate tests. That was a long time ago. He didn’t use the referral, and he didn’t return. I later learnt he had got into trouble, then died.

GPs need to be taught or told that if they can’t cure piles (or even see them), and if they have anyone with symptoms that suggest a bowel problem, they should send the patient to a private surgeon or physician immediately. The prudent GP will use the phone on his/ her desk to set this up, and write the name of the specialist and the date and time on the envelope. Having done that, they will just have to hope the patient has the sense to overcome their fear and keep the appointment.

Roger Ridley-Smith (Khandallah, Wellington)