By the way... GPs can’t diagnose cancer in ten minutes
THE fact that GPs in Britain are slow at cancer diagnosis compared with other countries is troubling many of us.
There seems to be little doubt that, for most types of cancer, early diagnosis offers the best possibility of cure and delay will inevitably lead to worse survival rates.
There are many factors behind our low ranking. Being forced to allocate only eight to ten minutes to each patient is a major one.
It is impossible to take an adequate detailed history and conduct a careful physical examination in that short time, both of which are needed to evaluate whether a symptom of pain, fatigue or weight loss is sinister and needs further investigation.
The only solution to this is spending more time with each patient — and that means more doctors at the coal face.
Scanning technology also plays a key role. A GP from Turkey, offering her own explanation for why Britain ranks so far behind other countries in terms of late cancer diagnosis, pointed out to me that in Turkey, every patient with almost any symptom of whatever suspicion or relevance that could suggest cancer receives an MRI scan.
Indeed, in a bid to improve early cancer diagnosis, the National Institute for Health and Care Excellence recently announced new guidelines recommending that GPs have better access to CT scans and other forms of imaging tests.
While this is a welcome move, Dr Giles Maskell, president of the Royal College of Radiologists, is correct in his fear that NHS radiology services are going to be overwhelmed. They are already unable to cope with current levels of demand.
And the scan-all approach is not without complication. One potential problem is misdiagnosis — the interpretation of such images requires considerable skill and that needs years of training. You can’t whistle up new radiologists any more than you can whistle up trained, experienced GPs.
The other danger is overdiagnosis: subjecting patients to scans is fraught with complex and often puzzling unexpected findings, all of which must be explained and then acted upon or dismissed.
Aside from this detail, I cannot help but feel that the Department of Health and the minister could have spent a little less time foisting ever more regulation on medical practitioners and a bit more time addressing manpower issues.
They would also do well to take note of the ever greater complexity of medical care in an ageing population with many having a range of conditions demanding so much more thought and care than was ever anticipated in 1948 when the NHS was created.