Steven Harley is a 41 year old man with tongue cancer. According to last week's Daily Mail (12 May), he is the victim not of the malignancy itself but of a “cancer blunder.” What was the blunder? He had been seen by many different doctors before the final diagnosis was made. The delay was, according to the Star (11 May), clear evidence of “scandalous treatment.”
The member of parliament for Barnsley, Eric Illsley, raised the issue of misdiagnosis in the House of Commons on 10 May. Mr Illsley spared no detail and declared himself disgusted with the specialists' failure to find the cancer in time. “How did doctors miss my cancer 22 times?” screamed the front page of the Daily Express (11 May). On the same day the Star contributed “12 docs fail to spot dad's cancer” and declared that the “GPs, hospital medics and specialists . . . should be sacked.” The BBC1 evening news made it their second story, after leading with British troops in Sierra Leone.
As anyone familiar with these stories could have predicted, nowhere in the most prominent coverage were the difficulties of diagnosis discussed. Mr Harley is a non-smoker, which made tongue cancer an unlikely diagnosis even when his sore throat persisted. He was seen by an ear, nose, and throat surgeon four days after requesting the appointment, but nothing was found.
With the benefit of knowing that he had cancer all along, it is easy for the MP and the media to think this was a mistake, but we do not yet know. Steven Harley had “already guessed that he was seriously ill with cancer” (Star), but there are many patients with similar symptoms who think they have cancer but are clear of the disease. Steven Harley had several investigations and saw a number of different doctors from different specialties. Some of these were in the private sector. The original working diagnosis was that Mr Harley's symptoms were non-organic in origin. Is it possible that something in the way he or the disease presented made a more serious disorder less obvious?
Eventually, a neurologist found a cervical lymph node. A rapid referral to an ear, nose, and throat surgeon led to the diagnosis being made by a needle biopsy of the tongue. The procedure was ludicrously described by the Star as a “simple test.” This was typical of the simplification and lack of medical voice in the story—but then the Express, Star, BBC, and even the Guardian reported that Mr Harley might lose his “tongue, larynx and voice box.”
There were no ear, nose, and throat specialists on BBC television. The media stories all ended with the unadorned statement from the chief executive of the local NHS trust that there was no evidence of fault. Professors Gordon McVie of the Cancer Research Fund and Michael Richards, the “cancer tsar,” used the opportunity to underline our generally poor cancer services and how we have an uphill struggle. We know that already; this was the reason for Professor Richards' appointment.
Even when cancer services are better funded and reorganised and the extra hundreds of oncologists have taken up their posts—perhaps within 10 years from now—cancers will still be missed. We finally got to hear an ear, nose, and throat specialist's view in an interview on Radio 5 Live. The surgeon pointed out just how difficult such cases as Steven Harley's can be, and how it is sometimes impossible to locate the primary tumour even when the patient presents with an involved lymph node as the first symptom. The Guardian later published a couple of letters sympathetic to doctors' difficulties but “balanced” them with another containing a sarcastic jibe saying that the chief executive had given “hope and inspiration to all patients.”
All this was in the same week as the report on dead babies' stolen organs (judging the behaviour of yesterday by the rapidly changing standards of today), a plastic surgeon named in the House of Commons (described under the shield of parliamentary privilege as “a psychopath”), and the neonatal ventilator study in North Staffordshire Hospital (where something does seem to have gone seriously amiss). Countless millions of medical decisions are made every year. The steady drip, drip reporting of every medical misdemeanour that reporters can find is harming the morale of medical staff. The “scandals” are taken up with gusto by politicians desperate to avoid being blamed for the state of an NHS damaged by years of underfunding with staff having to work harder with fewer resources.
We now have promises of more money from Tony Blair and Gordon Brown. We have agreed to systems of reaccreditation and revalidation. The press should give the NHS a chance to put these new systems in place. It is all too easy for the papers to find stories of the small minority of doctors who are uncommunicative and self serving.
Claire Rayner, president of the Patients Association, was commissioned by a newspaper last year to write a story about the NHS. She discussed NHS Direct, and the tone of her piece was optimistic. The paper pulled the story, saying that it was not interested in good news. Ms Rayner's response contains a powerful warning: “Who do these news editors think is going to look after them when they get ill? The consequence is that if the NHS has been fatally flawed by their ill treatment of it, there won't be anyone.”