Non-attendance for cancer investigation

Jefferson et al¹ demonstrate the fallibility of the supposedly straightforward ‘2-week wait’ system for ensuring prompt investigation of ‘suspected cancer’ patients. A 5–7% failure rate may not seem alarming, but it is the vulnerable, as always, for whom the system fails. And I suspect the true failure rate is higher still because the vulnerable are less likely to consent in research.²

No one emerges blameless from this sad exploration of GP practice. Some GPs have abandoned their patient advocate role or even their willingness to explain and clarify. Blaming workload is not valid. Taking time to ensure patients understand and are safety-netted is essential general practice. The ideal is that the patient leaves the surgery with an appointment in their hand, fully understanding what to expect. Receiving hospital departments often seem insensitive and difficult to contact. And patients who are borderline of inclusion criteria (and the Gaussian reality of biological variables means these are inevitable) are worst treated of all. Balint’s ‘collusion of anonymity’ speaks to us from half a century ago.³

If GPs lack the time or skills to provide quality care for these important patients, perhaps practices might employ a ‘fixer’ to support them and help them cut through the bureaucracy.