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Wednesday 25 October 2006

NHS Crisis First Hand [drdave]

Serious blog time...
As you may or may not be aware, the NHS has recently introduced the so called "two week rule". A simple measure that states that any patient presenting to a GP where a cancer is suspected or likely will be referred to and seen by a consultant within two weeks. Any treatment thereafter will be treated under the same rule. The idea been that the earlier you catch these things, the better.
Sounds good right?
Back in mid-June I was taking a bath and I noticed a new feature on my body. I'd never noticed it before, it was large (about 1cm), dark brown and, to say the least, it put my hackles up. Having seen my grandad ignore the obvious symptoms of cancer for far too long, then pass away in a most unpleasant way, I wasted no time in seeing my GP. The next day in fact. She agreed that it was suspicious, though probably benign, and said she would refer me to the dermatologist with urgency.
Happy that I was safely in the hands of the professionals, I went home and awaited notification of the appointment - within two weeks, according to the guidelines.
By mid-august, two months later, I was still waiting. Eventually, the appointment came. August 28th, over two months since my GP referred me! The dermatologist took a look at it and immediately recommended surgery to remove it. The procedure was booked for the following week, September 7th. Quite quick and painless, under local anaesthetic and I now have a two inch scar to show for it.
Anyway, I went away thinking that the results would be processed quickly and I'd be notified in due course. However, no-one told me how long this would take or how I would be told. I started to ring them every week, but each week was told that the results hadn't come back. Two weeks ago, I was told that the results had come in but the consultant hadn't had chance to look at them. Last week I was told that the results had been looked at, and they would be sent to my GP in about a week. No-one would tell me what they were, I'd have to wait another week.
Finally, this morning I saw my GP and got the results. Mercifully, the lesion was not malignant. It was a dysplastic nevus, which is kind of a mole gone wrong that has a small chance of becoming cancerous later on. For that, I am profoundly grateful. I still need to have another small procedure to make sure the whole of the lesion is gone, but the urgency isn't there anymore. In total though, this whole process has taken four fucking months to just get a diagnosis! Does this not strike anyone as worrying? Maybe not if you haven't just spent that four months wondering if the universe is going to have to get used to not having you in it.
In case you need convincing of how serious a four month wait in this case is, here are some facts. Melanoma, the worst kind of skin cancer, accounts for a relatively small percentage of cancers (3%), but it is a disproportionally large killer. This is because the metastases of melanoma, the secondary tumours, are notoriously resistant to radiation or chemotherapy. When a primary site melanoma spreads, it gets into your bloodstream and spreads to your lungs, brain, liver, anywhere really. If left untreated, a melanoma that undergoes metastasis will kill you in months rather than years.
However, if you catch it early, melanoma is extraordinarily survivable. At stage 0 (where the tumour is in situ and hasn't yet spread downwards) the survival rate is 100%, you're effectively cured. Stage 1, with a 1mm invasion of deep tissue, has a 10 year survival rate of 95% - good odds I would say. But it needs to be caught early. I understand that in Australia, suspicious mole removals have become commonplace procedures, precisely because they recognise the need to get them off as soon as possible.
Somewhere, the system has failed me, but thankfully I might get away without paying the ultimate price. I'm lucky enough to have just started a private healthcare scheme with my employer (which started, ironically, just after I finally saw my dermatologist) so hopefully I won't have to suffer the failing NHS again. And failing it does seem to be... I'd previously defended the system, saying that it might not be particularly efficient when dealing with bad backs or stubbed toes, but that it was fantastic when your life was on the line. Maybe it is, maybe my case is just an isolated case, but I hear far too many scare stories to be complacent anymore.
If I have one piece of advice to impart at the end of this, I would say only one thing: use sun cream, please, you really don't want to go through what I've been through the last four months!


  1. Jeezus and you a doctor too!
    I've always thought the NHS is exemplarary when presented with an immediate crisis. "car crashes, broken limbs, stabbings" all that sort of blood every shit.
    as soon as it's got to plan stuff out it all goes to pieces, takes forever to get from dept to dept and this with ever better IT systems and paper pushers aplenty.
    Can happen the other way too though. I had a blood test a few weeks ago and forgot to call in for the results. Wifey took eldest to doc (vomiting bug) he remembered about the blood test and demanded I call. Low iron again so need a course of tables, which explains why I've been feeling knackered for a while.
    Again organisation.
    You've had a lucky escape Dave, got to say I don't look for stuff like that at all. Time to get the digicam out and have the wife take a session of body snaps for future reference, so long as I get to do it back of course.

  2. I went to see the dermatologist this afternoon, after they hastily arranged an appointment when they acknowledged I'd been treated badly. She was very apologetic, and appreciates that the system is walking on its arse. The reason I'd not fallen into the two week rule, incidentally, is that my GP had not indicated it on the referal letter. Instead of writing "TWR", she'd written "urgent" with the same intent.
    Imagine a situation where this extra month and a half delay resulted in you having a significantly worse prognosis. Would you be prepared to accept their apologies then?

  3. I'm sure, in that case, you could win some compensation off them but whether you choose to spend your remaining time doing that is another matter entirely I guess. Horrific.

  4. Foiled again...