I am a typical NHS GP so let's start by getting something straight about the latest article in the national press about how useless I am at diagnosing cancer. No adult ever attends my surgery without a potential diagnosis of cancer being at the forefront of my mind. Every pain is cancer. Every cough is cancer. Every lump is cancer. Likewise every chest pain is a heart attack. Every childhood rash is meningitis. I defer to the worst case scenario for everyone and everything I see.
In any other walk of life you would call me a pessimist. In medicine I'm just a pragmatist. Everyone I see has one foot in the grave until I have proven otherwise to my own satisfaction. I listen. I ask questions. I examine. I ask questions. I hypothesise aloud. I ask questions. And when I feel that I have enough information to work with; I come to a decision. Often that decision is: I don't know what the hell is going on here but I don't think it's serious. Let's try a bit of time. Let's try some sort of drug intervention. Let's allow nature to take its course. And you know what, most of the time whatever it is gets better.
Rarely someone walks through my door and my baseline concerns are proven right. Despite all my attempts to deny them a catastrophic outcome all the data I accumulate leads down one inevitable road- cancer. They are the easy ones to get right.
What of those that could be cancer but I can't quite get the pieces of the jigsaw to fit together? Some of those I refer on. For over a decade now we have been blessed with what is termed as the '2-week rule' where we can refer anyone with suspected cancer to secondary care in the knowledge that they should be seen within 2 weeks. That was a huge relief to me when it was first introduced but since then such referrals have been ever more protocol driven so that certain boxes need to be ticked before those patients will be seen. Sometimes I cannot tick those boxes. Some people just don't fit into text book descriptions. Sometimes all I've got to go on is a well-informed hunch and that, often, is just not good enough. So there is a delay and sometimes nature does take its course and that delay leads to a slumbering cancer waking up.
My life and those of my patients would doubtless be made less stressful if I had direct access to sophisticated but costly investigative technologies such as MRI/CT scanning- but I do not.
My life and those of my patients would doubtless be made less stressful if I had freedom to order whatever tests and investigations I felt were necessary- but I do not. However I have been chastised for over investigating patients and that has left me feeling quite intellectually bruised.
My life and those of my patients would doubtless be made less stressful if I had access to a consultant's opinion on the phone or email but I do not and even if I did that consultant's opinion would count for little since he/she too has to operate to a hospital's protocol on patient referrals.
It would be so lovely to have a second informed opinion on every patient that I have doubts about but I can't. I guess that's why I am paid to be a doctor. Decisions come with the job.
So yes; every cough is a chest infection; every abdominal pain is indigestion; every irregular period the menopause and every night is sleepless worrying about every such patient until hopefully they get better and I realise that once more I was kept awake solely by my nihilistic anxieties. And conversely every cancer is a frustrating failure that only highlights my professional impotence when faced with the irrational unpredictability of life.
I'm trying to do my best. I am a typical NHS doctor.