Every day, tens of thousands of people with a multitude of diverse complaints seek medical advice, and it is usually quite straightforward to distinguish the (potentially) serious from those that are less so. This is certainly, if self-evidently, the case for the acutely ill (stroke or heart attack) or those whose alarming symptoms (sudden loss of sight, vomiting blood) demand prompt attention.
Meanwhile for the much more common coughs, aches, pains, change in bowel function, etc, a few searching questions, physical examination and appropriate investigations will usually provide the answer.
Still, the “serious” may be overlooked with tragic consequences, highlighted recently in an article where half a dozen readers described their experience of a missed or delayed diagnosis. The details vary but are illustrative of the pitfalls or misleading assumptions that can lead doctors astray.
The first is “too young to have cancer”. When aged 29, David Chapman consulted his family doctor with abdominal pains for which he was admitted to hospital several times being treated for, among other things, kidney stones. He was eventually found to have a rare aggressive form of cancer of the bladder from which he died six months later. Here it should be noted that cancer is powerfully age-determined, with those in their 70s and beyond accounting for half of all diagnoses. It is thus necessarily low on the list of probable explanations for those, like David Chapman, in their late twenties.
Next is “we have done lots of tests but can’t find anything wrong”. Jane Spencer’s husband sought medical advice for stomach pains, poor appetite and weight loss, a worrying trio of symptoms suggestive of bowel cancer but excluded by a normal colonoscopy performed by a gut specialist whom he consulted privately. When repeated five months later with the same result he was apparently told “there was nothing wrong”.
Soon after, a bleed from his kidney led to the diagnosis of a large tumour that had already metastasised with an inevitably fatal outcome. The false reassurance of two normal colonoscopies in this instance was compounded by the silo mentality to which specialists are prone where, having ruled out the obvious diagnosis in their field of expertise, they do not pursue the matter further.
The third misleading assumption is illustrated by Joanne Messenger’s husband who, over five years, had attended his surgery on several occasions with acid reflux and excessive tiredness, warranting all the usual blood tests and eventually attributed to vitamin D deficiency. He then started coughing for which he was prescribed cough medicines and then steroids. But perhaps, one might infer, his doctor felt he had already been extensively investigated and so delayed requesting a chest X-ray which confirmed advanced cancer of both lungs and stomach.
Doctors in general are aware of the hazard of being misled by such pitfalls, though they may be more prevalent than in the past because of the current parlous state of the general practice. This was commented on by Essex family doctor Fiona Underhill in response to the Telegraph article – specifically the difficulty many encounter in getting a “timely appointment” and “the lack of continuity”, where patients often see a different doctor every time they attend the surgery.
All the more reason, then, to be aware of the twin cardinal criteria of the persistence and deterioration of symptoms which can minimise the likelihood of the “serious” being overlooked. Most illnesses are brief, resolving with simple treatment or on their own accord. But, if they persist over weeks or months without adequate explanation, and particularly if they get worse, then no stone should be left unturned in finding out what is amiss.
Email comments and queries in confidence to Drjames@telegraph.co.uk
Pushing for a second medical opinion could make all the difference