Should the label “cancer “ become obsolete?

Should the full medical terminology be used instead and be used only by a few?

Cancer is after all a whole spectrum of diseases, some completely curable, some aggressive and everything in between.  Some cancers are quite slow growing, even when spread to other parts of the body, especially with present day treatment. It should not be assumed that the patient, even with advanced cancer, will soon be pushing up the daisies.

Cancer patients may live a long time and become ill with unrelated conditions that require treatment.

Should people be open about the fact they have ever been diagnosed with cancer?

Or should they take the view that their health is nobodies business but their own and the medical staff treating them?

Should medical history be exempt from todays fashionable “tell all” transparency culture, and revert to what is becoming the now “old fashioned” patient confidentiality?

My view is that patient confidentiality should be conserved at all costs but in many small ways it appears there is a movement away from this.

This article is rather worrying and I fear may be the way things often are.

THE UNSPOKEN SENTIMENT TOWARDS PATIENTS WITH ADVANCED CANCER

COUNTRY: USA

“Do you know my breast cancer friend, X?”

I have come to realize that while the use of a cancer diagnosis to describe a patient is common, it can also trigger assumptions that may not be correct, which may result in terrible consequences. Beyond the care and compassion rendered in oncology practices throughout the world, there may be an unspoken sentiment within society and within other realms of medicine that treats patients with advanced (or chronic) disease as “hopeless” or “terminal,” regardless of where they are in their disease state.

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A CONVERSATION WITH MY CHILDREN

As you all know, recently within our family, an emergency situation arose.

Since it happened on a Saturday night, when A and E departments are busy and ambulances are in full swing, it was thought it might be best to transport the patient to the nearest A and E department by car since there may have been a delay before an ambulance arrived. Although some emergency treatment for what turned out to be an accurate diagnosis was given at home it was clear the patient would need hospital admission for stabilisation and further investigation. However, it was found to be impossible to get the patient out of the house into the car without help and so a decision was made to contact the 24 hour NHS UK telephone service. This was an error, the intention was really to dial 999 in spite of possible Saturday night ambulance delay.

Firstly someone who seemed to be a lay person answered the phone and asked several questions very politely and calmly – all of them were relevant.

There was no doubt she was following a protocol on a computer screen in front of her and this clearly informed her that she would need to pass on the problem and in due course a nurse would phone back.

The nurse phoned back quickly. Very politely, reassuringly, and calmly she asked another battery of questions that delved deeper into the problem. These questions again were clearly protocol driven. The nurse concluded that a visit from a paramedic was required. To be fair, the nurse said if the patient’s condition deteriorated, to dial 999, but gave no indication how long a response would take.

The patient was reasonably stable. It was expected an ambulance would arrive soon. The paramedic arrived soon in a car with a bag full of equipment, not in an ambulance.

He asked lots of questions and did a few blood tests, ECG etc. He decided that the patient had to be transported to hospital and phoned for an ambulance.

The ambulance arrived quickly and with flashing lights transported the patient to A and E where she was seen immediately. Further investigations were performed, she was kept in the acute medical receiving ward overnight and transferred to another medical ward the next day to be discharged stabilised a few days later.

Everyone worked as they should have done. There were no obvious delays. Nevertheless the clock ticked on and the procedures involving 4 separate levels of NHS staff,  took 4 hours before the patient reached an A and E  department. That is, it took four hours to see a doctor. It didn’t seem as long as that, but that’s what the clock said.

The problem with all of this, is that although the various team members involved all worked as the system decreed they should in an emergency, not one of them was trained in diagnostic skills. And so it took four hours for a patient who had collapsed semi-comatose with multiple serious  pathologies and therefore various possible diagnostic problems to see a doctor. Proper treatment cannot begin without proper diagnosis.

So, my children, should things have been done differently? With hindsight what should have been done? What would you do in future? Dial 999? If possible bundle the patient into the car and speed to A and E and hope there are no traffic lights obstructing the journey?

In an emergency, it is often difficult to know what to do for the best.

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