41 gp surgeries

Casdon
Whoever devised the ‘pathways’ it was devised with the express intent of delaying proper diagnosis and therefore treatment. I find it hard to believe that doctors really want to do that. I have a degenerative condition of the cervical spine. This can only
be diagnosed by an MRI scan. After the hand consultant said there was nothing whatsoever wrong with my hand/arm, and the surgery he had performed some years earlier was fine (I knew it was) he said the problem was most likely to be my neck and I needed to be referred to the spinal team, but he couldn’t do that as he worked in the wrong city hospital, although he could have referred me had he still been working in the other city hospital (these hospitals are about 3/4 miles apart.) He advised me to go back to my GP who he said could refer me to the spinal team. However, my GP told she couldn’t refer direct to the spinal team either, she must refer me to the physiotherapist, who would decide if he should take my case to the spinal team meeting. He did decide to do that, and I was then accepted by the spinal team, who then referred me for the MRI. After that I had to go back to a different physiotherapist who explained the results of the MRI to me, not completely correctly, and he then referred me back to the spinal team to assess for possible spinal injection. I then went to see the spinal consultant, hurrah, it only took almost a year to get to the correct consultant! All the time, in pain, taking painkillers and the vile drug Pregabalin daily. And steroids to enable me to take the long flights to and from New Zealand. Next week I’m having the long awaited spinal injection to block the pain, but only temporarily, and so possibly surgery next.
There is no way that any reasonable person would devise a pathway such as I was on thinking that it was in the patient’s best interests. It’s to keep patients off waiting lists in my opinion.
My daughter is a doctor. She would not devise a pathway such as this which aims to keep patients away from a proper and prompt diagnosis and then treatment.

Just to add, none of the above is the fault of the doctors I saw. All were exemplary in their treatment and concern. The problem was not the doctors. The problem is the pathway!

maddyone As I explained on another thread, almost the exact same thing happened to me about 25 years ago. It took about 18 months before I was given any treatment, but modern "pathways" can't be blamed. With hindsight, the problem was that the GP didn't recognise or acknowledge that pain in my hand was caused by a problem in my spine.

More recently, treatment for breast cancer was delayed unnecessarily for six months. It's still affecting me because I had more of my breast removed than would have been the case if I'd been officially diagnosed earlier and a second tumour was found in the same breast. I kicked up a fuss and had meetings with the GP senior partners and managers from the clinical commissioning group. They both denied responsibility (not surprisingly), but the root cause was because the GP had used the wrong referral pathway. I should have been put on the "two week" cancer pathway, but I was instead referred for a routine mammogram, which was refused because I wasn't due for a routine scan. It was complicated by the routine service and the emergency cancer pathway being run by different trusts. Although I knew there was something wrong and cancer was found in exactly the same place I was experiencing pain, the GP didn't really believe me (because I had no lump) and saw no urgency.

In both cases, the fault was human error rather than any flaws in pathways.

Clinical pathways are the way clinicians manage their workload maddyone, it’s that simple. If there were no restraints on budgets and other resources they wouldn’t be necessary. I’m not denigrating clinical professionals’ ability to do their jobs, they are the only people who can do what they do - and they are the only people who can decide how to best manage patients when there is not enough resource to go round. I know it’s easier to blame ‘the system’, but this situation is not about the system, nor about the ability of individual clinicians. It’s about resources.

In my recent experience, I was put on the 2 week urgent cancer pathway even though cancer was not considered likely by my gp. She warned me that the hospital would assume that cancer was present.
So do I feel cross that I had to wait 2 weeks for the results of a biopsy after hysterectomy, with the worry that it might be cancer? Or do I say that I needed to go that route to receive much needed timely treatment? Or do I ask why there are no other fast track treatments for non cancer patients?

A consultant who recognises that the patient needs to seen by a different team but can’t refer a patient because they work in the ‘wrong ‘ hospital?
Absolute madness!
And not his (the doctor’s) fault or decision!

A GP who isn’t allowed to follow the advice of a consultant and so can’t refer a patient to the correct team? That’s not the GPs fault, it’s whoever devised the pathway.

This is not about poor doctors, the doctors did everything they could. My GP had already explored the most usual possibilities, hand X-ray, carpal tunnel conductivity test, etc. This is/was about doctors being restricted from doing their job efficiently and effectively because of pathways devised not by themselves. It is designed to keep patients away from diagnosis because diagnosis opens the door to treatment and many patients need the spinal team’s expertise.

I agree it’s about managing scarce resources, and I want to see more resources put into the health service. But using physiotherapists to keep patients from seeming the correct consultant/team is wasting money, because it puts the patient on the waiting list to see a physiotherapist rather than the spinal team!

Physiotherapists do a wonderful job, where it is appropriate. They shouldn’t be used in this way, in my case twice, to prevent patients accessing the care they need.

I’m sorry you suffered the same difficulty that I did growstuff. It’s a painful condition.

I was assessed and treated by spinal neurology over two years ago. An intervention (rhizolysis) gave much reduced pain for a few months then back it came. The consultant clearly said come back when the pain returns - the intervention could last up to two years, in my case several months.

As it had been over a year since my last appointment with him I needed a new referral. My GP was regretful, unable to refer directly. The referral has to be via the Muscular Skeletal Service (MSK). After waiting five months for MSK I have been dispatched for an MRI (no problem with that) but told unless they assess the outcome as being suitable for surgery I will not be re-referred to spinal neurology. Instead a pain management course. When working I taught the wretched things! Happy? Of course not, frustratingly the consultant I saw has now retired so no hospital contact to ask for help. The original consultant was clear, there are other things to try before surgery. Could I convince the MSK assessor? It seemed not. Currently waiting the outcome of the MRI, wish me luck.

cornergran yes I do wish you luck. At least the results of the MRI should not be too long a wait?