With more than 12,000 new cases of bowel cancer a year it’s good to see something being done about screening for colorectal cancer. But with the national colorectal cancer screening program now being rolled out nationally, you have to wonder why the program sidelines GPs and does not build on the experience gained from the very successful and well run screening programs we already have for cervical and breast cancer.
Imagine, for example, if the government sent out spatulas unsolicited to all women and asked them to do their own Pap smears. And then if they manage to do it correctly, a central registry sends the patient a letter saying “Dear Ms Jones, you have had a positive result for the cancer test, please go see your GP...” Because this is essentially how the current bowel cancer screening program model will work.
Patients are sent a complicated and fussy FOBT test to their home, without the knowledge of their GP. They are expected to complete it without any help or counseling as to what a positive or negative result might mean. Their GP only becomes involved if the patient has a positive FOBT. And even then the program assumes the patient will nominate the most appropriate GP and that the patient will contact them after having a positive result.
But what if a patient has more than one GP or is unable to nominate a doctor they know well (perhaps if they have been seen by a locum or in a multi-partner practice)? What if the patient is too worried and in denial about the result to contact their GP? What is the duty of care for this patient’s doctor – and what happens if a doctor receives a notification of a positive result from a patient they have never heard of? How far should the practice go to try contact a patient with a positive result?
According to the information from the screening register, the doctor’s duty is to make one attempt to contact such a patient. But there is more to this than legal obligations. What about holistic care? How do GPs feel about their patients being sent tests without their knowledge? The GP is being kept out of the loop when they are the ones who know the patient’s circumstances. What if the patient has had family members with bowel cancer, for example? Or if the patient has difficulty with English? Excluding the family doctor until very late in the screening process is a recipe for confusion and compromised care.
The screening program is still in the early stages of rollout – let’s hope there are still chances to modify it to bring GPs to the forefront of bowel cancer screening, not left as an afterthought.
Comments
Hardness Succumbs to Gentleness
Although I was already a doctor of traditional Chinese medicine (TCM), the experience of losing my son to cancer caused me to look much more deeply into cancer therapies. I realized indeed the futility of Western antagonistic therapies like chemotherapy, radiation and surgery, and have sought to provide an alternative to these that supports the body's own immunological capacity to overcome the cancer naturally.
My approach differs from the usual approach to cancer practiced in TCM, to "treat poison with poison." In order to support the self-healing functions of the patient, I use instead of toxic, specific "anticancer" herbs, non-toxic supportive herbs but in very high doses, to "adjust the whole body and to balance the Yin and the Yang." The method has resulted in many cures of patients in early or intermediate stage disease, and also improvement in patients already in advanced stages of disease that require intravenous treatment. Indeed, some patients even in these advanced stages have been cured by the method.
The specific therapy is oriented to cancer cure and takes 1-2 years of close work between physician and patient. The method can be used either as a stand-alone treatment or as an adjunct to conventional therapies. In either case, the specific course of therapy is individually tailored to the medical and economic circumstances of the patient. Included in the program may be oral administration of herbal teas, intravenous injections of non-toxic or minimally toxic Chinese herbal preparations, external herbal treatments to "draw out poison," and hospitalization in a "VIP ward" for foreign patients.
Doctors can really only be responsible for responsible people. If you are told not to smoke and you still do, it is your own responsibility. If the screening program is well advertised , and a person takes no notice, it’s their own responsibility. G.Ps cant be made responsible for the population at large. Only if one of THEIR patients asks about, then it would be the doctors responsibility. If the program picks up even a small percentage of people, it’s worth it.
Posted by Isaac Brajtman on Tuesday, 9 October 2007
With more than 12,000 new cases of bowel cancer a year it’s good to see something being done about screening for colorectal cancer. But with the national colorectal cancer screening program now being rolled out nationally, you have to wonder why the program sidelines GPs and does not build on the experience gained from the very successful and well run screening programs we already have for cervical and breast cancer. 
