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EventThis Westminster conference discusses the Government’s Women’s Health Strategy for England and the next steps for implementing ambitions in the context of a new Prime Minister. Delegates will look at the priorities for improving women’s health outcomes, service delivery and workforce education. Areas for discussion include: the strategy - scope and emphasis - implementation - the leadership and accountability to achieve progress service development - improving diagnosis - integration - tackling variation in access and other areas of inequality stigma - improvement of the first points of contact in primary care sexual and reproductive health - care and support across the life cycle - diagnosis rates - accessibility of services and information - patient-centred approaches research - areas of focus for women’s health - improving the data and the evidence base inequalities - tackling disparities in health outcomes - building a responsive environment for women’. Register
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News Article
Doctor struck off for falsely diagnosing children with cancer
Patient Safety Learning posted a news article in News
A paediatrician has been struck off for falsely diagnosing children with cancer to scare their parents into paying for expensive private treatment. Dr Mina Chowdhury, 45, caused "undue alarm" to the parents of three young patients - one aged 15 months - by making the "unjustified" diagnoses so his company could cash in by arranging tests and scans, a medical tribunal found. Chowdhury, who worked as a full-time consultant in paediatrics and neonatology at NHS Forth Valley, provided private treatment at his Meras Healthcare clinic in Glasgow. But the clinic made losses, despite "significant" potential income from third-party investigations and referrals for treatment – with patients charged a mark up fee of up to three times the actual cost. In all three cases, Chowdhury gave a false cancer diagnosis, without proper investigation, before recommending “unnecessary and expensive” private tests and treatment in London. Parents previously told the tribunal of their shock and upset at receiving Chowdhury’s diagnoses during consultations between March and August 2017. He told the parents of a 15-month-old girl - known as Patient C - that a lump attached to the bone in her leg was a "soft tissue sarcoma" and a second lump had developed. Chowdhury urged them to see a doctor in London who could arrange an ultrasound scan, a MRI scan and biopsy in a couple of days, saying: "If things are happening it is best to get on top of them early." He also warned that it would be "confusing" to return to the NHS for treatment. But the parents spoke to an A&E doctor and an ultrasound scan revealed that the lumps were likely fat necrosis. Patient C later was discharged after her bloods tests came back as normal. The child’s mother told the tribunal that she and her husband had been "very upset" at Chowdhury’s diagnosis. She was also left "angry" after she later read Dr Chowdhury’s consultation notes and realised they were a "total falsification" of what was discussed. Read full story Source: Medscape, 18 July 2022 -
News ArticlePatients are at risk of a missed cancer diagnosis due to a reliance on paper records, an NHS trust has admitted after a man died due to his tumour being overlooked. Michael Lane, 50, from Shrewsbury, was “failed” by Shrewsbury and Telford Hospital Trust, his family has said after his cancer scan result was misplaced leaving him with a growing kidney tumour for 10 years. The trust is yet to fully launch an electronic record system a year after an investigation into Mr Lane’s death warned other patients were at risk due to the gap in paper records. Mr Lane went into Shrewsbury and Telford Hospital for a scan following a referral for suspected cancer in 2011. The radiographer flagged a small tumour but the scan was overlooked, placed within his paper records and never reported as being a concern. In an investigation report carried out by the trust in May 2021, seen by The Independent, the hospital admitted that had his tumour been seen and operated on earlier he may have survived. The report also admitted there were ongoing risks within the trust due to gaps in its electronic records system. It said: “The implementation of an IT solution will not prevent sad cases such as that of Mr Lane where the scan report that was missed took place before the widespread availability of such systems, however, it is clear that until we have an electronic requesting and sign-off system we remain at risk of new cases of missed results and harm occurring as a result of the ongoing reliance of paper-based results.” Read full story Source: The Independent, 17 July 2022
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Content ArticleSome patients are unable to tolerate imaging procedures such as MRIs due to pain or anxiety. In these cases, a variety of medications are routinely used prior to imaging to allow the procedure to be carried out successfully. Varying levels of sedation before imaging can be appropriate given the need for patients to remain still during the imaging process, but the minimal amount of sedation should be used to mitigate unwanted side effects and reduce the risk of adverse events. This article examines two cases that highlight the risks of minimal-to-moderate sedation for imaging procedures, especially in high-risk patients, when multiple medication doses are required and when monitoring is limited or inadequate.
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News Article
UK skin cancer deaths higher in men than women
Patient Safety Learning posted a news article in News
More men are dying from melanoma skin cancer than women in the UK, Cancer Research UK is warning as the country's heatwave continues. Rates of the cancer, which can develop in sun-damaged skin, have been rising in both men and women in recent years. Late diagnosis may be part of the reason why men are faring worse. Melanoma is treatable if it is diagnosed early - the charity is urging people to take care in the sun and get any unusual skin changes checked. Melanoma death rates have improved for women in the last 10 years, but not for men. Michelle Mitchell, chief executive of Cancer Research, says the figures "drive home the importance of sun safety". "We all need to take steps to protect ourselves from the sun's harmful UV rays. Getting sunburnt just once every two years can triple your risk of skin cancer," she adds. Read full story Source: BBC News, 15 July 2022 -
Content ArticleRates of blood testing in primary care are rising. Communicating blood test results generates significant workload for patients, GPs, and practice staff. This study from Watson et al. explored GPs’ and patients’ experience of systems of blood test communication. The study found that methods of test result communication varied between doctors and were based on habits, unwritten heuristics, and personal preferences rather than protocols. Doctors expected patients to know how to access their test results. In contrast, patients were often uncertain and used guesswork to decide when and how to access their tests. Patients and doctors generally assumed that the other party would make contact, with potential implications for patient safety. Text messaging and online methods of communication have benefits, but were perceived by some patients as ‘flippant’ or ‘confusing’. Delays and difficulties obtaining and interpreting test results can lead to anxiety and frustration for patients and has important implications for patient-centred care and patient safety.
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Content ArticleThis study in the journal Current Problems in Diagnostic Radiology aimed to explore the perspectives of radiology and internal medicine residents on the desire for personal contact between radiologists and referring doctors, and the effect of improved contact on clinical practice. A radiology round was implemented, in which radiology residents travel to the internal medicine teaching service teams to discuss their inpatients and review ordered imaging. Surveys were given to both groups following nine months of implementation. The vast majority of both diagnostic radiology residents and internal medicine residents reported benefits in patient management from direct contact with the other group, leading the authors to conclude that this generation of doctors is already aware of the value of radiologists who play an active, in-person role in making clinical decisions.
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Content ArticleClosed-loop communication—when every test result is sent, received, acknowledged and acted upon without failure—is essential to reduce diagnostic error. This requires multiple parties within the healthcare system working together to refer, carry out tests, interpret the results and communicate them in language the patient can understand. If abnormal test results are not communicated in a timely manner, it can lead to patient harm. This Quick Safety case study looks at the case of a 47-year-old school teacher who had a screening mammogram. The radiologist identified a suspicious area of calcifications, which required follow up. The patient’s GP was not on the same electronic medical record (EMR) as the imaging centre and, because of front office changes, missed the notification to follow up. The patient was told that the radiologist would contact her if the results were abnormal and therefore assumed she was okay. A year later when seeing her GP, the patient was told that she needed follow-up testing and that she had stage 3 cancer. Her lesion had grown significantly, and she now required surgery, chemotherapy and radiation for advanced breast cancer. The case study suggests safety actions that should be considered to prevent this error from happening again.
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Content ArticleThis retrospective cohort study in JAMA Internal Medicine aimed to determine whether there are systematic racial and ethnic biases in pulse oximetry among patients with Covid-19, and whether these biases result in patients not being accurately recognised as candidates for oxygen threshold–specific therapy. The authors found that patients from racial and ethnic minority groups with Covid-19 are often subject to overestimation of arterial oxygen saturation levels. This contributes to them not being recognised, or a delay in them being recognised, as eligible to receive Covid-19 therapies.
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News Article
Are we failing young people with cancer?
Patient Safety Learning posted a news article in News
When you think of cancer, a glamorous mum in her mid-30s is not the first image that springs to mind. But You, Me and the Big C podcaster Dame Deborah James was just 35 when she found out she had bowel cancer. Blood and stool tests had come back normal and her GP had laughed "not once, but three times over the course of six months" at the idea she could possibly have a tumour in her bowels. The diagnosis came only when she paid to have her colon examined privately. Her experience has raised questions about how good we are at spotting and treating cancer in the under-40s. Simply - are we failing young people with cancer? Overall, around 4.3% of cancers diagnosed in the UK are in the under-40s, while those over 75 make up more than a third of all cancer cases, which poses a challenge for us and the doctors who treat us. When we are young, we're less likely to attribute any ill health to cancer. Changes to our bowel movements could just be stress, blood in the toilet after we poo could be inflammatory bowel disease or haemorrhoids. Because, for most people, cancer is something that happens to our parents or grandparents. Your doctor should be alert to major warning signs of cancer, but there is a medical saying: "When you hear hooves, think horses, not zebras". It's a call to look for the most common or likely explanation, and the younger you are, the less likely cancer is to be behind your symptoms. This helps channel the health service's limited resources to those most likely to need them. But that means some younger people aren't being seen quickly enough, although the problem can affect older people too. Bowel Cancer UK's Never Too Young report in 2020 found that four in 10 people surveyed had to visit their GP three or more times before being referred for further tests to see if they had cancer. "I don't think GPs are a problem," says Genevieve Edwards, chief executive of Bowel Cancer UK. "It [bowel cancer] is rare in younger people... It will usually be something else." The question is - what if you are the zebra, that relatively rare case who does have cancer at a young age?" Read full story Source: BBC News, 14 May 2022 -
Content ArticleDr Harsha Master, Dr Ashish Chaudhry, Dr Nicholas Gall, Dr Louise Newson, Dr Sarah Glynne, and Dr Paul Glynne present their experiences of diagnosing, managing, and referring patients with long COVID and associated conditions. Read this article to learn more about: the definition, prevalence, and symptoms of long COVID exclusion of alternative diagnoses, and identification of red-flag symptoms the authors’ experiences of managing long COVID and its complications.
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Content ArticleThis white paper from the Institute for Healthcare Improvement (IHI) describes a framework to guide health care organisations in their efforts to provide safe, equitable, person-centred telemedicine. The framework includes six elements to consider: access, privacy, diagnostic accuracy, communication, psychological and emotional safety, and human factors and system design.
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Content Article1 in 6 people in the UK live with a neurological condition, but there simply isn’t the workforce or services in place to provide the support they need. Every two years, The Neurological Alliance runs My Neuro Survey to give a picture of the experience of care, treatment and support for people with neurological conditions. From a lack of mental wellbeing support, delays to life changing treatment and care and a lack of information and support at diagnosis, over 8,500 people living with or affected by neurological conditions across the UK shared their experiences in the 2021/22 My Neuro Survey.
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News Article
Almost 100,000 facing excessive wait for serious cardiac care in England
Patient Safety Learning posted a news article in News
Almost 100,000 people with serious heart problems, including some “living on borrowed time”, are enduring long waits for potentially life-saving NHS care because hospitals are so busy. Some of them are in such poor health they will have a heart attack and die as a consequence of facing such “dangerous” long delays, the British Heart Foundation has warned. The number of patients in England being forced to wait more than the supposed maximum 18 weeks for cardiac treatment has trebled since Covid-19 struck, from 32,186 in February 2020 to an unprecedented 96,321, a BHF analysis of published NHS England data shows. They are waiting for procedures such as having a stent or balloon inserted to reopen a blocked artery, a pacemaker or implantable defibrillator fitted, or open heart surgery, including bypasses or valve replacement operations. Others urgently need to have an echocardiogram, CT or MRI scan to help doctors decide on treatment. Dr Sonya Babu-Narayan, a consultant cardiologist who is also the BHF’s associate medical director, said: “Cardiac care can’t wait. Without timely treatment, heart patients may be living on borrowed time.” “Tens of thousands of people feel in limbo, waiting many months or even years for cardiac surgery, invasive heart procedures or important diagnostic tests. During this time they could quite quickly become much sicker, and tragically some could even die before they can receive the heart care they so desperately need,” she added. Read full story Source: The Guardian, 16 June 2022 -
Content ArticleThis article in The BMJ examines the risks and benefits of current prostate cancer screening methods in the UK. It highlights issues that prevent early diagnosis including great variation in how prostate cancers behave and the poor performance of prostate specific antigen (PSA) testing in identifying disease that requires treatment. As a result of the limited benefits of screening for prostate cancer, routine screening is not recommended by the UK’s National Screening Committee or the US Preventive Service Task Force. The authors highlight that a bid by NHS England to find an estimated 14,000 men who have not yet started treatment for prostate cancer due to the pandemic, seems to contradict this recommendation. The NHS campaign warns that people shouldn’t wait for symptoms and encourages men to use a risk checker which informs patients of risk factors including family history, age and ethnicity. The authors express concern that the campaign implies there is great benefit in detecting asymptomatic disease, which could lead people to believe that the NHS is promoting screening. They argue that the NHS needs to be clearer and more consistent in its messaging, making sure that information aimed at the public emphasises that although PSA testing is available on request for men older than 50, it is not currently recommended, and why.
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Content ArticleThis retrospective cohort study in the British Journal of General Practice aimed to identify opportunities for timely investigations or referrals in patients presenting with potential symptoms of colon and rectal cancer, or abnormal blood tests. The study found evidence that patients with these cancers presented with low haemoglobin, high platelets and high inflammatory markers as early as nine months pre-diagnosis, and the authors suggest that starting cancer-specific investigations or referrals earlier may be beneficial in patients with some of these diagnostic markers.
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News Article
High Street pharmacists to make cancer referrals
Patient Safety Learning posted a news article in News
People with a worrying cough, problems swallowing or blood in their urine will soon be able to be referred for scans and checks by a pharmacist, rather than having to wait to see their GP. The new pilot scheme, in England, aims to diagnose more cancers early, when there is a better chance of a cure. High Street pharmacies will be funded to refer customers for the checks. The NHS will also send out more "roaming trucks" to perform on-the-spot scans in the community. Lung-scanner vans driven to locations, including supermarket car parks and football stadiums, have already resulted in more people having checks. Now, some liver lorries will join them. Health and Social Care Secretary Sajid Javid said: "Ensuring patients can access diagnosis and treatment easily in their communities and on High Streets is a fundamental part of our 10-Year Cancer Plan." Dr Anthony Cunliffe, national clinical adviser for primary care, at Macmillan Cancer Support, said: "Doctors and nurses are working tirelessly to diagnose and treat the tens of thousands of people entering a very busy cancer care system. "This pilot will give people the opportunity to access more trained professionals in their community to get symptoms investigated." Read full story Source: BBC News, 15 June 2022 -
Content ArticleFew things are more devastating than a cancer diagnosis, shares Maria Caulfield, minister for women’s health. She should know – she’s worked on a cancer ward for the best part of twenty five years and supported women through diagnosis, treatment, and recovery. Here, she speaks exclusively to Marie Claire UK about her ten year plan and how we can make gynae issues a thing of the past. Not only does she want to prevent the five gynaecological cancers, but she wants to help make sure we diagnose them early, too: we know that the earlier you are diagnosed, the higher your chance of survival.
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News ArticleWhen Jenny* had a mastectomy after being diagnosed with breast cancer, she believed the major surgery to remove her breast, although traumatic, had saved her life. She described feeling “rage” when at a follow-up appointment three years later, she said to her surgeon, “I would probably be dead by now” if she had not received the surgery, to which he replied: “Probably not.” It was only then, after she had already undergone invasive and life-changing treatment, that Jenny learned about “overdiagnosis”. While breast cancer screening programs are essential and save lives, sometimes they also detect lumps that may never go on to cause harm in a woman’s lifetime, leading to overtreatment, and psychological and financial suffering. Jenny is 1 of 12 women from the UK, US, Canada and Australia whose stories were published in the medical journal BMJ Open. It is the first study to interview breast cancer patients who believe they may have received unnecessary and harmful treatment, highlighting the effect this has had on their lives. “The usual story of breast cancer screening is ‘screening saves lives’,” an author of the study and a professor of public health at the University of Sydney in Australia, Alexandra Barratt, said. “This study reports the other side of the story – how breast cancer screening can cause harm through overdiagnosis and overtreatment.” Read full story Source: The Guardian, 8 June 2022
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Content ArticleThis study from Pickles et al. explores experiences of women who identified themselves as having a possible breast cancer overdiagnosis.
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News Article
Racial disparity in cancer diagnoses via screening in England
Patient Safety Learning posted a news article in News
Black people are more than a third less likely than white people to be diagnosed with cancer via screening in England, according to the first study of its kind, prompting calls for targeted efforts to improve their levels of uptake. Screening programmes save lives by preventing cancer from occurring or spotting it earlier, when treatment is more likely to be effective. In England, screening for cervical cancer is offered to women aged 25 to 64, breast cancer screening is offered to women aged 50 to 70, and everyone aged 60 to 74 is offered a bowel cancer screening home test kit every two years. The latest research, however, lays bare stark disparities in screening diagnosis rates between different ethnic groups for the first time. The study of more than 240,000 cancer patients over a decade found that 8.61% of patients were diagnosed via screening. Broken down by ethnicity, the figure for white people was 8.27%, almost exactly the same as the national average, but among black people it was 5.11%. The findings suggests that black people are 38% less likely to be diagnosed via screening than white people. Diagnosis via screening in mixed-race patients was much higher at 9.49%, and higher still in Asian patients at 10.09%, almost double the rate for black patients. The results were published in the British Journal of Cancer. Jabeer Butt, the chief executive of the Race Equality Foundation, said the findings should prompt urgent action. “Cancer screening saves lives,” he said. “That’s why it is so important that effective outreach and culturally appropriate interventions are prioritised to reduce health inequalities. “We know that awareness of cancer symptoms is lower among minority ethnic groups, particularly black Africans, with higher reported barriers to seeking help. But we also know from previous research on colorectal cancer interventions that speaking to someone who explains the steps of the screening process ahead of time can lead to improvements in screening uptake in minority patients." Read full story Source: The Guardian, 6 June 2022 -
Content ArticleUK Asian and Black ethnic groups have poorer outcomes for some cancers and are less likely to report a positive care experience than their White counterparts it was found in a study from Martins et al. reported in the British Journal of Cancer. The study investigated ethnic differences in the route to diagnosis (RTD) to identify areas in patients' cancer journeys where inequalities lie and targeted intervention might have optimum impact. Across the 10 cancers studied, most patients were diagnosed via the two-week wait (36.4%), elective GP referral (23.2%), emergency (18.2%), hospital routes (10.3%), and screening (8.61%). Patients of Other ethnic group had the highest proportion of diagnosis via the emergency route, followed by White patients. Asian and Black group were more likely to be GP-referred, with the Black and Mixed groups also more likely to follow the two-week wait route. However, there were notable cancer-specific differences in the RTD by ethnicity. These findings suggest that, where inequalities exist, the adverse cancer outcomes among Asian and Black patients are unlikely to be arising solely from a poorer diagnostic process.
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News Article
Autism diagnosis six years longer for girls, research finds
Patient Safety Learning posted a news article in News
"I knew I always felt different, but I didn't know I was autistic." For Rhiannon Lloyd-Williams, it would take until she was 35 to learn just why she felt different. Now research by Swansea University has found it takes on average six years longer to diagnose autism in women and girls than in males. A study of 400 participants found that 75% of boys received a diagnosis before the age of 10 - but only 50% of girls. It also found the average age of diagnosis in girls was between 10 and 12 - but between four and six for boys. Now charities in Wales are calling for greater investment into services to help better understand autism in females and speed up a diagnosis. "The parents responding to the study said there was a marked impact on the girls mental health while waiting for a diagnosis," said Steffan Davies, who carried out the research. "Girls represented in the study had a lot more pre-existing diagnosis, which suggests they are being misdiagnosed with anxiety disorders, eating disorders, and that tends to defer from the root diagnosis which tends to be autism." Autism UK said this gender gap has long been an issue and is the down to the diagnosis criteria and research used, which has been focused around young boys. "Many girls end up missing out on education, because the environment they're expected to learn in is just too overwhelming, while accessing healthcare can be difficult. Women are often not believed," said executive director Willow Holloway. Read full story Source: BBC News, 23 May 2022 -
Content ArticleThis practice pointer in The BMJ explains why diagnostic errors occur and provides five strategies that healthcare workers can use to achieve diagnostic excellence. Each of these strategies is explored in detail: Seek diagnostic feedback, which includes tracking patient outcomes and seeking feedback from patients, families and other healthcare workers. "Byte sized" learning, which involves digital learning activities. Consider bias by getting to know patients and treating them as individuals, and through taking a 'diagnostic pause' to consider whether bias is playing into decisions. Make diagnosis a team sport through multidisciplinary huddles that include healthcare workers from different professions. Foster critical thinking by using intentional strategies to foster reflective scepticism and regular review.
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Content ArticleThis study in The Joint Commission Journal on Quality and Patient Safety aimed to investigate factors affecting length of time to diagnosis in primary care in the USA. The authors found that patients presenting with new or unresolved problems in ambulatory primary care often remain undiagnosed after a year. There were no provider or patient-level variables associated with lack of diagnosis and further research is needed into the causes and consequences of lack of timely diagnosis.
