Vague and Non-Specific Cancer Symptoms: A short Tweetorial.
A bit of context courtesy of #GP150w for the #blackandwhitechallenge faced in Primary Care:
Vague and Non-Specific Cancer Symptoms
Continuing the shades of grey, we differentiate the specific cancer signatures from those non-specific symptoms, noting the lowering of the threshold for Positive Predictive Value to the current 3% level.
Vague and Non-specific Cancer Symptoms
So, what does the evidence for new pathways say?
Quite alot of support for 'gut instinct' or Clinical Suspicion- one of the two commonest reasons for referral to Multi-Diagnostic Centres, and statistically significance to support it.
Vague and Non-specific Cancer Symptoms
A 2021 @BJGPjournal review by the Lead Author has suggested that given the degree of less common cancers diagnosed via MDCs that this pathway exceeds that 3% PPV threshold- opportunity for hope!
Vague and Non-specific Cancer Symptoms
A useful moment to stop and highlight the data from this @BJGPjournal Systematic Review from Friedemann Smith on how valuable listening to that inner voice is!…
Vague and Non-specific Cancer Symptoms
Considering Unexpected Weight Loss:
Helpful evidence from @BrianDNicholson that we don't need to investigate all cases through these pathways, but associations with other features/symptoms should give you the nudge. #PracticeChanging
Vague and Non-Specific Cancer Symptoms
We're all set to launch our local pathway, but how much will the pandemic affect the 1st presentation of the patient?
Will we see more presenting at late stages and less at the vague or non-specific?
@CRUKHCPs @dottietipsy @_JamesGwilt
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More from @ArtfulDoctor

29 Jul
@MartinRCGP @rcgp 2/9 See our press release and action plan here:… - GPs and their teams have played a pivotal role throughout the COVID-19 pandemic, but even before the pandemic, GPs were under immense workload and workforce pressures.
@MartinRCGP @rcgp 3/9 We simply do not have enough GPs to meet the needs of a growing and ageing population, with increasingly complex conditions, on top of managing the fallout and backlog from the pandemic. If general practice collapses, the rest of the NHS will follow.
@MartinRCGP @rcgp 4/9 GP consultation rates were 11% higher in June 2021 than in June 2019 while the number of fully qualified GPs in England has fallen as the population grows - the number of full-time equivalent GPs fell by 1,307 (4.5%) between September 2015 and March 2021.
Read 9 tweets
22 Apr
Delighted to be living the lifelong career ambition: Roger Neighbour is presenting on the Consultation for our VTS.
Wonderful stuff. #MedEd
Patient centredness: not doing all that the patient wants, but putting all of your skills, expertise and attitude at the disposal of the patient.
This does require a skilled application of structure within the Consultation
The greatest opening line heard by Roger Neighbour:
(From the mouth of an Orthopaedic Consultant)

Tell me what you need me to hear, in your very own words.

Subtle, nuanced, appreciative enquiry!
Read 9 tweets
30 Mar
Today during my on call I was asked to review the following case. The parents have given their consent to discuss via social media for educational purposes:

The case of the blue willied boy.

A thread 🧵
...The child in question was very upset and complained to his teachers that to his great surprise and distress that his willy was blue.
No other symptoms, no pain, going for wees without difficulty.
No fever, no cough and no change in smell or taste.
Sorry, force of habit. 🧵
So the understandably concerned teachers required a visual confirmation of the blue willied boy’s claims: cue call to parents, resulting in my involvement.
What was the cause?
Venous congestion or engorgement??
Read 9 tweets
25 Feb
From @TARGETabx toolkit on @rcgp website- prescribing of ABx has been creeping up since the turn of the century- it's a popular misconception that ABx were only overprescribed in the bad old days...! But there's been better news recently...
The response to this? #ESPAUR
#AntibioticGuardian #KeepAntibioticsWorking
The picture before a focussed commitment to tacking antimicrobial prescribing for a 5 year period. Bit of local flavour for context for our @MidRCGP AiTs
How it was going...
Read 13 tweets
7 Feb
#NFL Teams as English #PremierLeague teams: A thread
Disclaimer: this may wind you up with some tenuous links... post your ideas as comments!
Dallas Cowboys:Arsenal
Wins in the 70s & 90s but some way off those glories in recent years. Still up there with the best
#NFL Teams as English #PremierLeague teams: A thread
Disclaimer: this may wind you up with some tenuous links... post your ideas as comments!
New England Patriots:Chelsea
A 21st Century explosion of titles putting any previous history into paler comparison.
#NFL Teams as English #PremierLeague teams: A thread
Disclaimer: this may wind you up with some tenuous links... post your ideas as comments!
49ers:Man Utd
Red, black & gold brand transcending the sport, once truly dominant, not so in recent years. Still up there
Read 9 tweets
16 Jan
@gmcuk National Training Survey data on Satisfaction in Speciality Training.
Every year the question was asked:
GP Trainees highest satisfaction rates.
Credit to the investment made by GP Trainers & Programme Directors
Patients are rather satisfied with us too.
A Proud history of high satisfaction in comparison to the NHS over the years; up to us in Primary Care to maintain this:
Read 6 tweets

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