2008/11/28 Paul Bromley <[log in to unmask]>:
> 67 year old-chap normally fit and healthy presents with 2 week history of
> constipation - very definite change of bowel habit. Would you refer on a
> 14-day wait? Bowels usually completely normal. NO co-codamol or anything
> like that. Soft faeces sitting in rcetum - abdominal examination normal
>
> The reason I ask is that my usual course of action would be to refer. The
> centre that I normally refer to accepts just a letter and a 14-day request
> sheet. The place that he wishes to go to has the rigid proforma that they
> stick to - change of bowel habit persisting over 6 weeks. Am I wrong
> referring this chap as a 14 day wait as until proven otherwise I would like
> to exclude neoplasia. Should I be sending these patients away with a
> laxative and just review in 6 weeks???
>
>
I had a similar case recently, 58 yr old man with altered bowel habit
which didn't satisfy the criteria for 2ww, but I have known him years
and something about his presentation set alarm bells ringing. I sent a
2ww with a rider saying that although he didn't meet the criteria I
was worried. He was seen at the hospital and the consultant said he
didn't meet the criteria, but "as the GP who knows you is worried we
will do a colonoscopy to be sure". He had a Dukes A Carcinoma, now
resected and doing well following his chemotherapy.
The reason we are better than protocols is that people are variable,
and protocols, while providing useful guidance, do not give all the
answers.
If you have a clinical suspicion of malignancy you must refer under
2ww rules. If they choose to reject the referral they must take the
responsibility.
Cheers Geoff
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