Scenario 2 - this patient is real, but names have been substituted.



Mrs Nicks sees Dr Jones, her family doctor. She is a 35 year old lady who has previously well. Consulting her chart, the doctor finds that the patient has made just 3 visits in the last 5 years. First for contraception, then for diarrhoea continuing after travel in Vietnam and lastly for headaches, perhaps related to a family history of migraine.


This time she presents with a lump in her left breast that she has not felt before. She has had cyclical mastalgia in the past, but she feels this is different Š the lump is not really tender, and seems different to the generalised tenderness and lumpiness that she is more used to.


Examining her, the doctor feels that there is no definite lump, but the lower outer quadrant of her left breast is definitely different to the right breast.


Discussing the options with Mrs Nicks, although he suspects there is nothing that serious, he decides to refer her to the rapid access breast clinic, where she will be seen in 2 weeks. He tells her that he will do so at the end of the clinic.



The next morning Dr Jones catches up on the previous dayÕs paper work. As often happens, the clinic overran and he had other engagements in the afternoon. The second set of notes he looks at is that of Mrs Nicks. He calls up the local hospital breast clinic and is told that he needs to fill in an online form, then email this back to the clinic to facilitate the process.


One of the questions relates to the patientÕs BRCA 1 and 2 genotype. Dr Jones realises that he had not asked about this, nor about the patientÕs family history of breast cancer. He decides to call her by phone to ask about this before submitting the form to the clinic. However her home phone number goes to ansamachine and so he leaves a message.



Four weeks later Mrs Nicks calls the surgery to ask if they have heard anything about the appointment. The receptionist consults the records and finds a record of the initial consultation, but no further information. Dr Jones is now on annual leave, so the receptionist discusses the case with one of the other doctors, who arranges for the patient to be seen in 3 days time at the breast clinic.



After investigation, Mrs Nicks is found to have disseminated breast cancer.