Building Confidence at the GP

As part of our Something’s Not Right campaign to improve early cancer diagnosis, Jo shares her advice on how to feel more confident to speak up about symptoms and how GPs can support their patients feel heard.

Body Changes

I noticed some changes in my breast: some discolouration and hardness of the nipple rather than a lump. To check if these changes were hormonal, I waited from one period to the next, knowing that often these things can come and go.

I also did some online research through the charity Coppafeel and the NHS website. I watched a video on how to examine your breasts as well as a list of changes to look out for. Seeing the nipple changes I’d experienced, I felt concerned and validated enough by this information to see a GP.

'You're too young' attitude

I found the act of phoning the GP quite scary in itself; I’d not had to ring about anything so serious and personal before. Thankfully, I was able to get an appointment easily and was relieved I’d soon receive medical advice.

At the face-to-face appointment I explained my concerns, but very quickly they were dismissed by the doctor with an attitude, “you’re too young." I felt foolish for worrying, but not reassured that all was well. The doctor did a thorough examination but the whole time it felt like she was going through the motions to placate me.

She didn’t think the changes I’d highlighted were visible and dismissed my description that the nipple was a different colour from my unaffected side. We briefly discussed the risks of breast cancer and eventually she sent me home with some cream as she thought my nipple looked a little dry and told me I should come back in a couple of weeks if nothing improved.

More Worried

I wasn’t given any other information or signposted to resources and left feeling just as worried as I arrived. I couldn’t see how the changes could be cast aside so easily and felt sure something more serious was happening.

Learning to Self Advocate

I used the cream, more to placate the GP and prove I was taking her advice seriously. It took me a while to build up confidence, but when the symptoms didn’t improve, I returned to see another GP.

The second GP was a locum and things were much more serious from the start. As it was a second, I think they took me more seriously and she certainly didn’t have the same dismissive attitude. Again, the doctor did a thorough examination but this time she said she could feel a lump and did an urgent referral for a scan. 

From there, things progressed quickly and within weeks I was diagnosed with multi-focal invasive ductal and invasive lobular breast cancer. I went on to have immediate fec-t chemotherapy, followed by a mastectomy, radiotherapy, herceptin and ongoing hormonal treatment as my cancer was both ER and HER positive. 

The cream I was sent home with the first time was never going to do the trick! 

My advice to doctors and medical professionals is:

1. Encourage Just because something might be a low chance doesn’t mean it’s not possible. There are people behind the stats that make up the 1%. Your patient could be that person. If you don’t feel it’s relevant to immediately refer the person, then explain why and encourage them to keep an eye on their symptoms and come back ASAP. Make them feel they've been a good advocate for their own health by making the appointment.
2. Respect Courage If someone is willing to discuss something private with you, respect that. It took a lot of courage for me to see a GP and that wasn’t recognised in the slightest. Use positive language and validate patients' concerns rather than using patronising terms and making them feel foolish.
3. Build Campaign Awareness There are a multitude of NHS campaigns telling you to visit the GP if you notice any changes. GPs need to recognise these campaigns and help patients by not shutting them down, or making them feel dismissed. Yes, I was young (33) but I was showing visible changes that weren’t easily explainable. 

If you find yourself in my situation?

1. Go with your gut. If you feel something isn’t right push for a referral or second opinion. I felt so dismissed after my first appointment it took a while to get the courage to go back. I will always wonder: if I’d been more forthright or gone back quicker would my diagnosis have been less severe?
2. Be knowledgeable, but don’t scare yourself with sensationalist stories. Stick to reading articles or advice from NHS, CRUK, Macmillan or other cancer charities. I found the videos and information on Coppafeel really useful to check my concerns were valid without sending me off down an internet spiral.
3. Self Advocate. Call out the GP if you feel you aren’t being taken seriously. You know your own body and that something doesn’t feel right. There are so many stories of people who took years to get diagnosed. Be your own advocate and make sure your feelings and worries are heard.  Keep a log of the changes so they can see how seriously you are taking it. Ask to see a different doctor if required and keep going back and ask for a referral to a specialist.