A doctor writes: Where are all the non-Covid-19 patients?

There is mounting concern among general practitioners and hospital doctors about the “missing” non-Covid-19 patients. Where are the people we know have developed chest pain, acute abdominal pain or red-flag symptoms of cancer in the past four weeks but who have not reported those symptoms to a health professional?

Workload surveys tell us that GPs see approximately two people a month with acute onset abdominal pain. At least one of these will have appendicitis, an ovarian cyst or a bowel obstruction. If one patient of each of the country’s 2,500 GPs with relatively serious gastrointestinal diagnoses feel unable to access medical attention every month, the resulting morbidity is highly significant.

Cancer will not stop during coronavirus and it is so important that people continue to be aware of the signs and symptoms

Every GP sees about four stroke cases a year as well as four new cases of angina (chest pain from coronary heart disease). If we stay in coronavirus pandemic mode for three months, that means each GP in the country will not see one person with these life- altering conditions. It means another 2,500 people potentially losing out on lifesaving treatment.

The Irish Cancer Society (ICS) says it is concerned that people are putting their lives at risk because of a reluctance to seek medical help if they notice cancer symptoms. A GP sees 6-8 patients with cancer every year. But if these people opt not to attend their local doctor with an unexplained lump, a pain that doesn’t go away, unexpected weight loss or unexplained bleeding, they risk losing the opportunity of early treatment and cure. ICS chief executive Averil Power says, “Cancer will not stop during coronavirus and it is so important that people continue to be aware of the signs and symptoms and act on any concerns they have . . . Timing is key”.

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The ICS commissioned a study from the National Cancer Registry in 2017 which showed that, during 2010-2014, three in every 20 cancers were diagnosed as a result of a symptom presenting as an emergency.

Do Not Ignore: Symptoms of cancer, stroke and heart attack

The following is a list of potential cancer symptoms you should not ignore:

• A lump or swelling
• Bleeding that is not normal for you
• Unexplained weight loss
• Pain that does not go away
• Persistent cough or hoarseness
• A sore that does not heal
• A persistent mouth or tongue ulcer
• A change in your bowel habit
• A new mole or change to an existing mole

Early diagnosis and treatment of stroke is crucial. Remember the FAST mnemonic:

• F: Facial drooping
• A: Arm weakness
• S: Speech difficulties
• T: Time to call for medical help

Chest pain that could be a sign of a heart attack has the following qualities:

• Located behind your breast bone
• Pain may travel to your neck, your back or down your left arm
• Is worse upon physical activity
• Is crushing in quality (but may also be burning or stabbing)
• Makes you feel short of breath
• Makes you break into a cold sweat
• Makes you feel nauseous
• Makes you feel light-headed
• And remember, if you are in doubt about any symptom, contact your doctor.