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You’re listening to the Cornwall Cancer Cafe podcast. With me, Matthew. And me, Emma. Thanks
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to the National Lottery Community Fund for supporting this podcast. So this week we are
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talking about the GP patient relationship and we’re not doing this from a GP surgery,
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we’re actually doing it from the Royal Cornwall Hospital and there is a reason to that because
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our guest this week is Dr Rebecca Hopkins and you, well rather than me trying to explain it,
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why don’t you explain to us your role? Thank you very much, Matthew. So I’m a GP
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in St Agnes and that’s the majority of my work actually throughout the week. I’ve been a GP now
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for about 17 years, so certainly been around the block a little bit, but also have another role
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as clinical non-executive director at Royal Cornwall Hospitals Trust. So I’m on the board
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there and I provide a GP and neighbourhood perspective to the hospital to help them
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shape their decisions and just give a different perspective to the acute hospital.
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Okay, so Emma, we’ve been talking about a lot of these sort of things over the months that
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we’ve known each other about that diagnosis period and going to the doctor and symptoms
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and we’ve got lots of questions brewing. Yeah, we have because it can be a very
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trying time for patients for many reasons and it must also be a trying time for the GP as
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who’s trying to diagnose something. One of the things that I was aware of when I was in that
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diagnosis phase, which I know Rebecca you’ve said there’s a whole lot of stuff to talk about
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there, haven’t you? Don’t talk about it now. There’s absolutely tons to talk about around
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that side of it, but actually recognise how very stressful it is and even sort of thinking
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about going to the GP and what you do beforehand such as thinking about it, talking to other people
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about it, looking on Google for example or even chat GPT now before you come in and then actually
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coming in and speaking about it and what is most important to you and that can be quite
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hard to do and what your worries and your concerns are and that’s what we really want
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to know so that we can kind of filter it together with our kind of clinical knowledge
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and your symptoms and see exactly how it all fits together. Because when I was first thinking
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oh something’s wrong here and pre getting that diagnosis, yes I went to the doctor and felt
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you know for lumps and things like that, my brain was still kidding me oh it’s something else.
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Yeah I think I was the same I was also in the in thinking oh it’s nothing you know I’ll go to
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the doctor and they’ll go oh don’t be silly it’s nothing go away but then the doctor started going
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that’s that calm mechanic breathe through the teeth and she was so lovely though because she
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I went to her because my anxiety was sky high and she said I know you’re really anxious
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she said but we need to deal with this and I need to deal with it quickly so I thought
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she handled it brilliantly. And that there must be an initial thing with the GP patient
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relationship on that that anxiety stage right at the start. Absolutely and I think that
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relationship is absolutely key for everything and so building that relationship with patients
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straight away is is really important building that rapport understanding what where they’re
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coming from but also what they’ve you know what their background is what’s what’s life like at
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home for them if you’ve already got that relationship with your GP then that’s absolutely
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brilliant because you’re starting off from a from a place if if you have if it’s the first
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time you’ve met them they’ll be wanting to know those things about you so that they can
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kind of put it all into context so having the really good relationship with your GP or
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couple of GPs in the practice to maintain that continuity is going to be really important
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both in terms of gosh there’s something here that we might need to be thinking about a
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referral and a quick referral for but also in terms of addressing your ideas concerns and
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expectations and it’s really interesting thinking about that that actually sometimes
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you might be a little bit in denial because as part of the the process of all of this is
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adapting to something new as well so we’re meeting people at different stages of worry
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different stages of expectations and that’s kind of where the the beauty of general practice the
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art of it comes into into being as well as the kind of science of what’s actually going
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on in your body I suppose going back to my diagnosis I remember going into the GP
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and feeling for lumps because a big lump was on my neck so I mean that was pretty obvious really
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but nothing was said at the time saying okay well we’re booking you in for an ultrasound
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scan you know they were it wasn’t so you know no this is cancer this is non-Hodgkin’s lymphoma
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it was just okay now we’ll book you in for something it so it’s about how much you tell
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the patient at that stage as well isn’t it yeah absolutely and actually with lumps on the neck
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there might be lots of reasons why you’ve got it sometimes it’s quite more obvious that it could
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be a lymphoma type lump than others but actually we’re working in a lot of uncertainty in general
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practice and so it depends on really what what the situation is so some symptoms are very
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vague and we don’t quite know what what it is and it could be a a list of up to about
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20 things that it could be so we look we’re starting from right from a very beginning
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starting point with things sometimes it can be quite obvious such as the you know looking
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and seeing a melanoma and you think oh gosh that really is a melanoma and that’s maybe
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where the sucking of the teeth came in so unfortunately but but actually and we’re all
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human so we’ll have those kind of reactions at times but but I think you know sort of you
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recognizing the thing and going right we need to do something quickly about that
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we’ve got quite specific pathways for faster what we call fast track pathways which were
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previously been called two-week referral pathways so we know what those criteria are and we will
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be looking to see whether we can need to go down that route or not sometimes it’s a bit
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less obvious and that’s where other tests come into first so there’s a lot to kind of
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it’s also about kind of meeting the person where they are so but I think we always try to be
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as honest as possible if we think it is a cancer it’s really important to say look we
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think this is something serious we’re not 100 certain yet but we need to do this pathway to
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to check it out and similar things like breast lumps for example it’s rarely that I would
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think oh that is a definite cancer there but it’s a breast lump I need to get it reviewed
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and so it very much depends so if I think oh gosh that really is one I
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I’ll be having a slightly different conversation to someone who I’m not certain
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because we just we just don’t know so all of those things make it make a difference to
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to it but but absolutely you’ve got to be honest with people
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so I was just thinking there’s there’s a lot of different cancers and the GP is our first
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port of call and you can’t know every single cancer so it must be quite challenging for
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you as well so from a patient point of view we go in with our symptoms but you know you
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can’t know everything so yeah you need to not tick off the boxes but sort of say it’s not this
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it’s not this it’s not this you go down the diagnosis route don’t you but basically what
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I was saying but I was also thinking about how you choose or how you decide whether you go down
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the two-week pathway or whether you think it might not be this or you might think oh I
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recognize this cancer it’s a slower cancer therefore we can take more time over it which
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might be easier for the patient because it gives them more time to deal with it
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although some personalities might need to deal with it more quickly so you’re in a really
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position aren’t you it can be quite tricky I mean we certainly have I mean we’re generalists so we
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know a bit about everything but we accept that we also don’t know everything about a specific
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thing and that’s why we do referrals to specialists who will look at things in much
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more detail for that specific thing so we’re kind of a gatekeeper as well but there are for
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fast track pathway or previously known as two-week wait it’s a there are very specific criteria
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and so we we will refer those people with with those specific criteria and if they don’t
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meet the criteria that’s when we might be looking into what tests do we need to
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prove or disprove that that might be the case so we’re looking at it before even
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that point for some things but for there’s there’s not many slower growing cancers that
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we would be thinking oh we don’t need to refer under fast track so the only one I can think
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of what might be a basal cell skin cancer which is one that doesn’t spread and so that
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one just grows locally into the skin with time could go deeper and those ones don’t need to
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referred on the fast track pathway and so yes there’s a whole whole lot to think about
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and your GP’s mind is going in the background while you’re talking to them
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and so it’s so that’s that’s where we’re at it’s a bit like being a detective really
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can we just simplify things down to a few tips at this stage for patients just to think
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about at this really early stage some you know they’ve got a worry just some really
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simple pointers so in terms of I would say tell your GP all the things that are
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worrying you and if you can do that do it at the beginning we often will have
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people who will come in with a few of the bits and bobs and then leave that really cool
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juicy thing they’re really worried about to the last minute
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and people do it we know they do it we receive training on it actually and how to deal with it
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but if you can and you feel able to and if you’re able to say those things at the beginning
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that gives us the time to utilize that 15 minute appointment to its maximum but it’s
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part of we know that that’s not always easy for people to do so that’s something that we
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kind of try and tease out and try and get that out earlier on if we can
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it doesn’t always work and we go oh by the way doctors you’re just sleeping in the room
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can you just look at this thing on my back and so you know come back in at that point
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actually but so I think those are the that one and also tell us what you’ve looked up already
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a lot of people apologize for that they apologize for looking on google or they say
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no I shouldn’t have done this but I’ve looked on that I’ve put it in my symptoms into chat gpt
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there’s nothing wrong with that we want to know because actually we want to know what
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you’ve already looked at and what things because not everything on the internet is always 100
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or in the right context for you so that’s going to be really important as well so we
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never worry about what you’ve already looked up tell us because it helps us to understand
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what you’ve come to what you’ve been exposed to information wise or what conclusions or thoughts
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or expectations that you have before you before you’ve come in so we’d like to know those
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things so they’re my top tips we often talk about when you go to the consultant at the
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hospital having someone a relation a husband a wife a friend with you a second pair of ears
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is I mean is that something for the gp stage yeah 100% um particularly say for example
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for any any phase of a gp consultation because if you’re very worried that you might have a
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cancer you’re probably not going to hear much more than whether you whether your gp thinks
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you’ve got one or not and similarly if we’ve got an ultrasound scan or a ct scan or
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which we think this isn’t going to be good news actually for that person
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then we’ll ask people to come in with somebody else for some support but also
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for that second pair of ears as well so I would recommend I would advise or welcome
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other people in if you felt comfortable too so we always check that people feel comfortable
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with the person that’s coming in with them as well I was um watching oh yes it coronation
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street has got a guy who’s just been diagnosed with breast cancer and he did not want anyone
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to know no one he told one person and and there are people who are like that and it it’s
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that’s a challenge it’s a real big challenge and I think that male breast cancer in particular
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might have a bit of a stigma associated with it and uh and so or some people feel
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you know that they don’t want people to know about it for lots of different reasons
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and so we’re having to deal with that kind of social stigma of things as well
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men can get breast cancer too rarely so you know anything where you find a lump or there’s
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something that’s concerning people to come and speak to their gp about it we don’t mind at
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all there are some things which are really important that we look for things like
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loss um that’s a really big red flag for us um things like any sort of cough that’s going
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on for more than three weeks any coughing up of blood bleeding from places that shouldn’t be
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bleeding from at the wrong time they shouldn’t be bleeding at that time looking at your poo
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yes absolutely looking at your poo so you know a lot of people say they don’t look at it
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um and i do i don’t know whether that’s the case or not but let’s look at my poo now i like
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talking about my poo do you like talking about your poo i don’t but i did want to ask a question
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about it because um there’s just been a big a big thing where lots of um all the test kits
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have gone out for the bowel for the bowel cancer testing yeah i’ve done mine yeah yeah i
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did mine a few weeks ago and i got a letter back saying it was all clear but if it’s not
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all clear do they come to the gp or do they go direct to the person and say go and see your
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gp with with the national bowel screening program they’ll get automatically invited for further
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tests so that kind of bypasses us completely if it’s been picked upon the national screening
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test uh so that that so we get notified about that book person gets an appointment
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we actually have a similar test for stool for blood which is a lower level of or higher
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sensitivity than the national screening program so if you have ongoing even if your bowel
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screening test is normal if you’ve had particularly an alteration your bowel habit
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mostly to lose the stools or there’s any sort of unusual bleeding or weight loss
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um don’t think oh i’ve had my screening program test i’m all right go and speak to your gp
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because we can we can detect blood in your stall at a lower level than the national
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screening program so that’s really important for people to be aware of i had to have
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a catheter which i called clarence clear water you sit and think how am i going to cope
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after surgery when i was diagnosed i really just didn’t have anywhere to go with my
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i think it’s about giving them support and knowing that whatever their situation is there
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is always someone there share this podcast on your social media so others may benefit
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let’s move on to that say that that phase where um the person has been to their
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consultants they’ve had their diagnosis yeah what is the gp’s role once they’ve gone into that
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you know engine of the hospital to deal with their cancer well that’s a really important
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question mathie and something that is really um what i’d really like to speak about today
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and i often will tell people that um who we think are going to have a cancer diagnosis or
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sometimes they’ll come in and talk about their diagnosis and uh and their interactions
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with the specialist as well and that’s absolutely fine because we’re there to as a uh to help
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listen and to translate some of the medical stuff as well and and also provide support and
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i will tell people it’s going to get very busy for you actually you’re going to have a lot of
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appointments through you might have loads more tests you’ll have consultant appointments
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there’ll be multidisciplinary team meetings that they your case gets discussed at
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and learn lots of words you never knew in the past 100 it’s a whole new language mostly
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it’s a whole kind of new world of kind of navigating all of these things as well
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which we’re aware of all of the pathways or as much as we can be
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so i would say we might need to take a step back here because you’re going to be you’re
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busy you’re going to be so busy but the door is always open so if you need us for anything
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um then let us know because we’re there for kind of physical symptoms that you might be
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um such as nausea or pain relief that side of things particularly
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we’re there for the psychological aspects of it so you know it’s a huge thing i don’t need
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to tell both of you what what about that you know it’s it’s uh you know there’s a lot of
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things that can either come as a result of that or you know come back from the past because
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of it as well and so there’s a whole lot of things to to kind of deal with and and that’s
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something where we can help we can help with uh listening we can help with you know signposting
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you to the right services or treating kind of um things like depression or anxiety so there’s
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a whole host of things that we might be involved with with that we’ve got a wider social
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prescribing team with the within the gp practices as well to help people who are
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feeling really isolated and we can direct people to things if they’re having struggle
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any social things or you know going i really don’t know where to go about these financial
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things well we’re not financial experts you know we’re gps we’re dealing with the health
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health side of it but we can direct you to where you should be going to to get that kind
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of support and help so there’s a whole host of things which we can direct people to as well
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and then also we look after you any other long-term conditions that you have it doesn’t
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other conditions happening that the fact you’ve had you’ve got a cancer diagnosis
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you know other things that pneumonia i got pneumonia after my yeah yeah there was one
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thing i wanted to add to that because it was something i learned from the macmillan finance
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support people was that once you get a cancer diagnosis your doctor surgery can you fill in
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a form and you can get free prescriptions for five years now the amount of drugs that i was
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to get each month grew and grew and grew so if i didn’t have that free prescription thing it would
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have cost me an arm and a leg you know it’s almost 10 pounds an item now isn’t it i mean i
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picked my prescription up yesterday there’s eight items in it yes so that’s something that i
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found out by accident really you would fill in the forms yourself for any of those kind
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of prescription things so but there are some conditions which we can sign off and say
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you’ve got you can have free prescriptions so but it’s interesting and i’ll need to look
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into that well i got my form from my consultant so that was from that side and i suppose
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when you’re in the system at the hospital you’ve got a cancer nurse specialist as well who
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is into the sign posting as well for the financial side as well i was just also going
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to highlight the mcmillan the financial team as well so you can email them or phone them but
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as you said your cancer nurse specialist can help with that i would also agree with that completely
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both the cancer nurse specialist and the mcmillan things there’s all sorts that can be done you
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know with the bank and can sometimes freeze mortgages for example and that side of things
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so there’s a whole host of stuff and we we’re not the right people to talk to about that
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with with with either mcmillan advice line citizens advice for example or speaking to your bank
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particularly so there’s a whole host of things there that and there’s a whole host of benefits
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and things that you may be entitled to and that’s where citizens advice or department of
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work and pensions are actually better placed to deal with that and not only that but also
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for carers as well for attendance allowance and that side of things so there’s a whole
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signposting is really important i think what we’re going to do now is just move it on to
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another phase which is okay so you’ve been told by your consultant you’re in remission
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what is the gps relationship with the patients post that treatment phase it’s really an
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important one actually because there are often that’s often a time when people start to
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process what’s been going on in that time and that can lead to a lot of different adaptation
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things for them or almost like a kind of grieving process in some ways for what’s a big event
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that’s happened in their life sometimes it’s living with cancer and the the fears or
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physical symptoms or the things that go on with that as well so but we’re talking
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particularly about remission then it may be kind of right how can we get you back to
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who you are and you know that side of things so there’s a whole host of things both from a
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physical perspective from the psychological particularly and then the social side of it
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and so all those things particularly signposting to things like the cove
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where there’s lots of support groups and things to help people you know cope with what what
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they’ve been through really so there’s a whole host of stuff that we can do and some people
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want or need a lot of support and other people don’t so it’s very much tailored to
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what they want and need and and and you know it’s as big and wide as it is long
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one of the thoughts i had previously was when one of your one of your patients comes to you
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with a suspected cancer and then they go through the journey do you also dive into
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that cancer to find out more about it or do you try not to get involved because there’s there’s
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you know your gp side of it as well you know you’re looking after other patients
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but obviously you you must hone in on some patients where you think that person needs
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extra support yeah and and if you know we know a lot about cancers as well we know a
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lot because we do a lot with our training about what the you know what the kind of
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courses of different cancers may be but of course it’s changing and advancing all the time
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and there’s whole hosts of kind of immunotherapy things which can hardly pronounce these days let
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alone spell so there’s a whole host of things it’s advancing at a quite considerable rate
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so yes we do have to keep ourselves up to date with all of that and we do we have to do
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50 hours of continual professional development a year so if there’s anything that particularly
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oh i i actually you know need a bit of an update on that specific cancer we we will do that
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it’s not just one one person it’s a whole team and that involves the hospital and
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everybody else as well so we’ll be looking at that side of things but also well what’s
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going on with the patient in front of us right now what’s happening with them
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what do they need what matters most to them and so it’s kind of a slightly different
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take on things rather than what your cancer is and what your molecular bit of you and your
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genetics that’s what the specialist to do so we’re looking at it in a kind of a different
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way to support you i think well i think that’s a matter for another podcast we’re coming to
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the end of this week’s show and i i think there’s an important thing that we haven’t
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dealt with here two important things we haven’t dealt with the fact that we have an expert gp
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doctor with us and i’m not a doctor i’m not an expert i’m not trained in anything
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are you i’m not a doctor i’m not an expert we are people who have been diagnosed with cancer
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and live with cancer but we are not doctors so we’re not the experts we’re not the experts
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but we like talking oh hang our hands up i think that you are the experts because you’re
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because you’re expert patients you’re expert in what you’re what you’re um what you’ve gone
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through um and so that is very valuable to to to that so it’s a different um you know having
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a lit having lived experience with cancer um is sorry it’s so very important to um and
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this is why this podcast is absolutely fantastic brilliant and the other part of the fantastic
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part of it is um uh we haven’t done something have we no no we haven’t shall we shall we do
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it we’d like to send everybody a big hug because when you give a hug you get a hug
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i have actually started working on this piece of music this song to to play out and um you
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maybe when you come into the studio next time we might have a go at it because
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it’s a bit of fun isn’t it when you give a little hug yeah you get a little hug
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when you give a little hug yeah you get a little hug when you give a little hug yeah
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you get a little hug when you give a little hug yeah you get a little hug when you give a little
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some humour and some fun and something light through your journey, isn’t it?
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Yeah, and actually we’ve not just got cancer in common, have we?
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We’re both musicians, we both love playing music, so as we’ve gone through our journey,
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we’ve discovered things about each other that we’ve got in common, so that’s one of them.
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And I’m a little mad.
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You are.
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Are you expecting to see me too?
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Well, a mutual friend of ours calls me Quirky, Quirky Clarky.
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Quirky Clarky, I know who you’re talking about.
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So we’re going to have you back because your point of view is just so important to anyone
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with a cancer diagnosis and for them to understand that.
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So thank you so much for taking part in this week’s show and we look forward to having
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more conversations to enlighten ourselves because, you know, we’re still on the journey,
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although that we’re, you know…
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We are, and the more people we meet, the more questions we have.
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So it’s really good to hear different perspectives.
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So thank you.
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Thank you very much, Dr Rebecca Hopkins.
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Thank you very much.
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Should we call Rebecca or Becca?
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Becca, Becky, anything is fine.
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I should have asked that right at the start.
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It’s a bit late to ask that, isn’t it?
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This is why Emma’s here, to keep me, you know, on track.
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I didn’t think about it and then forgot to say so.
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Thank you very much.
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See you in the next edition.
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Brilliant. Thank you.
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Such a pleasure. Thank you very much.
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Here to support you, the Cornwall Cancer Cafe podcast.
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Thanks to the National Lottery Community Fund for supporting this podcast.