This ‘rule’ encourages GP colleagues to ‘rethink’ a diagnosis, or the lack of one, if a patient presents three times with the same symptoms or concerns.
Colleagues are invited to consider the following approaches in such a scenario:
Reflect: Consider what has happened so far and offer a F2F appointment, with the opportunity for an examination, if this has not occurred already.
Review: Consider a peer review, such as an in-house presentation or discussion if this occurs, formally or informally, within your practice. Also consider whether any ‘red flags’ are ‘hiding in plain sight’.
Rethink: Consider onward referral, or Advice and Guidance.
It is the case, that such an approach to patient care aligns with existing good professional practice, especially in the context of ‘difficult to explain’ symptoms, or when considering the risk of atypical or unexpected cancer. This was sadly the scenario with Jessica Brady, after whom this ‘rule’ is named, who died in December 2022 of stage 4 adenocarcinoma at the age of 27, having reportedly been seen at her GP practice twenty times prior to her diagnosis.
It is likely that this ‘rule’ may be raised by patients in the course of consultations; obviously colleagues will reflect with patients their concerns, but equally the highly pressured environment within General Practice means it may be challenging to offer the time and clinical continuity that would be desirable. If a patient believes a referral might be appropriate, despite long waiting lists, this should be discussed.