A TIREDNESS OR cough that just won’t lift. Bleeding between your periods. A lump that wasn’t there before. Those changes can bring on worst case scenario thoughts: what if it is cancer?

You ring your GP and they order tests, and maybe make a referral to a specialist. This will often lead to a reassuring: “You have nothing to worry about, it is just…”

But what if you can’t make that call to your GP? What if you don’t have one?

This is what we faced, as a family, a couple of years ago.

It was summer, we were on the landing upstairs, my husband was wearing a cotton t-shirt. I brushed my hand across his chest in a light caress, I got a shock. “What’s wrong with your chest?” I lifted up his t-shirt to look at his mole: it had clearly changed.

He had noticed it too, but it was my reaction that shocked him into action.  What’s the first thing you do when this happens? Well, you call your GP.

That was when he discovered his GP had retired.

Somehow, Paul* had fallen through the cracks, he either hadn’t been notified or had missed the notification from the GPs surgery. In his 30s, a busy dad with two kids under five, he had little reason to visit the GP anyway. He rang around trying to get an appointment.

Not only could he not get an appointment, no one would take him on as a patient.

They wouldn’t even place him on their waiting lists. They advised him to call back at various intervals: six weeks, six months, and they might consider putting him on the waiting list.

As a last ditch effort, he tried the online doctor service through the private healthcare his company provided. It was September by now. The online doctor was great, but was a bit flummoxed by the whole thing, it’s just not what the service was for.

She chanced sending a referral letter to our local suspicious mole clinic. It worked, but the wait time was going to be long.

Left begging for care

At his first Friday morning appointment, he was asked to come back later to have the mole removed. That afternoon, the onsite surgical team said that the mole was too big for them to remove. They would refer him to the regional team.

If you are familiar with the usual pace of Irish healthcare, then it comes as a shock when it speeds up. On Sunday evening, he got a call scheduling him to come in the next morning. The news afterwards was bad: he had at least stage 2C melanoma.

Again the lack of GP was a problem. Where would letters be sent? Who was his GP? We rang all the GPs surgeries once more.

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Still reeling from his diagnosis, we explained he had cancer and needed a GP. One receptionist was quite indignant: “How could he even get a diagnosis without a GP?” How indeed.

In the end I got a tip from a friend about her GP. I explained the situation to the receptionist, and she told me one of their GPs would ring my husband back. They were willing to take him on.

You learn a lot when you go through a cancer diagnosis. From Paul’s wide excision operation, we learned there was thankfully no spread to his lymph nodes. We learned that melanoma is a tricky cancer, you have great survival rates from its first occurrence, but less good from the second or subsequent.

We learned that it usually takes 30–40 years for most melanomas to develop, and that you can’t undo childhood skin exposure to the sun. We learned that melanoma cells like to travel.

We have learned to read between the lines. Paul has regular appointments where they do full body skin assessments, and afterwards sometimes there is another scheduled excision. He has regular brain and full body scans. After the excisions or scans there is always “the wait”.

We have learned to take the time we have together as precious.

One thing we do know is that it is hard to get a referral without a GP, and that means it’s hard to get a diagnosis when you need it most, and when time is of the essence.

No one should have to beg for care or beg to be put on a waiting list for care. But this is where we are.

I go back to that indignant receptionist: How do you get a cancer diagnosis without a GP? And also ask… How do you get cancer treatment without a GP referral? Too many people are left out in the cold when it comes to GP care. We need to do better.

The author has remained anonymous to maintain privacy. 

*Name has been changed.

The Journal Investigates

‘Powering through and praying’ — Read more of our readers’ stories about the impact of the GP crisis here >>

This is part of our investigation into the GP shortage which done in collaboration with other members of the European Data Journalism Network (EDJNET).