Holistic General Practice: A Student`s Perspective

This patient was a lady in her 50s who had previously been diagnosed with anxiety, depression and rectal cancer. She had undergone neo-adjuvant chemotherapy designed to shrink the tumour before it was removed surgically. However, the cancer responded better than expected to the chemotherapy, and the oncologists could no longer find evidence of active cancer within the patient. The oncologist had recently been speaking with the patient about whether or not she should continue with the surgery they had originally planned. The oncologist was keen to go ahead with the surgery, as it offered the best chance of long term disease free survival. The patient, however, was extremely nervous about going through major surgery, and was less sure that it was the right option now that she had been told that there was no evidence of active cancer. However, she had been unable to come to a definitive decision despite 3 consultations with her oncologist and the surgeons ready to perform the operation and the oncologist had written to the patients GP to this effect. This patient taught me a variety of things. Firstly, the background given to me about this patients’ first consultation opened my eyes to the importance of certain parts of the medical history. For example, the rectal cancer was only picked up due to additional symptoms found during the review of systems. The patient consultation that I witnessed was regarding a decision the patient was struggling to make over whether or not to have surgery following seemingly successful neo-adjuvant chemotherapy. The patient was struggling to make this decision due to a lack of support and the GP had scheduled this appointment to help her come to terms with the decision that she needed to make.