"Colposcopy: Caring professionals in a slightly overly streamlined system"

I was recently referred to the Whittington Hospital, North London, for a colposcopy following my first abnormal pap smear. Based on the biopsy results from the colposcopy I was recommended to undergo treatment.

Summary:

Service is well-organised but the high standardisation of care means that individual patient circumstances are not always taken into account. I recommend that interested patients get medical records and make an appointment with the hospital to discuss treatment decisions in their holistic context.

What was good:

- The NHS cervical cancer system is clearly very well organised:

o I got timely letters and brochures informing me of the procedure.

o When there was a delay to be expected, the letters told me so.

o I was able to reach people at the phone numbers given.

o The NHS cervical cancer screening programme site is very helpful

- I never had to wait more than 10 minutes to be seen when I came for appointments.

- All the healthcare workers (my GP, nurses and consultants/registrars) I interacted with were professional and caring, and took time to explain things to me.

- The colposcopy was as pleasant and painfree as they could have possibly made it. Everything was explained well, I could see the images my colposcopist was looking at (live! quite weird!) and I felt they really took the time to examine me well. The ward is clean and well-run, if a little outdated in places.

- For some parts of the colposcopy (the admin part) the hospital team asked for feedback, which shows a high professional standard.

What could have been better:

The only problem with the whole procedure was that they did not take the time to make the right treatment decision in my particular case.

Don't get me wrong: the decision they recommended was perfectly fine from a medical point of view. But it was only one of two options, and I was not given the second option.

Had I not had the good fortune of having a scientific background and medical family, I may not have had the inclination to 'fight' for the second option as I did.

The full story:

I was a slightly 'special' case, as my diagnosis was just on the border between two completely different treatment decisions (CIN1: observe VERSUS CIN2: treat).

The problem was that at the two stages in the diagnosis process (1. the pap smear, 2. the colposcopy and biopsy) I was only given the codified diagnosis (1.severe dyskaryosis, 2. CIN2) whereas the detailed lab reports were much more nuanced (1. moderate to severe dyskaryosis, 2. CIN1 with possible CIN2).

Based on the codified diagnosis, the hospital decided to call me in for treatment. Because of my family planning, I wanted to avoid treatment if possible.

The head colposcopy nurse (who was just as competent as the consultant in this particular case) answered my emails and telephone calls to allay my fears, but based her answers on the treatment decision that had already been made.

I had to

- get the medical records with the detailed lab results from my GP (the hospital wasn't allowed to send them in the post and their 'records access department' refused to hand them to me in person) and

- insist on a face to face meeting to discuss the records in person.

Only in that face-to-face meeting, faced with my detailed lab results, with me explaining my future family plans, and my background as a patient (healthy, compliant, non-smoker, specific shape of transformation zone) could I get agreement with the consultant/nurse that observation was an option for me, i.e. that I did not necessarily need treatment yet.

My advice: get all your records from your GP and if you have any concerns insist on discussing your results with your GP and/or the specialist face to face to ensure you understand and support the treatment decision. That is your right as a patient, but can sometimes fall by the wayside in this very streamlined system.

Again: trusting the NHS with their decision would not have been at all a problem in this case. But as a patient who prefers to be fully aware of all decisions I felt I had to 'fight' quite hard to be heard in this case.