July 18, 2000
In a letter published in our edition of Thursday, July 13, the Cancer Survivors' Action Group referred to the poor service people with cancer had experienced from a number of laboratories in this country. "It is hard," they wrote, "for anyone who has not undergone this experience to understand what it is like to suffer the long waits to get results, the incorrect diagnoses apparently resulting from faulty procedures and/or equipment, the unexplained differences of 'opinion' between labs reading the same slides, the running from one to the other in the desperate attempt to get an accurate and definitive diagnosis, not to mention the frequent hostility that a patient could be rude enough to want more than one opinion of whether she/he has cancer and has to undergo treatment including the loss of part of her/his body."
The members of the group went on to say that they were aware that mistakes were made all over the world, but that "with respect", they were of the view that what obtained here was "a pattern of mistake-making".
The real problem for lay people confronting the scientific domain is to know exactly what the local labs are capable of, and what the patients should be demanding of them. Modern diagnoses require a technical input, but outside the medical community no one is too clear about the kind of equipment which is necessary, or the levels of expertise which are needed. When issues of capability arise in relation to labs, therefore, it is relatively easy for medical personnel to bat away the anecdotal accounts of patients who have been misdiagnosed, and whose lives have been put at risk as a consequence.
There is no tradition in this country of medical law suits, and in a small society such as this, patients have been understandably reluctant to name names for fear that the medical fraternity will victimize them, or perhaps even victimize some relative of theirs who goes for treatment in the future. Whether there is any foundation to this fear is not the point; what is the point is that people believe that it is so. More daunting, perhaps, than even the courts for the average patient with a complaint or a malpractice allegation, is the Medical Council itself. With its complement of largely doctors, it is perceived as a forum which would be unsympathetic to the layman's cause. Again, the fact that this might well be an incorrect perception, is not the point. That is how the public believes the situation to be.
In the old days, people who had stories to relate about misdiagnoses or mistreatment had no one to complain to except their close friends and relatives. But with societies and action groups forming, and with far greater ease of communication between individuals than has ever been possible before in history, patients and their relatives are beginning to compare notes. It is now becoming possible, therefore, to see 'patterns' emerging.
At whatever level a lab is equipped to function, it should be able to operate competently. It does not matter that it is not in a position to perform some sophisticated tests; all patients want to know in the first instance is what can be done efficiently locally, and what not. What they do not need is a lab operating beyond the limits of its capacity.
At the present stage, there clearly has been an erosion of public confidence in some of the labs in this country. It is in the interest of all of them - however good they might be - and of the medical profession in general, to restore that confidence. At the end of their letter, the action group recommended an urgent inspection of all labs "by a well-appointed team, followed by a public report and a public identification of what (if anything) each lab needs to do, by when, to bring its services to an acceptable, human level."
The hospitals have been inspected, and it is only reasonable that the labs should be too. Perhaps in this instance, professionals in the region could be recruited to join qualified local personnel on the team, to bring an outside perspective to the matter of standards. "It would reassure us to be told, very early, that the competent authority has been identified and is taking immediate action," wrote the group. Yes, indeed.
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