This morning I saw a man in his mid-thirties who recently noticed that his right testis is hard and a bit swollen. On examination I found a hard craggy and slightly enlarged testis. This is most likely to be a seminoma. We talked about this and its relatively good prognosis. I was about to refer him (under the famous NHS two-week wait scheme) when he told me that he is due to go abroad on holiday tomorrow for two weeks.
This put me in a quandary. It would be a shame to cancel the holiday if his appointment were to be towards the end of the two weeks. A few days delay in treatment probably wouldn't make much difference. On the other hand, even when the prognosis is good it is better to start treatment as soon as possible. If the appointment were to be in the next few days it would make sense to stay here and get his treatment underway. A quick phone call to the Cancer Referrals Centre by Myrtle, our ever-reliable practice manager, provided the answer. The next available appointment for testis lumps is one whole week after he gets back.
I do wonder in how many other countries in the western world there is a delay of three weeks between a family doctor diagnosing seminoma and the patient seeing an oncologist? Perhaps our service is a little sub-standard, but we do at least have Regulatory Excellence. We can't be caught out there!