This tweet was distressing to read – from a woman on the womb cancer diagnosis pathway – referred by her GP for further tests. Absolutely the right thing for the GP to do.
There are lots of lessons to be learned from her experience and we wanted to explain a bit more about what could, and should, have happened.
Charlotte was asked to come in for further tests at the hospital with a specialist consultant. She’d already had blood tests and a trans vaginal scan (a probe in the vagina to look at her womb and ovaries) at her GP surgery so she was expecting ‘a chat about her scan and blood test’.
Charlotte was keen to get her results, her brother died of cancer, and she was understandably anxious to be diagnosed. She has been through sexual trauma but was not unduly anxious about seeing a gynae specialist. She just wanted as fast a diagnosis as possible.
In outpatients, the consultant did not sit with her to explain how the procedure that she needed was going to work. The word ‘hysteroscopy’ wasn’t used, and the procedure was explained as ‘having a look with a camera’. This limited information was conveyed as a busy consultant walked out of the consulting room and into the treatment room, preparing for the hysteroscopy.
During the procedure Charlotte had a seizure – she found this out from the description by the nurses when she came around.
Understandably traumatised, she left the hospital with many questions and angry about her treatment – and no idea what the follow up would be and when she would receive her results.
There’s no doubt, that for some, hysteroscopy can be an uncomfortable and sometimes painful procedure. But it’s a critical test when it comes to diagnosing womb cancer.
We find that people are often anxious about the procedure, leading up to it – often because they have many questions and clear information. When this is the case, their experiences can be much poorer. Good communications and information from medical staff prior to hysteroscopy is essential. Patients need to know what to expect.
There is much debate about pain relief during this procedure, and indeed if it should be offered under general anaesthetic rather than in outpatient clinics. However, many women do have the procedure very effectively and with good outcomes without a general anaesthetic.
The key points for any gynae examination – and clinicians and patients all take note!
- Communication is key – please display empathy and take time to talk to your patient in advance and during a procedure, letting them know what to expect and that they are in control during the procedure. Keep checking in and explaining what you are about to do before going ahead with each step
- Always be trauma informed. You don’t need to ask invasive questions. Before you start a procedure, just ask a simple question to give your patient the opportunity to raise any issues. The best one is ‘Is there anything I should know, or be aware of, before I start?’
- Any gynae procedure is not ‘one size fits all’ – quite literally when it comes to speculum sizes! Every gynae procedure should be approached sensitively with the patient feeling able they can opt out at any point and be rebooked (to enable them to bring a friend if possible, or indeed for anaesthetic).
If you have been given a referral to a hysteroscopy and have any questions, do get in touch with our specialist nurse info service Ask Eve, nurse@eveappeal.org.uk.