Abstract
A patient attends struggling with their mood and feeling overwhelmed by life. They tell you their partner has been diagnosed with metastatic breast cancer and is currently having palliative treatment. They are struggling to sleep, to attend work and to concentrate. One major issue for them is that their partner is ‘shutting them out’ and will not let them attend any oncology or palliative care appointments with them. Their partner is someone you have met a few times before and you feel internally sad and quite shocked for them as you were unaware of this diagnosis. They ask for some support and maybe some time off work to regroup. You signpost them to the local MACMILLAN service and give a Med 3, you arrange follow-up in 2 weeks.
Two days later it is the palliative care meeting in the practice. You note there are no patients with breast cancer on the palliative register at all. You discuss with the multi-disciplinary team the encounter this week with your depressed patient and a group decision is made for one of the coders in the team to review the medical records in case an oncology letter has been missed. There are no entries at all pertaining to cancer, the only recent entry is for travel vaccinations for an upcoming trip to South America and you note they have a face-to-face appointment booked with you tomorrow.
How would you proceed? How might you feel now you know that either your first patient is not being truthful, or their partner is lying to them? Was it justified to go into the partner’s records?
