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Gp wont refer without examination? Is this necessary under the nhs guidelines?

Kay12321
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Hi, 

Ive been to the GP about abdominal pain, loss of appetite, weight loss, indigestion, tiredness and hes given me a blood test and stool sample, the stool sample has come back with blood. I have a strong family history of bowel cancer including my mum who was in her 40s (i am 35) .... my gp called me in yesterday to offer a rectal examination to which i refused but he says he will not refer me for a colonoscopy or any further testing until he has done a rectal examination, he also stressed the importance of me being referred and that i would be on the 2week wait list.. my question is is the rectal examination necessary for referal given my symptoms, positive fit test, family history and ive recently been treated by them (in last 6months) for low iron? .. is there any guidelines anywhere that i can refer to and show him. Hes actually refused to do the referal and ive been told to go back monday for an examination or leave it. He had my fit results since tuesday so will be almost a full week thats been added ontop of my wait.

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    Well I certainly got referred for a Colonoscopy without an examination beforehand so I think you're right to expect to be referred .

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    I got referred without an examination beforehand, so I think you have a right to be referred.   

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    Speak to another GP. You're well within your rights to seek a second opinion within the same surgery.

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    I was referred without an examination. I can only think that your GP wants to do a rectal examination to see if you have internal haemorrhoids which may be the cause of blood in your stool. If you have these, it means the GP can get away without sending you for a colonoscopy (and probably saves on the Practice budget). A colonoscopy (in my experience) isn't a pleasant procedure but you really need some answers to your problem so I would ask to see another GP at the practice. If there isn't one, I would speak to the Practice Manager & voice your concern.

    Have you been given the results of the Fit test as this may also be an indication as to why he's insisting on a rectal exam. I haven't found any particular guideline with reference to rectal exam before referral but this article may be of interest https://www.nice.org.uk/news/article/nice-recommends-extending-use-of-tests-for-colorectal-cancer-which-could-reduce-waiting-time-for-colonoscopies especially this quote 'The committee agreed it is important that GPs can refer people for colonoscopy without a positive FIT result if they think it is necessary and where symptoms persist'. So even if your FIT isn't positive your GP can refer you.

    Good luck

  • Hello there and thanks for posting

    I am sorry to hear about the symptoms you have and appreciate this must be a worrying time for you.

    It is important to speak with the GP again or you may prefer to ask to speak to another if you prefer to get a better understanding of your situation.

    Whilst you have a positive FIT test you haven't said what level it came back as. It if was over 10 the threshold for symptomatic patients alongside your symptoms this should warrant a referral. However if it were below this then the doctor may be wanting to gather more information through a rectal examination where they can assess for piles, fissures or any other lump that could be causing the blood and or add value to your referral.

    There is more information about referral to a specialist for bowel cancer and the guidelines on our website.

    Speak with your doctor when you can and I hope you find out more about your situation soon.

    Please get back to us if you need any more information or support.  You may find it helpful to talk things through with one of the nurses on our helpline.  The number to call is Freephone 0808 800 4040 and the lines are open from 9am till 5pm Monday to Friday.

    Best wishes

    Naomi

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