Introduction to Jess’ Rule
GPS in England are asked to "think again" when they see a sick patient three times and cannot determine a diagnosis or find that their symptoms get worse. The new NHS initiative called Jess’ Rule is named after a young woman who contacted her family doctor more than 20 times after she felt uncomfortable in the summer of 2020. She was told that her symptoms were related to Long Covid and that she was "too young for cancer". She died later that year at the age of 27 of Advanced Stage 4 Cancer.
The Story Behind Jess’ Rule
The young woman from Stevenage was a talented engineer who was involved in the design of satellites. Her mother said that she was a very healthy young woman when the pandemic struck in 2020. But in July that year, she did not feel right and repeatedly visited her general practitioners for her symptoms over the next five months. Over time, she became "increasingly weak". She had lost a lot of weight unintentionally, had night sweats, chronic fatigue, a persistent cough, and very enlarged lymph nodes. But because of her age, it was obviously assumed that nothing was wrong.
Delays in Diagnosis
In her GP practice, she had contact with six different doctors and three personal consultations with a family doctor, but no referral was made to a specialist. "Your body failed her," her mother said. "It was difficult for her to stand up for herself." When the family decided to make a private appointment and transferred her to a specialist, it was too late. She received a terminal cancer diagnosis of adenocarcinoma, cancer of the glands that lie near the organs, and died three weeks later – only days before Christmas 2020.
The Importance of Jess’ Rule
The family hopes that Jess’ Rule will help raise awareness of the importance of GPs being quick to refer patients who are steadily worsening. "She wanted to do something," her mother said. "She knew that her delayed diagnosis was significantly involved in her having no treatment options, but only palliative care." The rule is not a law, but a strong reminder to GPs to "pursue and rethink three strikes". This means taking action after a patient has visited three appointments with the same symptoms to prevent avoidable deaths.
How Jess’ Rule Works
This could mean dealing with a patient who previously only spoke on the phone, ordering additional tests, or asking for a second opinion from a colleague. GPs should also consider transferring patients to a specialist. The Royal College of General Practitioners (RCGP) said that no doctor ever wants to miss signs of serious illnesses like cancer. "Many diseases, including many types of cancer, are difficult to identify in primary care, since the symptoms are often similar to other, less serious and more common illnesses," said a professor from RCGP.
Implementing Jess’ Rule
Studies indicate that younger patients and people from ethnic minorities are often subject to delays before a serious illness is diagnosed, since their symptoms are not similar to those of white or older patients. Younger people like the young woman can also be dismissed just because they seem too young to have a serious illness. The RCGP worked with the young woman’s family to develop an educational resource for GPs on the early diagnosis of cancer in young adults. The Ministry of Health said that many GP practices have already used the right approach, but that Jess’ Rule would make this "standard practice across the country".
Conclusion
The Secretary for Health and Social Welfare thanked the young woman’s family and said that they had tirelessly used "unimaginable grief" to ensure that her legacy saves the lives of others. "Patient safety must be the foundation of the NHS, and Jess’ Rule ensures that every patient receives the thorough, compassionate, and safe care that they deserve, while supporting our hard-working GPs to catch potentially fatal diseases," he said. The rule should be implemented "quickly and consistently", and it is also absolutely necessary that specialist teams have the resources to deal with potential increases in demand that result from increased referrals.
