“Dignosis - cancer”: doctor competence

Doctor competence varies greatly in Latvia when it comes to detecting cancer in its early stages. Most general practitioners detect one to five instances of early stage cancer per year. There are some doctors with a three times better result, however others have not diagnosed any cases.

Catching cancer in its early stages is vital for improving chances of survival. On average 32% of cancer patients die within a year of their diagnosis. Diagnostics cannot be left solely in the hands of general practitioners (GP) and specialists who know the basics about cancer, but lack practical experience.

“Medical students are taught to recognise only lingering tumors. GPs can’t do it either. My suggestion – include mandatory diagnostics courses in doctor recertification. So that they understand that when people come in with some sort of minimal, suspicious mass, the best option is to send them for a consultation to be sure it’s harmless. I approvingly acknowledge those GPs who have finished the courses and bought dermatoscopes, out of their own initiative, so that they can quickly examine and diagnose patients themselves. That's how it’s done in Australia and the United Kingdom.” says Dermatologist Aleksanrds Derjabo.

Catching Cancer

Violeta Celma, a GP from Liepāja,holds the 2017 record for early cancer detection with 18 patients. Dr. Celma admits that she’s accomplished this due to her persistent character. “I call everywhere myself to get my patients in line for further examinations and keep a close eye on what happens next,” says Dr. Celma.

Others aren’t so lucky. Sarmītei Hippe had thyroid problems for many years, going for an examination twice a year and going to the gynecologist once a year. Her GP Ingrīda Latkovska wrote off her complaints to her thyroid issues, however in reality it was intestinal cancer. Eventually she didn’t want to go to her GP anymore, but eventually got a referral to an endocrinologist, who works with thyroid problems. Her stomach pains worsened. 

After waiting for her GP to go on holiday, once she went to see Līga Beijere her oncological disease was apparent. She was sent to the “green corridor”, but it was too late – the cancer was in the final stage.

In 2016 the "green corridor" initiative was created in Latvia to help catch early-stage cancer. It helps people who are diagnosed with cancer for the first time to gain access to an examination or specialist within 10 days. While this is a well-meaning initiative, it is still plagued with many problems such as lack of a standardized approach to diagnosis and treatment, as well as quality controls for examinations and treatment, among others.


Systematic Issues

“She went for tests. The results never made it to me. It’s because we don’t have a common database. That’s a failure of e-health,” explains GP Ingrīda Latkovska. Currently doctors aren’t responsible for entering results into the system in a way that other specialists have access.

“There are plans to improve functionality, which means laboratory examination integration. This means that future plans include the creation of such a national database, which would provide access to a broad spectrum of information on patients,” says National Health Service (NVD) Representative Sintija Gulbe. She goes on to explain that this will most likely be created only next year.

Still other patients are left make their own diagnosis. With the first symptoms Aigars Ozoliņš diagnosed himself with intestinal cancer with the help of the internet. He asked his GP to send him to the “green corridor” and was able to diagnose his cancer in the early stages. Ozoliņš had an operation and returned to work within a month.

Quantity or Quality

“We’ve created a schedule that devotes half hour to each person. I don’t understand how we’ve created this standard, were we give each patient 12-15 minutes. Half an hour – that’s the minimum. For us it’s teamwork. We go help each other out, sometimes all three of us are prodding a stomach,” says GP Inguna Riževa.

In Latvia there are 1275 GPs, which see around 18 patients every day. On average each GP practice receives 67 000 euros per year from the national budget, totalling to 85 million euros. LTV data shows that half of GPs aren’t interested in reaching better results in detecting early stage cancer, even if the government would pay more. Frequently patients are just as careless with their own health.

Prevention

The Ministry of Health creates policy on cancer diagnosis and treatment, and it’s carried out by the (NVD). Medical Services Department Representative Līga Gaigala says their aim is for GPs to focus more on cancer prevention.

There are currently three state-sponsored screenings – for breast, cervical and colon cancer. Women are sent invitations to screenenings and every three months GPs recieve an additional payment – 250 if at least 60% of patients show up to breast screenings and at least 50% to cervical ones. However this is a volunteer program and currently only 38% of GPs participate and only 195 out of 1275 doctors reached their result.

Colong cancer screening had the worst attendance, so the NVD plans to purchase tests with the government budget. To motivate docors to more carefully recognise patient’s first complaints and reach a diagnosis more quickly, GPs will recieve a special payment of 75 euros for each diagnosed first or second stage cancer case.

The Ministry of Health has conducted calculations for implementing a fourth screening for prostate cancer. Unfortunately, the idea doesn’t have enough support and currently won’t be implemented.

Implementation of Standards

The Ministry of Health aims to improve oncology patient care after diagnosis, from treatment to dynamic observation. The NVD has put forward new criteria for ensuring oncological services, for example, that at least 80% must have access to services within 28 of reception. Also, that after discharge they receive written instructions on what to do next. Levels of professional for surgeons operating on cancer patients are also defined.

From April 2019 patients have access to acute rehabilitation services where the doctor decides it is necessary. In 2019 there are also plans to begin financing the creation of psycho-emotional support centers for patients and their relatives from the moment of diagnosis, through the acute treatment process. At the same time, NVD continues to develop guidelines and a quality assurance system within the European project.

As previously reported, the “Diagnosis - cancer” project consists of more than 200 stories from cancer patients and their relatives. Stories were gathered this year beginning from the end of spring, and Latvian Public Media would like to thank everyone who conquered their tears and fears to share their stories. The journalistic team spent several months analyzing statistics, exploring the system in Latvia, and speaking to oncologists, as well as several NGOs to draw a variety of conclusions.
 

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