A Stockwell based GP and council member of the RCGP has written in the GP's trade paper Pulse requesting that GP's show more understanding to patients who make contact seeking advice regarding PIP implants.

Dr Una Coates stated that she was "disheartened" to hear that GP's and Primary Care Trusts were not reading the latest guidance from the Department of Health meaning that GP's were refusing to refer distressed patients for scans and refusing to fund a NHS scan for private patients. Dr Coates has been advising any patients refused referrals by their GP's to print off correspondence sent to all GP's on 6th January 2012 (and updated on 27th January 2012) and show it to their GP's so they can be "enlightened" on the current advice.

Dr Coates also stated that GP's should be non-judgmental and practise holistic medicine, they should empathise with patients physical pain (from effects of leakage of untested industrial fillers) and with psychological pain from the anxiety that comes with knowing they have the banned PIP implants inside of them. She quotes a leading plastic surgeon as reporting a one in four rupture rate and an independent PIP implant report group survey which put the rupture rate nearer 31%.

She asked GPs not to judge or castigate but show compassion for the distressed; "All they ask of us GPs is sympathy, and referral for an ultrasound".

Dr Coates used her article to raise awareness among fellow GPs of the types of symptoms they should be looking for, Those associated with a rupture included silicone in the lymph nodes, swelling, pain and inflammation of the breasts, burning breasts, numbness in the arms, fatigue and fibromyalgia. "Silent rupture" she reminds can only be found via a scan and as a consequence all GPs should be referring at-risk patients for a breast scan regardless of examination findings, which although seemingly normal can be contradicted by scan findings.

She points out that this scandal is affecting the patients well being, marriage, relationship, family, finances and employment. It is causing depression and extreme prolonger anxiety. She highlights that even if patients have their implants removed on the NHS they must then face the daunting decision as to whether or not to remain without the implants - leading to further possible disfigurement with stretched skin and removal of affected breast tissue - or pay £3,000 to £4,000 for a new implant. A procedure under general anaesthetic requires a mandatory two weeks off work so arguably having the NHS remove and private clinics replace means a month without work.

She is of the view the blame lies with the MHRA for approving the PIP implants and failing to recall them sooner and with the clinics for charging to replace faulty implants instead of funding replacements via malpractice insurance. She asks that a review of the MHRA be carried out urgently as this government body approved trilucent, hydrogel and PIP implants which were subsequently banned. The US FDA refused to approve the same products.  

In an impassioned plea Dr Coates argues that:

"It is inhumane to expect our patients to live with the extreme anxiety of knowing they are at risk of rupture of PIPs made from window sealant, brick weatherproofing, and mattress fillers that could enter the lymphatic system and migrate. As no research has been conducted into window sealant and mattress filler leakage inside human beings, how can the MHRA confidently say they should remain in situ, as they have not rupture yet, and have no risk of cancer?"

"GPs, please show compassion to the distressed. If a scan does not show a rupture but the patient still has symptoms, refer the patient to the breast clinic for an MRI scan or for removal. Give the patient the freedom of choice to self-pay for replacement of the implant at NHS explanation or do as compassionate Wales and Europe are doing - offer all private or NHS patients free removal/replacement.

Let us as a nation of GPs come to patients' aid - not judging them as private or NHS patients but treating them as human beings, and always putting the disease in the psychosocial context."  

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