Jess’s Rule: new approach adopted by GPs to rethink symptoms if they see a patient three times without a diagnosis

The initiative, named ‘Jess’s Rule’, is not a law but is a reminder for GP’s to take stock and rethink their approach if patients attend appointments more than three times with the same symptoms to prevent avoidable deaths.

Jessica Brady contacted her GP on more than 20 occasions after she began feeling unwell and was told her symptoms were related to long Covid and that she was too young for cancer. Sadly, Jessica died later in the year from advanced Stage 4 cancer with her death being called ‘a preventable and unnecessary tragedy’ by Health Secretary Wes Streeting.

Prior to the Covid pandemic, Jessica had been a healthy young woman however in July 2020 she contacted her GP due to feeling unwell and continued to attend repeatedly over the next five months.

During this time, Jessica saw six different doctors at her GP surgery and three face to face consultations with a family doctor but no referral to a specialist was made despite unintentionally losing weight, having nights sweats, chronic fatigue, a persistent cough and enlarged lymph nodes.

Eventually, Jessica’s family decided to arrange a private appointment and then referred on to a specialist however it was too late. Jessica was given a terminal cancer diagnosis and subsequently died just shortly before Christmas 2020.

Jess’s Rule therefore urges GP’s to ‘think again’ if they see a patient more than three times but are unable to pin down a diagnosis or the symptoms are getting worse. This could be ordering extra tests, asking for a second opinion from a colleague or, referring patients to a specialist.

The Royal College of General Practitioners (RCGP), which was involved in drawing up the guidance has said no doctor ever wanted to miss signs of serious illness such as cancer and ‘Many conditions, including many cancers, are challenging to identify in primary care because the symptoms are often similar to other, less serious and more common conditions’. 

RCGP has worked alongside Jessica Brady’s family to develop an educational resource for GP’s on the early diagnosis of cancer in young adults.

Research suggests that younger patients, as in Jessica’s case, often face delays before being diagnosed with serious conditions because their symptoms aren’t similar to those of an older person.

Whilst many GP practices already adopt similar approaches to Jess’s Rule, it is evident that this new initiative will be welcome and will ensure standard practice around the country.