Jess’s Rule: Three strikes and we rethink

 If a patient presents three times with the same symptoms or concerns, particularly if symptoms unexpectedly persist, escalate, or remain unexplained, it’s time to rethink.

 Reflect: Think back on what the patient has said and consider what has changed or been missed. Offer ongoing continuity of care with follow-up. If previous consultations have been remote, see the patient face-to-face and conduct a physical examination.

 Review: Where underlying uncertainty exists, consider seeking a view from a peer and review any red flags that may suggest another diagnosis, regardless of the patient’s age or demographic.

Rethink: If appropriate, refer onwards for further tests or for specialist input.