What follows is perhaps not for the squeamish, or for reading too close to mealtimes...
It is an inconvenient truth, but there are some things we
are called on to do that are just plain awkward and embarrassing to have done.
Until Dr McCoy’s hand held “Wibbly” scanner is invented we have to make do with
more archaic and difficult methods, and en route to that same Star Trek tech we
are developing methods that though better than the traditional, are still plain
odd at first blush. (Blush being very much the operative word here).
There, how very English of me. I’ve spent an entire
paragraph skirting around a difficult topic without saying anything meaningful
or illuminating. And I’m risking spending another doing just the same, so time
to bite the metaphorical bullet and get on with it. There’s an old surgical aphorism
that’s as true today as it’s always been, and it simply states “If you don’t
put your finger in, you put your foot in it!”
Men of a certain age, and ladies of pretty much any age will
now be cringing and looking away squeamishly. The awkward reality is that there
are some bits of us that can go spectacularly wrong, that we can’t actually
see, and so, to gain a better understanding of certain symptoms of alarm we
have to rely on other methods. These begin with the simple (?) “digital exam”.
No, not some clever electro replacement for “analog exam” just the humble expedient
of placing a gloved finger into an orifice and “rummaging” (it’s actually a bit
more technical than that at the operators end, but I fear further explanation
would put us all off our cornflakes). This method remains the gold standard for
initial assessment for enlargement of the prostate and early examination of
some suspected ovarian problems and can help differentiate the likely causes of
some abdominal pains or “funny bleeding”.
Moving along we have an array of other bodily intrusions on
offer from the now antique barium studies through scopes for use from either
end (though separate scopes for each you’ll be glad to hear), there are also
scopes that go up the hooter (or schnozz for American clinicians). The latest
innovation in our neck of the woods is an ultrasound probe designed to bypass
the bones of the pelvis to generate ultrasound images of the uterus and ovaries
internally. All of these would fit nicely into the folklore attending those
lurid tales of alien abduction so beloved of Midwestern agrarian types and hairy,
wild eyed, science geek conspiracy theorists.
So why am I mentioning all this now, I hear you ask. You did
ask didn’t you? You’ve not just read a couple of lines at random and run away
screaming?
Good.
So why indeed.
On a handful of occasions down the years patients, including
one of mine right now, resist the suggestion that we intrude on their “personal
space” to such an extreme degree. Despite careful explanation they find the
concept of an invasive examination too personally challenging. Mostly, with
some gentle persuasion they can be won round, or alternative methods can be
found to garner the necessary information, but every doctor carries with them a
few cases where this has not been possible, and for the want of a timely smear,
or prostate exam, or colonoscopy or other such “space invader” examination, an
aggressive disease has taken hold where it need not have.
For these patients, as Dr Neighbour so elegantly put it a
few weeks ago, it’s as though they are “dying of embarrassment.”
