Friday, April 27, 2012

Roll on the 23rd Century

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?


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.”

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