Posted by: Nicholas Ramscar24 August 2012
‘Have a quick listen to my chest, doc, and I’ll be off.’
Sixty years old, and with immaculately blank medical notes, this patient is embarrassed to be here. Apparently, his wife saw one of the lung cancer awareness adverts and chivvied him into making an appointment. He knows he’s got a cold. After a two-minute chat about his symptoms, I know it too. But we might as well do things properly, and he slips off his shirt as I rummage for a stethoscope.
The mole sits in the centre of his back.
‘Oh, that. Suppose it probably has grown a bit. How does the chest sound?’
I suspect we all have a diagnosis we fear most for ourselves, something that at some level we know will be our own downfall. Mine is melanoma – even in Britain’s thin, watered-down sunlight, I scurry from one patch of shade to the next. My Room 101 would contain nothing more than a sunbed.
This man has a more relaxed attitude – a bit of a sun worshipper, he isn’t overly worried about a 2cm mole growing in an attractive mix of colours. By contrast, I would have been down to the solicitor’s with a DIY will kit. Eventually, he reluctantly agrees to see the dermatologist, grumbling about scars and a fuss over nothing.
His histology came back a week later, reporting a completely excised malignant melanoma, with minimal thickness and an excellent prognosis. I phoned him up and he answered at the golf course. The stitches had come out and his swing was getting back to normal. He was confident about beating his friend, who had taken the ingenious and unsporting approach of booking as many games as possible immediately post-excision.
Friends in more obviously glamorous specialties still ask if general practice is all just coughs and colds. Are we, as Matthew Parris recently asked, simply being needlessly bothered by ‘the citizen’s first sneeze’?
Sometimes, perhaps, it might feel that way. But even with the most initially uninspiring consultation, there may be a chance for a life-changing outcome. This man will probably be on the golf course with his dubious friend for many years. But if his coughing had never annoyed his wife, he might not have been seen by a doctor until this vicious cancer was peppered throughout his body. I can think of nothing worse.
There is something poetic about any job, however unglamorous, which allows you to help someone else dodge the fate you fear most for yourself.
Dr Nick Ramscar is a GP in Twickenham