‘I know I’m a fatty,’ the overweight gentleman in his 60s proclaimed before I’d even closed the door behind him, before I’d even met his eye. ‘And I know I’m a piss head,’ he continued rather brashly, too brashly in fact, and I was certain the diabetic screening technician next door must have heard. ‘But..!’ he paused, for dramatic effect, ‘but…!’ he repeated, slightly quieter, ‘I’m worried about cancer.’
He was concerned his back pain represented the prostate cancer his father had died from some years before. Towards the end of the consultation, after examining his back AND prostate, I asked why he’d mentioned his weight and alcohol consumption earlier on? At this point he winked: ‘Ah.. you see, I gets it in and out the way early, before you lecture me, so we can get on with the real problem..’
The ‘real’ problem was mechanical back pain, caused, in part by his outdoor job with heavy lifting. The ‘lesser’ problem was his BMI in the mid 40s, 7 cans of lager every night, high blood pressure and an unknown cholesterol. He was obviously concerned about cancer, yet the fact his lifestyle was increasing his chances of succumbing to this, or more likely, a heart attack, seemed lost on him. Yet he wasn’t interested in reducing his weight, or drinking, or even statins (he reads the Daily Rag). As my trainer only last month reduced my slots to 10 minutes with no catch ups, I had to accept that the best I could do for him was some analgesia, physiotherapy self-referral and then to move on.
It’s frustrating, when people can’t see the woods for the trees. And frustrating, having only 10 minutes to deal with a myriad of problems. What an uphill battle we fight!
Dr Julie Fry is a GPST3 in Cheltenham.