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25/10/2014

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Excuse me, I’m a patient!

Stick admin where it hurts, says Mark Stevenson.

Stick admin where it hurts, says Mark Stevenson.

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Last week a man I hardly knew stuck his finger up my bottom, and followed that with a large tube.

‘Do you mind if I play jazz?’ asked Dimitri, as I lay, butt cheeks exposed, ahead of my colonoscopy.

‘You’ve got a piano in here too?!’

‘No, I don’t play any more,’ he replied holding up a hand one digit short of the normal compliment. ‘I lost a finger, see? So now I’m a surgeon. I meant on the radio.’

I couldn’t help but laugh, not just because this was funny, but because Dimitri had done something almost impossible in that nervous pre-bottom-incursion moment. He’d made me relax.

Still, later on, as the endoscope turned an intestinal corner on its way to my appendix, triggering a feeling akin to the worst stomach cramps you can image, I questioned for a moment why that I had fought so hard to be here. I could have been at home with a nice cup of tea and my underwear on.

Ticked box talking

Back in 2011 while researching the book I was writing at the time I had my genome profiled. The results indicated I had double the risk of prostate cancer compared to the average for a man of my ethnicity. I knew this put me into the same risk category as black African and Caribbean men, men whom the NHS sensibly encourages to get early screening for the disease.

Referring to her computer my doctor had told me, ‘If you were Afro-Caribbean I’d recommend a test, but you’re not.’

I argued my case. I’m not a hypochondriac. I rarely get ill and when I do my preferred coping mechanism is to pretend fiercely that I’m not, and undertake complex DIY tasks that involve power tools.

Intestinal trauma

But my family has a history of intestinal trauma, with both my father and brother ending up in surgery as a result (the two notable legacies of these interventions is that they are both still alive and my brother’s farts can now affect property values near where he lives).

All this was not well received. In fact, I got the distinct impression that an informed and interested patient was not a welcome presence in the consulting room, rather an annoying challenge to authority. I wasn’t a patient any more: I was a ticked box that was still talking.

Envelope at reception

Shouldn’t my genome profile be appended to my medical records at least? If I wanted that, I was told, I could print out the bits I thought were relevant and leave them in an envelope at reception. Rather than being empowered by knowledge of my genetics I was feeling disenfranchised. It seemed that my actual medical data was less important than the colour of my skin.

And then I ended up in A&E with a suspected ‘twisted colon’ (you’re not eating, are you?). Even with all this, it took a second opinion for me to get a referral.

A day without food (coupled with a dose of humorously-powerful laxatives) allowed Dimitri to guide, without fear, a tube through one of my bigger sphincters while discussing the merits of Thelonius Monk.

Under-utilised resource

I’m constantly in awe of advances in medicine (many discussed in this publication) and humbled by the skill and dedication of our doctors and nurses.

In equal measure I’m staggered and horrified by the bureaucracy that crowds out the most under-utilised resource in healthcare: the relationship with the patient.

Despite a six-month wait to get there, pretty much the first moment I felt like I had any kind of therapeutic, rather than administrative, relationship with a healthcare professional was just as he was about to stick some expensive machinery up my back passage.

Surely, that’s too late?

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Mark Stevenson
Mark Stevenson is a writer, businessman, comedian and founder of the League of Pragmatic Optimists
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