The old (age) runaround at the doctor's office
Why try the easy route first when there are probes and appointments and tests and more tests to be done? asks Cedric de Beer
One of the consolations of “getting on” is that one gets to spend more time talking to doctors — or, rather, having doctors talk to one with that casual condescension that probably takes a full year of training to acquire.
About 15 years ago, concerned about the number of black and growing spots on various parts of my body, I ventured to the consulting room of a friendly dermatologist. He ran his clever machine over my body, projected all kinds of enlarged and ugly images on a screen and declared me entirely free of any concerning blemishes. Those black spots? “Senile warts, nothing to worry about.”
After about 10 seconds of relief, I say: “Wait, what? You call them what? Senile warts?” “Yes,” comes the breezy retort. “Nothing to worry about” — which I'm sure is the first time I've heard “senile” and “nothing to worry about” in the same paragraph, never mind the same phrase.
I recently returned to said esteemed dermatologist at my wife's urging. Another, bigger, blacker and growing “wart”. Same process, same outcome. Only this time I am informed that it's an “age appropriate” wart. He tells me that, as he got a little older, he felt this sounded better than “senile”. I suppose I should be grateful that my warts have progressed from being senile to being age appropriate, but I still couldn't help feeling slightly insulted.
I had heard the phrase in a medical context before. A year previously my GP had phoned me up one Saturday morning and, without even a “hello how are you”, told me that my prostate blood test (PSA) was strongly suggestive of cancer and I needed to see him and a radiologist and urologist in quick succession.
And so I entered a procession of finger pointing (if you get my drift) and other procedures that led to 12 snips of my prostate presided over by the urologist's son-in-law (also a urologist. It felt a little like insider trading.)
Some time during this whirl of tests, someone, I think it was the radiologist, informs me that the enlargement of my prostate was “age appropriate”. I think that was meant to be good news, but I could not help wondering why. Perhaps my prostate waits until all its little prostate-offspring have gone to bed before telling dirty stories? I mean, my prostate has seen some things that are not fit for sharing with the younger generation. But we won't probe that line of inquiry any further.
Somehow the phrase feels patronising. It has a kind of “you're lucky to be alive, stop complaining” air about it.
Also, somewhere in this process I ask about false positives — are there explanations other than cancer for a high PSA reading? Indeed there are. What are they, and why don't we try to establish if they are responsible before getting into the rather intrusive biopsy? No. First we look for cancer, then we look at alternative explanations. No reasons given, it's just the way it is. OK, you're the doctor.
So it's off to the urologist's son-in-law, who performs the biopsy with as much gentleness and dignity as is possible while you are having clumps of cells snipped by a dinky little probe deeply embedded up your backside.
The weirdest thing happens to the doctor's face. He looks up with a slightly pained smile. 'The good news is there is no sign of cancer'
A few days later it's back in the father-in-law's consulting room. He opens an envelope with the results, which he has not looked at before you go in. It's a kind of “money or the box” moment (that's an age-appropriate allusion).
And then the weirdest thing happens to the doctor's face. He looks up with a slightly pained smile. “The good news is that there is no sign of cancer.” He says the words, he definitely smiles encouragingly, but you can also see it's not good news for him. He is losing interest as he talks. I never do hear from him what the other reasons for the high PSA reading might be. He says he will send a report to my GP, but he never does.
I go and see my GP. He puts me on an antibiotic and, boom, my PSA reading is right back down. I barely restrain myself from asking why we didn't do the antibiotics first and the biopsy only if my PSA remained high. But I swallow the words and accept that doctor knows best. It seems like the age-appropriate thing to do.