Filler

The patient might be right

Callow and naive, I had recently started in general practice. But, full of confidence and believing I knew it all, I worked my way through my newly inherited list of patients with the enthusiasm that some of us may remember from earlier days. The Wing Commander stopped me in full flow: "I have come for my annual medical." My protestations about the lack of evidence of benefit in such procedures were to no avail. His service background and a certain familiarity with health procedures in the United States gave support to what he thought was an entirely reasonable request. He was asymptomatic, with a clean medical history, and not taking any medication. He made his request simply and politely, and I had little option but to acquiesce.

I decided that, rather than just a simple blood pressure measurement and feel of his pulse (this was before the days of NHS sponsored health promotion examinations), I would "give him the works." That should dampen his enthusiasm. Stripped and ready for examination, he chatted amiably as I set about checking him from top to toe. Cardiovascular system, normal; respiratory system, normal; cranial nerves, no appreciable disease; peripheral nervous system and musculoskeletal systems likewise. When I came across a mass just palpable in the left renal area, however, my indifference vanished rapidly. Early referral and surgery led to removal of a malignant, but fortunately entirely localised, tumour. His gratitude embarrassed me, since it was I who should have been grateful to himfor teaching me, early in my career, that it is just possible that the patient might be right.

I went to see him last week. He is now 92 and has just had to give up his beloved fishing. I wanted to ask his permission to write about him. This was freely given, and we reminisced over our first meeting and what each of us has been doing over the intervening 30 years. And he has never once said, "I told you so."

Peter Strangeways, retired general practitioner. 

Warminster