The other week, whilst treating one of my regular patients for a neck complaint, I engaged him about his ongoing bowel and bladder condition.
The patient told me that he would have to have part of his bladder removed because pre-cancerous cells had been found in the bladder. A few years earlier this patient had been diagnosed with bowel cancer but had been successfully treated.
The patient had been told that because pre-cancerous cells could become cancerous cells at the drop of a hat, the time frame between check-ups was too great to provide certainty that the cancer would be picked up early enough. Thus, the best option was to have a colostomy for the rest of his life. The patient is 61.
Consequently, the patient had made arrangements to retire and was coming to turns with the ignominy of wearing the bag.
I asked him why, if such pre-cancerous cells could change so quickly, the check-ups were not more frequent. He did not know the answer to this question. It seemed that the NHS had made a valued judgment that it would be more cost effective to provide a one off colostomy as opposed to ongoing monitoring of the problem.
I strongly suggested that, when the patient next saw his consultant, he asked what the risks were in his situation of the pre-cancerous cells turning cancerous.
Last week the patient arrived at my clinic with his wife, who had a maintenance appointment. He was delighted to inform me that he had taken the consultants to task with the resultant effect. Previously he had presumed that his probability of getting cancer was very high. In fact following detailed discussion it was less than 15%. Further, during discussions with the three consultants, he had become aware that none of them knew of his bowel cancer some three years previously. None of them were aware of his adhesions following the operation to deal with his previous cancer. Thus, once the conversation had been opened up, it had been agreed that the risk of him getting cancer was much smaller than he had presumed, and with all his previous history it would be much more beneficial just to monitor him more regularly.
Thus, he can continue to work until his normal retirement, will not have to deal with the psychological issues of having a colostomy, and can get back to planning a holiday away to Tuscany with his doting wife.
Like most patients, Stephen had presumed that the consultants knew what they were talking about and had blindly gone ahead with their recommendation.
Like most patients, Stephen had presumed that, in considering the best way forward for him, they would have looked at his recent medical history and been fully aware of his non associated cancer from a few years ago.
Like most patients, Stephen had presumed that the consultants were putting the best clinical interest of the patient ahead of the cost benefit of the colostomy to the NHS.
Stephen is a delightful man who had foolishly believed that everyone had his best interest at heart. Stephen has now learnt a hard lesson; that unless you look after number one, no one else will.
10th August 2019