The 36 year old man who went in through a door and saw a doctor

The patient and his wife sat in the waiting room having enjoyed the coffee that they now traditionally enjoyed just before going into the six monthly results meeting.

They both, now being used to these results meetings and also having generally an attitude in life that what will be will be and that you can’t change anything by worrying, sat there in the waiting room worrying.

This was, concluded the patient, perhaps one of those times in life when it was probably considered normal to be worrying, and so he felt satisfied that what he was doing was normal, and that his wife’s worrying, if indeed she was doing so, was normal too.

The source of the worry was that the doctor the patient and his wife had come to see had written a scientific paper, which the patient had recently read. It had concluded that a brain tumour vascularity score of 4.8, a score which the patient did in fact have, would put his tumour in the category of grade three, rather than grade two tumours.

According to the usual convention, where grade one might be considered good and best, and grade four might be considered not good and worst, a vascularity score of 4.8 was on the whole likely to be not good and worst.

The patient’s strategy, having read the paper which the doctor he was about to see had written, was to first indicate his understanding of a high vasularity score and second to enquire whether this vascularity had increased any. And if so, he would thirdly enquire whether the doctor would thus now class the patient’s tumour as good and best, or not good and worst.

And further more, the patient’s strategy ran, the doctor would be asked, politely of course, why he had not mentioned to the patient that he had written the paper which he had written, when the content of the paper was likely to be of some considerable interest to the patient, given his vascularity score of 4.8.

So, that was the patients’ strategy as he waited to see the doctor. But after lots of waiting, it became clear to the patient and his wife that somehow things weren’t going to quite work out as they had expected.

In fact, the patient found his strategy somewhat waylaid by the fact that when he was called through by the doctor, it wasn’t actually the doctor he had come to see that called him through, but in fact someone else.

The someone else introduced himself as a registrar, and after making general enquiries as to the patient’s well being, declared himself not a little surprised to see the patient. To which the patient and his wife thought, but didn’t say, that they themselves were surprised to see the registrar, because the registrar was not in fact the doctor the patient and his wife had come to see.

The registrar explained that, having looked at the papers on his desk, he had expected to see not the patient in front of him, but rather a 63 year old woman, that being how the papers on his desk had described his next patient.

The patient surmised, not in fact being a 63 year old woman, that the registrar had in fact invited the wrong patient into his surgery. And given that the registrar was not in fact the doctor which the patient had come to see, that somewhere in the chain of administration, that something perhaps had gone amiss.

Except that when the patient explained his assessment of the situation to the registrar, the registrar nevertheless insisted that the patient was indeed the patient he wanted to see and that it was the information in the paperwork that was wrong.

The registrar then asked the patient for a few moments to read the paperwork again, and the patient said that would be fine. This in turn left the patient and his wife in sight of a brain scan on the registrar’s computer clearly showing a brain tumour in the same place as the brain tumour that the patient had got, but one that appeared considerably bigger than the patient’s tumour had been six months ago.

For reasons which I hope will be obvious, that caused the patient and his wife yet more worry than the worry they had already had before they had been called in.

When the registrar had finished looking over his notes, and had concluded that the patient sitting in front of him, though not a 63 year old woman, was indeed still the patient he wanted to see, he asked the patient and his wife whether they would like to see the latest scan results. Which the patient and his wife said, with some haste, that they most certainly would.

The registrar, indicating his screen, said that this wasn’t the patient’s scan. Nor, apparently, was it the scan of a 63 year old woman, but rather was a scan of someone else entirely.

Which then led the patient and his wife to wonder whether the last five minutes hadn’t perhaps been a total waste of time. But those thoughts soon became unimportant, because it turned out the next 15 minutes were to prove a total waste of time too.

The registrar told the patient that, apart from the paperwork he had just read through, that he knew nothing of the patient’s case, and would the patient please answer some questions, so that the registrar could become more familiar with it.

After gaining the information that the registrar would have known had the registrar been the doctor that the patient and his wife had come to see, the registrar declared that now he had a grasp of the situation. He could, he said, inform them that the scans had shown no growth in the tumour and no increase in the vascularity score.

“Good news then,” said the patient.

“Good news then,” said his wife.

“Good news then,” agreed the registrar, to which he added an enquiry as to whether the patient would like to see the doctor he had come to see, because the doctor would probably want to see the patient.

This confused the patient and his wife because the registrar, not being the doctor he had come to see, had led them to assume that the doctor they had come to see was either not available, or didn’t want to see them.

“I’ll take you through,” said the registrar, to which the patient and his wife indicated their satisfaction by moving in the general direction in which the registrar was himself now heading.

Meanwhile the patient and his wife indicated to each other not a little puzzlement that if the doctor they had hoped to see did indeed want to see them where the last 20 minutes with the registrar fitted into the picture.

So the patient and his wife did see the doctor they had expected to see, and this being the doctor who had written the paper the patient had recently read, the patient wondered whether now to revert to his original strategy of quizzing the doctor about the paper he had written but chosen not to share with him.

Once the patient and his wife had greeted the doctor they had come to see, and the registrar himself greeted the doctor that he wasn’t, the patient embarked on questioning the doctor about his vascularity score. The patient indicated to the doctor that he had read his paper and asked whether his assumption that his tumour would now be considered a grade three a correct one, to which the doctor answered that it wasn’t.

“What can I say? You’re an odd ball,” said the doctor, which the patient wasn’t quite sure whether was an insult, or a compliment, or a joke, so just smiled until the doctor spoke again.

“In fact, I don’t think I’ve ever seen this in a brain tumour like yours,” said the doctor.

To which the patient replied that surely that must mean something, but which the doctor said that on the contrary, it meant exactly nothing, and that no growth was no growth.

“So what do you want to do?” asked the doctor, and the patient replied that he didn’t want to do anything, because he didn’t quite understand what he was being asked.

“Good, that sounds like a plan. Are you happy with that?” asked the doctor.

And the patient, still being not quite sure what he was being asked, said to the doctor: “Are you happy with that?”

To which the doctor declared himself very happy indeed.

“Good,” said the register.

“Good,” said the doctor.

“Good,” said the patient and his wife, confirming the consensus among those present that doing precisely nothing was the best strategy to take, compared with doing something which would not be best.

After which, generally satisfied with the conclusions of the meeting, the patient and his wife left the doctor who they had expected to see and the registrar who they had not expected to see and went out of the surgery.

There the patient asked his wife if she would like now to go for another coffee, to which his wife replied that she most definitely would.

With apologies to Jonas Jonasson

10 Comments

  1. What an altogether strange tale! If it were not for the seriousness of the situation, it might be considered a total waste of time.

    I suppose the moral of the story is: Keep On Carrying On.

    P.S. Love the writing style 🙂

  2. Commendable restraint! Most of us would have completely lost our tempers, and justifiably so, after being put through the emotional wringer you describe. I am so glad the tumour has not grown.

  3. Goodness me I should imagine another coffee was the least you needed after that shenanigan! No words really but just wondering what the 63 year old woman was told?!!

  4. Jesus

    It’s not what you need is it. You want to feel a firm one on one concentrated decision being made. But you got the right ending and you have to trust that they’ve looked at very result and really concluded that is that.

    I got my six monthly scan results last thursday and the mri people hadn’t given a full report but my doctor had a good look at the results and told me she couldn’t see any growth. She later phoned me to confirm she had got the full results from the team and it was definitely stable. But somehow because of the delivery it didn’t seem quite as comforting.

    Oh well I still love the nhs

    great writing

  5. What a very patient patient you are! A Very entertaining account of a very frustrating situation !

  6. I ve been there gideon. My conclusion was , and still is, never to see a register, refuse to meet with them and insist on the right doctor. Otherwise it does indeed all get very strange.

  7. A too common situation, frustrating & unwarranted but beautifully described.
    Now I have ordered the original from our library.
    Yes we still have one & I try to support it. Like the NHS a wonderful resource!
    Thanks for educating your readers in literature as well as medical matters.

  8. Only just discovered your blog. This is a fantastic entry – you had me and my husband (the one with the brain tumour) laughing out loud, me so much I couldn’t speak! It is just brilliant to read something so funny about the situation we’re all in. Thanks zillions, and keep it up!

    1. Debbie,

      Thank you very much. Nothing makes me happier than knowing I’ve raised a smile, as well as inform, about the condition. I wish you and your husband the very best, and please do keep reading.

      G

  9. Hi,

    I would just like to say that I have really enjoyed reading your book and now your blogs. It all helps to make sense of this roller coaster of a journey we are on.

    I have a question for you and others who add to your blogs. Is it normal to have a meeting with a consultant/doctor to discuss your results? I was diagnosed with a low grade glioma 2 years ago in my parietal love, approx 2cm x 2cm. I haven’t seen any consultants concerning my tumour in over a year and a half, I do have 6 monthly scans but always just get a letter to give me results. I have not had a biopsy as I was told my tumour is in my motor strip and if they do I would have a stroke. Unfortunately I have also been diagnosed with multiple sclerosis but get lots of support for this with amazing staff.

    Many thanks for your help
    Pammie

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