Bad news

bad new, colorectal cancer, rectal cancer, Shropshire, Shrewsbury

I walk down to the waiting room and call out his name. After introducing myself we walk down to the consulting room together. Bob  is in his fifties, owns his own successful company and knows his own mind. I open his notes, there’s a brief letter from his GP about piles causing rectal bleeding which have been treated with piles creams for the last 6 months, these haven’t helped his symptoms. He would like some more definitive treatment for his symptoms. I imagine him putting the morning aside to get his piles sorted, I can almost see the entry in his diary.

Bob tells me about his symptoms. “It’s been going on for ages now. I get bleeding pretty much everytime I go to the toilet. It’s fresh blood mainly when I wipe. The GP gave me some piles cream to use – but it hasn’t really done anything.” “So what about your bowels, have they changed?” I ask. “Yeah maybe a bit l go to the toilet maybe 3 times a day no. Sometimes I go a sit on the toilet and nothing happens. I have had couple of times when I have thought I needed to pass wind and just blood came out”.  My cancer antennae start twitching, Bob is describing tenesmus – a feeling of wanting to defaecate when nothing happens and also “wet wind”, both these are symptoms associated with rectal cancer. I ask a few more questions about his past medical history, Bob is pretty fit and his only health problems have been knee injuries from football. I ask Bob to undress and get onto the couch so I can examine him. The abdominal examination is normal and I ask Bob to turn over on his left side so I can do a rectal examination. “Don’t fancy your job much!” he quips. I put on a pair of blue rubber gloves and apply some lubricating jelly to my finger. “Just a little finger inside the bottom now” I warn. I feel it immediately, a hard, craggy malicious mass in the rectum – its a rectal cancer. I take some biopsies with a pair of forceps and ask Bob to get dressed.

I leave Bob behind the screens and go and sit  back at the desk. I imagine the next few weeks for Bob;  scans, a colonoscopy,  maybe some radiotherapy and  a big operation. Bob reappears, “So what’s the verdict then, Doc?” he smiles.  I want to pause time, I know he has cancer and he doesn’t. I want to preserve and stretch this exquisite moment. Of course I cannot do that. “Well Bob, I have found the problem. When I examined you I can feel a lump in the rectum. I am afraid that it’s not piles. The lump I can see is almost certainly a  cancer of the rectum.” Bob’s face dissolves, smile gone now, confusion and anguish in its place. He swears, several times. “So err its not piles then?” he says, clutching at straws. “No” I say quietly. We sit there together in silence for what seems like ages, but was probably a minute or less. I feel a huge urge to break the silence and speak, but I know Bob needs time to process the bombshell I have just dropped. I manage to control the urge and  sit in silence opposite Bob meeting his gaze. Eventually it is Bob who breaks the silence, “So what happens know?” he asks quietly. We make arrangements for some scans and a colonoscopy. Bob is distracted and I know  any more information in, the unexpected bad news has overloaded his mind and  shut down his capacity for rational thought.  I arrange to see Bob after his scans and ask him to bring his wife with him next time.

April is Bowel Cancer Awareness Month.

Bowel Cancer UK


futurefit, healthcare, shropshire, shrewsbury and telford nhs hospital trust, Sath

As FutureFit, the much-needed programme to improve the delivery of healthcare in Shropshire, continues  towards a conclusion, I think it’s time to take stock of where we have got to so far. Much of the discussion in the press and on social media has focussed on differences between points of view. At times, the debate has become rather heated and has resulted in opinions polarised around geography or party politics.  If we are going to make any progress, I think we need to take a different track. My work on the Generation Q programme looking at dialogue offers some different possiblities. In modern society we have tended towards using adversarial debate as a way to change public services. The way this works is I state my position, people who disagree with my point of view point out all the flaws in my thinking and I then explain why they are wrong. In my experience, this intensive advocacy rarely results in  anyone changing their mind or in any new ideas.

Dialogue is different to debate. The word dialogue comes from an Ancient Greek root and can be understood as “meaning through words”, in dialogue we aim to find new meaning rather than impose a point of view. The concept of dialogue has its roots in ancient civilisations when decisions were made by a group of people sitting around a fire and talking. In the twentieth century, people such as David Bohm and Bill Isaacs resurrected the concept of dialogue as an antidote to the adversarial nature of interactions in modern journalism, business and public life. Issacs describes 4 principles of dialogue:-





It is only by giving attention to all these areas that we can make any progress towards a new understanding and make the difficult decisions we need to improve healthcare in Shropshire and the whole of the UK. A key feature of dialogue is to find areas when we agree and build on these, rather than our traditional and destructive focus on differences. So perhaps if we really wish to improve healthcare in Shropshire we should develop a list of things we agree on and develop them. Here are my first thoughts, let me know what you thing.


I propose that we agree that:-

People  in Shropshire deserve the same quality of healthcare as people in London.

We need to change the way healthcare is delivered in Shropshire.

General practice in Shropshire (and the UK)  is struggling to recruit doctors and keep up with the workload.

(So are some of our hospital services .)

People should only go to hospital if that’s is the only way to deliver the care they need.

Healthcare  in the U.K. is underfunded compared to other Western nations.

The current means of allocation of healthcare care cash favours cities over rural counties like Shropshire.

Consolidating some of our hospital services on one site will improve  quality.

We cannot afford to wait too long before we make some changes.


I am sure there’s more we can agree on , or maybe not! Let me know!

I hope we can use the forthcoming public consultation on FutureFit to develop this ideas further, rather than resorting to name-calling and narrow-minded parochialism.