A third of people with embarrassing health conditions would rather use the internet to self-diagnose than visit the doctor, according to a recent poll. I understand why people would rather quiz their computer than have me scrutinise their private parts, but it can be a risky strategy.
Having met a lot of embarrassed patients - and been one myself - here are some thoughts on how to tackle embarrassment and avoid risking your health.
When I was a 14-year-old boy, my breasts started to grow. To me there were only two diagnostic options. The first was too grim to contemplate: breast cancer. The second was too embarrassing for words: I was turning into a woman.
I couldn’t see how the school doctor could do anything other than confirm my worst fears or laugh at me, or both. Somehow my Dad persuaded me to see the doctor. After a quick prod he confirmed that I had what’s known as pubertal gynaecomastia - transient swelling of one or both breasts, which affects about half of all boys going through puberty.
Instantly, my changing room phobia and D-cup anxieties melted away.
If the internet had existed in those days and I'd searched for 'breast swelling in boys', I’d have come up with gynaecomastia and breathed a huge sigh of relief. But if I'd typed in 'breast lump' or 'male breast cancer' it might have been a very different story.
Either way, my best bet was to get properly checked out by someone with the medical expertise to assess my particular problem.
Imagine the relief
Worries have a habit of growing out of proportion, particularly when they're allowed to fester unchallenged. Some people are visibly shaking with fear as they tell me about their symptoms. It's great to see the relief on their face when they finally spit out their story.
So rather than focusing on the potential embarrassment of seeing your doctor, try to imagine how it will feel to leave the surgery feeling fully reassured, or just relieved that something is at last being done.
Examination worries
Classically, people get embarrassed about sexually transmitted infections or bowel problems. The poll found that half these people are worried about having a physical examination.
It’s natural to be apprehensive about any sort of intimate examination. After all, it usually means being seen without your clothes on and being touched in private areas by a stranger. But while these worries churn around in your head, it might help to know what’s going on in your doctor’s mind.
As I snap on a pair of latex gloves for my first rectal examination at 8.30am, I'm just doing my job. Since medical school I 've had it drummed into me that an abdominal examination is not complete without putting a finger into the patient's back passage.
If I don't, I could miss vital clues, from suspicious lumps or an enlarged prostate to simple haemorrhoids. As our tutors used to say: "Put your finger in it or you’ll put your foot in it."
I must have done many hundreds of rectal examinations. I'm totally focused on inspecting and then feeling the rectum, ticking off a mental checklist as I go. I cannot afford to miss anything. The same is true for a breast or genital examination.
And when you’ve had to empty someone’s bowels by hand, remove shards of glass from a woman’s vagina, or drain a large breast abscess, there’s little that will shock you.
Chaperones and consent
A doctor can’t examine you without your permission. If you really don’t want to be examined, or you'd rather be examined by a doctor of your own sex, then just say so. You can always book another appointment with a doctor you feel more comfortable with.
When doctors have to carry out intimate examinations (usually breast, genitalia or rectum), the General Medical Council advises that we should always offer a chaperone.
That doesn’t mean you have to accept one - many people find having an observer in the room intrusive and embarrassing. But if you'd like one, then ask. Chaperones aren’t always available at the drop of a hat though, so be prepared to wait.
The 'hand on knob' consultation
GPs will recognise what's known as the 'hand on knob' consultation. This is when a patient spends his full ten minutes discussing, for example, his well-controlled asthma, then, just as his hand touches the door knob to leave the room, he turns back and says: "Oh, there was one other thing doc - I’ve got this rash on my penis."
I’ve done this myself as a patient, but now I know what a waste of time it can be. Doctors are trained to discover your ideas, concerns and expectations as soon as possible. Without knowing what’s on your mind, how can we hope to address your concerns?
You don't need a 'mundane' problem as a passport to discuss a more embarrassing one
I know it can take time to build up the confidence to say something awkward, but you'll be doing yourself - and the doc - a favour by getting to your main worry as quickly as you can. You don't need a 'mundane' problem as a passport to discuss a more embarrassing one.
Some patients begin their consultation with: "This is a bit embarrassing doc, but…" This means I instantly understand the patient's concerns and I can start to empathise and reassure. It also suggests they're being open about what they've really come to discuss, and won’t spring a 'hand on knob' consultation on me.
Getting past the receptionist
For many people - myself included - the biggest hurdle is making an appointment in the first place. What if the receptionist demands to know about my embarrassing problem? What if they give me an appointment with Dr Nasty? What if they all start talking about me?
If you know you would prefer to see a certain doctor, then make that clear. You may have to wait longer for an appointment though.
You should never have to worry about surgery staff talking about you: confidentiality is the cornerstone of the job and breaching it leaves NHS staff open to a charge of serious professional misconduct.
Receptionists often do ask about the nature of your problem or how urgent it is, so they can book you an appropriate appointment. But you don’t have to give them details if you don’t want to.
Having been through this myself, I'd suggest a polite but firm approach: "Well, the nature of my problem is rather personal, something I’d prefer to discuss in confidence with the doctor. I don’t feel it’s a medical emergency, but I am concerned about it and would like to see a doctor as soon as possible please."
Being embarrassed is not something to be ashamed of, but please don’t let it affect your health.
Dr Graham Easton works in a London GP practice with around 10,000 patients. It has three GP partners, three salaried doctors and fully computerised medical records. His medical training was at The Royal London Hospital. He's also an experienced medical journalist who has worked for BBC Radio Science and the British Medical Journal.
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