My friend has an enlarged prostate. In one way – I’m quite envious. 

You see, he called the GP surgery because he isn’t feeling right but beyond that there might well be other issues really concerning him that he wants also to talk about. 

But he is a man. 

So if he had just developed a giant  talking wart with the horns of the devil on his elbow  he would probably see the GP about a sprained ankle and say at the end  “ oh and there was one other thing ….” 

Not ideal. Stupid really, but we all have our little foibles and his is that he will worry about something but really it takes him a lot to talk about it . 

He  called the surgery and said “ I’m not feeling right, not sure why,  but can I book myself in for a general physical and have everything tested so I can have some form of reassurance?” 

“ No” was the answer. “ We don’t do that sort of thing .”

“ You don’t do preventive  medicine ?” 

“ No.” 

So what do you do?”

“ Well if you have problem then we can  book you in and he can examine you and hopefully sort it .” 

“ Any problem?”

“Yes” 

“ I have an enlarged prostate .” 

“ That will do, 4pm Tuesday ?”

This isn’t a dig about surgeries, GPs , GP receptionists, none of that, it is a dig at the priorities we have as a society and the fact that what we say and what we do, don’t really match up. It certainly isn’t a dig at the Scottish Government who prioritise health higher in their spending than “Down South” and who pay nurses for instance better than in England . 

This year I have heard a dozen ( at least ) footballers  ( other community minded sports people are available ) talk about the importance of men speaking about their feelings, the issues they have . Health is an issue. What is the point of encouraging people to listen to themselves and their bodies if we erect barriers to their accessing people to talk to? 

Or do we all have to have enlarged prostates? More on that later . 

It seems to me that COVID has radically changed medical priorities. It is also a postcode issue too. In the Borders my GP (European – she was Dutch, the implications of that will appear later ) bugged me to come for physical check ups, in the South West of Scotland we pretty much get by with Locums, you will rarely see the same GP twice. It isn’t their fault and while I see the GP very rarely, none has been anything other than helpful. 

We have heard that cancer diagnoses have fallen through the floor during the Pandemic. People aren’t magically getting cancer less they are just not bringing issues to their GPs, and it isn’t  because people like Jason Leitch have stopped encouraging people to go. Rather the opposite. In the meantime we are building up a cancer crisis. 

It isn’t a medical thing, it is a behaviour thing. People “ don’t like to bother the Dr  “ they are reluctant to be direct about what they might think is wrong with them.  There is embarrassment of course. My friend’s surgery asks that you share what is wrong with you with the receptionist. Sort of understandable, logical but since when were people,  especially men logical about their health?

I could suggest that society’s approach to men’s preventative health has been less well developed than to women’s. My wife and I both did the bowel  cancer tests,  what has happened to that? Nothing since lockdown . She had access to the dreaded smear and breast screening and I have had a test to see if my Aorta was up to scratch. ( Who knew I even had one ?) 

One in 10 men in Scotland  will get prostate cancer  one in 8.5 women will, get breast cancer.  Women’s health screening programmes are very visible and  requests to come and get screened are  programmed into public health processes. Where is the prostate screening programme? We don’t have one, what we have is a Prostate Cancer Risk Management Pack for GPs the pack says :- 

“Any man over the age of 50 who asks for a PSA test after careful consideration of the implications should be given one.”

Can you see a problem with that? How do you express a concern if you can’t get to see the GP? what happens if you only see locums? Where is the consistency of care? Are you filled with confidence that men, without a significant degree of concern (and often prostate cancer has no obvious symptoms) will make that call? 

While with early treatment, survival rates are very high, later diagnosis leads to worse outcomes. “ Worse outcomes” is a euphemism for death. We men are not that good about talking about that either, if we were we’d eat less red meat have slimmer waistlines  take more exercise …I could go on. 

I am 70 next year, other than the poo test and  the aorta scan, I have not had a preventative medicine discussion with a GP in at least 7 years, and since my friend  and I share the same GP, it would seem if I wanted one, I’d not get it. Unless I borrowed his enlarged prostate. 

It seems wrong. It seems as if we are getting our priorities wrong, for men certainly but for women also. I don’t begrudge my wife the scans she has had over and above mine, in fact the opposite I’d prefer that we both  had access to a proper preventative medicine plan. 

We speak about a health crisis and the issues that the NHS will face in the winter with; Flu, COVID and Norovirus but how many people could we keep out of hospital  through preventive medicine ? 

The Westminster Government likes to bamboozle people with big figures but when it comes down to a proper analysis,  what do we spend on health ? Of course with  the pandemic the figures will be skewed so it makes sense perhaps to look at pre COVID figures. We spent pretty much the same as other OECD countries £2, 987 per person  on health but of the G7 developed countries we were second bottom of the list. 

The Fish Filching French spent £3,737 and the Brexit deploring Germans spent £4,432. The figures had been falling between 2013 and 2017 . Scotland consistently spent more on health care  per person than any other part of the UK with the England ranking bottom but over the years showing a higher increase in spending year on year than  the other 3 nations. 

So it is about choices on how you spend your money. Would Scotland under independence have the where withal and will to spend more on Health ? That  is a different argument. 

But the message to all Governments is that they need to get their priorities right. 

Preventative medicine needs to be a priority if only for the sake of common sense and ensuring our Hospitals are not overwhelmed. It should be on expectation not on demand. 

In the meantime I have had chat with my prostate and it seems to be reasonably content.