Leading the wayBMJ 1998; 317 doi: https://doi.org/10.1136/bmj.317.7157.523 (Published 22 August 1998) Cite this as: BMJ 1998;317:523
My patient had always been apprehensive about undergoing medical procedures. He came to see me with a broad smile and told me about his recent gastroscopy.
He and five other patients were lined up in beds in the day ward. A rather frail 83 year old woman had been selected to go first. Everyone listened as the nurse went behind the screen, explained the procedure in detail to her, and requested consent. No, she said, she would not have an injection in her hand, she would have it done without the injection. The nurse went out and returned with the surgeon. He patiently explained the procedure again and emphasised that it was not really an anaesthetic that would be given—more like a light sedative. No, son, she said firmly, she would not have the injection, however light it was. But she did want to have the procedure done. Eventually a reluctant compromise was reached—she would have it done with just the spray on the back of her throat.
She returned after the procedure, quite unconcerned, got dressed, and promptly went home. The next patient decided that he, too, would have only the spray, went for his procedure, and returned in good spirits. My patient was next. More than a little apprehensive, he decided that if they could do it, so could he. He, too, just took the spray, found the procedure tolerable, and felt fine afterwards. In the end all six patients declined intravenous sedation. The surgeon was heard to ask the nurse if she was putting the patients up to it: perhaps in future the patients would be doing their own gastroscopies.
My patient now tells me, somewhat proudly, that he would have no worries about undergoing any future medical investigations.