Bad news, brush-offs and the opposite problem

The rule is simple. Some of what follows from it isn't, and I should be straight about that.

The wait for results. Between the appointment and the answer there may be days or weeks. There might be a referral, a scan or a biopsy. This stretch is hard, and it's the part people fear when they say they'd rather not know. Two things may help. The first is that a referral for tests isn't a diagnosis. The NHS says of breast clinic referrals that the tests usually show a lump is not cancer. Doctors refer when they can't be sure, and that's a low bar on purpose. The second is that this wait, unlike the last six months, has an end date, and you aren't carrying it alone any more. If it becomes hard to bear, tell someone close to you, and tell your GP. If you've heard nothing by the time you were told to expect, ring and ask. Letters do go astray.

If it's something. Sometimes it is. If that happens to you, I'm sorry, and I won't offer you cheer you haven't asked for. I'll say one thing. Going when you did was the best move available to you, and nothing about the diagnosis changes that. You may be tempted to blame yourself for the months before you went. Try to resist it. Nearly everybody delays. The reviews in chapter 2 show it's the normal human response, and hindsight makes the signs look clearer than they were. What matters from here is the treatment and the people around you. Your clinical team, your GP and the cancer charities all offer support for the fear as well as the illness, and it's there to be used.

If you feel brushed off. Sometimes you gather your courage, go, and come away feeling that you weren't listened to. The study in chapter 6 found that a dismissive consultation made people less likely to come back, which is the worst result it could have. If the problem persists, changes or gets worse after you've been told it's nothing, go back. You're not being difficult. The standard NHS advice for many symptoms includes returning if things don't improve. You can ask to see a different doctor. You can say, "I came about this two months ago and it hasn't gone away, and I'm still worried." A reasonable doctor will take a persistent symptom and a persistent worry seriously. If you feel seriously unheard, every surgery has a complaints process, and you're entitled to a second opinion.

Things that can't wait. The rule says to book it that day. Some things shouldn't be booked at all, because they need help now. The NHS says to call 999 for the chest pain symptoms listed at the front of this book. For anything else sudden or severe, or if you're not sure, NHS 111 will tell you what to do. You're allowed to use emergency services for an emergency, and you won't be wasting anyone's time.

The opposite problem. I said at the start that this book isn't for people with health anxiety, and I'll say why. The NHS describes health anxiety as spending so much time worrying that you're ill, or going to get ill, that it starts to take over your life. The signs it lists include constantly worrying about your health and frequently checking your body. They also include always asking for reassurance, worrying that doctors or tests have missed something, and obsessively looking up health information. For someone in that pattern, "get it looked at" makes matters worse, because the reassurance never lasts and the checking feeds the fear. Some people swing between the two. They avoid for months, then check frantically, then avoid again. If you recognise yourself here, a GP or the NHS talking therapies service can help, and the NHS page on health anxiety has self-help steps. The treatment involves doing less checking. More appointments won't help.

Lapses. You'll put something off again. A letter will sit on the side for a fortnight, or you'll notice something and hear the reasons and go along with them for a week. That doesn't mean you're back where you started. The old habit had a long head start. When you catch it, the rule applies from that moment. Book it today, and don't spend any time scolding yourself for the fortnight.

If someone you love is the one putting it off. You can't make the call for another adult, and nagging tends to harden the avoidance. What sometimes works is to make it easy and keep it kind. "Would it help if I sat with you while you rang?" "Shall I drive you?" You might also leave this book where they'll see it.