As almost every Briton of the wartime generation will confirm, there’s only one correct way to answer the question: ‘How are you?’
No matter how lousy you feel, how agonising your arthritis or how vicious your hangover, the rule is that you have to reply: ‘I’m fine, thanks. How are you?’
Variations on the formula are acceptable. You can say you’re ‘blooming’, ‘in the pink’ or ‘never better’.
Or, if things are going seriously badly, you may just be able to get away with a ‘mustn’t grumble’ or ‘could be worse’.
Cancer Research UK has found that cultural factors may be partly to blame for Britain's shockingly poor cancer survival rates (Britain came joint bottom with Denmark) While the traditional British 'stiff upper lip' may in part be why we don't visit the doctor, it also may be because we fear lectures over our bad habits, such as smokingBut the great thing is to be positive, to betray not a trace of self-pity (except of the most drily humorous kind) and to keep that upper lip stiff at all times.
True, some who lived through the war observe this rule less strictly than others. In my family, as I may have mentioned before, we were always warned never to ask my great-uncle Pat how he was, because he’d still be telling us 20 minutes later about his bad back, wonky knee and the nasty twinge in the chest he’d suffered on his way to the Post Office.
But my stoical old mum was a more typical member of the breed. As she lay on her deathbed last year, she was suffering from a broken hip, acute jaundice, diabetes and inoperable bowel cancer, which had spread to her liver and bones.
Survival Early intervention: A study found people in Britain do not seek help for early symptoms of cancer because they are embarrassed or reluctant to waste their doctors' timeYet every time a doctor, nurse or member of the family asked her how she was feeling, she answered without fail (on the days when she could speak): ‘I’m very well, thank you. How are you?’
I thought immediately of her when I read this week’s finding that cultural factors may be partly to blame for Britain’s shockingly poor cancer survival rates.
In a study of more than 19,000 over-50s from six countries offering similar access to modern healthcare, Cancer Research UK sought to discover why Britain came joint bottom with Denmark for survival, behind Australia, Canada, Sweden and Norway.
Indeed, the disparities between the best and worst are startling, with only 30 per cent of patients with lung cancer surviving for a year in Britain, while in Sweden the figure is 44 per cent.
And one of the explanations, finds the survey, is that we Brits are far more reluctant than Swedes to visit our GPs with early symptoms.
‘A high proportion of people said that not wanting to waste the doctor’s time and embarrassment might stop them going to their GP with a symptom that might be serious,’ says Dr Lindsay Forbes, of King’s College, London.
Putting the most tactful possible construction on this national trait, she adds: ‘The traditional British stiff upper lip could be preventing people from seeing their doctor.’
Now, I haven’t the slightest doubt that this was true in my mother’s case. One of her guiding principles in life was that it was wrong to ‘make a fuss’ about even the worst that life could throw at her — and the idea of troubling the doctor with a silly thing like a spot of terminal cancer was anathema to her.
Indeed, the disease that was to kill her came to light only when she was carted off to hospital five years ago with two broken legs, after blacking out at the wheel of her car and driving into a wall.
Survival rates for many cancers are improving, but only when early detection through procedures like mammograms (pictured) are used, which requires Britons to visit their doctorsBut then my mother was born in 1927 and, as I say, stoicism like hers is far from unusual among those who lived through the horrors and privations of the war.
I just wonder if Dr Forbes isn’t being a mite too kind to the rest of us British over-50s, born after the war, when she suggests that we, too, are being kept away from our GPs by our stiff upper lips.
I’m not for one moment challenging the accuracy of her survey’s findings. No doubt almost four times as many Britons as Swedes do, indeed, claim we avoid seeking medical help because we’re worried about wasting the doctor’s time. My only question is: are we telling the truth?
Surgery More from Tom Utley... Never trust anyone who is certain about anything. Of that, I'm absolutely 100 per cent sure 30/05/13 Listen up, folks, this British snob has a confession to make. Americans speak better English than us... it's a no-brainer 23/05/13 What would my old village Bobby make of these swaggering RoboCops toting assault rifles that fire 750 rounds a minute? 16/05/13 Read one grumpy column by Tom Utley - and get next week's free: Or why I keep falling for devilishly ingenious supermarket offers that actually pick my pocket 09/05/13 I hate Nimbys... but I hate the new lean-to on my neighbours' patio even more! 18/04/13 A heartfelt letter to my grieving mother and Maggie's great unknown quality - her human kindness 11/04/13 Mr Osborne looks like a French aristo in a powdered wig. But that's no reason to put on this prolier than thou routine 04/04/13 Forgive me, but there is nothing David Miliband can teach me about feeling murderous rage towards your brother 28/03/13 Repeat after me: If 100 experts say it's wrong for children to learn by rote, they must all be nitwits 21/03/13 VIEW FULL ARCHIVESpeaking as someone who has troubled his doctor only four times in the past 44 years, all I can say is that the rarity of my visits has nothing whatever to do with fortitude or a stiff upper lip. Quite the opposite, in fact.
All right, one of the reasons is that I’ve been blessed with far better health than I deserve, as a heavy smoker and drinker with an aversion to exercise and a passion for red meat and double cream.
Another, as Dr Forbes suggests, is embarrassment at the thought of being poked about and having to discuss the workings of my innards with my GP (though I can’t for the life of me see what this has to do with a stiff upper lip).
But much more to the point, and above all else, what keeps me away from the surgery is my abject terror of doctors and what they might have to tell me. For if I’m riddled with cancer and heart disease, as I often suspect I may be, the very last thing I want is to know for sure.
I’ll always remember the first time in my adult life when I went to the doctor’s. This was when I was forced to undergo a medical for a new job. After a long series of humiliating tests, the doctor said that only one thing was worrying him.
As I braced myself for the worst, he asked: ‘Are you by any chance frightened of doctors?’I confessed that I was terrified.
‘Ah, that explains the sweating and the astonishingly high heart-rate,’ he said. And he signed off my clean bill of health.
Then there was the occasion, years later, when my wife could no longer bear my complaints that I was dying of chest pains.
She drove me to the surgery herself, and I plucked up all my courage to describe my symptoms. But before I could do so, I was made to fill in a form about my smoking and drinking habits.
hen the woman doctor read it, she gave me such a rocket that I took fright again. So when she finally asked me why I was there, I pretended it was because of the tiny, benign subcutaneous cyst I’ve had in my arm since childhood.
WorryShe told me, as I was perfectly aware, that it was nothing to worry about — and I fled from her surgery without so much as mentioning my chest (which, oddly enough, hasn’t given me a moment’s trouble from that day to this).
Which brings me to another reason why post-war Britons, including braver ones than I, may be more reluctant than Swedes or Australians to consult their doctors.
Could it be that, under our over-stretched NHS, visiting the doctor may be a less welcoming experience than in other countries?
The research, by Cancer Research UK, found the disparities between the best and worst countries are startling, with only 30 per cent of patients with lung cancer surviving for a year in Britain, while in Sweden the figure is 44 per centI’m not thinking only of the way patients are routinely kept waiting until after lunch to be seen for a 9am appointment — often without a word of apology when they finally reach the front of the queue.
Wonderful though so many doctors are, aren’t there a great many others who might offer kinder and more courteous treatment if their patients paid them directly, instead of through the tax system?
Indeed, I was astonished to hear this week that some GPs insist their patients raise no more than one health concern per appointment.
Yet I’ll never forget a doctor friend telling me one of the oldest sayings in the profession: ‘If a patient comes to me with a list of ten things wrong with him, it’s the 11th that he’s really worried about.’
So, yes, a stiff upper lip may still keep many of the wartime generation away from their doctors. But for huge numbers of the rest of us, cowardice and embarrassment are the main problems.
Wouldn’t it help if more doctors made an effort to be a little less forbidding?
