I once met a man who let his testicle swell to fifteen centimetres – larger than a grapefruit – because he was embarrassed at having a lump down below and, as it got bigger, he was worried that his GP would think he was an idiot for leaving it so long. It wasn’t until it really pressed on the nerve endings that he sought help. He survived his cancer but lost a testicle that might well have been saved if he’d come earlier.

Another man asked for a visit when the pain in his testicles was so severe he fainted. The pain had been excruciating for four hours, and he had a torsion on both sides – a twisting of the tissue that fixes the testicles in the scrotum. It can lead to irreversible damage if it isn’t swiftly untwisted under anaesthetic. His delay in asking for help was also down to embarrassment and he too lost a testicle. This cycle of delay caused by a recurring mixture of embarrassment, fear, stoicism and misplaced optimism is common throughout medicine. It causes huge suffering and occasionally death, and isn’t always easy to predict. Some patients may be ashamed at having a sexually transmitted infection or shy about revealing a breast lump or rectal bleeding. But embarrassment is a barrier in just about every chronic disease (epilepsy, asthma, diabetes), particularly if you’re overweight.

Dandruff, warts, halitosis, prominent ears, burst condoms, incontinence, dribbling, man boobs, excessive sweating, cotton buds stuck in the ear… just about any illness you care to name, someone has delayed getting help for fear of what the doctor or nurse might think of them

As one of my patients confided, ‘I’ve just let a shoe assistant sell me completely the wrong shade of polish. The mistake was obvious but I didn’t say anything because she’d just think, “silly fat cow, what does she know?”’ If overweight patients are too shy to buy shoeshine, imagine how hard they find it to access the NHS?