Bowel charts are a thing of the devil. I hate even mentioning them. In fact, I won’t; let’s talk about blood glucose diaries instead.
A bunch of folk just like me, but sweeter, fill in a smattering of glucose columns whenever they can, missing a few days while getting on with their lives. They never bingo all eight sugar boxes on the one day, because they are normal, fallible human beings. They diarise to please their diabetic educator, who secretly knows that the patient eventually learns to write fiction and will merely go through the motions. Which brings us straight back to bowel charts.
Examining the motions is acceptable only in very isolated social groups: mainly microbiologists or dung beetles. Even then, it’s only ever someone else’s sh**. Describing your own waste products in any more than vague terms is, as I say, diabolical.
I have a middle-aged patient—let’s call her Julie: the name and gender have been changed to protect his identity. Actually, his real name is Julian. Julian is a hypochondriac with a comprehensive approach to health—all known diseases are divided into those he has had already and those still to come. Although he is essentially a good person, Julian owns a bowel chart. Unsatisfied with the date and time column, he devotes two thirds of his page to description. And, unlike my diabetics, this white space is never left unsullied.
“Food terms should only ever describe contents upon entry, not exit.”
I could almost handle reading hard, soft, hard. But egg-white mucus is pushing the relationship. Perhaps I should take this seriously (I put it down to too much pavlova), but I reckon food terms should only ever describe contents upon entry, not exit. The words custard and chocolate, Julian, have no place in the faecal lexicon.
Julian is an earnest, sincere man. Like many hypochondriacs, he is chronically lonely, having never married—the bowel chart wouldn’t have helped. I feel reluctant to deny him his anxiety pressure-release, yet my chart-reading role is psychological torture. An ethical dilemma. That’s when I thought of my medical student.
‘Julie,’ I said recently (that’s not her real name). ‘Julie, I’d like to know more about the next patient’s bowel habits. Take as long as you need and call me in when you’re finished. Completely finished.’
The Bristol stool chart pictorially displays a spectrum of seven stools, much like the seven wonders of the world. The pyramids are at the top (ouch), progressing to the splendid Colossus and ending with mud dripping off the Hanging Gardens of Babylon.
I paced guiltily outside the room, knowing Julie didn’t require a Bristol chart to apply meaning to Julian’s excreta any more than a psychic needs tea leaves. Julian the Elder emerged first, beaming, virtually whistling the Hallelujah chorus (coincidentally, the last of Handel’s 52 movements).
I cringed as Julie followed him, but she looked surprisingly serene. ‘He reminded me of my grandfather,’ she observed. ‘Nice enough.’
‘And his bowels?’
‘Normal,’ she snapped quickly. We never spoke of it again.
drjustincoleman 
Oh Justin, I feared there would come a day we didn’t see eye to eye on an issue… and today is that day. I never picked you as the squeamish type, or one to look a gift horse (or in this case, a gift chart) in the mouth (or, in this case, a different orifice).
The hypochondriac Julie/Julian’s of this world need something to obsess about and I’ve found that BSL, BP and bowel charts provide handy distractors. I would much rather be presented with a monthly chart of bowel motions to discuss than to deal with more nebulous tickets of entry such as vague dizziness or intermittent numbness.
I concur that reading faecal descriptors can be distasteful but not nearly as unpleasant as being presented with fresh samples in jam jars, or even photos of said bowel motion (camera phones have made gathering photographic evidence too easy and tempting for some). This is where the Bristol Stool Chart comes into its own. Far from being the work of the devil, it can be a saviour in disguise. For the uninitiated, in the Bristol stool form chart, a numerical value is assigned to each faecal type – from 1 to 7 – in ascending order of liquidity. There are pictures and descriptions of each type e.g. Type 1 – separate hard lumps, like nuts. Type 2 – sausage shaped but lumpy. And there are even child friendly descriptions. corn on the cob, chicken nuggets, porridge, gravy etc
All very gross, yes, but the beauty for the GP is that once your bowel-obsessed patient has become introduced to the chart, you are far less likely to get evocative descriptions at appointments. Instead, you’ll get more palatable reports, such as “I’ve definitely improved since I started the All Bran Challenge 26 days ago. Mostly “3’s” and even two “4’s”, together with immense gratitude for the provision of the Bristol Stool form guide. They love it!
A sure-fire way of dealing with the problem, in the absence of an eager med student.
And talking about bowels and bowel charts can be amusing.
There are some who will say poo jokes are in poor taste and just cheap fodder for the desperate comedian for whom sophisticated satire and word play is beyond reach, or whose erudite humour is not connecting with his/her audience. This may be true. But they always get a laugh, or at least a groan. I’m not proud of it, but my comedic attempts have been propped up by toilet humour now and then over the years. And I’m heartened to see that you too are not above using edible descriptions of faecal types in your writing, even if it only to (ostensibly) denounce them. Perhaps we see eye to eye on this after all. 🙂
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You haven’t lived until you’ve had a patient with delusional parasitosis with a positive matchbox sign.
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The Bristol Stool Tart: http://thepowerofpoop.com/wp/wp-content/uploads/2013/06/Bristol-Stool-Tart.jpg
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oh my lordy!!!
“The pyramids are at the top (ouch), progressing to the splendid Colossus and ending with mud dripping off the Hanging Gardens of Babylon…”
Nearly spat my mouthful of tea all over the computer screen!! love your work!
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Great blog you have herre
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