Over a number of consultations, I have shared my strategy for pain-free vaccinations. I sing Twinkle, Twinkle, Little Star and that totally distracts young and old.

So much so, that one elderly patient calls me ‘Painless Pam’, or ‘Painless’ for short. So that is the necessary background you need to fully appreciate the following story.

My patient, having chosen for me to monitor his PSA, had a slightly raised result. It could have waited until next year to be reviewed again, but if he had a palpable nodule, I would have referred him to the urologist immediately.

My patient wasn’t too enthused with the prospect of a PR exam.