And they’re proud of it.
To be fair, you do need to make enormous personal sacrifices to reach the top in surgery, and brainless hectoring is one way of coping with a very stressful job Likewise, laughing at misfortune. When I asked a group of medical students whether it was possible to have a sick “salami surgery” sense of humour and be a good doctor, most not only agreed but declared it essential. As one put it; “All humour is laughing at misfortune, and if you’re surrounded by it every day you’re bound to laugh at it more than, say, someone who works in Thorntons.” “Surely if you work in a chocolate shop you see lots of unfortunate fat people?” “Yes, but they’re not going to buy your chocolates if you laugh at them, so you don’t do it At least not in front of them.”And there’s the rub. The students decided it was both ethical and practical to have prejudicial or disrespectful attitudes in the privacy of your own mess or coffee room in a “you’ve got to laugh or you’ll go under” sort of way, provided they don’t spill out in a consultation This, it appears, is where surgeons fall down. “Some of them say exactly the same things in public as they do in private.” “Isn’t that just refreshing honesty?” “Not when it causes so much distress. It’s as if they’re so powerful and unaccountable that theirs are the only feelings that matter.” Although in theory every patient has a right to a second opinion if a doctor upsets you, the practical reality is that it’s very difficult. Much more difficult than say, switching chocolate sellers – unless you’re prepared to pay.

I’m no great fan of private medicine, but it’s amazing what the promise of lucre does to a bedside manner. No one mentions salami surgery in the Balmoral Clinic.All this surgeon bashing is enough to make us GPs feel smug, but we’re not in the clear by any means, especially when it comes to obesity. After smoking, this is the biggest single cause of premature death in the UK, and much more besides. Overweight patients have lower self-esteem and more psychological problems than any other single patient group, including cancer sufferers. Many of them never go near a chocolate shop, and many eat no more than slim patients.

Yet virtually every obese patient I’ve met has had a doctor say to them at some stage “there were no fat people at Belsen”. This a typical arsey doctor’s way of saying “If you ate less, you’d lose weight” – which is undoubtedly true – but the message is lost in the gag and patients leave feeling more stigmatised than ever Alas, they rarely tell the doctor how upset they are. It took the Daily Mail to blow the whistle when a doctor told a woman that “nobody fat walked out of Auschwitz”, without realising she was Jewish.I recently met a woman who had conquered her obesity but said at the time how it took over her life “Every decision I made was coloured by my low self-esteem. I was buying a pair of shoes and the sales assistant asked me if I wanted some polish for them. She chose a shade I was certain was wrong, but I didn’t say anything because I’m sure she’d have thought “Silly fat cow, what does she know” – so I let her sell me the wrong one.” If over-weight patients can feel so threatened by shoe fitters, imagine what doctors do to them. The denial is massive, widespread and subtle.

Tell a friend that you’re starting to feel wobbly as you begin to approach your 50s and chances are, if she’s around the same age, she’ll say, “Oh, I feel fine.” Most women I know of my own age are on “the patch” and feeling in the pink. Women of my mother’s generation will say they can hardly remember a thing “One day the periods stopped, that was it. I remember the odd hot flush, nothing much else.”

For those of us not on HRT, however, the experience can be problematic Ghastly, even. But who’s telling? There seems to be a conspiracy of silence.

Or was.
A couple of weeks ago on a rainy Tuesday night, I saw an amazing sight at Edinburgh’s 1,000-seat Festival Theatre – a foyer packed almost exclusively with groups of women the wrong side of 40, chatting, giggling, generally having a good time.They had come to see a new play, Women on the Verge of HRT, written by the 40-something Belfast writer Marie Jones. And, according to Pam Brighton, the show’s director, the Edinburgh audience’s almost exclusively female bias repeated the pattern set during the original Irish run: “during weekdays, women coming out in groups, and at weekends with their husbands”.Women on the Verge is unashamedly populist, a comedy with songs and a steadily darkening undertow. For once, it is a West End play addressed directly, says its producer Jenny King, at “all those women whose voices have not had a chance to be heard before”. Middle-aged women and sex, after all, continue to be a source of some amusement. Only last week, the arrival in London of Sir Cliff’s Heathcliff caused one paper to smirk: `Phenomenon really is too weak a word to describe what happens to otherwise sensible, middle-aged women when Cliff Richard rolls into town. They scream, they shout, they spend all their savings on tickets and then when the show is over, they throw teddy bears at him.”Marie Jones – a bouncy, Belfast-born actress-writer who for 10 years was the scripting brains behind Charabanc, a Belfast-based women’s theatre company, and who now runs the North-South divide-straddling Dubbeljoint company (its name an allusive twinning of both Irish capitals) – would probably feel for Cliff’s fans. For her new play – a ribald riposte to the usual consigning of middle-aged women to sexual invisibility – uses as its trigger a real-life Irish equivalent of Sir Cliff – the Hibernian C&W star, Daniel O’Donnell.Now O’Donnell may not be a name that springs knowingly from Independent readers’ lips, but, to millions, he is the nearest thing to heaven.