Medical War Zone

In 2000, I retired from the Royal Army Medical Corps. However, reading through this week’s medical journals, I had the distinct impression that I should be taking my uniform out of the mothballs; for it appears that a war is even now taking place; one that I am firmly embroiled in, whether I like it or not. The battle ground is the National Health Service, and it currently has several open fronts.

The most important issue is the saga of the Health and Social Care Bill, which at the time of writing has just entered the Lords for its final stage there. As readers of this column know, I originally voiced serious concerns at the content and intention of this Bill in one of my earliest columns back in 2010. At the time, I was one of the few who dared to break ranks and speak out against the Government’s plans. Many of my immediate colleagues were muttering behind closed doors, but few would pin their colours to the public mast of disquiet and dissent. However, I thought the public had a right to know what was going on. After all, the NHS is your service as well as mine and, if there are to be major changes which will adversely affect the way health services are made available and delivered to patients, then the public has a right to understand.

However, in recent months, the map of those organisations expressing foreboding and alarm at the content of the Bill has altered considerably. Despite a continued rhetoric from the Government that the medical profession is behind the plans, there is now clear evidence that the majority of the health care professions are against the Bill. Such organisations include the British Medical Association (BMA), Royal College of Nursing (RCN), Royal College of General Practitioners (RCGP), Royal College of Midwives, Royal College of Radiologists, UK Faculty of Public Health, Academy of Medical Royal Colleges, Royal College of Physicians, Royal College of Anaesthetists, and the Royal College of Surgeons. Many are calling for the Bill to be withdrawn completely, on the grounds that it will do irreparable damage to the NHS.

Of course, there has already been damage inflicted, despite the fact that the Bill has not been enacted. Even before the Bill had gone through the first stages, the Department of Health was re-organising the local Primary Care Trusts, with widespread redundancies taking place in anticipation of the Bill being passed by Parliament. These changes cannot be reversed even if the Bill now fails, as important people have been lost to the service; people with a vast experience of running the NHS. In my opinion, that in itself deserves a judicial review. It is a gross misuse of a government’s power when it brings about widespread fundamental changes well ahead of a Bill’s debate and enactment in law. It is political arrogance beyond belief.

As a distraction to the above, there is the less well-known roll out of a service called NHS 111. At its core, this is a good idea; a national number to ring when health assistance is required at times other than in an emergency (when telephoning 999 is appropriate). However, the pilots have raised serious concerns for patient safety. In all, there have been nine serious untoward incidents across four of the seven pilots, wherein potentially life-threatening delay has occurred in patients getting assistance. The view of the medical profession is that the service should not be rolled-out until it is safe. The Department of Health is, as usual, playing deaf.

Other battle-fronts include the intended abolition of practice boundaries, thereby increasing the pressure on over-stretched GP practices that already feel under siege. Then there is the significant reduction in funding for practices, a GP recruitment crisis with unfilled vacancies, the imminent GP Revalidation process, and the need to register practices with the Care Quality Commission. That is all before we mention the subject of pension fund changes.

A recent study found that four in ten GPs have emotional exhaustion, a sense of depersonalisation, negativity, and a reduced sense of accomplishment; in effect they are burnt-out. Sadly, that finding is not a surprise, but it should raise significant public concern.

(First published in the Scunthorpe Telegraph, Thursday, 16th February 2012)

Who Do You Think You Are?

‘Are you the poet?’

It was an interesting question; especially as it was posed towards the end of an entirely unrelated conversation. Well, it was towards the end of a medical consultation to be precise. I admit that it took me a little by surprise; not least because this heretofore unknown patient somehow knew that I write poetry. However, being something of a pedant, the question immediately raised further questions, particularly in respect to how I answered my inquisitor.

For example, the obvious difficulty for me was my patient’s use of the definite article. By using the word ‘the’, the implication was that there existed only one poet, which clearly wasn’t true if the question is taken in the context of the wider world of writing. However, to my knowledge, none of my medical colleagues in the surgery writes poetry, so the answer could be in the affirmative if that was the intended focus of the question.

The second conundrum was based on the concept of when is a person one thing as compared to another? For example, I think of myself as a doctor regardless of whether I am seeing patients or not. But am I a writer when I am not writing; or a poet when I am not physically writing poetry? Furthermore, can I be a doctor, a writer and a poet all at the same time? In our society, we tend to define ourselves and others by the person’s employment. So, for example, once a baker retires, he becomes ‘retired’; he is no longer a ‘baker’, and very rarely a ‘retired baker’. The fact that he is no longer baking tends (rightly or wrongly) to render the skill redundant when it comes to describing the person. So you can now see how such a small question can inadvertently lead me into a minefield of indecision in respect to giving a truthful answer.

Another question which now stumps me is ‘Where are you from?’ Until a few months ago, I would assume that the question was an enquiry into where I started life, in which case I would instantly reply that I am a Kentish Man. However, thanks to a research unit based in Cambridge University, I now have difficulty in answering even that seemingly innocuous question.

It is all Dr Peter Foster’s fault. He is the director of a research programme called Roots for Real (www.rootsforreal.com), which analyses a person’s mitochondrial DNA (mtDNA) and Y-chromosomal patterns and correlates the findings to a database linking modern-day man to the earliest of humans stepping out of Africa and, more specifically when, on their subsequent journey, their DNA mutated to its present-day form. The science is complex but fascinating, and I will leave you to read more on the website should you so wish. However, the upshot is that my Y-chromosomes (inherited through my father) originated 10,000 years ago from an area now known as northern Italy, at about the time of the last ice-age. As for my mtDNA (inherited through my mother’s maternal line), that is firmly centred on Crete and dates back some 40,000 years ago (yes, one of my great great etc. grandmothers knew Neanderthal Man). Furthermore, the same mtDNA has been identified in the remains purported to be those of the disciple, St Luke; thus making him a distant relative. St Luke, of course, was also a physician. So, when someone asks why I became a doctor, at least I can now honestly say that it is ‘in my genes’. However, it brings a whole new meaning to the question ‘who do you think you are?’ To answer honestly, I now need to know whether to take my reference from 52 years, 10,000 years or 40,000 years ago; for I now seem to be a Kentish Greco-Italian of an indeterminate age.

As for the original question, ‘are you the poet?’ I admit that I took the easy route. After a moment’s deliberation, I smiled and simply said ‘yes’.

(First published in the Scunthorpe Telegraph, Thursday, 9th February 2012)

Revisiting the Expert Patient

‘Generally, society deals with death in a near hysterical manner, viewing practically every death as a tragedy and bereavement as an illness requiring healing.’

Such is the view of Blair Robertson, an NHS chaplain (BMJ, 14 Jan 12). His words were interesting to read as, in the same week, I had taken the topic of dying as the subject for this column. Society’s response to death is hardly surprising when we read of the remarkable lives of people such as Professor Stephen Hawking, the famous cosmologist, and author of the best-seller, A Brief History of Time. Only one week previously an article appeared in the national press informing the world that Prof Hawking was too unwell to deliver his 70th birthday speech (Telegraph, 9th Jan 12). Of course, Prof Hawking is always too unwell to deliver any speech, owing to a condition called motor neurone disease. In reality, any speech he has is electronically composed letter by letter, and then delivered by him using his cheek muscles to operate a voice synthesiser.

Prof Hawking is a wonderful example of how people with long term conditions can still lead remarkable lives. The fact that he has even seen his 70th birthday is a modern-day miracle. Although we tend to use the verb ‘to suffer’ in order to describe the process of living with a chronic condition, Prof Hawking is an example of how people can lead fulfilling and enjoyable lives despite their condition. I am sure that suffering does come into the equation, but so too does a life of satisfaction and pleasure. The trick is to know how to turn around the perception of unavoidable misfortune and pull from life a positive outlook and a sense of well-being.

Last year, I wrote about a new course available in North Lincolnshire. At the time, NHS North Lincolnshire was looking for ‘Expert Patients’; volunteers to train to deliver the course known as the Expert Patient Programme. Now, having seen the satisfactory completion of the first course, patients wishing to participate in future courses are being asked to put their names forward. Delivered during one afternoon per week over a six week period, the course is aimed at people living with long-term conditions. Note that I use the term ‘living with’ rather than ‘suffering from’, for that is indeed what this course is aimed at bringing about. It teaches the skills of self-management and action planning, how to deal with pain and extreme tiredness, how to coping with feelings of depression, the skill of relaxation and how best to exercise, tips on healthy eating, the need for communication with family, friends and health professionals, and last but no means least, how to positively plan for the future.

Writing in the Times Literary Supplement in September last year, the writer and poet Hugo Williams described his reaction to his need for dialysis to treat his kidney failure. Given the choice of dialysing on a daily basis at home or visiting the hospital four days a week, Williams chose the latter on the grounds that it would offer him the chance to ‘pretend to be still in the old free world’. That was his way of trying to ‘live with’ his condition rather than allowing it to take over his entire life. I have no doubt that both Williams and Prof Hawking would fully approve of the Expert Patient Programme.

Christopher Hitchens is another writer who I am sure would have given his seal of approval to the course. Sadly, he died last December. However, true to his inimitable self, and in spite of various tubes and other paraphernalia attached to him, he insisted on being propped at his desk during his final days and finished writing an article just hours before his own ultimate deadline. Hitchens amply demonstrated Prof Hawking’s exhortation: ‘Remember to look up at the stars and not down at your feet. However difficult life may seem, there is always something you can do and succeed at; it matters that you just don’t give up.’

(First published in the Scunthorpe Telegraph, Thursday, 2nd February 2012)

Doctor on Patrol

As a doctor, one of the delights of living within a rural area is the strong sense of being part of that community. A large number of the local inhabitants know the doctor, and the doctor usually has a fairly good idea as to who you are, as well as often knowing your parents, children, cousins, aunts and so. A stroll up the High Street becomes punctuated by nods, smiles of acknowledgement, fleeting conversations and other casual greetings. A ‘big fish in a small pond’ perhaps, but in a world where we live in an increasingly large ‘global village’ it can be an enjoyable sense of belonging.

However, there is a downside to the local pseudo-celebrity status afforded the country doctor. If one is not careful, walking to a meeting with the local solicitor at his office becomes an al fresco surgery; a quick trip to the supermarket can turn the aisles into a gauntlet of patients ceasing the moment to quiz the doctor about their latest symptoms or acquaint him with the outcome of their hospital appointments; an evening with one’s wife at a restaurant can even be interrupted by enquiries about blood test results from diners or waiters who also happen to be patients. One memorable day, whilst standing in the queue at a bank, the chap in front started to inform me of the lump he had recently detected in his nether regions. His hands were quite graphic in illustrating the size and whereabouts of the problem; a display which attracted curious and amused attention from others in the bank. His opportunism was brought to an abrupt halt when I politely suggested that he could either drop his trousers and I would take a look there and then, or alternatively he could make an appointment to see me in the surgery.

However, all of this is about to change if the Department of Health gets its latest wish granted. The NHS Future Forum, a sort of health ‘think-tank’ for the government, has made the recommendation that all healthcare professionals should ‘make every contact count’ to promote health. According to the forum, doctors should miss no opportunity to quiz their patients about their lifestyle, advise them on their diets, and counsel them to reduce alcohol consumption, stop smoking, reduce weight and take more exercise; as if we haven’t already been doing that for years.

Nonetheless, according to the government, it should be the role of doctors to ‘make use of contact with patients wherever appropriate’. So, the table may be about to turn folks. If trying to consult your doctor in a public place is acceptable to you, no doubt you will not mind if we wave an admonishing finger as you enter the wines and spirit aisle, have a quick review of the contents of your trolley at the checkout, or make ‘tut tut’ noises when you order a particularly creamy, sugar laden pudding on your evening out for dinner. Perhaps larger medical practices could start local ‘community doctor patrols’, making the round of fish and chip shops and other takeaway outlets at lunchtimes. One can see the scenario now: ‘No, Mrs Smith, with your obesity, uncontrolled diabetes and high cholesterol you really shouldn’t be ordering that large portion of chips. Put it back and let me introduce you to the salad bar down the road.’ Like young boys in danger of being caught scrumping by the village policeman years ago, patients will start placing lookouts at the door of the cake shop, and furtive shouts of ‘Psst! Watch out, the doctor’s about!’ could become commonplace.

Alternatively, we could all agree to act reasonably and live in respectful and tolerant harmony with each other. As a doctor, I will keep my comments regarding your less healthy habits to the confines and privacy of my consulting room if, when we meet in the street, the shops, a restaurant or the bank, you promise to talk to me about anything other than the state of your arthritic knees, the quality of your phlegm and the difficulty with your bowels. Paraphrasing Ecclesiastes (chp.3), there is a time and place for everything, despite what the government says.

(First published in the Scunthorpe Telegraph, Thursday, 26th January 2012)

Ars Moriendi

Ars Moriendi (The Art of Dying) was a medieval book first published around 1415. The author was an unknown Dominican friar, who subsequently became a bestseller for some 200 years. The book gave the lay person instruction in respect to understanding death, how to prepare for it, and how to think and behave at the time of death (whether yours or someone else’s).

‘I have often seen the most difficult cases make a beautiful death’, said the priest in Brideshead Revisited. Evelyn Waugh’s novel of the same name as its later ITV adaptation by John Mortimer gives considerable time to the build-up, preparations for, and subsequent death of Lord Marchmain. The scenes are tender and peaceful, with humour interlaced with religious angst, and ultimately contain a deep poignancy. The messages contained therein are not necessarily for everyone, although it does demonstrate one way to prepare well for death.

Nonetheless, not all of us can have a Chinese drawing room, an antique and regal four-poster bed, an army of servants and a coterie of aristocratic attendants to assist us from this world. Happily, we can still hope to have ‘a beautiful death’, whether it be in the Roman Catholic sense of finding ultimate Grace, or overtly atheistic. For most people in the modern century, death does not come suddenly. In a 2010 essay published in the New Yorker, the author Gawande quotes a doctor working in an American intensive care unit as saying ‘I am running a warehouse for the dying’. For many people death is now, up to the ultimate point, a medically controlled process.

The 16th century philosopher, Francis Bacon, argued that the purpose of medicine was to preserve health, cure disease, and prolong life. The concept of controlling the ultimate process of dying in order to render the inevitable a peaceful and painless process (both physically and psychologically) is, I believe, something to which Bacon would not have demurred. However, he might have been less impressed with the recent publication of the report by the Commission on Assisted Dying, wherein the current laws regarding assisted suicide are debated and challenged.

Many readers will be familiar with the Dignitas Clinic in Switzerland where, in the last few years, 76 Britons are known to have ended their lives. There is sadness in the fact that a few feel forced to travel to a foreign country to die in unfamiliar surroundings and away from family and friends. It is therefore understandable that there is a call for a change in the English law in order to legally allow assisted suicide in Britain. Nevertheless, desirable though such a debate may be for some, it is not a debate many doctors feel ethically or morally able to participate in. Indeed, the British Medical Association refused to attend the Commission’s hearings. Some would argue that doctors should be involved in the debate. However, many feel that would, de facto, give credence to the topic. Medicine may be many things to many people, but most doctors did not train to kill people or assist them in killing themselves; preventing suffering whilst letting nature take its course is a very different process to that which the Commission is now publicly debating. It is a debate which is beyond a ‘right to die’, for we all have no choice in that matter. The difficulties for doctors are manifold and multiple, including the question of how to tell when someone has less than a year to live, and how to be sure of a patient’s true capacity to make such irreversible decisions when depression, fear of the unknown, and family and social pressures may also have an influence in their decision making?

‘Oh build your ship of death, Oh build it! For you will need it. For the voyage of oblivion awaits you’, wrote D. H. Lawrence. Quite so; preparing mentally and physically for death is to be commended and encouraged. Knowledge of the existence of death encourages us to delight in living and savour each waking moment. ‘I’m alive; it’s all that matters,’ were the words of a terminally ill friend. Doctors should be helping people to live with their illness, not to die. We change the law to the ultimate risk of us all.

(First published in the Scunthorpe Telegraph, Thursday 19 January 2012.)

An Open Apology to India's Kinsfolk

It is a sad but astonishing fact that a seemingly harmless comment can escalate to something far more than was ever intended. Nonetheless, that is precisely what happened to me this week, with the end result that I have inadvertently offended many people, when I would not have dreamt of deliberately causing offence. It is therefore that I now use this blog to issue an open public apology to anyone sleighted by my comments.

The punishment for me has been the accusation that I am racist, when I am truely nothing of the kind; a statement I am absolutely sure that everyone (of any nationality) who knows me would have no hesitation in supporting, and which other articles of mine would bear testimony to.

Perhaps I may be permitted a few lines to place in perspective and try to explain what I said and meant.

Last week, The Times of India (5th Feb 2012) published an article quoting Mr Pranab Mukherjee as saying in the Rajya Sabha that India did not need British aid, stating that the money was 'peanuts'. This was further reported in the British press as being forced onto India by the UK Government, as the latter was desperate to win a fighter jet contract from India; a contract that has, of course, since gone to France.

Understandably, there are many in the UK who cannot understand why our Government persists in giving such aid, when the Indian Government has rejected it; especially when the UK economy is in a perilous situation, and many of us are being taxed to a very high level in order to assist the UK's recovery. As an example, see today's Sunday Telegraph: http://www.telegraph.co.uk/comment/letters/9075195/India-should-no-longer-qualify-to-receive-British-foreign-aid.html

When I read the comments from Mr Mukherjee, I placed a comment on Twitter which said something along the lines of 'India rejects UK aid. Good. Please now reduce my tax so that I can spend it in the UK'. This was sent by me via Twitter to the Downing Street Twitter site. The thrust of this was not meant as an insult to India, but a call on the UK Government to stop mistakenly spending our tax where it was not needed or wanted, and to allow us to personally start having a little surplus to spend in the UK and assist our own economy.

However, several readers misunderstood my stance and made various comments to which I attempted to reply within the confines of short Twitter messages. The points I tried to make were:

i. That if India didn't require UK aid, then we shouldn't be trying to force that aid onto India. To do so is insulting to India.

ii. That to try and manipulate India by the giving of aid in the hope of acquiring the Tornado contract was in itself offensive, and suggested that the UK government was acting in some 'pseudo-colonial manner'.

iii. I also pointed out that many respected people within India were on public record as saying that the provision of aid was undermining attempts at bringing real reform to attitudes within India amongst the wealthier classes, and that what was really needed is for the wealthier Indians to start suporting the poorer members of Indian society, as happens in other wealthy nations. This is on the back of India becoming an increasingly prosperous country, with a Gross Domestic Product expected to exceed that of the UK within the next few years.

So, what I was trying to do through Twitter was reiterate what was already a view being expressed within the Indian Government and by various Indian people. None of those comments were meant to be offensive to India in any way whatsoever, and it was therefore to my great dismay that they were perceived to be so.

Having realised that my words were being misunderstood, I immediately removed them from my Twitter site, so as not to inadvertently cause more distress. However, it is my understanding that they have since been repeated in Indian blogs. Of course, I have no way of knowing how I am quoted, and whether my comments have been altered. Neither, am I able to directly respond to those sites as I do not know where they are. Hence, I am presenting this article in the hope that those who have felt offended might now better understand the context of what I was saying, and be reassured that I truely did not mean any offence to India or its people.

I have had the pleasure and privilege of travelling in India, and have nothing but admiration for the beauty and history of the country. I also have the pleasure of working on a daily basis with many colleagues who were either born in India or are of Indian descent. They are respected colleagues who I treat as nothing less than equals. I can therefore only repeat now, as clearly as possible, my apology to anyone who I inadvertently caused offence, and hope that they will direct others similarly offended to this article in the hope that they too will understand that I meant no ill.

Yours with respect and in peace.

Thought for the Day

"If I don't write to empty my mind, I go mad."

Lord Byron

Training to go Through the Keyhole

I am not usually a competitive person, at least not in respect to other people; although I do constantly compete within myself, striving to attain new goals and improve personal standards. However, my sense of isolated self-confidence took a thorough beating over the course of the New Year weekend. Indeed, ‘beating’ is probably not the correct word; I was, without an iota of doubt, comprehensively thrashed.

Finding myself in the position of ‘opponent’ for a game of glorified skittles, and then watching shamefaced as my challenger scored one ‘strike’ after another compared to my own one or two pins, was a humbling experience. The completion of my ignominious defeat was a round of golf, wherein I bounced from one bunker to another (when I wasn’t in the rough or hitting trees), whilst my competitor took hole after hole for a double-bogey (that’s two over par for the uninitiated). The problem was that I have never really mastered the art of ten-pin bowling or golf. Indeed, I have never previously played golf; the nearest I have been to a tee being a romp in the rough as a teenager (trying to find lost balls to turn into cash), and the occasional quick dash across a green as an adult, whilst negotiating an awkwardly placed public footpath.

There is worse to come, for I have more terrible confessions to make than the above. Not only was my opponent female (if you will allow me to be sexist in defeat), but she was considerably younger than my five decades. Indeed, she hadn’t quite reached her first decade. Oh, okay, I confess it; she was only four years old. There, I am totally chastened now; my morale has well and truly sunk below the horizon. I was decisively beaten by a debutante from a kindergarten.

By now you may well have guessed that all may not be what it seems. In truth, we were playing with games on a Nintendo Wii, with a television screen being the nearest we got to a bowling alley or the big outdoors. ‘Shame’, I hear you cry. However, before you castigate me for encouraging a child to waste valuable development time in front of a television screen, allow me to offer you the following for consideration.

In my daytime profession of medicine, the technical skills required in an operating theatre have changed beyond all recognition. Minimally invasive (keyhole) surgery has been one of the most radical changes since I qualified. No longer is there a need to operate through large open wounds for many procedures; including unblocking coronary arteries, repairing torn knee ligaments, removing gall-bladders, or taking a peek inside a bladder or the bowel. Instead, the surgeon often stares at a television screen whilst manipulating various gadgets, the ends of which have disappeared down small holes in the patient. Often life-saving miracles are seemingly performed by remote control.

The skills required to perform such procedures are feats of dexterity; dexterity which I clearly lacked whilst trying to salvage my ego from the skilful attack of a four-year old. The real problem for me is that I became an adult when such computerised games were in their infancy, and I have never made up for that short-coming. By comparison, today’s children are masters of such technology. Whilst I am the first to agree that children should regularly get outside in the fresh air for a spot of healthy exercise, I also have no doubt that they should be allowed to spend time in front of televisions and computer screens, playing entertaining computerised games. At such times, what they are really doing is learning valuable skills of dexterity and spatial awareness which may serve them very well in their professional adult lives. Achieving a balance between the two extremes is important, but I suggest that computer games are not necessarily the childhood evil they are often painted to be.

As for my four-year-old opponent, after the game of golf she went off to play with her toy doctor’s trolley. Who knows, perhaps I have just been witnessing a future brain-surgeon in the making.

(First published in the Scunthorpe Telegraph, Thursday, 12th January 2012)

Men's Talk

Whilst the Christmas festivities are still in our minds, I thought we would start January with one of those cracker-style questions. What do the Book of Psalms, Sir David Frost, the European Commission, Loyd Grossman, the Irish Republic, the Chancellor of the Exchequer, and His Royal Highness the Duke of Edinburgh have in common?

The comedians amongst you will think of all sorts of answers. However, this particular quiz question has a serious message, especially if you are a man. (Ignore the female reader who just remarked that all men are jokes, and keep reading for the important bits).

As we have just had an important religious festivity (that might come as a surprise, but we’ll not go there today), I will start with the Book of Psalms from the Bible’s Old Testament. ‘But ye shall die like men’, reads verse 6 of Psalm 82. I doubt whether the writer of that particular psalm had the concept of 21st century public health in his mind. However, unknown to the author, it was a prescient statement with great modern-day significance.

But back to the quiz; have you got the answer yet? Perhaps Loyd Grossman can help. Grossman was the location presenter of the 1980’s TV game ‘Through the Keyhole’, hosted by Sir David Frost. One of his catch phrases, as viewers were about to be shown around a celebrity’s house, was ‘let’s go through the keyhole’. Ah, I can hear the penny dropping. Yes, you are quite right; the Duke of Edinburgh has recently undergone cardiac surgery; being the recipient of a minimally invasive technique, commonly called ‘key-hole surgery’. (Yes, I know the links are a bit corny, but I did liken this article to the standard found in Christmas crackers.)

So that leaves us with the European Commission, the Republic of Ireland and the Chancellor of the Exchequer to pull into the conundrum. Since you have done so well by reading up to this point, I will quickly quell your mounting sense of suspense. Towards the end of 2011, The European Commission published a report called ‘The State of Men’s Health in Europe’. Apparently, of all the European countries, the Republic of Ireland is the only member which has a national men’s health policy; all the rest treat men the same as women and children. Unfortunately, a ‘one size fits all’ approach doesn’t do men any favours, as working age men have significantly higher death rates than working age women (210% higher, in fact; not quite what the psalmist had in mind, but he was right, nonetheless).

Flawed life-styles are not the only reason for men’s greater mortality rates; although smoking, obesity, high-fat diets, excess alcohol and a lack of exercise are important causes of coronary heart disease. Road and workplace accidents are also significant issues. The fact that men do not make best use of health services and health-related programmes as much as women is also a contributory factor. (A good example is the fact that only 42% of patients participate in cardiac rehabilitation after a heart attack, bypass surgery or angioplasty; although I am afraid that Prince Philip’s example of attending a shooting-party lunch does not count as cardiac rehabilitation).

Finally, why should the Chancellor of the Exchequer be concerned about all of the above? Well, it is estimated that by 2060, there will be 24 million fewer working age men across Europe. That is a lot of lost tax revenue. There will also be 32 million more men (mainly not working) over the age of 65 years; a fact that should exercise both the Chancellor and the Secretary of State for Health. Perhaps we should be lobbying our MPs for a ‘men’s health policy’, rather than let the Government spend valuable resources on re-arranging the deckchairs on the Good Ship NHS. ‘Equality for Men!’ – now, there is a good slogan for 2012. As for me, I think I might pop over to the Irish Republic for a spot of masculine pampering.

(First published in the Scunthorpe Telegraph, Thursday, 5th January 2012)

New Year Expectations

‘Be not inhospitable to strangers, lest they be angels in disguise.’

The latter was not written by W. B. Yeats (as is commonly quoted), but can be found in the book of Hebrews (13.2). It seems a good New Year resolution for us all to adopt, for wouldn’t the world be a greater place? However, a less sanguine approach will be taken by many, with the realisation that we have yet to resolve the financial difficulties that have recently beset us. A line genuinely by Yeats, from his poem Easter 1916, is more appropriate to the straitened times we continue to face: ‘All changed, changed utterly: A terrible beauty is born.’

I suggest that the beauty in this case could come with the growing need to increasingly draw on our own resources for food and entertainment, as money and jobs become scarcer. Growing your own fruit and vegetables is a remarkably healthy activity, with fresh air and exercise providing physical and mental well-being, combined with fresh food and a reduced grocery bill. Home-grown entertainment provides another mental boost, such as the company of friends around a table of home-cooked food, digging out those old board games, or re-discovering a good book that has languished untouched on a shelf for years. In the year of Charles Dickens’ 200th anniversary, perhaps re-reading one of his would be a good place to start for mental nourishment (for the New Year, what better than Great Expectations?).

You may have other New Year resolutions such as losing weight, exercising more, stopping smoking, drinking less alcohol, reducing cholesterol, and so on; all good worthy aims. However, why not add to those one or two other issues that you would like to see society confront as a whole? New Year should not be just about tackling personal issues. If society was made a better and healthier place, so too would be our own lives by default.

For example, just consider some of the problems society is currently facing. Eleven million people alive today will live to see their 100th birthday (almost 18% of the population), meaning that the pension crisis is only in its infancy. The concomitant reduction in the social care budget for elderly care only compounds the difficulties our elderly are already facing. At the other end of the spectrum, there is a global shortage of midwives (including in the UK), costing a million lives per year in infant and maternal deaths; whilst our own under-age pregnancy rate continues to rise, as does the rate of sexually transmitted disease amongst teenage girls. Of course, alcohol remains part of the problem; additionally causing injuries, relationship breakdowns and loss of working time.

Elsewhere, a lack of donor organs for transplantation sees precious (often young) lives needlessly lost; whilst the medico-legal world struggles with the issues of voluntary euthanasia and the use of organs harvested as a result. In Britain alone, tens of thousands of children wait for families to adopt them, as their formative years disappear, often amidst peripatetic lives of one foster home after another. Meanwhile, the bedrock of our caring society, the National Health Service, is under very real threat, as is our traditional approach to General Practice as the centre of that service. And if that is not sufficient, the very core values that often drive individuals within caring professions are being demonised and extruded from the workplace; I speak of those values deeply rooted in a person’s faith, be it Christianity, Islam, Judaism, Buddhism or any other where the fundamental teaching and beliefs, when appropriately harnessed, can be a powerful aid to all in our society.

New Year is about resolutions, change and fresh starts. Exercise more and stop smoking by all means (in fact, please do). However, what about making 2012 the year when you resolve to make a small contribution to at least one of the many other challenges facing our worldwide society? After all, major successes all start with small steps.

A happy, healthy and thoughtful New Year to you all.

(First published in the Scunthorpe Telegraph, Thursday, 29th December 2012.)

Power of Positive Thinking

‘I am very well, thank you. If I was any better, I wouldn’t be able to cope.’

There cannot be many doctors who have been greeted by such an enthusiastic response when enquiring of a patient’s state of health. However, it was a delight to hear, and said much for the frame of mind of the patient. I imagine he generally has an optimistic outlook on life, requiring some considerable misfortune before his solid sense of well-being is shaken.

There is no doubt that psychologically having a glass that is half-full rather than half-empty is beneficial on the way our bodies cope with the stresses of life. Numerous accounts have demonstrated over time how some individuals have survived extremely unpleasant situations, which would prove to be the ultimate test of courage for most people. Terry Waite’s experience of being a hostage in Iran in the 1980s is an example that figures prominently in my own memory; and there have been many other similar stories since. One can add to that many wartime heroes, as well as those who have been tested to their physical limits by personal accidents (think of the Chilean coal miners, for example).

Positive thinking has the power to drive you to health (boosts immunity), happiness (banishes depression and anxiety) and success (motivates and empowers); whatever the odds against you may be. It has the ability to change your life for the better. It is a mental attitude that expects nothing but good to come of any situation, however difficult or dire the experience may be. It is almost a case of ‘believe in it, and it will happen’.

For example, how often does someone greet you by complaining about the weather? Last week, I had several people gloomily comment about how cold it has become. No surprises there; after all it is winter. However, looking on the bright side, the temperature was still in double figures in early December and it was sunny; a considerable improvement on the same time last year when we were struggling with ice and snow. I would say that is a good reason to be glad and rejoice.

Even ill-health and impending death can be fought with courage and a positive outlook. I have previously commented on an old friend who, weeks before he died, replied to my enquiry as to how he was by saying ‘I’m alive; it’s all that matters’. Last week I had the need to attend two funerals; one of a young cousin, and the second of a well-known local farmer. Both men showed courage in the face of adversity. At a time when he could not walk unaided, the farmer refused to give in to his increasing frailty by insisting that his grandson hoist him on a fork-lift so that he could change a light bulb in a barn. My cousin fortified himself for his death by stating that he was ‘looking forward to seeing Heaven’. Both men were dignified and positive in their response to an otherwise very negative situation in life.

A few weeks ago I had great pleasure in presenting an award for Outstanding Achievement in Acting to a member of the Duck Egg Theatre Company. The successful actress confesses on her Twitter site that she is ‘over-enthusiastic’. On the contrary, young lady; it is your enthusiasm that has helped to make you what you are; a rising star. What we need is a bit more enthusiasm from everyone, not less of it.

(First published in the Scunthorpe Telegraph, Thursday 15th December 2011)

Repetition, Repetition, Repetition

Repetition, repetition, repetition…

It was a mantra drummed into me by one music master after another. Although whilst at school I found the process of making music to be pleasurable, the requirement for constant practice was not quite so enthralling. With the impetuosity of youth, I was keen to move to the next bar, the next page, the next piece of music, even the next instrument.

Forty years later, my attitude has changed. Now, the drive to capture every nuance of sentiment from each musical phrase is a powerful force; an irresistible compulsion; an absolute obsession. Yes, playing musical instruments feeds my obsessive-compulsive disorder to a level of sheer gluttony.

However, there is a downside to the above. Whilst the end product is often worthy of an audience, the process of rehearsal frequently drives my wife mad as she is subjected to the same phrase of music over and over again. It wouldn’t be so bad for her if I was confined to the piano; but when the saxophones follow on, and then perhaps some classical guitar, and maybe a quick blow on the clarinet for an encore, well it is sometimes a wonder that I am still alive, let alone married.

The plus side is that playing music keeps me healthy and fit. Research has demonstrated that playing a musical instrument increases the ability to memorise new information, improves the ability to reason and problem-solve, enhances time-management and organisational skills, fosters a team-spirit, develops mathematical skills, acts as physical exercise (good exercise for arthritic joints), develops lung capacity (wind instruments are good for asthmatics), cultivates self-expression, discipline, pride, concentration, communication skills, and acts as a relaxant and an anti-depressant.

Music has lasting health benefits for all ages. Even just listening to music can, in addition to some of the above, reduce blood pressure and the severity of pain, reduce the effects of loneliness and depression, and help prevent or ease the effects of dementia. Recently, it was demonstrated that listening to classical music whilst driving can decrease the chance of an accident.

For readers in their later years who didn’t have a musical education, do not despair; it is never too late. You may never become a virtuoso, but your brain will benefit nonetheless. Even an older brain has the ability to change in a positive way, developing new connections, new circuitry and new levels of neurotransmitters.

The downside is that you might get to the stage where you drive yourself mad with the enthusiastic repetition of it all. The theme tune to Downton Abbey was recently my nemesis. There was a day last week when, after a weekend of piano practice, I just could not shake the tune out of my mind. Every time I set foot in a corridor, ventured up the street, or turned the car onto a road, the mesmerizing, repetitive beat of the music flooded my brain and set the rhythm of my movement. At one stage, it got so bad that I was imagining a yellow Labrador walking by my side. The ultimate cure was to sit down and start on another piece of music (the Labrador has gone, but Nellie the Elephant is proving harder to displace).

Of course, having an enthusiasm to learn means that selecting presents for me is easy; just think of an instrument I haven’t got and I will be delighted. That said, my wife wasn’t quite so pleased when she saw the letter I sent to Lapland…’Dear Santa, all I want for Christmas is a drum kit…’

(First published in the Scunthorpe Telegraph, Thursday, 8th December 2011)

A Medical Miscellany

Christmas: a strange occasion when time seems to slow whilst people enjoy a few days of enforced relaxation and normal routines are put on hold. For some (including myself) it can induce a mild anxiety. Being used to a life-style that is frenetic, I greet the Christmas break with trepidation. The unease comes from the sudden indecision as to what to do with days free from packed surgeries, medical meetings and deadlines. It seems an opportunity too good to waste on relaxation. With all those hours to fill with something of personal interest, letting them seep through my fingers with nothing to remember but too much food, drink, television, party games and company…well, yes ok I admit it, bah humbug!

Nonetheless, I usually manage to rescue myself from the horrors of compulsory socialisation by diving into the calming pages of a good book. With any luck, Father Christmas will have squeezed the odd tome or two down the chimney, and I can pretend to be entering the Christmas spirit by playing with my favourite presents. As books are my favourite presents (closely followed by malt whisky, in case anyone is interested), such a ploy means escaping into a different world altogether (clever, eh?).

So what might a doctor read at Christmas? We all vary of course. However, one section of my library reads like a collection of the medical ghosts of Christmas Past, with each book reminiscent of a different year. Dr Zhivago by Boris Pasternak is one of my all-time favourites; a heady mix of dashing doctor and anguished poet, with a lashing of passion thrown in. Does that remind you of anyone? Well, one can dream.

Another firm favourite is The Story of San Michele by Axel Munthe; the classic and absorbing memoir of a 19th century Swedish doctor who, via the high society of Paris, built a villa on the island of Anacapri. A.J. Cronin’s The Citadel is another classical ‘must’; whilst Ask Sir James by Michaela Reid is a fascinating tale of Queen Victoria’s physician. Will Pickles of Wensleydale, by John Pemberton, returns us to the ordinary with the story of a GP from North Yorkshire whose research helped in understanding the spread of infectious disease, and who was a founder of the Royal College of General Practitioners.

Patrick Devlin adds some intrigue in Easing the Passing, as he relates his account of being the judge at the 1957 trial of Dr John Bodkin Adams, a forerunner of Dr Shipman. Alternatively, John Berger’s A Fortunate Man is another classic story of a country doctor; or there is always A Ring at the Door, providing the personal experiences of George Sava, a Harley Street surgeon of the 1930s.

Reminiscent of one of my recent columns is a 1953 book entitled A Doctor Heals by Faith, by Christopher Woodward; not that I could let the General Medical Council know that I have been reading that one. The Doctor by Isabel Cameron is in a similar league, albeit fictitious, and featuring a Doctor of Divinity rather than medicine. The book, a Scottish classic in the early 1900s, sold 240,000 copies.

For those with a military interest, The Red and Green Life Machine by Rick Jolly is a Royal Navy surgeon’s absorbing account of the bravery of medical personnel in a field hospital during the Falklands War. Finally, and to balance the last, no reading list should be without some humour, and Richard Gordon provides just that with his Doctor in the House series of uproariously funny tales from the wards.

I could go on (as indeed does my collection of medical literary miscellanea). However, I am sure you have mistletoe to hang and presents to wrap. Speaking of which, I can see a least one book-shaped parcel with my name on, alongside something that could easily be a bottle of malt whisky. I think I’ll just position them next to this armchair in preparation. With that, a very happy and healthy Christmas to you all.

(First published in the Scunthorpe Telegraph, Thursday, 22nd December 2011)

In Praise of Eccentricity

‘Where have all the flowers gone?’

It was a question posed to a crowded lecture hall of final year medical students twenty-six years ago by a much respected consultant physician and lecturer at the Charing Cross Hospital Medical School, London. His name was Dr P B S Fowler, although I think that is where any tenuous personal connection ended. As we were about to set forth into the world of medicine as fully fledged doctors, Bruce Fowler was about to retire from the NHS. A huge man, who always wore an academic’s black gown when addressing the students, he was an entertaining lecturer and could fill an auditorium to over-capacity regardless of the subject of his lecture. On this particular occasion he took as his theme the demise of doctors with individual characters, lamenting the modern trend for medical schools to manipulate new undergraduates into identical clones. Those who initially showed promising signs of individuality were systematically humiliated by the teaching methods of the day, until they succumbed to a life constrained by the need to conform to the rules of professional conduct.

Of course, Britain has always been a country of eccentrics; possibly containing far more per head of population than many larger countries. The history books are full of them. Relating to behaviour considered to be unusual or odd, eccentricity is often found in the company of the artistically creative and the intellectual, and frequently invokes the concepts of genius and madness; as Mr Pickwick remarked in Charles Dickens’ Pickwick Papers, ‘Eccentricities of Genius, Sam’. This failure to conform to society’s norm is one often loved and admired from a distance, but can be quite disturbing to close members of the family. A former patient of mine was a man of great character, quite unconcerned by the community’s occasional disapproval of his behaviour to the point of being a local eccentric. I praised his individuality to his son one day, whose reply was illuminating: ‘Characters are wonderful people, as long as you don’t have to live with them’. Having an eccentric in my own family, I found myself warming to his words.

So what makes someone an eccentric? In a 1995 study of ‘sanity and strangeness’, Dr David Weeks and Jamie James concluded that the principal characteristics an eccentric possesses are: non-conformity, creativity, being motivated by curiosity, idealism, an obsession with one or more hobbyhorses, an awareness from early childhood of being different, higher than average intelligence, a tendency to be opinionated and outspoken, a love of solitude, and a mischievous sense of humour. Do you know anybody like that? I suspect that younger readers are more likely to say yes, as eccentrics are nearly always older than ourselves, and of course we never recognise eccentricity in our own behaviour; after all, for an eccentric it is the rest of society who has got it all wrong.

I was reminded of Bruce Fowler’s lecture recently by a wonderful coincidence of timing. Sadly, in August this year he died, albeit at the age of 90. His obituary appeared in the BMJ on the 29th October. It just so happened that the Ancient Order of Eccentrics was reformed on the very same day, with eccentric guests travelling from all over the British Isles to attend a banquet in Lincoln. First founded over two centuries ago, the Eccentric Club exists to celebrate ‘Great British eccentrics and original thinking, flying in the face of the bland modern world’. I am sure that Dr P B S Fowler would be overjoyed to know that the flowers he once lamented are in fact alive and blooming in the 21st century. If only I was an eccentric, I would be tempted to become a member.

(First published in the Scunthorpe Telegraph, Thursday 24th November 2011.)

Fiction Today, Reality Tomorrow?

How many readers remember the television programme ‘Tomorrow’s World’? The presenters’ mantra on this forward looking weekly survey of the cutting edge of scientific development could almost have been ‘today’s science fiction is tomorrow’s reality’. In many cases that has indeed been the case, especially if you consider the modern technology behind mobile telephones, computers, satellite navigation, the ability to carry around hundreds of books on a Kindle, MP3 players that can store an entire music collection, cloning Dolly the sheep, the space shuttle, micro-surgery, and so.

Such thoughts recently took my mind back to a book I read when I was fifteen years old. It was called ‘Colossus’ by D.F. Jones. Published in 1966, the book was hailed as a ‘horrifying instalment of the man versus machine competition’ by the New York Times, and ‘hellishly plausible’ by the Sun. Colossus was about man creating the ultimate machine; a computer (as we would now call it) about the size of a large room, which took on its own personality and assumed responsibility for the defence of the free world. It was captivating stuff for a teenager in a pre-computer era; so much so that I still have the aged paperback in my library.

I was recently reminded about Colossus when two separate headlines caught my attention and connected my thoughts to a column I wrote last year, when I invited you all to my 120th birthday party in 2080 (Scunthorpe Telegraph, 20 Oct 10). The first headline was ‘Breakthrough brings human cloning a step closer’ (The Daily Telegraph, 6 Oct 11); the second was ‘by 2040 you will be able to upload your brain…’ (The Independent, 7 Oct 11). Ah! I can almost hear the penny dropping with your realisation as to where this preamble is taking us…

Suspend your disbelief (and possibly your cerebral discomfort) for a moment and consider this: scientists have developed a technique called somatic cell nuclear transfer, whereby they take the nucleus from a cell of a piece of human skin and transfer it to an egg cell. A wave of a magic pipette later and you have an embryo; and in theory, just like acorns and oak trees, from little embryos big people could grow. Now, needless to say, various international ethical committees are not about to allow some mad scientist to grow a real-life soft-tissue version of Frankenstein’s monster; nonetheless, the whiff of the possibility of replicating your own body is there on the borders between today’s scientific fiction and tomorrow’s reality.

However, what use is a personalised clone if it doesn’t really think like you? Well, a scientist called Ray Kurzwell may have the solution. He believes that by the end of the 1930s we will have the ability to upload the entire contents of the human brain to a computer; thereby salvaging, in Kurzwell’s words, ‘a person’s entire personality, memory, skills and history’. Kurzwell is internationally respected by senior scientific figures and his work is taken very seriously. Whether that uploaded personalised database is then installed into a mechanical android or a real-life soft-tissue clone, the fact is the end result is as near to immortality as our present mortal frames will ever get.

Now, returning to my stated intention of living to 120, I will be eighty in 2040; just about the right time to take on a youthful transformation for my second innings, therefore I shall be making contact with Kurzwell in the near future to book my place at the front of the queue. So, to all those of you who diligently saved my column from the Scunthorpe Telegraph of the 20 October 2010 as proof of your invitation to my 120th birthday party (and I know for a fact that some of you have done so), well done and I will see you in January 2080. As for the rest of you cynics, I am sure the editor may have a few back copies he will let you have…at a price, of course. Immortality doesn’t come cheaply.

(First published in the Scunthorpe Telegraph, Thursday, 17th November 2011)

Pessimism or Realism?

Amongst family and friends I am well-renowned for being an early riser, with a willingness to extol the virtues of making use of the time between 5am and 7am to an effect more rewarding than sleeping. However, this morning my newspaper colleague, the Honourable Columnist for ‘Strictly Speaking’, kept me in bed for an extra hour. Such is the stuff of rumour and gossip. However, before the editor makes room on the front page for a lurid exposé, let me explain that I simply awoke thinking about something my fellow correspondent recently wrote about the NHS. In his article on Thursday 27th October, Hugh Rogers expounded on why he felt confident about the future of the NHS, stating that in this respect ‘pessimism has no place’.

Whilst I am a person of strongly held views, I am always willing to consider the possibility that I have got something wrong. With this is mind, I lay awake pondering my recent proclamations within this column in respect to the current changes the NHS is being subjected to in the form of the Health and Social Care Bill 2011, asking myself whether I have been too pessimistic.

The answer can perhaps be drawn from a trawl of recent news articles regarding GPs (bearing in mind that the majority of medical care in the UK is carried out in general practice and not in hospital). According to a BMA survey, the majority of GPs believe the relationship of trust between them and their patients will be damaged by the NHS reforms. Commissioning will also bring a greater workload to GPs, who are already disenchanted trying to deal with an excessive workload and an administrative nightmare. Additionally, new work makes it harder to fit everything into a ten minute consultation slot, especially as a great deal of the work GPs now do used to be done in hospitals. One answer is to recruit more GPs. However, the evidence suggests that fewer young doctors are being attracted into general practice (this August there was an 11% fall in doctors accepted onto GP training courses compared to 2009); on top of which it takes ten years to train a GP from scratch, so increasing medical student training may help in a decade’s time, but doesn’t answer today’s problem. Then we have the suggestion that the government wants to do away with practice boundaries, so patients can see a doctor anywhere they wish. This may be handy for minor acute illnesses, but would be difficult and potentially dangerous for complex issues, apart from making it hard to predict demand for some popular practices.

What about the patients’ perspective? Well, I think everyone knows how hard it is to get an appointment with a GP at present. I am sorry to tell you that the forecast shows that it is going to get worse; a large percentage of GPs over the age of 50 years are actively looking at taking early retirement or going part-time. The reason is low morale, four years of seeing GP pay decrease year on year, government threats to the NHS pension, and a totally skewed work-life balance. Personal health budgets should also raise patients’ concerns. 50,000 people will get personal budgets over the next three years, with a view to rolling it out to more thereafter. These budgets will initially apply to patients with complex medical problems. So what happens when your personal budget runs out? After all, the changes are not just to make the NHS a more efficient service for patients; they are also to reduce the overall cost to the nation. This is further evidenced by the ‘care crisis’ induced by the one fifth cut (£1.3 billion) in government funding for nursing homes at a time when the elderly population is expanding.

I agree with Hugh Rogers that as a nation we tend to triumph at times of adversity. However, I don’t think I am being pessimistic in my expressed views. The evidence is out there and we are unwise to ignore it. Honesty and truth does not equate to pessimism; it is called being realistic.

(First published in the Scunthorpe Telegraph, Thursday, 4th November 2011)

First Amongst Equals - A Tribute to a Former Colleague

I like to think that it is a rare individual who cannot name one person who has influenced their life. Most of us can probably name a parent or teacher. However, just occasionally somebody comes along who is more than just influential; someone who is inspirational and whose memory lives on as a person against whom we measure our actions.

I have several such mentors; most of whom are oblivious to their role in shaping my personality and actions. The first in medical terms was a doctor who was my immediate senior when I was a houseman in a Devon hospital. His unfailing courtesy, diligence and attention to detail made him stand out from all other doctors I had come across during my training. His name was Dr Assad Al-Doori, and he was an Iraqi. Over subsequent years, I have often thought of Assad and hope that I have incorporated some small measure of him within my own practise of medicine.

Until recently, there have been few doctors who have measured up to Assad’s standards. Then I had the fortune to meet a doctor some twenty years my junior, who subsequently became an associate within my practice. Such was his dedication to his patients that one year ago we offered him a partnership, recognising that he would be a tremendous asset to our community. He embodied the very attributes I had recognised in Assad: unfailingly kind, gentle, polite, thoughtful, and dedicated to the art of medicine, the care of his patients and the teaching of young doctors. He was an untiringly hard worker who thought of himself last of all.

His name was Dr Imran Arfeen. He was from Pakistan and he was a devout Muslim. It was his Islamic faith which strongly guided his principles and actions and, alone in his consulting room, he would snatch moments of his busy day to incorporate his ritual of prayer. To observe Ramadan, he worked non-stop throughout the day in order to overcome his hunger. Imran was inspirational and influential; holding long conversations with me regarding the comparative values of Islam and Christianity, the Koran and the Bible. I discovered from Imran far more about how the two religions overlap than I had previously discovered. Imran also quietly and gently reminded me on numerous occasions of the reason why we practise medicine – to serve the poor and sick. My colleagues now tell me that I was not alone in benefitting from his wisdom and humility.

I write of Imran in the past tense as, shortly after being offered a partnership, he was diagnosed with a terminal illness. He died two week ago. Throughout his illness, his courage and fortitude remained inspirational. Taking strength from his faith, he never lost hope and fought an heroic battle. Insisting that work was best for him, few of his patients knew that he was receiving chemotherapy, and was in effect more gravely ill than many of those he was treating.

Ironically, on the day he died, the practice received a letter addressed to Imran from a patient who is a retired Church of England priest. The letter is an outstanding testimonial to Imran’s attitude, beliefs and character; extolling his work as a doctor. It was meant as a private letter, but sadly not one Imran was to read. If he had, I am sure that we would never have known about it; such was his self-effacement.

No parent should ever suffer the grief of losing a child. It is equally true that no doctor should see a younger colleague succumb to a fatal illness. However, Imran was a devout Muslim amongst Christians, the most Christian of Muslims, and medically the first amongst equals. He taught us all something of value and his humanitarian legacy will live on as we endeavour to serve our masters the poor and sick.

(First published in the Scunthorpe Telegraph, Thursday, 3rd November 2011)

Thought for the Day

Nothing in life is to be feared - it is only to be understood.

Marie Curie (1867-1934)
Physicist & chemist

Crossing the Line (Part 2)

Last week I wrote about the need for doctors to adopt a holistic approach to caring for patients, reflected on the General Medical Council (GMC) guidance on religion, and finished with the historic connection between priests and doctors.

Last month a Kent GP was accused of ‘crossing the line’ when he asked a patient whether he had ‘considered Christianity’ as a means of psychological support. The patient was apparently willing to listen (BBC News, 22 Sept), but later told his mother that the GP had said that he ‘just needed Jesus’. The mother reported the GP to the GMC. Following a disciplinary hearing the GP was given a formal warning, which he has appealed against and the case will now go to a public hearing. The appeal is yet to be heard. However, it does raise many important issues; not least the manner in which patients interpret what is said within consultations. We all know of patients with incurable problems who, after the GP has gone through the long-term management plans of (say) pain relief, physiotherapy, occupational therapy, home adaptations, diet and exercise, tells his family that ‘nothing can be done’; which is not quite the message the GP had in mind.

However, there is also the issue of whether a GP is wrong to raise the subject of religion. The GMC stated that the Kent GP ‘crossed the line’, meaning the GP moved from acceptable to unacceptable practise. So what happened to the holistic approach to caring for a patient? This is where I believe that the medical profession is confused and acting illogically. On one hand, the GMC has announced that it is ‘tightening up’ the guidance on religion in practice (Pulse Today, 5 Oct), by making it a duty for GPs to consider patients’ ‘religious, spiritual and cultural history’, whilst simultaneously castigating a GP for having that very discussion. Unless a GP can openly explore a patient’s views, how are the requirements of the new GMC duty to be met? The conundrum is added to by a recent Health Foundation study, which states that doctors should adopt the role once taken by a ‘local priest’. I cannot see the GMC warming to that report.

So what of other views? The Department of Health issued guidance earlier this year warning against ‘proselytising’, stating that it is the role of the NHS Chaplaincy Service to meet patients’ spiritual needs. Fine, but when did you last see an NHS Chaplain in your surgery? Many doctors have told the British Medical Association that they want the right to pray with their patients without fear of being suspended; whilst the co-director of Patient Concern has stated that patients often welcome the offer of a prayer as a ‘warm and kind thought’. Understandably, the National Secular Society has the counter view that health and religion should not mix.

Holistic care means precisely what it says. The key point amidst all of this is for a doctor to be sensitive to a patient’s views, regardless of what they may be. Patients need doctors to be human beings and to consider them likewise; for some this occasionally means the need to include spiritual matters within a consultation. However, until the GMC, RCGP and BMA agree how doctors can approach such matters, doctors will find themselves between Scylla and Charybdis; damned if they do and damned if they don’t consider patients’ religion. One thing is certain: extracting the spiritual component from medical care produces a large hole in ‘holistic’.

(First published in the Scunthorpe Telegraph, Thursday 27th October 2011)

The Remembrance Day Parade

As he walked up to the rostrum,
silence round him fell;
and whilst he gazed upon the steadfast ranks,
emotive lines began to tell.

Too many lives were lost before today:
young men and women – yesterday’s youth.
They were the cheques we drew to pay
for the blinded search for fallacious truth.

You are the inspired; the fortunate few
who have lived through to this day:
the ones who now must tell the world
to find a better way.

It is the charge of those who live
beyond vanquished dreams of many men,
to find the strength to forgive;
to learn and love as best you can.

And in so doing, let us ensure
a sense of remembrance, not of rage;
may this quietude beyond the war
turn pugnacious soldier into reflective sage.

Thus, he stood upon the rostrum as
the silence round him fell,
and gazed upon the steadfast ranks
of those returned from hell.


© Copyright Robert M Jaggs-Fowler 2011

Crossing the Line (Part 1)

Being a doctor, and particularly being a GP, is a complex process. It is not enough to simply spend five or six years at medical school, followed by four years or more in hospitals and general practice as a junior doctor. Neither is it enough to have a list of qualifications, or to have worked in your own practice for decades. Nor is it sufficient to hold a licence to practise, read all the recent research, apply all the latest guidelines, pass an annual peer-conducted appraisal, or be revalidated by the General Medical Council (GMC) every five years.

According to the Royal College of General Practitioners’ guidance ‘medicine…is based on a set of shared beliefs and values, and is an intrinsic part of the wider culture’ (Being a General Practitioner, 2010). For centuries, doctors have been exhorted to consider the ‘physical, psychological and social’ aspects of their patients’ health needs. This is called taking a holistic approach and, according to the RCGP guidance, requires caring for the person in the context of their ‘personal values, family beliefs, family system, and culture in the larger community’. This, of course, is the ‘art’ of medicine, rather than the science. The RCGP guidance acknowledges that ‘the holistic approach…admits that people have inner experiences that are subjective, mystical (and, for some, religious), which may affect their health and health beliefs’.

The GMC ethical guidance is equally of interest. In the booklet Good Medical Practice, the GMC states that patients' ‘personal beliefs may be fundamental to their sense of well-being and could help them to cope with pain or other negative aspects of illness’. It also recognises that ‘all doctors have personal beliefs which affect their day-to-day practice’, and advises a doctor that ‘if carrying out a particular procedure or giving advice about it conflicts with your religious or moral beliefs…you must explain this to the patient and tell them they have the right to see another doctor’. The GMC guidance also states that a doctor ‘must not express…personal beliefs, including political, religious or moral beliefs, in ways that exploit (a patient’s) vulnerability or that are likely to cause them distress’. What the GMC does not state is that a doctor is barred from expressing personal beliefs in any way or at any time during consultations, or indeed at any other time.

The holistic approach is not new. Throughout my career I have often expressed the view that modern GPs are ‘part physician, part priest and part social worker’. The second aspect of that statement is in recognition of the diminishing impact of the parish priest within local communities. (I accept and respect the fact that communities with a faith system based on something other than Christianity may still have a stronger daily role for their religious leaders). However, in communities where the population would once have been regular church attenders, many of the problems now brought to a GP are issues where a person may once have sought advice from the parish priest. That acknowledgement brought me very close to becoming a non-stipendiary priest some twenty years ago; a move which would have seen me officially wear the combined mantles of ‘white coat and dog-collar’. Such a move is not new; before Hippocrates, priests were also the physicians of the day, and prior to the advent of scientific medicine, laws regarding health and the practice of healing rituals were largely laid down within religious texts (the Bible’s Book of Leviticus being a prime example).

Next week I will explain how all of the above is topical, why I think the medical profession is confused and acting illogically, and why I believe such muddled and contradictory thinking is not good for doctors or patients.

(First published in the Scunthorpe Telegraph, Thursday, 20th October 2011)

A Spiritual Uprising

Only on Halloween in the UK could The Telegraph have made such a wonderful typographical error.

In their article published on the 31st October 2011 regarding the resignation of the Dean of St Paul's Cathedral, Richard Alleyne, Victoria Ward and Martin Beckford wrote as follows:

'The Dead of St Paul's had pushed hard for the church hierarchy to back legal action by the Corporation of London to remove the 200 or so tents from St Paul’s churchyard.'

(http://www.telegraph.co.uk/news/religion/8861089/St-Pauls-branded-laughing-stock-as-Dean-Graeme-Knowles-resigns.html)

What is in a Name?

‘That which we call a rose by any other name would smell as sweet.’

William Shakespeare’s Juliet in the play ‘Romeo and Juliet’ knew that it is not what things are called that matters; what is important is what they are or what they do.

In the world of healthcare in general and medicine in particular, the names of professionals has caused disquiet as far back as the 16th century, when only two educational establishments were allowed to grant licences to men (and only men) qualified in medicine. The first, the Royal College of Physicians of London was founded by King Henry VIII in 1518. The second was not a college but the Archbishop of Canterbury, under the Peter’s Pence Act 1533. Physicians took the title of ‘Dr’ as a reflection on their learned status and their possession of a degree in medicine.

Working within the same environment as the physicians were barber surgeons. As their name implies, these were men who earned their living cutting hair, shaving men, letting blood, setting bones, amputating limbs, extracting stones from bladders, and other similar surgical delights. They were tradesmen who learned the tricks of their trade by apprenticeship or simply raw experience. They did not have a degree in medicine and therefore were not entitled to call themselves ‘Dr’.

The third category of 16th century healthcare workers was that of the apothecary. Apothecaries made up the medicines prescribed by the physicians. Today, they would be called pharmacists. However, in the 16th century, apothecaries would often be asked for advice by the poor, who could not afford the fees of physicians. This unlawful practice of medicine was legalised by the Apothecaries Act of 1815. As a result, apothecaries became what we now know as general medical practitioners (or GPs).

Today, all medical practitioners (regardless as to whether they end up as hospital doctors or GPs) qualify in the same way and hence have the right to the honorary title of ‘Dr’. Those taking postgraduate qualifications in surgery, enabling them to become specialist surgeons, then often forsake this hard-earned title and revert to calling themselves ‘Mr’ as a historic reflection to the time of the barber surgeons. So in hospitals, consultants are usually ‘Dr’ if they are physicians or ‘Mr’ if they are surgeons.

I called the title ‘Dr’ an ‘honorary title as all medical practitioners qualify with two bachelor degrees in medicine and surgery (e.g. MBBS). In academia, the title ‘Dr’ is usually retained for those obtaining higher degrees (a doctorate), such as an MD (Doctor of Medicine) or PhD (Doctor of Philosophy); the latter meaning that not every ‘Dr’ is medically qualified.

If that isn’t confusing enough for members of the public, there is a growing trend for dentists to call themselves ‘Dr’. A similar situation is found with chiropractors. Some senior nurses take a PhD degree and hence rightly adopt the title ‘Dr’. Then there is the growing list of non-doctor job titles such as ‘nurse consultant’, ‘nurse practitioner’, ‘consultant podiatric surgeons’ and ‘operating department practitioner’ (neither of the last two being medically qualified surgeons).

Over the twenty-seven years since I became medically qualified I have been called by many names, some of which cannot be repeated here. However, I am still amused by one chap who, from a crowded waiting room and with a cheeky grin, usually forgoes the pomposity of titles and greets me with a loud ‘Morning, Robert’. As he has often said to his daughter, ‘they all have to wipe their bottom the same as us’. He is quite right, of course. Ultimately, it is not the title that matters; but professional honesty and transparency most definitely do matter. Clarification of health professionals’ titles and roles is urgently required if the public is going to understand the educational background of the person treating them in an increasingly complex health arena.

(First published in the Scunthorpe Telegraph, Thursday 13th October 2011)

Great Expectations

It is now one year since I was invited to write this column. As I look back over those twelve months and the forty-five resulting articles, I am struck by a recurring theme. Yes, I admit there has been the frequent mention of poetry and literature as I have attempted to combine those subjects with the art, science and politics of medicine. There has also been the occasional guest appearance of my wife; often as my ‘fall guy’ in introducing or illustrating a topic. However, there has additionally been a theme that Charles Dickens would have understood only too well: that of ‘great expectations’. In this case, not the personal expectation of one person, but the expectations of the community in respect to what medicine should, in the view of society, provide for that population as a whole. Such deliberations have covered concepts such as why society needs to decide what it wants from the NHS, how proposed changes to the NHS will fundamentally alter the service provided, and whether medicine as an organised profession is really useful to society in the first place. Some views have been personal, others widely held and accepted. However, as I consider the news of these past weeks, I am struck by another recurring theme; that of a duality of thinking within society.

By duality, I refer to the philosophical concept of dualism: being able to metaphorically look in two different directions at the same time, or consider two different and opposing views and be accepting of both; the sculptor Michelangelo was particularly good at introducing duality to some of his statues (e.g. that of Moses in Rome). The subject of recent articles exhibiting a duality of thought from a medical perspective has been that of cancer care and its funding.

Cancer is an emotive subject. It is one of the last disease groups to threaten our individual longevity, and it is therefore not surprising that headlines depicting early successes in cancer drug trials, new cancer drugs adding months to life, new ways of tackling the ‘cancer parasite’, and drives to reduce cancer screening ages, all give a sense of optimism to readers and an expectation of medicine (and by default, the NHS). However, those same headlines stare in the opposite direction to others that question the cost of the cervical cancer vaccine, query whether patients dying from cancer should continue to be given ‘futile’ drugs, and raise concerns that cancer treatment is increasingly unaffordable.

As a society, we have a serious problem to resolve. On the one hand, we all want to think that we will receive the best treatment for cancer, or that it will be available for every family member should the need arise. However, the reality is that cancer care is often prohibitively expensive, frequently experimental, and may only buy a small amount of time. Where cures are effected, many people are living longer and thus at greater risk of developing other forms of cancer. Some people alive today have survived two and sometimes three unrelated cancers, each with their own individual treatments and associated costs. Clearly, their survival is tremendous news for them; and it is what most of us would wish for as individuals. However, the significant question is whether society can continue to afford such care for everyone? At a possible £10,000 per month per patient, some economists say no.

The cost of treatment is a debate that is going to be a recurring theme. As a society, we need to stop having a duality of vision when it comes to care and cost. The two issues go hand-in-hand and cannot be separated. The debates will be moral and ethical in their scope; they also need to be realistic. Arguably, they should be international; as the solutions are not to be found within the health systems of small, individual countries.

(First published in the Scunthorpe Telegraph, Thursday 6th October 2011)

Ruminations from a Country Show

A week ago last Monday I took my wife for a day of what psychologists might class as regression therapy. The latter is a process whereby a person is psychologically taken back to a time in their earlier life. ‘We used to keep some of those’, was a phrase I repeatedly heard throughout the day; that and ‘oh, I can remember riding on one of those – no suspension!’ However, before rumours circulate that my eclectic lifestyle has finally driven my long-suffering wife insane, let me explain that we visited the Nidderdale Agricultural Society Annual Show. My wife was, one might say, ‘to the farm born’, and thus she was in her element, regressing the odd decade or so to memories of her childhood.

As for me, well there I was leaning on a stock barrier watching Highland cattle parading round the judging ring when my mind turned to Keats; John Keats that is, the poet and doctor. This in turn made me wonder whether badgers were considered to be a local problem. (Well, a chap has to occupy himself somehow whilst his wife goes for a trip down memory lane riding a vintage Fergusson tractor.) Enquiringly, I turned to a person dressed in the style of the typical farming-type. However, it turned out that she was Kirstie Allsopp filming a Channel 4 documentary and knew less about badgers in the Yorkshire Dales National Park than I did. (I later discovered that they are widespread but not that common).

If you are still with me on this circuitous journey, let me now explain that the main subject of my thoughts was the disease once known as consumption, but better known today as tuberculosis or just TB. Cattle can be infected by TB, and there is controversy as to whether badgers are the cause of its spread amongst herds. In humans, it is usually spread through coughing and sneezing in close proximity to others; which is why you hear of outbreaks in schools, barracks and other crowded environments.

All of which brings me back to John Keats. Unfortunately, Keats died of TB at the age of 25 years. He is in good company, as the disease has carried off many writers and artists over the years; the Brontë sisters, Robert Burns, D.H. Lawrence, George Orwell, John Ruskin, and Chopin, to name but a few. Even Florence Nightingale succumbed to its ravages. As a result, we often think of TB as a disease of history. The truth is, the infection is still rife today. On a world-wide basis, a new case occurs at a rate of one-per-second, and as such it remains the world’s biggest killer of women of reproductive age. In Britain, TB is mainly an urban disease, with an incidence of 15 cases per 100,000 population (the population of Northern Lincolnshire is about 300,000).

Symptoms commonly include fever, night-sweats, cough, blood-stained sputum, weight loss and fatigue; although it can have other manifestations. Fortunately, in the western world it is kept under reasonable control by good public health measures and the prompt treatment of contacts. Vaccination is only offered to those considered to be at high risk, such as health workers or babies born into a high risk community.

Whilst treatment is difficult (requiring prolonged courses of antibiotics), the good news is that the earlier TB is identified, the more effective the treatment. The fundamental point is, if you have had a cough for more than three weeks, go and speak to your doctor. You will probably not have TB. However, the doctor may want to rule it out, along with one or two other important conditions.

Oh, and don’t worry, as a human you are unlikely to catch it from cattle, badgers, beef or milk…and my wife didn’t really ride the tractor last week; I made that bit up.

(First published in the Scunthorpe Telegraph, Thursday 29th September 2011)

Book Review: The Ikinci Yeni - The Turkish Avant-Garde.

Ikinci Yeni - The Turkish Avant-Garde

Edited & translated by George Messo

Published by Shearsman Books Ltd (2009)

ISBN 978-1-84861-066-8


The Ikinci Yeni are five 20th century Turkish poets, who overturned conventional thinking and took Turkish poetry down a new, experimental and thoroughly modern path. The idiom is often dense and obscure; the metaphors frequently challenging for a reader more used to English classical and contemporary styles. The poetry of all five is illustrative of their melancholic lives; a fact exemplified by their seemingly collective problem with alcoholism. Previously unknown to me, this was not an easy collection to read and, perhaps with the exception of Süreya’s delightful ‘Striptease’, demands that the reader works hard at gaining access to each poem. Nonetheless, there is a power within this work which equally provokes the reader to read, puzzle, return and read once more with an almost masochistic inquisitiveness.

(First published on the website of The Poetry Society as part of the Corneliu M Popescu Prize 2011 Virtual Book Club. October 2011. http://www.poetrysociety.org.uk/content/competitions/popescu/bookclub/ )

The Bells, The Bells

One of the pleasures of working within a market town is the relative sense of peacefulness that exists even during the course of the working day. This in turn allows me to have my consulting room window open and thus appreciate another pleasure; the ringing of the bells from the nearby parish church.

Over the past couple of weeks I have been particularly conscious of the bells; not despairingly like Victor Hugo’s Quasimodo in The Hunchback of Notre-Dame, but in a manner appreciative of the different styles of ringing. Whilst life with all its challenges has been passing through my surgery, the church bells have lent their own musical accompaniment; reflecting life and death, happiness and sorrow, as various dramas have been played out beneath them.

It is not the first time I have had cause to muse on such a subject. In 2006, I wrote a poem called Life’s Refrain. Published in 2008 as part of my first collection, A Journey with Time, the poem is written in the form of a Chaucerian roundel, and reflects on how bells punctuate the path of life:

Life’s Refrain

The church bells rang for you today.
As water poured upon your head,
‘I name this child,’ the vicar said.

Betrothed, then vows without delay.
To tell the world that you have wed,
the church bells rang for you today.

‘For this departed soul we pray.’
The priest, in solemn homage, led
the mourners who prayed for the dead.
The church bell rang for you today.

For me, such sounds are pleasurable. However, for some people the sound of bells and ringing-type noise is nothing more than a perpetual torment. The word tintinnabulation describes a ringing sound, taken from the Latin ‘tintinnabulum’ meaning ‘tinkling bell’. From the same word we derive the medical word ‘tinnitus’, meaning a ringing or buzzing in the ear.

Tinnitus occurs from within the ear, and can be caused by a variety of conditions and diseases, from ear and nasal infections, ear wax, respiratory allergies, fluid in the middle ear, ruptured ear drums, head injury, tumours of the inner ear, exposure to sudden or sustained loud noise, congenital defects of the ear, side-effects of medication, and the process of ageing. Of these, exposure to loud noise is the most common cause.

Affecting one or both ears, tinnitus can take many forms, often being described as ringing, buzzing, whining, hissing or a continuous tone. Stress often makes the symptoms worse. Even without stress, tinnitus can vary from a mild distraction to a distressing and life-destroying affliction. The treatment depends on the cause, but is often unsatisfactory, and patients may have to use ways of masking the noise with more pleasurable sound.

Tinnitus is definitely a case of ‘prevention is better than the cure’. Avoiding exposure to loud noise and the wearing of ear protection where necessary is a good start. The latter includes when using hair dryers, vacuum cleaners, garden machinery, power tools, firearms, and riding motorbikes. Musicians are also at high risk, with professional musicians now being advised to wear special acoustic ear plugs that allow normal hearing but at lower decibels.

Tinnitus from a noisy workplace is considered an industrial injury for which you may be able to gain compensation. Your solicitor will be able to advise you further in this respect. Whatever the cause (with the exception of the parish church), if bells are disturbing your peace further assistance can be obtained from the British Tinnitus Association at www.tinnitus.org.uk.

(First published in the Scunthorpe Telegraph, Thursday 8th September 2011)

Thought for the Day

'Your time is limited, so don't waste it living someone else's life. Don't be trapped by dogma - which is living with the results of other people's thinking. Don't let the noise of others' opinions drown out your own inner voice. And most important, have the courage to follow your heart and intuition. They somehow already know what you truly want to become. Everything else is secondary.'

Steve Jobs (1955 - 2011)
Co-founder of Apple

(Reflecting on life, career and mortality in his commencement address at Standford University 2005)

The Downside of Paradise

‘I have just escaped from a physician and a fever, which confined me five days to bed … Here be also two physicians … I protested against both those assassins, but what can a helpless wretch do?’

The above excerpts are taken from a letter written by the poet Lord Byron in October 1810, written whilst he was touring the ancient ruins of Peloponnese in southern Greece. He had been suffering from a recurrent fever and shaking (rigors). Writing in this month’s edition of the Journal of the Royal Society of Medicine, Costas Tsiamis suggests that, from Byron’s own descriptions and a knowledge of the area in which he was travelling, it is quite likely that Byron was suffering from malaria. If so, he was fortunate to survive: not necessarily because of the dubious quality of his physicians, but because the disease was poorly understood and no effective treatments had then been identified.

However, two hundred years on, medical science has only brought limited advancement in the treatment of this mosquito-borne infection. According to a report from the World Health Organisation in 2010, 225 million cases of malaria are diagnosed every year and the disease kills almost 800,000 people; accounting for 2% of all worldwide deaths. Clearly, it is not a disease to be taken lightly. Nonetheless, each year thousands of holiday makers from the United Kingdom travel to exotic locations without a thought for the risks to their health; in the case of malaria, failing to take adequate courses of anti-malarial medication, and otherwise neglecting to enquire about vaccinations for other infectious diseases such as typhoid, polio, hepatitis A, yellow fever and rabies. Just because the destination of choice does not make the vaccinations compulsory for entry doesn’t mean you shouldn’t have them. If they are compulsory, it is to protect the inhabitants of the country you are travelling to, not because of that country’s concern for your well-being.

That said, exotic locations do not just bring risks of infection. With an increasing number of older adults taking time out to travel, insurance companies are seeing an astonishing increase in the level of medical expenses claims on travel insurance policies. Figures from the Association of British Insurers indicate that the cost of becoming ill whilst abroad rocketed to £275m in 2010, from a mere £74m in 2004, with the blame being firmly attached to those over 65 years of age.

Of course, holiday makers are not the only ones leaving our shores. Many of those in retirement go in search of greener grass (or at least lower taxes and better weather). Unfortunately, health care is not always of the same standard as in that provided by the NHS in the UK, or may only be available privately and for large fees. According to the British Insurance Brokers’ Association America is, not unexpectedly, the most expensive country for health care, whilst Greece is one of the cheapest. Surprisingly though, according to the Foreign and Commonwealth Office Britons are five times more likely to be hospitalised in Spain than in America.

There is little doubt that Lord Byron’s malaria affected his health for the rest of his life, and he died in 1824 at the age of 36. Of course, today he would be able to obtain advice on malaria prevention and travel vaccinations from physicians better qualified than his imagined ‘assassins’. Happily, your own experience of paradise can have a better outcome than Byron’s, but only with foresight and planning. Whether you are retiring abroad or merely taking a week’s holiday, it pays to discuss your plans with your GP well in advance.

(This article was first published in the Scunthorpe Telegraph, Thursday 1st September 2011)

Calling Expert Patients – Your NHS Needs You!

According to the Oxford English Dictionary, an expert is ‘a person who is very knowledgeable or skilful in a particular field.’ However, the American activist, Marian Wright Edelman, once said ‘Parents have become so convinced that educators know what is best for their children that they forget that they themselves are really the experts’.

Edelman may well have had a good point, as an analogy can be found when considering health care and patients. After all, who truly knows what it is like to live with a long term medical condition: the doctor, nurse or therapist with all their qualifications, or the patient, perhaps with nothing in the way of qualifications but with years of first-hand experience of the subject?

Speaking in an interview earlier this month, the chairwoman for the Royal College of General Practitioners, Dr Clare Gerada, emphasised that we are at time when ‘GP workload is exploding and its complexity is increasing’ (GP Magazine, 17 August 2011). At the same time, the number of whole-time equivalent GPs working in the NHS is falling. Inevitably, this means that the time GPs have for individual patients is under increasing pressure, with the end result that the nicety of long explanatory discussions about a patient’s long term condition is one of the first corners to be cut. Couple this with the fact that people are living longer (life expectancy is now 81.4 years for women and 77.5 years for men) and it becomes obvious that there is a problem.

Those are two of the reasons why NHS North Lincolnshire and the North Lincolnshire Council are trying to establish an Expert Patient Programme. As with all communities, North Lincolnshire has its share of patients with long-term (chronic) medical problems such as heart disease, asthma, diabetes, epilepsy, multiple sclerosis and arthritis. Such patients need assistance in learning about their conditions and how to live with them. The Expert Patient is an invaluable resource who can teach other patients, and assist in improving their confidence and skill in managing and living with their long-term conditions. In turn, the patient becomes less of a ‘patient’ and more of a ‘normal person who lives with a chronic condition’. Less time is spent in hospital or seeing GPs and life becomes more enjoyable, valuable and interesting.

The Prime Minister’s vision of the Big Society has been much derided of late. However, the Expert Patient Programme is one example of where the concept can truly work. That said, to be successful, volunteers with long-term medical conditions are most certainly needed. Such volunteers will need to complete a four day tutor-training course, after which they need to be prepared to deliver community-based self-management courses. All volunteers will undergo assessment, and the successful completion of two assessments will qualify those people for a Level 3 accreditation from the Open College Network.

If you are living with a long-term medical condition, then you are the expert we are looking for. So why not share that expertise with fellow patients and make their lives more manageable? If you are interested, call Helen Tindall on 01724 298422, or Sally Eaton on 01724 298404.

The last word must surely go to Lord Salisbury who, in a letter to Lord Lytton in 1877, wrote: ‘No lesson seems to be so deeply inculcated by the experience of life as that you never should trust experts. If you believe the doctors, nothing is wholesome: if you believe the theologians, nothing is innocent: if you believe the soldiers, nothing is safe. They all require to have their strong wine diluted by a very large admixture of insipid common sense.’

Expert Patients – you have that supply of common sense!

(First published in the Scunthorpe Telegraph, Thursday 25th August 2011)

Thought for the Day

The people who get on in the world are the people who get up and look for the circumstances they want and if they can't find them, make them.

George Bernard Shaw