Is There a Limit to Our Responsibility?

A few weeks ago, I was walking across the parking area of a motorway service station when I spotted a glass beer-bottle standing upright in the middle of a parking bay. I had two main options. I could walk past, ‘tut-tutting’ about someone’s carelessness and stupidity, or I could picked it up and deposit it in the nearest litter bin. (A third option of seeing how far I could kick it didn’t enter my mind at the time.) Conscious of the perceived danger to someone else’s car tyres, I chose the second of the options, and thus, just possibly, significantly altered the path of some unknown person’s journey later that day. Why did I act in the way that I did? Purely and simply because I felt that, having perceived a risk to someone else, I then had a social responsibility to do something about it. The act was a simple one; but not to have performed it would have been as socially irresponsible as the act of putting the bottle there in the first place.

I would have thought no more about that episode if it hadn’t been for a recent home visit in my capacity as a GP. My patient was an elderly lady who lives on her own. She had been unwell for a few days and a (much younger) female friend had called the surgery. The patient does not have any family living locally, so the friend stayed and tidied the house for her whilst waiting for me. I hadn’t met either of the two ladies before, but was impressed by the care being taken by the friend, who was able to give me a good history and presented me with various hospital paperwork and a list of medication.

Having examined my patient and diagnosed her problem, I wrote a prescription and handed it to her friend on the supposition that she would kindly collect the medicine. It was as I was leaving, feeling sure that the elderly lady was being well cared for, that her friend said something that has had me thinking ever since. ‘I’ll collect the medicine, but of course I’m just a good friend; she’s not really my responsibility’ were her words. It was the bit about ‘not really my responsibility’ which mentally stopped me in my tracks. Just what was the unwitting message behind that phrase? Clearly, she had no legal responsibility for the elderly lady; at least not in the same way as a parent or guardian has over a child, or a carer has over a resident of a residential home. Neither did she have the professional and legal ‘duty of care’ that I had as a doctor. Was the friend expressing the view that her ‘good friendship’ was conditional and only went so far; and when the going got rough, she didn’t really care that much?

Responsibility can be a legally imposed state. However, it is also about being morally accountable for one’s behaviour. In a society such as ours, surely we are all morally accountable for each other? Is there really a time when we can morally turn our back under the cover of the phrase ‘not really my responsibility’? W.B Yeats wrote ‘In dreams begins responsibility’. On humanitarian grounds, that responsibility never leaves us.

(First Published in the Scunthorpe Telegraph, Thursday, 1^st November 2012.)

We Are All In This Mess Together

October 2010 was an auspicious month. Amongst many other happenings, it was the month when I first voiced my concerns over the NHS reforms. One of those concerns was that there was (and still is) insufficient money to run the NHS in a way that pleases most patients and also satisfies the politicians who ultimately have to take account of public spending. Whilst many people lauded the Government’s concept of putting GPs in control of running the local services (whilst at the same time dismissing significant numbers of managerial staff who actually knew how to run the NHS), I voiced the concern that it would all end in tears. The money would continue to be insufficient, services would have to be reduced, hospitals would close, the public would be angry, and GPs, powerless to turn a pig’s ear into a silk purse, would get the blame from both patients and politicians. It was a poisoned chalice from the start.

Two years on, that moment of staring into a murky crystal ball is proving to be prescient. Nobody can doubt that the NHS is falling apart. Every day there are stories from across the country where patients are struggling to obtain an appointment to see their GPs, and clinics, wards and hospitals are closing. Most GP practices are inundated with work to a level where they simply cannot cope. Some have already had to close; others are hanging on whilst the doctors strive to maintain a resemblance of a credible service whilst seeing their personal income plummet. Meanwhile, the Government sits emulating the Emperor Nero, informing us all of how wonderful the reforms are, how necessary they are, and how the politicians are not to blame for the terrible mess they have created.

As an example, let us take one of the craziest tasks currently facing GPs. We must, we are told, reduce the number of A&E attendances. If we do not achieve this, we reduce the money coming into our practices. How, we all ask, are we to manage such a herculean task that is effectively out of our control? We may as well be asked to reduce the number of teenagers visiting the cinema on a Saturday night, for all the power we have over such a situation. People visit A&E for numerous reasons: genuine emergencies, convenience, lack of transport, inaccessible out-of-hours services and over-loaded day-time surgeries are just a few. The solutions for many of these issues do not sit within the grasp of most GPs. It is a multi-facetted, multi-organisational problem. It requires socio-economic changes out of reach of GPs. It also requires more money being spent to address it; not a reduction of finance to general practices.

No one group has the solution. However, you can start by helping us all out by not attending A&E for trivial reasons. The clue is in the title ‘Accident and Emergency’. If it is neither of these, please telephone NHS Direct for advice, visit an NHS walk-in centre, or wait until your local surgery is next open. If you do not, you are contributing to the financial waste and the subsequent decline in GP services. The truth is we are all in this mess together.

(First published in the Scunthorpe Telegraph, Thursday, 26^th October 2012.)

Don't Feel Helpless

Are you a fan of Doctor Who? If, like me, you watch every show with eager anticipation (even if it is from behind the sofa), you will no doubt be very familiar with the front door of the TARDIS. In particular, you will have seen numerous clips showing the distinctive black and white badge of the St John Ambulance on that very door (yes, even the Doctor travels everywhere with a first aid kit).

Well, the latest news is that the St John Ambulance, the country’s leading first aid organisation, has hitched a ride with Downton Abbey (another of my favourites), screening the first viewing of its new, hard-hitting campaign during the first episode of the latest season of Downton Abbey a few weeks ago. If you happened to miss it (the campaign, not Downton), do not worry as I will give you a web-link a little later.

The St John Ambulance film is called ‘Helpless’. It is a highly emotive drama, depicting the story of a young man who is diagnosed with cancer, is treated and survives; only to die of choking at a celebratory barbecue with his family. Why did he die? He died because nobody knew how to save him with simple first aid.

It is a worrying fact that so many people have not taken a first aid course because they do not see the point of doing so, or think it will take up too much time. However, there is a very good chance that everyone will get called upon to act as a first aider at some time in their lives. The tragedy is that some 140,000 people die needlessly each year, when simple first aid could have saved their lives. 140,000 deaths is equivalent to the number of people who die from cancer each year. Yet, despite these terrible statistics, 41% of people recently surveyed said that it would take something as severe as the death of a loved one to make them learn first aid. The obvious question is, why wait until then? Why not learn first aid now and be in a position to save your loved one from dying?

Fewer than 1 in 5 of our population knows first aid. If you are one of those four people who doesn’t, please take a moment to watch the new St John Ambulance film ‘Helpless’ (http://www.sja.org.uk/sja/support-us/the-difference/helpless.aspx) and then ask yourself whether you would have known what to do. If the answer is ‘no’, then enrol now for a first aid course (http://www.sja.org.uk/sja/training-courses.aspx) or at least download a free first aid app for your mobile phone (http://www.sja.org.uk/sja/support-us/the-difference/helpless/mobile-phone-app.aspx) or request a free pocket-sized guide (https://www.sja.org.uk/sja/support-us/the-difference/get-a-free-first-aid-guide.aspx or text HELP to 80039). There is even an on-line game for the children (http://www.sja.org.uk/sja/support-us/the-difference/helpless/rescue-run.aspx); after all, it is often children who help the adults in times of emergencies.

Don’t feel helpless. Don’t wait for a loved one to die before you act. Learn first aid now and be the difference – the difference between a life lost and a life saved.

(First published in the Scunthorpe Telegraph, Thursday, 11^th October 2012.)