Musings of a Literary Doctor

An Open Apology to India's Kinsfolk

2012-02-12T13:48:00.011Z

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

2012-02-05T17:45:00.001Z

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

Lord Byron

Training to go Through the Keyhole

2012-02-04T08:31:00.000Z

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

2012-02-04T08:27:00.001Z

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

2012-01-21T17:50:00.001Z

‘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

2012-01-09T05:40:00.001Z

‘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

2011-12-30T06:05:00.001Z

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

2011-12-23T04:43:00.001Z

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

2011-12-20T06:49:00.000Z

‘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?

2011-12-10T15:56:00.000Z

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?

2011-11-30T06:53:00.001Z

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

2011-11-21T05:47:00.002Z

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

2011-11-14T14:59:00.002Z

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

Marie Curie (1867-1934)
Physicist & chemist

Crossing the Line (Part 2)

2011-11-14T07:34:00.001Z

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

2011-11-11T06:26:00.000Z

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)

2011-11-07T21:14:00.000Z

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

2011-11-01T07:00:00.002Z

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?

2011-10-29T07:11:00.000+01:00

‘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

2011-10-26T06:17:00.001+01:00

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

2011-10-26T06:05:00.000+01:00

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.

2011-10-12T06:33:00.003+01:00

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

2011-10-10T06:35:00.000+01:00

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

2011-10-06T05:24:00.002+01:00

'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

2011-09-24T07:05:00.001+01:00

‘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!

2011-09-16T06:53:00.001+01:00

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

2011-09-15T15:37:00.000+01:00

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

Hope – A Foundation for Happiness

2011-08-31T07:46:00.002+01:00

It is well known that 2012 is the year of the London Olympics. What is less well-known, at least at present, is that 2012 is also the bicentenary of the birth of Charles Dickens.

Born on the 7th February 1812, Dickens was at heart a social reformer, and many of his books reflect his first-hand experiences of the struggles of the working class population and the effect of poverty on their lives. His own life was fairly short by our 21st century expectations, as he died of a stroke at the age of 58 years.

One of Dickens’s books, Barnaby Rudge, was an historical novel using the clash between the English Protestants and Catholics as its theme. The differences between the two religious movements came to a head in 1780, when there was widespread anger against the Papists Act of 1778. The Act allowed a softening of attitude towards Roman Catholics in England, and essentially reformed the Popery Act of 1698. Such was the unhappiness of the dissenters that riots ensued on the streets of London where, according to a writer of that time (Joseph Nightingale), destruction and looting became the worst that 18th century London experienced. The riots became known as the Gordon Riots; named after the leader (Lord George Gordon) of the Protestant Association, formed to overturn the new legislation. Such was the violence in the capital that the constabulary were unable to contain the mobs and the army was called in. It is recorded that the riots greatly damaged the reputation of Britain in Europe and posed questions in respect to the stability of British democracy as a form of government. Of course, many readers will no doubt by now have started to draw parallels between Barnaby Rudge, the Gordon Riots and the recent violent uprisings in London and other English cities. Once again, the international reputation of Britain has been damaged, and the validity of our system of government called into question by more authoritarian states.

Whatever the precise triggers in 1780 or today, it is clear that a significant percentage of the population is unhappy with their lot in life. Happiness is of course a very subjective feeling, meaning different things to different people. The Oxford English Dictionary defines ‘happy’ as ‘feeling or showing pleasure or contentment’. Being unhappy is not necessarily the same as being depressed, which has far more medical connotations. It is said that G. K. Chesterton knew what being happy was all about. A recent article by Bernard Manzo (Times Literary Supplement, 10 June 2011) discussed the life of this writer and journalist, who is probably most famous for his Father Brown detective stories. Chesterton apparently claimed that throughout his life he had ‘been indefensibly happy’; a claim which gives rise to at least two questions around what it was that made him so happy, and whether being in a permanent state of happiness is wrong. It is difficult to believe that Chesterton would ever have felt the need to join a riot on the streets of London. Manzo thinks he has the answer, attributing Chesterton’s happiness to his Christian beliefs, and more precisely, the sense of hope his belief brought to him.

In the diagnostic phase which will follow these present day riots, our politicians might do well to consider the lessons to be learned from the writings of Charles Dickens and G. K. Chesterton and the insights they give to the workings of society and the need for the human mind to be given at least a sense of hope. A state of hopelessness often leads to despair and depression. If social reform is to work, a sense of hope is possibly what is most needed as the foundation of that reform.

(First published in the Scunthorpe Telegraph, Thursday 18th August 2011.)

Is Medicine Society's Nemesis?

2011-08-24T05:51:00.002+01:00

‘The medical establishment has become a major threat to health.’

The line is taken from the opening paragraph of the introduction to Ivan Illich’s book, Limits to Medicine. First published in 1975, the book takes a philosophical and cynical look at what Illich classes as the rituals of medicine, the lack of evidence supporting the idea that medical interventions have played a major part of the increase in life expectancy, the senselessness of the medico-political game of football, and the inconsequentiality of most contemporary medical care in curing disease. I thought it was a book I would hate reading. As it was, I found myself warming to the argument and, by the time I reached the final page, I had become a distant admirer of Illich, if not a converted acolyte.

Limits to Medicine concludes by stating that ‘only a political program aimed at the limitation of professional management of health will enable people to recover their powers for health care.’ Of course, that view would not find any supporters amongst the current political health reformers. However, I suspect that Illich, eccentric social commentator that he was, had a good point. The basis to his argument is the concept that the curing of disease is often coincidental to medical care; an argument that raises a question about modern western society’s fixation on seeking a GP’s advice for every ailment, however minor the condition may be.

For most GPs this argument will be nothing new. We know that our surgeries are full with people who do not really need to see a doctor. That is not the same as saying that we do not care. The point is would you really seek the assistance of a bank manager to count the change in your purse, or a tree surgeon to dead-head your roses, or a car mechanic to top-up your windscreen washer bottle? No, of course you wouldn’t. So why do people take trivial issues to their doctor? By ‘trivial’, I mean complaints that will either be self-limiting or that the person could do something about themselves without the assistance of a highly trained professional (not to mention one who is an expense to society).

To some extent, our modern society is to blame. We have become used to the concept that there is an answer for everything, and that someone else will provide that answer (preferably free of charge). Over successive generations we have forgotten how to think for, and look after, ourselves. Self-care is nothing new to those living in the remote islands of Scotland, or even on Lundy (referred to in my column last week) where a visit to a GP requires a two-hour boat ride across an often rough Bristol Channel, followed by another two-hour nausea-inducing crossing to get back home. The inhabitants do not seem any the worse off for their isolation from the NHS; they are a hardy bunch, some of whom I have known for the past twenty years. They just use common-sense and good wholesome home remedies or over-the-counter preparations for most of life’s minor illnesses. For them, an urgent condition is one that requires the input of an air-ambulance; anything else they deal with without immediate medical assistance.

In Illich’s view, what society needs is the de-professionalisation of medicine and a fostering of people’s will to self-care. His ideas may not be before time, as by 2020 it is estimated that there will be a European Union shortfall of one million doctors and nurses (BMA News, 23 July 2011). Even now, 37% of UK-registered doctors have been trained over-seas. However, the last word must surely go to Voltaire, a 17th century philosopher who reached the same view two hundred years before Illich when he said: ‘The art of medicine consists in amusing the patient whilst nature cures the disease’. Time for some NHS sponsored clowns, perhaps?

(This article was first published in the Scunthorpe Telegraph, Monday 8th August 2011)

Quote of the Day

2011-08-13T11:23:00.002+01:00

This resentment ... had to do with feeling shut out. A library, I used to feel, was like a cocktail party with everybody standing with their back to me; I could not find a way in.

Alan Bennett on libraries of a lifetime
http://www.telegraph.co.uk/culture/books/8696077/Alan-Bennett-on-libraries-of-a-lifetime.html

Thought for the Day

2011-08-12T05:58:00.002+01:00

‘Poetry can save nations and people.’

Czesław Miłosz (1911 – 2004)
Polish Poet Laureate & winner of Nobel Prize for Literature

Quote of the Day (2)

2011-08-11T07:01:00.001+01:00

Medicine stands in his way. He would have been a much finer writer if he hadn't been a doctor.

Count Leo Tolstoy

Quote of the Day

2011-08-11T06:56:00.001+01:00

Medicine is my legal wife, literature my mistress. When I am bored with one I spend the night with the other. This is irregular but at least not monotonous and neither suffers from my infidelity. If I did not practice medicine, I could not devote my freedom of mind and my stray thoughts to literature.

Anton Chekov

Time Out

2011-08-10T07:52:00.002+01:00

My wife and I have just returned from a week in the Kingdom of Heaven.

For the benefit of those who have their doubts about such a destination, we had a most enjoyable time and, once there, had no desire to make a hasty return. That said, the crossing from this land to that was rather turbulent at times; a process which took just under two hours and involved high winds and tempestuous waters. Nonetheless, it was worth the struggle, with sunshine, peace, tranquillity, and a high level of hospitality. I was also reminded of St Matthew’s gospel (it is easier for a camel to pass through the eye of a needle than for a rich man to enter the Kingdom of Heaven); providing an interesting reflection of the effects of our straightened national economy on those working within the National Health Service!

As one would expect, a dominant feature on the landscape in the Kingdom of Heaven is a church, which can be seen from some distance. However, contrary to expectation, there is also a very welcoming tavern, with lengthy licensing hours and a very good home-labelled draught bitter. Indeed, I confess that our time there was indulgent, with no work and hours free for idleness or leisurely pursuits. Sadly though, all good things must end and we were only able to spend one week in the Kingdom of Heaven before being forced to return; although the journey back was considerably easier, with calm water and a gentle breeze easing our passage. Back in this land, we are mentally and physically revived and looking forward to entering the Kingdom of Heaven again at our earliest opportunity.

Perhaps I should at this stage give a little explanation. In the Bristol Channel lies the magical island that is correctly called Lundy (http://www.lundyisland.co.uk). Over the centuries it has been owned by several wealthy families, including one whose surname was Heaven. Amongst the family was one Reverend Heaven, and it was he who was responsible for building the church; hence the sobriquet, ‘The Kingdom of Heaven’. Lundy is now owned by the National Trust, and the properties on the island are rented to holiday makers by the Landmark Trust. There are no cars on the island, and to get there, involves a two hour crossing by boat from one of two ports in Devonshire. The island is a wonderful nature reserve, with only one shop and a tavern. Once there, one has three miles of unspoilt and uncrowded rural beauty to relax in.

Having had one of your questions answered, you are possible now asking what relevance this has to someone reading this newspaper. My answer is that it has every relevance, especially in economically chastened times. Holidays are meant to provide the panacea to our daily toil. Sometimes, going somewhere close to home (by that, I mean staying within the British Isles) and doing something very simple which does not involve large daily expenditure, can be just as restful (if not more so) than travelling half-way round the world. You don’t even need to travel far from Northern Lincolnshire to achieve that, as we are blessed with some beautiful rural areas in Lincolnshire, Yorkshire and the adjacent counties. Simplicity is sometimes the answer to life’s daily stresses.

This article was first published in the Scunthorpe Telegraph, Wednesday 3rd August, 2011.

Between Art and Science Sits the Patient

2011-07-28T06:47:00.001+01:00

‘Ars longa, vita brevis’.

The Latin inscription is above the entrance door to the Postgraduate Medical Centre at the Hull Royal Infirmary. It is a salutary reminder to the physicians and surgeons who gather there in the pursuit of furthering their medical knowledge. Translated into English, the phrase enjoins us to remember that ‘art is long, life is short’. The original quotation was not in Latin but in Ancient Greek, and can be found at the beginning of a medical text book written by that well-known ancient physician, Hippocrates. The rest of his quotation reminds us that ‘opportunity is fleeting, experiment dangerous, and judgement difficult’.

Although written sometime between 460 – 370 BC, Hippocrates’ aphorism is as pertinent now as it was 2,400 years ago. The ‘art’ he speaks of is not that which we would commonly think of as art today (paintings, sculptures, literature etc.). Hippocrates’ art is the art of medical practise, and in the early years of the 21st century medicine remains just that; an art. Today, however, the modern physician would extend the concept by saying that medicine is ‘an art based on science’. The word science is also of Latin origin, meaning ‘knowledge’. The phrase ‘evidence-based medicine’ is perhaps the commonest way modern physicians refer to the inter-relationship of art and science when applied to medical practise.

What this all means is that medicine is far from being able to offer a perfect solution to every single ailment that besets humankind. In the consulting room, the most a doctor can be expected to do is to diligently apply (the art) the most contemporary knowledge (the science) to a patient’s presented problem. Sometimes great cures are brought about; occasionally there is little that can be done; more often than not, the work of the doctor is to modify the symptoms suffered by the patient in order to make life more pleasurable. The latter is summed up in another (19th century) aphorism: ‘to cure sometimes, to relieve often, to comfort always’, which neatly returns our thoughts to Hippocrates and his idea that ‘judgement is difficult’.
Doctors make judgements all the time; judgements are the end results of their application of art and science to patients’ problems. Judgements are not perfect and, ipso facto, neither are doctors or medicine; which is one reason why I believe that it is the duty of responsible newspapers not to be over-dramatic about small gains in medical science. Often a small scientific gain presents doctors with just another tiny piece of knowledge in the vast jigsaw of medicine, based on which judgements are made. It is rare that significant life-changing discoveries are made which will greatly influence the treatment of today’s patients.

A good example is the recent national press coverage of how the effects of certain drugs in combination can (by something called their anticholinergic effect on the nervous system) increase the risk of cognitive impairment (confusion and dementia-like symptoms) and death in people over the age of 65 years. No doubt my colleagues across the country had patients arriving in surgery clutching those newspaper cuttings, anxiously querying the effect of their drugs. The fact is the survey was based on drugs commonly used in the early 1990s. Twenty years later, many of those drugs are no longer used, or are rarely used in the combinations stated. Science has moved on and thus, too, has our art.

When I was a cub scout in the 1960s, we would salute our Arkela with the words ‘Arkela...we’ll do our best’. As far as doctors are concerned, the words of Hippocrates are more erudite than the ‘grand howl’ of the cubs. Nonetheless, the meaning is the same. Patients...we’ll do our best; but please remember we practise an art based on science; a science which is not, and never can be, perfect.

First published in the Scunthorpe Telegraph, Tuesday 12th July 2011.

Being Human

2011-07-08T06:51:00.001+01:00

Have you ever wondered what is it that makes us human? What are the particular aspects that make you and me different; not only from other animals, but from every other one of the seven billion people alive today on this planet? The permutations are enormous. However, it is the small variations in physical and personal attributes which allow us to identify one person from the next.

Yet, amidst this pot pourri of the world’s humanity there are emotional traits which allow us to empathise with our next door neighbour, sympathise with struggling tribes in Africa, go to war with other countries, or fall in love with someone far removed from our own community. These are the complex peculiarities which bind us all together in that group called human-kind or humanity.

Stemming from the same Latin origin as the word ‘human’ is the term ‘humanities’; the academic disciplines that involve the study of that which we term the ‘human condition’. Included within this group are literature, art, music, languages, law, history, philosophy and ethics. By increasing our knowledge of these topics we can begin to really understand what it is to be human.

However, here lies a conundrum. We often turn to the doctor, and most specifically the GP, for help at times of both physical and emotional difficulty with the expectation that he or she will understand what it is that we are experiencing. After all, that is what doctors are trained to do, isn’t it? Paradoxically, the reality is that this is one area where doctors have the least training, and the problem starts early on when we are choosing A Level subjects. Traditionally, budding medical students are encouraged to study biology, chemistry and physics; three sciences that assist us to understand the physical nature of the body, and enable us to diagnose and repair it when something has gone wrong. We are academically forced, at a formative stage, to abandon those subjects which are equally important to achieve a rounded education and produce experts in understanding human-kind.

This omission is what has led some universities to now include a humanities module within their training programme for medical undergraduates. In addition, it is now possible to study for a Master of Arts degree in medicine and literature; investigating the interaction between the two disciplines. After all, some of the world’s greatest authors knew a thing or two about what being human really entails. Think, for example, of the works of Emily Brontë (Wuthering Heights), Shakespeare (A Midsummer Night’s Dream), Tolstoy (Anna Karenina), James Joyce (Ulysses), Thomas Hardy (The Woodlanders), Charles Dickens (Bleak House), Charlotte Brontë (Jane Eyre), D H Lawrence ( Women in Love), E M Foster (A Passage to India), and Evelyn Waugh (Decline and Fall). The list is endless. All these authors explored the emotional depths of humanity; that is why their works have found a lasting place in our collective souls; their characters are reflections of what it is to be human; to be you and me in all our times of trial and happiness.

So next time you wonder whether your GP is up to date, don’t ask which medical journals he or she is reading; ask whether your GP has recently read a classical novel. If the answer is ‘yes’, you may have found a doctor who really understands what being human is all about.

First published in the Scunthorpe Telegraph, Wednesday 15th June 2011

How Useful is the Establishment of a Duty of Care for our Armed Forces?

2011-07-01T06:11:00.004+01:00

Much has been written in recent months regarding the ‘duty of care’ this country has to its armed forces. Such a duty does not have to be enshrined in statute law and the establishment of such a duty is often left to the common law to determine in respect to individual cases. However, it is a welcomed fact that the duty is being enshrined within the Armed Forces Bill currently moving its way through parliament.

That said, whilst many people were, through the media of press and television, publically rejoicing at the Government’s decision, I was led to consider what such inclusion might mean in reality, and whether it was just a statement of the existing situation rather than a positive move towards establishing that which most people really want; that is, practical care of our serving forces personnel and their families, along with appropriate after-care when they leave the forces (and especially so if they are injured). The best way I can describe my concerns is to consider the duty of care which exists in respect to the role of healthcare personnel to our patients.

The Oxford Dictionary of Law defines ‘duty of care as ‘The legal obligation to take reasonable care to avoid causing damage’. Clearly, that is an understandable duty in respect to the actions of a doctor, for example. However, the same concept does not translate very well to a soldier serving in the front line of a war zone. In medicine, it is a duty which has been established in common law and is enshrined within the General Medical Council’s Code of Practice for doctors. From a patient’s perspective, the purpose of establishing a duty of care is to ensure that the patient is treated well. The flip side is, of course, that a patient might seek legal remedy should there be the perception that something has gone wrong in the process of that duty being performed. Therein often resides the difficulty, for establishing negligence (and thus being eligible for compensation) is a tortuous path to tread.

To establish negligence a patient must first show that there existed a duty of care; that done, the next step is to prove that there was a failure on the part of the doctor to fulfil that duty. Finally, it has to be shown that the failure directly led to the injury for which the patient seeks compensation. If there is no injury sustained, or the causal link between the three factors cannot be proven, then there is no remedy in law as negligence has not been established.

In medicine, the whole process is often confounded at the second hurdle, as what constitutes good or appropriate care is not always clear-cut within a profession that is only partially based on science. The Bolam test is often quoted, being a judgement stemming from a 1957 court case (Bolam v. Friern Hospital Management Committee), when it was established that ‘a doctor is not guilty of negligence if he has acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular art’. So, if it is as difficult as that within the realm of healthcare, what hope does the family of an injured soldier have, where the boundaries are even less clear? I fear that the current inclusion may be a good start, but the victory may still prove to be very hollow in a practical sense.

First Published in the Scunthorpe Telegraph, Monday 30th May 2011

To be or not to be (a doctor)

2011-06-17T06:46:00.001+01:00

'If you had your time again, would you still have become a doctor?'

The latter was a question to me a few weeks ago, not long after my article regarding the current NHS political changes. It was an interesting question, and one I have asked myself over many years. Careful consideration always produces the same honest, emphatically positive response. It is true that I can think of other paths I would have liked to travel; other subjects I would have enjoyed reading at university; other areas of the country (or even the world) where I would have enjoyed living. Then again, which of us (regardless of the nature of our upbringing, social status, occupation or interests) hasn't had similar thoughts? Is that not simply a case of 'the other man's grass is always greener'? Ultimately, we have to settle for something which will provide the backbone to our lives. Thirty one years after I first walked into a London medical school, I have no hesitation in saying that I would still chose to become a doctor.

Of course, 'becoming a doctor' is not quite the same thing as receiving a Bachelor's degree in medicine. There are many years following the five or six spent as a medical student before a doctor can feel that he or she has arrived at the long-sought destination, during which time a junior doctor jumps the various postgraduate hurdles of training posts and postgraduate examinations. Even then, there is the need for life-long dedication to continuing professional development.

So you may ask why I would do it all again; why, when the training is arduously prolonged, the workload overwhelming, and the political interference with the NHS so frustrating? The answer is because a medical degree can be one of life's most valuable passports. I am sure other professionals would claim similar attributes for their own qualifications. Nonetheless, the intimate involvement in people's lives that the practise of medicine requires can be both spiritually rewarding and tremendously humbling; bringing with it a tremendous sense of worth and satisfaction that few other occupations can easily trump. There is also the chance of a decent standard of living; although not necessarily a fortune to be made. However, the qualification is far more valuable than that. With imagination and determination, a medical degree can open so many opportunities in life that it is difficult to say where the boundaries are. In my view, those opportunities are far more valuable experiences than the acquisition of wealth.

This column is not a place for me to blow my personal trumpet. It is suffice to say that, suitably armed in educational terms, I have ventured into numerous occupational realms that, as a child, I never dreamt I would access. I have also had the pleasure of travelling the world, participating in grand society events and meeting people from all walks of life. For me, a medical degree has been the passport to life's sweet shop, enabling me to fulfil Rudyard Kipling's maxim of filling 'the unforgiving minute' in a kaleidoscope of ways.

So, the answer to the original question is an emphatic 'yes'; I would still become a doctor and, placing medical politics aside, I would encourage others to do so. More importantly, to any young person considering reading medicine, I would exhort you not to consider your degree as the 'be all and end all' of your aspirations. There is a whole world out there; with effort, determination, and imagination it is all yours to sample.

First published in the Scunthorpe Telegraph, Wednesday 11^th May 2011

The Encouraged Optimist

2011-06-13T07:01:00.001+01:00

Sign seen on the bar of a pub ('The Dog') in Whalley, Lancashire:

'I'm going to live forever.

So far, so good.'

Extra, Extra, Read all about it!

2011-06-04T08:48:00.001+01:00

Blessed with such wonderful weather, the Easter weekend was a great opportunity to clock up some time exercising in the great British outdoors; which is precisely what I had the fortune to be doing in that land known as God's own country, the Yorkshire Dales. However, with a few days away from the turmoil of the surgery, it was also an excellent time to catch up on some serious reading of an ever-growing backlog of medical journals.

Keeping up to date with medical developments is a task that doctors endeavour to perform on a regular and life-long basis. It is almost an impossible task, and we can only try to do some justice to the postbags of journals and medical newspapers that fall through our letterboxes on a weekly basis. However, most of us will select and concentrate on a few favourites and then scan the remainder for particularly eye-catching articles which the others may not have covered. For me, the British Medical Journal and the Journal of the
Royal College of General Practitioners are the main players, topped up with a couple of medical news magazines called GP and Pulse.

This particular weekend was of considerable interest, and I was able to update my knowledge of how vitamins pills may be bad for you by increasing the desire for fast foods (reported in the journal Psychological Science). I also took notice of various public health articles on the smog alert affecting Britain; found that the Archives of Disease in Childhood contained research linking excessively crying babies with the later development of behavioural problems; learned that the journal Arteriosclerosis, Thrombosis and Vascular Biology was reporting on the link between the time children watch television and the development of heart disease and high blood pressure; discovered that the General Medical Council is considering holding misconduct hearings for GPs behind closed doors; and that peat moss was once used for dressings for battle wounds during the First World War. Further reading included an article on euthanasia, and how elderly people in Holland are now carrying cards to ensure that doctors do not over-enthusiastically end their lives. There were also papers with evidence that playing a musical instrument may help protect against Alzheimer's Disease (reported in the journal Neuropsychology); reports on how air pollution raises the risk of breast cancer (reported by the American Association for Cancer Research), and finally, that the Boston University Medical School had discovered that the 'older' types of contraceptive pill may be safer than newer versions.

All of the above made for fascinating reading. However, the truth is, none of the articles were actually from the journals I earlier reported reading on a regular basis. In fact, they were all to be found in the nation's daily newspapers. I cannot imagine for one moment that any GP actually receives half of the journals mentioned above, let alone gets to read them. So, despite our best of efforts, we cannot possibly keep on top of every single development in medical science; I am not even certain that retirement would allow sufficient time to do achieve such a herculean task.

One often hears the phrase 'if in doubt, consult your GP'. However, a gentle plea on behalf of all my GP colleagues: whilst we do our best to keep our knowledge fresh, the next time you come to the surgery to discuss an article in this week's news, please bear in mind that journalists will often trawl through esoteric science journals to find eye-catching headlines which the jobbing GP will never read at first hand. If we sit their nodding wisely and saying nothing, it is probably because we are totally bemused and wishing we had paid more attention to the weekend's newspapers.

First Published in the Scunthorpe Telegraph, Monday 2^nd May 2011

A Columnist’s Life

2011-05-31T06:58:00.001+01:00

'Political language is designed to make lies sound truthful and murder respectable, and to give an appearance of solidity to pure wind.'

Thus wrote George Orwell in his 1946 book, Why I Write. His words will no doubt find support and understanding amongst many readers and writers alike. It might be construed that one raison d'être of newspapers in general is to see through such political rhetoric and bring to the public's attention the hidden aspects and undertones of a news story. That was certainly the reason behind my recent column on the subject of the current reforms to the National Health Service (Scunthorpe Telegraph, Friday 1^st April 2011). The article may have appeared on April Fools' Day, but readers of this newspaper are not foolish. Recognising the truth when they read it, the feedback from you in response to that particular article has been considerable.

All of which leads me to the question as to why I write a column in the first place. Many questions abound in the minds of columnists (at least they do in the brain of this particular one): What purpose does the column serve? Does anyone (apart from my mother) actually read the articles? What should I write about? Do people care what I write about? Are there particular issues that interest people more than others? Those are just some of the thoughts which pass through my brain on a weekly basis as I sit in my cold and draughty garret tapping away at the keyboard.

The answers to my many and varied questions are less readily accessible than the original queries. It is certainly the case that my editor cares about the subjects I choose; otherwise I would have my copies returned to sender with a red reject stamp accompanied by a large redundancy cheque (do I hear my editor saying 'dream on'?). Ostensibly, my column is supposed to be health-orientated; which on most occasions it succeeds in being, even if it does take a few detours through the world of poetry and literature. However, there, as Shakespeare's Hamlet would say, lies the rub. Whilst many people throughout Northern Lincolnshire have taken the trouble to write or speak to me in person in order to express their views on the column's subject matter, their desires in respect to the future content of the column seems to be quite varied. Some would like to see more on medical politics; others appreciate my occasional attempt at humour, whilst a further group wish I would write more about poetry and literature, even to the extent of requesting that I publish my own poems in the column. Ultimately, my editor has the final say in such matters, and unless I am commissioned to write on a different subject matter, the column has to continue (in respect to my own commission) to be health-orientated. However, I do promise to try and take the occasional meander into other, more erudite pastures to try and satisfy everyone. After all, you, the readers, are the final arbitrators over whether the column is worthwhile and meeting your needs. So, please do keep the feedback coming in and, in turn, I promise to continue burning the midnight oil for you. Meanwhile, a Happy Easter to you all.

First published in the Scunthorpe Telegraph, Easter 2011

Second Thought for the Day

2011-05-30T19:41:00.001+01:00

Interviewed by Lucey Jarrett in the ALCS News (Spring 2011), Russell T Davies remarked:

'... gradually I came into contact with writers, and realised they were ordinary people. This was before I realised that they are all, in fact, mad.'

Thought for the Day

2011-05-30T19:37:00.001+01:00

A marvellous quote in the ALCS News (Spring 2011):

'The freelance writer is a person who is paid per piece, or per word, or perhaps.'

Robert Benchley (1889 – 1945)

Snap a Quill

2011-05-25T07:03:00.001+01:00

Whilst in recent conversation with Penny Grubb (www.pennygrubb.com) , crime-writing author and Chair of the Authors Licensing and Collecting Society, I remarked that there ought to be a literary equivalent to the acting world's 'break a leg' salutation when wishing a writer good luck in a forthcoming venture.

The suggestion from Penny was 'snap a quill', which seems wonderfully appropriate.

So, over to the rest of the writing world – who knows, it may be a phrase carried on into the literary centuries to come!

Happy Talk

2011-05-25T06:45:00.001+01:00

'What is this life if, full of care, we have no time to stand and stare?'

So begins the famous poem by the Welsh poet, William Davies. There can be no doubt that the lives of many of us are under pressure; not only because of the current economic climate and the (often difficult) changes thereby necessitated at home and within our workplaces, but also through a predilection for the tendency of those living in a western society to squeeze more and more into each day and week, until the months and years become but a passing blur - so much for the 1970s concept that computers (for example) would make life easier for us all, and allow for greater leisure time.

Holidays are a time when many of us realise the undesirable qualities and true nature of our working lives. It was the topic of leisure that was on William Davies's mind when he penned his 1911 poem. It was also something he took very seriously, living his early adult years as a tramp (I recommend to you the Wikipedia website for a fascinating account of his life). Leisure was also the topic on my mind when I pensively sat overlooking the terraced farm land and distant slopes of the Troodos Mountains in Cyprus last week, where life in the hillside village of Pissouri is still conducted in the slow lane of time. Whilst there, I pondered on the various blessings of my life, some of them immediately tangible; others less so, such as the privileges of being a Freeman of the City of London (it is such a great comfort to know that, should I ever be hanged for treason, it will be by means of a silk-rope: so much easier on a delicate neck).

Of course, as individuals we have a myriad of ways of finding happiness, and it doesn't need a trip abroad or the quasi-benefits of an archaic preferment to discover happiness within our lives. Being happy and feeling free of stress are often two overlapping concepts. It was therefore interesting to learn about a new campaign recently launched by the likes of the Buddhist leader, the Dalai Lama, and our own poet laureate, Carol Ann Duffy. Called the Action for Happiness Campaign (http://www.actionforhappiness.org), and drawing on research by the London School of Economics, the campaign aims to encourage and assist the British to rediscover the pleasures to be found in even the most simplest of lives.

We all know that stress is, in its extreme, bad for our health. However, how many of us make the time within a busy week to sit still for even a short while and reflect on the pleasant aspects of life? Perhaps we should all take a leaf out of the Quaker practice of sitting quietly still for at least one hour per week? For, as William Davies ended by saying: 'A poor life this, if full of care, we have no time to stand and stare'.

First published in the Scunthorpe Telegraph, Friday 15^th April 2011

The Coffin

2011-05-07T09:08:00.001+01:00

I this week discovered that a poem from my first collection was used at a recent funeral.

It is always a momentous occasion to send a piece of work out into the world for public consumption, as one never quite knows how it will be received. It is therefore rewarding to know that some poems subsequently take on a life of their own.

The poem in question is The Coffin, taken from the collection A Journey with Time (ISBN 978-1-4092-2847-9), first published in 2008.

The Coffin

A lifetime encased:

your boundless intellect and

energy, swathed in

a vast cloak of achievement,

simply borne by two trestles.

©Copyright Robert M Jaggs-Fowler 2008

Looking into the tea-leaves

2011-05-06T06:48:00.001+01:00

Anyone who has opened a box of Twinings tea will be familiar with the quotations on the inside lid. One is from George Gissing (a 19^th century English novelist), who is reputed to have said 'The mere chink of cups and saucers tunes the mind to happy repose'. It is in the spirit of trying to induce even a mild state of euphoria that I am now drinking a large cup of Breakfast Tea whilst writing this article. However, the conversion is proving to be a challenge, and I will explain why.

My medical career began in 1980, when I entered a London medical school with tremendous enthusiasm and the single focus of qualifying and practising medicine. Even then, I knew I wanted to be a GP, despite various professors trying to sway me in other directions. I was one of the lucky ones, having previously gained a place in one of the country's top grammar schools, and then, with the aid of a decent student grant, topped up by a small scholarship award. I was, as the saying goes, upwardly mobile.

After several years of working a long and arduous passage through a variety of junior hospital jobs (120 hour weeks were the norm), I landed in North Lincolnshire and had the great fortune of being offered a medical partnership. For the major part of the past twenty-one years I have tried to offer a decent quality of service to my patients; many of whom, by virtue of living within a small community, I would now call friends. The long working days and pressured demands have been compensated for by the firm belief that I have been helping others in need and putting something back into society.

Now, in 2011, the present NHS reforms have overturned my enthusiasm and ideology. Whilst it is true to say that I still enjoy the individual patient-doctor relationships of everyday general practice, the pathway the NHS is now being forced down makes me increasingly look for alternative ways of spending the next decade of my working life. Such a statement comes as a surprise to many who have known me for a long time. However, the truth is, I (and many others on a national basis) fear for the future of general practice in particular and for the future of the NHS in general. Along with a large proportion of my GP colleagues, I can see through the political rhetoric of 'giving GPs the power to run the NHS'. Whilst it is true that we are to be given the responsibility of keeping within restricted budgets (not a bad thing when dealing with tax-payers' money), the exhortations of the Secretary of State for Health that the reforms are going to 'free up GPs to spend more time with patients', 'empower clinicians to make the decisions', 'liberate the NHS', and that 'the majority of doctors support the reforms' are, many of us believe, far from the reality.

It is true that there are a few doctors who are enthusiastic about the changes. There are slightly more who are pragmatically getting on and trying to make something decent out of the reforms. However, the majority of GPs are disquieted and fearful; certain that the changes will see greater privatisation of NHS services and hospitals, a loss of experienced managers, greater demands on GPs' time in respect to running the service rather than treating patients, increasing pressures to achieve unreachable targets, insufficient money to provide a decent service, closure of some hospitals and surgeries, and ultimately a dismantling of primary care as we know it. Of course, GPs will get the blame when it all goes wrong (nothing new there), whilst those presently in Government, who should carry the responsibility for the wholesale destruction of our national health service, will have moved on to pastures new. In the meantime, it is you, the patients, who will suffer.

If you think I write as a burnt-out fifty-year old GP who can no longer stand the pace, you are quite wrong. However, I am angry, demoralised, and reflectively surprised that I should find myself seriously considering a career change after years of enthusiasm for life in medical practice. I strongly believe that the nation needs to wake up to what is happening before it is too late. Don't swallow the political rhetoric without reading the label; there are some serious side-effects to these present reforms, and many of them are yet to become apparent. Use your wits and start asking questions of your MPs and doctors. Seek out the truth and then decide whether you personally wish to influence the changes before it is too late.

There, I have said my piece. As I drain my cup, I am mindful that Noel Coward once asked 'Wouldn't it be dreadful to live in a country where they didn't drink tea?' I quite agree, although I find myself wishing I hadn't used a tea-bag; a few tea-leaves may have helped decipher the future. As it is, looking at the bottom of my cup, there is nothing there. Then again, perhaps that is also the future of the NHS as we know it...

First published by in the Scunthorpe Telegraph, Friday 1^st April 2011

‘Robin in Flight’ by Paul Adrian

2011-04-28T06:53:00.001+01:00

The winner of the Poetry Society's National Poetry Competition 2011 is Robin in Flight by Paul Adrian.

Previously unknown, Paul Adrian has produced something that many poets will envy (apart from the fact that he won £5,000 for it). It is a beautiful conceptual work, which has caused me to read and re-read it many times. I find the last two lines particularly impressive.

Hopefully, this will not be the last we hear of Paul Adrian. I, for one, will be keeping an eye on his progress.

Robin in Flight can be found at: http://www.poetrysociety.org.uk

The Power of Love

2011-04-28T06:28:00.001+01:00

Earlier this month the national newspapers reported the death of L/Cpl Tasker, a military dog-handler working in Afghanistan. What makes this sad loss of a member of our armed forces even more poignant is the fact that his specialist dog, Theo, died of a seizure three hours after the death of his master; such was the bond between the two.

The above case may not be considered unusual by animal lovers, who often form strong emotional bonds with their pets. That the same applies to humans is also well-known; I have often encountered stories where someone with a serious illness has evidently stayed alive against all odds, simply to meet an important personal or family deadline (a wedding anniversary or landmark birthday, for example). The determined power of the human spirit is the only factor deciding on life or death. Never, however, had I met the situation in person until shortly after I qualified as a doctor:

'She refuses to die whilst her husband is still alive,' said the staff nurse.

I was in the first week of my first hospital job as a House Surgeon in Kent. Mary (as I will call her) was in her mid sixties and extremely frail. She was quiet and undemanding, and held little in the way of conversation apart from requesting a daily report on her husband. Her diagnosis had been confirmed some four months previously; inoperable cancer of the ovary. Over the ensuing months, Mary became progressively weaker, being unable to take food and surviving on the occasional sip of tea and the fluids being dripped into her veins. Such was the extent of her emaciation that her skin appeared to have been wrapped like Clingfilm around every curve and contour of her bones.

Mary's husband used to visit her every day at 2.15pm precisely. He was a dapper little chap; always in a tweed jacket and tie, and carrying fresh flowers. He would give her a gentle

kiss on the cheek then sit down in an armchair next to the bed. A few words might pass between them, perhaps some small happening from events back at home. However, for most of the time they would remain quiet; content in that easy silence that comes of many long marriages. Often, Mary would sleep. For his part, her husband remained vigilant, quietly stroking her bony hand; reassuring her by his continued presence. Then at 5pm, he would rise, give her another kiss, move the odd wisp of hair from her face, give her hand a final two-handed squeeze, pick up his cap and leave. Mary would follow him with her eyes until he disappeared from view. All of this I would observe from the distance of the ward office.

One day, in the cruel way that fate often works, Mary's husband suffered a major stroke, which left him paralysed and unable to speak. As a result, he was admitted to another ward within the same hospital. Both being too ill to move, the only contact between them was Mary's daily enquiry after her husband. Then, at 8am one weekday, the telephone call came through to the ward to inform us that Mary's husband had died in his sleep during the early hours of that morning. The ward Sister broke the news to Mary, who listened carefully but showed little in the way of emotion.

Just after lunch, my pager summoned me back to the ward and I was asked to see Mary. I knew at once that she had passed away. I stood there, quietly pensive, noting the hand stretched out towards the empty chair beside her. As the nurses averted their red-rimmed eyes, I knew that I was not the only one to be moved by her death. For many months, Mary had survived against all odds, taking strength from the power of her husband's love and her love for him. Then, within a few hours of being informed of his death, she had simply stopped living.

I still wonder at how the power of love fuelled Mary's resilience. The story of L/Cpl Tasker and his dog Theo reminded me of this story, and of how love for another being is sometimes stronger than any medicine.

First published in the Scunthorpe Telegraph, Friday 25^th March 2011

Just, Perfect and Regular

2011-04-27T06:04:00.001+01:00

My wife thinks she is sleeping with the enemy.

Before there are any misunderstandings, my opening reference is to the 1991 film of the same name (starring Julia Roberts, Patrick Bergin and Kevin Anderson). It is most certainly not a sleight on my wife's fidelity; nor am I suggesting that I am an abusive husband. However, Patrick Bergin's character and I do share one thing in common; we both stack the contents of the kitchen cupboards in tidy, orderly rows, with the labels facing outwards.

Initially, my wife put it down to my army background instilling in me a strong sense of regimentation. However, having known me for a while, she started to reconsider her preliminary diagnosis. The colour co-ordinated shirts, socks and sweaters in my wardrobes were further clues, as was the need for absolute precision when hanging paintings and arranging furniture. Twenty years on, my wife was reminded that the years have not changed me (at least not in this sense) when I proudly demonstrated to her the results of my weekend's work of re-arranging the library at home. Shelf upon shelf of neat books, arranged according to category, and then alphabetically by author within each category. Furthermore, all the books are forward adjusted to compensate for differences in size, so that the leading edges are all in a wonderfully straight line. The CD collection suffered a similar fate last month. To me, the result is one of blissful order, if not a work of art; to my wife, it is a sign that I most certainly have an obsessive-compulsive personality. Psychiatrists know it better as Obsessive-Compulsive Disorder or just 'OCD'.

Whether it is put down to my military training or the fact that I am an Aquarian, or any other plausible explanation, the fact remains that I prefer a structured pattern to my life; which is perhaps that is why I was drawn to joining the army. It would seem that such a preference extends deep into my subconscious mind, as I often wake at precisely 3.33am, 4.44am or 5.55am; a fact which then keeps me awake and starring at the clock in wonderment that it has happened yet again (and I often wonder what numerologists would have to say about it all). I was even born at 5.55pm; which, you have to agree, is a great start in life for someone with OCD.

For me, OCD does nothing more than renders me a mild eccentric in the eyes of my family and friends. By and large, I am not perturbed by my predilection for routine and life goes on in an harmonious fashion. The problem comes when that routine is disturbed by major upheaval and change. People with OCD do not greet change with any degree of warmth or enthusiasm unless it is of their own making (so imagine how I feel with the current re-organisation of the National Health Service). The truth is, for some people change in their routine is immensely disturbing to the point of making them psychologically ill. Such people may also demonstrate far more obsessive characteristics than I do; such as the need for continual hand-washing (although not a bad trait for a doctor to have), repetitive checking of door locks, and that gas knobs and taps are turned off, etc. For those people and their families, OCD can become akin to a living nightmare and is most certainly not a joke. Such issues create poor health, ruin jobs and destroy marriages. The trick is to recognise the behaviour early, well-before it becomes a major problem. It is important not to be frightened of confronting the issue and seeking help if you think the condition is affecting you in an adverse way. Your GP can act as a guide to local counselling and therapeutic services, and there are also support groups available (such as OCD-UK, which can be accessed at http://www.ocduk.org/4/groups.htm).

Meanwhile, I am looking forward to the next weekend. Those tools in the garden shed could do with a bit of a tidy-up, and then of course there is the garage, the loft, the wine cellar...

First published in the Scunthorpe Telegraph, Monday 21^st March 2011

The Value of Childhood Reminiscences

2011-04-18T05:30:00.001+01:00

As all members of the National Trust will know from the recent issue of the members' magazine, there is a poetry competition running until the 31^st March. Called 'Landlines', the competition has two categories: 'under 16' and 'over 16'. The judge is the well known poet Ian McMillan (who, amongst other things, is the Humberside Police's Beat Poet.) Introducing the competition, McMillan reflects on how the great outdoors, landscape, weather, buildings and places can all be strong images we carry in our memory for years to come.

I know this for a fact, as I carry fond and vivid recollections of my teenage years in Kent spent in the buildings and grounds of great houses such as Knole (the setting for Virginia Woolf's novel, Orlando), Sissinghurst Castle (home to the writer Vita Sackville West), Winston Churchill's home at Chartwell, Down House (where Charles Darwin lived and wrote his On the
Origin of Species), and Quebec House (childhood home of General James Wolfe). That these historic houses and grounds, along with their eminent owners, left a lasting mark on my formative years is beyond question, as even today I recognise parts of my actions, thoughts, words or possessions as relating to those early experiences.

Early memories play an increasingly important role as we get older. They are the first memories we have, and those of a greater age than I will often relate more to those early years than to recent events. I am sure that we all have the experience of aged relatives relating stories of their younger years for the thousandth time as though they were telling them afresh.

The same memories can be a source of great value when it comes to dealing with someone with early dementia. For such people, the present can often be bewildering, strange and even frightening. The usual platitudes of reassurance are of little value and quickly forgotten, and the person is left fearful, distressed and mentally alone in a perplexing modern world. Such people will often still respond in a positive and knowledgeable manner to stimuli which provoke images from their childhood and early adult years, and it is to these memories that family members and other carers should be looking in an effort to satisfactorily communicate with their loved ones. The present means very little to them. However, pictures of familiar places, houses, countryside and people will often trigger deep-seated memories which will bring some meaningful actions or conversations.

As an example, I can remember the case of a gentleman who lived in a residential home. He had dementia, was relatively immobile and was quite isolated within the home. One day a care assistant started playing records of dance music from the 1920s. To everyone's surprise, the man got out of his chair and accompanied the care assistant in a faultless waltz around the day room. Unbeknown to his carers, he had won medals for ballroom dancing in his twenties and the playing of the records had unleashed those memories.

So, if you find yourself looking after, or trying to relate to, someone with dementia, forget about the present and look to the past. The trick is to discover the background of the person you are dealing with; you may be in for some pleasant surprises.

First published in the Scunthorpe Telegraph, Friday 11^th March 2011

I Am Alive Awareness Day

2011-04-16T06:43:00.001+01:00

As I write this article I am conscious of the fact that Wednesday 9^th March is this year's No Smoking Day. Once again, there will be substantial local and national news items aimed at trying to persuade people of the sense in stopping smoking and to highlight the assistance available to smokers in order to raise their chance of achieving this more than sensible aim.

Laudable though this endeavour is, it has made me ponder the wisdom of having specific days set aside for highlighting such issues. After all, in respect to the subject of smoking cessation, it is not as though the problems of smoking are not highlighted all year round through a variety of sources and not least of all from GPs. I am sure smokers must be surprised these days if they can attend their surgery and come away without having been advised that they should stop smoking. Of course, it is also only eight weeks since we underwent the joyful celebration of welcoming the New Year; is it really the case that we have already forgotten our well-intended resolutions that we need an entire day set aside as a reminder of specific ones?

I do not mean to sound negative over such important issues. Stopping smoking is one of the most important health-enhancing activities a person can take, and I am all for stressing the importance of being smoke-free. However, I am concerned that by having specific days set aside in the year to highlight such matters, rather than lending renewed emphasis to the subject we run the risk of reducing the impact to just a twenty-four hour period, after which the topic can be dropped as we prepare for the next one. I have the feeling that it risks turning important issues into nothing more than the equivalent of a passing festivity. After all, who now holds the memories of the last Christmas festivities foremost in their minds, or can instantly recollect the occasion of their last birthday? Whilst such occasions are very important, we do not continue to lend emphasis to them all year round. However, that is what we should be doing with topics which presently crop up as specific 'Awareness Days'.

A quick survey informs me that we have at least fifty-four observance days set aside as 'world observance days' for the remainder of 2011 (excluding religious festivities, national saints' days, and specific occasions such as Mothers' Day, etc), with many more 'awareness days' on a national basis (over 100 at the last count). The majority of these will no doubt pass unnoticed by the majority of the population, which makes me question the entire purpose. There are now so many that it becomes nonsensical, with a new one almost every other day. Do we run the risk of 'awareness day fatigue' as a result? (Now there is an idea for a new 21^st century medical syndrome.)

About ten years ago I lost a well-respected, aristocratic friend and colleague. The week before he died of cancer he attended a black-tie charity ball in London. Remarking on how good it was to see him there, I gently enquired as to how he was getting on. His reply has stayed with me ever since: 'I am alive; it's all that matters', he said. I must think about that comment several times a week. As a result, every day becomes something special, and I often find that my friend's words urge me to squeeze just a bit more out of every day, no matter how busy or tired I am. There is always extra one can do, a resolution to adhere to, a little more to learn, something new to experience or appreciate; and when all else fails, there is the simple act of sitting back and relishing the company of a loved one and simply rejoicing in being alive.

So, for me, all the hundreds of 'awareness days' and 'world observance days' amount to very little. I prefer to make every day an 'I am Alive Awareness Day'. As my friend said, that is all that really matters.

First published in the Scunthorpe Telegraph, Thursday 3^rd March 2011

Comparisons with Cuba

2011-04-15T06:09:00.001+01:00

For the past ten days I have been your man in Havana; although I confess that it was not quite in the true Graham Greene style, insomuch as I was neither selling vacuum cleaners nor recruiting agents for the Secret Service (although, in keeping with Greene's fictional character, I did develop a distinct liking for a rum cocktail called a daiquiri). What I was actually doing (between the daiquiris) was comparing some interesting vital statistics; for the avoidance of any doubt, I am referring to the public health and economy type of statistics. The results of my enquiries make for some startling comparisons between Cuba and England (for example, I cannot find a decent daiquiri since returning to England).

In economic terms, Cuba is officially recognised as a third world country; shortages of every commodity, from food and clothes, to computers and cars younger than 60 years old are common, and all Cuban households still have ration cards for every day essentials. Cuba's population in 2008 was 11.25 million in an island just half the size of the United Kingdom, or almost the same as that of England, and compares to a current population for England of just over 51 million. Most Cubans live in houses or apartments provided by the state, and the average monthly salary of 420 pesos (equivalent to about £13) leaves nothing for what we would consider to be the luxuries of life. By comparison, the 2008 average disposable income per household in London was £19,038 (£1,586 per month) and £12,543 (£1,045 per month) in the north-east of England (Office for National Statistics).

Another newspaper recently ran an interesting article highlighting the North-South health divide in England (The Independent, 16 February 2011). The article reported on a study which has shown that people in the north have a 20% higher chance of dying before the age of 75 compared to those living in the south. This is despite £20bn being spent by the last government in an attempt to narrow the north-south divide. The cause has not been blamed on lifestyle factors such as smoking and drinking, but on the amount of disposable money available to a person.

However, for me, having been to Cuba, there is something missing in the reasons given for the health and socio-economic problems facing us in England. According to the United Nation's 'crude death rate figures' for 2005-2010, Cuba, for all its economic difficulties, has an average life expectancy of 78.3 years (compared to 79.4 for the UK as a whole), and a mortality rate of 7.6 per 1,000 (compared to 9.9 per 1,000 for the UK). Infant mortality (which is always a sensitive indicator of good health care) is 5.1 per 1,000 births for Cuba, which is only slightly higher than the 4.8 per 1,000 for the UK. In Cuba, there are 5.9 doctors per 1,000 people, compared to 2.2 per 1,000 in the UK.

Another interesting statistic concerns the literacy rate. In Cuba the literacy rate is 99.8%, compared to 99% in the UK (United Nations figures for 2009). The higher figure for Cuba has been due to a concerted education drive, with a 'literacy army' of teachers being sent into the poorer areas of Cuba.

If the statistics are to be believed, money alone is not the answer to the UK's health problems. From personal observation, many Cubans live in basic accommodation, have little money, are overweight, smoke cigars, eat excessive quantities of sugar, and drink a lot of rum; yet they exude a sense of happiness, and enjoy longevity. For all his alleged faults, Fidel Castro seems to have got something right in Cuba that we are yet to achieve in England. Unless it is all down to the daiquiris; I might just explore that theory a little further.

This article was first published in the Scunthorpe Telegraph, Monday, 28^th February 2011.

Goodbye, Dr Finlay?

2011-04-01T16:22:00.004+01:00

Writing in the 4^th century BC, the Greek philosopher Socrates came up with a piece of wisdom which seems an apt aphorism for these present, chastening times. He wrote:

'Remember that there is nothing stable in human affairs; therefore avoid undue elation in prosperity or undue depression in adversity'.

With the publication of the Health and Social Care Bill on the 19^th January, I am trying to remember those words of Socrates, although in this case I cannot help but think that there may be extremely good reasons to be justifiably pessimistic. Perhaps I am too cynical, having become worn down by three decades of sailing on the NHS sea of constant change and reform.

Nonetheless, I cannot help but fear for the future of the National Health Service; or more to the point, I fear for the intimate caring nature of the service which generations older than me will remember with some fondness through the rose-tinted characterisation of programmes such as Dr Finlay's Casebook. That said, I would be one of the first to say that even I was delighted not to have to work round the clock anymore when, as a general practitioner, I was able to stop night work and weekends a few years ago. After all, years of working 120 hour weeks do take their toll; I would not wish to return to such times.

However, aside from all the glowing nostalgia of yesteryear, I genuinely fear for the role of the family doctor within the evolving world of the NHS. Note that I said 'family' doctor, for it is there that change is likely to be most felt by patients; perhaps more so than at any other level of the NHS. I have no doubt that the doctor who practises as a generalist will remain in demand, because it is within the general practice setting that the vast majority of health care takes place. What is likely to continue changing is the intimate knowledge a doctor gains of generations of families during his or her thirty or so years practising in the same town, seeing the same people year on year. The wisdom a doctor receives from older partners in respect to previous generations is invaluable when caring for subsequent generations of the same families. It is a form of 'corporate knowledge' which gets passed on from one practitioner to the next during tales told over a hastily snatched cup of coffee during the progress of the morning surgery, and then added to by further experience. I have often found such learned information of great assistance in forming a professional 'special relationship' with patients, which in turn enables a genuine degree of empathy to be offered in respect to the various ails and misfortunes which life presents to us all. That is something all the government reforms can never rebuild once it is lost to society.

Nevertheless, having expressed such a morose view of the future, there has been a source of humour amongst the 'on the hoof' proclamations from Westminster in recent times. The debacle over the influenza vaccines is the source of my amusement. GPs have been blamed by the Department of Health for the lack of vaccines this year. We get used to such blame-shifting, so no real concerns there. However, the government then went on to suggest that it might take the future ordering of the vaccines out of the hands of GPs to avoid future 'debacles' of the same nature. Will the wise readers of this column please explain to me how that sits alongside the concomitant drive to hand GPs control of 80% of the NHS budget? In medical politics truth remains stranger than fiction.

This article was first published in the Scunthorpe Telegraph, Thursday, 3^rd February 2011

Patients, Doctors and Writers

2011-03-06T07:53:00.003Z

I have been called many things in my life and, although my memory likes to pretend otherwise, not all of them have been complimentary. However, one epithet that has cropped up several times in print over the past couple of months is that of 'literary GP'. That is one soubriquet I am happy to wear, feeling that my modest attempts at becoming known as a 'man of letters' just about scrapes through to justify the description. The part I find harder to consider is the very flattering, albeit hyped, comparison between me and great writers such as Wallace Stevens and T S Eliot; both of whom continued with day jobs whilst writing (they were a lawyer and banker respectively).

Nonetheless, the reporter who kindly made the above association within the Scunthorpe Telegraph (25Nov 2010) not only fleetingly bolstered my ego (thank you), but additionally raised the question in my mind as to how many writers and poets are, or have been, medically qualified. A quick search of the literature revealed an estimate that, since 1930, about 0.0019% of doctors in the United States of America have also been poets (BMJ, 11 Dec 2010); which, I have to say, doesn't sound very many. Nonetheless, continuing the quest I came across several names, many of which will be commonly known.

One of the first, of course, was St Luke; a physician and writer of the gospel by the same name. Other, more contemporary names, include Oliver Goldsmith (The Vicar of Wakefield), John Keats (Ode to a Nightingale, etc.), Anton Chekhov (Russian playwright), Sir Arthur Conan Doyle (Sherlock Holmes stories), David Livingstone (travel writer), W. Somerset Maugham (Of Human Bondage), Axel Munthe (The Story of San Michele), William Carlos Williams (American prize-winning poet), A J Cronin (The Citadel), Graham Garden (The Goodies), Richard Gordon (Doctor in the House), and so it goes on. Needless to say, apart from the possession of a medical qualification, I cannot even begin to compare myself to any of the above (perhaps with the one tiny exception of Chekhov, whose birthday I share one hundred years later to the day). Realistically, I can only resign myself to the act of clutching at the coat tails of greatness.

Now, you may well ask where all this is leading. The answer is right back to you, the reader. For, apart from being a patron of today's newspaper, you are also, or have been, or will be, a patient. All of the aforementioned writers and poets have had the benefit of dealing with that constant conundrum of how to make sense of the human condition. Patients have been the daily source of characters, stories, insights and inspiration that have in turn encouraged the production of some wonderful works of literature. Thanks to you all, that particular mine is inexhaustible. It is said that the world of fiction only contains seven basic plots. However, you all bring your own individual variations of those themes to the doorsteps of physician-writers, for which my writer colleagues and I should be most grateful. Whether we are patients, doctors or writers (or any combination of the three), we are all trying to understand what it is to live and be human. For me, the art of poetry is to distil that quest into the fewest and richest words possible. So next time you have to attend a surgery, just remember that your woes may actually be the inspiration for a great work of literature. Failing that, you might at least be helping to keep our draughty garrets warm.

This article was first published in the Scunthorpe Telegraph, Wednesday 26^th January 2011.

Preliminary Reflections of a Responsible Officer

2011-03-06T07:45:00.003Z

It is now nine weeks since I, in my existing capacity as Medical Director for a Primary Care Trust (PCT), was appointed a Responsible Officer.

Now, I would like to pretend that the position was fiercely fought over, with many applicants of a high professional calibre, and that only by virtue of my greater skills and experience was the Appointments Board so impressed as to be eager to secure my services. As many other Responsible Officers will no doubt concur, the truth is actually far from the latter, and in most PCTs the existing Medical Directors have been shoe-horned into the role for the sake of expediency; essentially in order to meet the Government's deadline of having a Responsible Officer appointed by the 1^st January 2011. No doubt it has been the same process for the acute trusts.

Nonetheless, here I am. For the first time since retiring from my army commission eleven years ago, I am an officer again. Not only that, it is now official that I am a responsible one; a title which, for reasons best known to themselves, caused both my wife and my medical partners to unite in previously unknown depths of merriment.

However, despite the aforementioned cynicism, for the past three weeks I have dutifully donned my mantle of responsibility and sallied forth, prepared to be...well...responsible; and therein lies the problem. What, I have found myself asking on an almost daily basis, am I currently supposed to be responsible for? Feeling as though I am the epitome of the idiom 'all dressed up and nowhere to go', I have plundered such sobering documents as HM Government's 'The Medical Profession (Responsible Officers) Regulations 2010', the Department of Health's 'The Role of Responsible Officer: Closing the gap in Medical Regulation – Responsible Officer Guidance', and the General Medical Council's document 'Revalidation: The way ahead', searching for inspiration and guidance. It is true that there are, within the aforementioned formidable tomes, many pages of legalese and aspirational directions that are no doubt supposed to clarify the nature of the undertaking. However, with the general turmoil the NHS is currently enduring, along with the still less than clear future format for so-called 'strengthened GP appraisals', and indeed a continuing fog around the precise manner in which the process of revalidation will happen, the diligent fulfilment of the role of Responsible Officer seems to be a somewhat Sisyphean task.

Questions abound, not least of all: will the present Responsible Officers retain a role when the PCTs are abolished in 2013, and if so, to whom will they be answerable? Will they be employed by the GP Consortia, or linked through to the Commissioning Board? Other conundrums are: who revalidates the Responsible Officers?; can a Responsible Officer continue to act as an appraiser for GPs, on behalf of whom he (or she) will eventually provide statements to the GMC in respect to revalidation?; and can a Responsible Officer act on behalf of partners within his (or her) own practice? The more one considers the subject, the more the whole process is seen to be fraught with the huge potential for conflict of interest. Untangling these labyrinthine riddles is currently a challenge for the Strategic Health Authorities; thereby in itself lending an interesting extra dimension to their own Danse Macabre.

So, in summary, nine weeks into the job, I know from the Oxford English Dictionary that being responsible means that I have an 'obligation to do something' and that I now 'have control over someone'; other than that, I remains in a state of obfuscation. It will be fascinating to see how long it takes for enlightenment to occur. Meanwhile, I will endeavour to maintain the illusion of conscientious behaviour as befits my newly anointed status.

Postcard from Cuba

2011-03-05T08:48:00.002Z

It is a land of fascinating dichotomies; a process that started in the arrivals hall, where tourists, supposedly vital to the economy of the island, are led through a complex customs and immigration process which takes two hours to complete.

'Take no notice', says our Afro-Cuban guide; 'we want you to feel welcomed. It is very safe here; you can walk into the town in the evening without any fear.' Jorge, our native Hispano-Cuban driver, evidently doesn't feel quite the same degree of security, and is over-heard negotiating with a couple of local lads who, for a few pesos, will guard the car overnight.

Havana reinforces the perception of a living duality. The four-star hotel looked opulent in the fading light of day. However, we should have been prepared for the tea to turn peppermint green at breakfast the following morning when, the evening before, the barman was unable to mix a pina colada for the want of pineapple juice, the wash basin had no plug, the piping-hot water trickled from the showerhead and the electrical voltage dropped so low that unpacking became an impossible task. Black tea is evidently only one of many scarce commodities.

For an island which continues to have a political stand-off with the USA, the reverence of the people for the memory of the American writer, Ernest Hemingway, is intriguing. In places such as Cojímar he is almost revered; yet, though the country boasts a literacy rate greater than that of the United Kingdom, Hemingway's books, as with all printed materials, are hard to obtain and too expensive for the average Cuban, who battles with an economy of two currencies. Paid in worthless pesos, anything of value can only be purchased with the Convertible Peso; the currency of the tourist.

After a few days in Havana, the comparisons continued in Cienfuegos and Trinidad, which vie for the award of best preserved town. The central squares are surrounded by beautifully maintained colonial buildings of Spanish extract. However, the view from the hotel rooftop reveals a different story. The imposing historic facades take on the appearance of film sets as one observes the poverty of the shanty dwellings tightly clustered immediately behind the spacious and immaculately kept public spaces.

The motorways are also revealing. Passing though vast tracts of fertile land so inadequately farmed that food is still rationed, the tarmac stretches for mile upon empty mile, devoid of transport save for a few modern tourist taxis and a scattering of ponderous sixty-year-old Cadillacs; all eagerly hailed by gaggles of local villagers hopeful of a lift to work. Every so often, bill-boards carry reference to the ideals fostered by the revolution of the fifties, and the iconic image of the long-deceased Che Guevara continues to be used as an attempt to inspire the contemporary population; the current political leaders are only conspicuous by their invisibility.

Meanwhile, in numbers too great to count, the ubiquitous turkey vulture circles ominously overhead, like an American metaphor waiting for Castro.

Thought for the Day

2011-03-01T07:03:00.001Z

It is not the strongest of the species that survives, nor the most intelligent that survives. It is the one that is the most adaptable to change."
- Charles Darwin

Thought for the Day

2011-01-25T06:48:00.004Z

'Remember that there is nothing stable in human affairs; therefore avoid undue elation in prosperity or undue depression in adversity.'

Socrates, Greek philosopher, 470-399 BC.

Warding Off the Bugs

2011-01-07T20:45:00.003Z

'Hello, Doctor. How are you?'

It is a phrase which is rarely heard, but when it is forthcoming the questioner, usually in the form of a patient entering my consulting room, immediately scores a few points. After all, shouldn't it be the other way round? Isn't it my role to ask them how they are? The mere idea that someone is showing the slightest concern as to the well-being of their doctor is always received with a sense of gratification; although I usually have to ward off the desire to respond with a list of complaints: 'not too good – tired all the time, back ache and repetitive strain from over-use of this computer, stressed from too much work, and the Secretary of State for Health doesn't understand me...'

However, it is generally true that, as a profession, GPs are a fairly healthy group of professionals and when we do succumb, it is usually to something fairly dramatic like heart attacks, bleeding ulcers, brain tumours and so forth. Not for us the fortnight off with a box of tissues and a glass of lemon and honey. Which leads me to the question as to why that should be so? I, for one, cannot remember the last time I needed antibiotics for sinusitis, bronchitis, tonsillitis or some similar infection.

Now, I am not for one moment suggesting that GPs are somehow imbued with an invisible cloak of invincibility. It is not that the adornment of a stethoscope acts like a magic amulet, warding off all assault by infective bugs (in the same way as a red-cross arm band worn by army doctors wards off rockets fired from hundreds of miles away). Neither is it that we have a turbo-charged immune system, upgraded as a perk of passing our exams. The truth is fascinatingly simple, and I will now share the secret with you all as a perk of your patronage of this newspaper. It is:

WASH YOUR HANDS

There, I have said it. Now, you too have the power to be infection-free, and no longer need to spend Fridays trying to see a doctor for a course of antibiotics before the weekend.

Without wishing to cause an outbreak of obsessive-compulsive disorder in North Lincolnshire, you need to think smartly and realise that these crafty bugs are everywhere you go. They are on your office telephones and keyboards, the door handles to your favourite shops and cafes, the escalator handrail, the buttons in the lift, your friend's mobile phone, and the money in your pockets. We cannot steer clear of them. However, what we can do is to avoid transferring them to our nose and mouth, where they will thrive and you will suffer.

The simple rule is, do not touch food or drink, or let your fingers anywhere near your mouth or nose (even to rub or scratch it) unless you have recently washed your hands.

Simple, isn't it? Now, with the addition of a few years of studying, you too could be a healthy doctor.

This article was first published in the Scunthorpe Telegraph on Friday 17^th December 2010

Don’t Be A Winter Ostrich

2010-12-28T07:21:00.002Z

There is something about winter that makes ostriches of so many people (except that at present they have to stick their heads in the snow rather than sand). Even after twenty years in general practice, it is something that never ceases to amaze me. What is it that I am speaking of? It is the simple issue of people not wishing to protect themselves against a potentially serious infection, and the infection I refer to is influenza.

As a doctor, it concerns me that less than 50% of the eligible population of North Lincolnshire have had the influenza vaccine this year. Put bluntly, being 'eligible' basically means that you have a significant risk of dying from influenza and its side-effects. So, if that is the case, why do people choose not to protect themselves? Simply assuming that you are super-immune to influenza simply because you have not caught it for so many years doesn't guarantee your survival. I have never had the misfortune to be knocked down by a car; but I still take the precaution of looking both ways before I step into the road; if I do not then one day my folly will catch me out, at which point it will be too late.

In an average winter, there are 25,400 more deaths in England and Wales than at other times of the year. The precise death rate depends on various factors, including the temperature. However, influenza is implicated in many of these deaths. The peak period is between December and March, so we are now entering that time; and as you are aware, it is very, very cold.

Everyone who has not been immunised has the chance of catching influenza. However, amongst those most at risk are children and adults with asthma or diabetes, those with heart disease, anyone whose immunity is reduced (e.g. because of treatment for cancer) people over the age of 65 years, and pregnant women. Anyone within those categories should seriously consider having the influenza vaccine as soon as possible. Carers and health professionals should also be setting the standard by getting themselves vaccinated; by not doing so, they are putting other people at added risk.

The serious side effects of influenza include bronchitis, pneumonia, exacerbation of asthma, convulsions, heart failure, and encephalitis (inflammation of the brain). I am sure that you would agree that none of these sound particularly trivial, and they are not. They are very distressing to the sufferer and the observer, and often cannot be cured. On the other hand, the side effects of the vaccine are usually very mild or non-existent despite all the myth surrounding it.

So, let us not think of the risk of death from influenza in terms of statistics. Consider instead individual human beings known to you. If you are not personally in the high risk categories, do you have a relative or friend who is? Have they been vaccinated against influenza this year? If not, start nagging them to go and get vaccinated. Let us face it, none of us would wish our elderly parents, our children with asthma or diabetes, our husband with heart disease, or our pregnant wife to be one of those 25,000 extra deaths this year. However, without the influenza vaccine, they are at significant risk of becoming one of them. I know I would not want that on my own conscience.

(This article was first published in the Scunthorpe Telegraph on Wednesday 8^th December 2010.)

Something for After School, Young Man?

2010-12-18T06:30:00.005Z

One month ago, Pope Benedict XVI announced that the use of condoms may be morally justified 'when the sole intention' is to combat the spread of AIDS. My immediate response was to ask 'so what?'

As I am writing this column in my capacity as a physician, this is not the place for me to start a religious debate, and I certainly have no wish to upset anyone. However, whilst the Pope's edict may influence the use of condoms in parts of the world, I feel sure that it will do very little to improve condom usage in this country; especially amongst our younger members of society where such improvement is desperately needed.

Two months ago it was announced that the teenage pregnancy rate in the United Kingdom has fallen from 46.6 per 1,000 in 1998, to 40 per 1,000 in 2010. Whilst we should be pleased to make any improvement on this front, it remains deplorable that, in this country, there are 40,000 pregnancies per year in people under the age of 18 years. Although I am all for the United Kingdom taking the lead in respect to many issues the world's stage, having the highest teenage pregnancy rate in Europe is not an achievement to be particularly proud of.

Unfortunately (in respect to condoms), the majority of our young people are not influenced by the traditional teachings of the Roman Catholic Church. Neither (speaking from a Northern Lincolnshire perspective) are they greatly influenced by the risk of contracting AIDS, as the incidence of the latter is mercifully low in this region compared to some of our cities, and very low compared to certain countries in Africa. Nor do our teenagers particularly concern themselves with preventing other forms of venereal disease; except that is, in respect to Chlamydia infections. Though, with the latter, my perspective is that we also seem to have got the message over in the wrong way. Anecdotally, I come across teenagers informing me that they have responsibly taken another Chlamydia test (note the word 'another') as they have recently changed partners. Yes, that is good news to a point. However, if they were to use condoms in the first place then there would not be the same need for the Chlamydia tests. We are not doing very well in communicating the real messages.

The truth is, our sex education program is not working. Yes, there is a place for moralistic debate and reasoning, greater parental responsibility and informing youngsters of the health risks. However, there is also the pressing need to make condoms 'cool' in the eyes of those most influenced by fashion. Regardless of society's laws, or the best of moralistic and religious teaching, sex happens and will continue to happen within an hormonally fuelled younger generation.

Thus far, we health and social educationalists have got it wrong. Perhaps our sporting and celebrity heroes are the people to recruit in a renewed drive to relegate us from the top of this particular league table.

(This article was first published in the Scunthorpe Telegraph, Friday 3^rd December 2010)

Do You Have a Mo?

2010-12-03T06:44:00.004Z

For one brief moment this month I thought I was a trendsetter; a man of the moment; a fifty-year-old icon of fashion.

What was the cause of the delusion that I had become a leading light in the world of masculine style? It was the realisation that upper lips were becoming hirsute; or at least some male ones were. As someone who has sported lip foliage ever since my teenage days (apart from when fellow students shaved it off during a university Rag Week in 1980), I was happy to form the advance party of 21^st century masculine chic.

Then I read about 'Movember'; the Canadian-based movement to raise awareness of prostate cancer. Now, for older readers of this column, the name Little Mo may bring back memories of the 1950s tennis star, Maureen Connolly. However, younger readers may be more familiar with the character from the soap opera, EastEnders. Nonetheless, I suspect that neither group will immediately guess that 'mo' is slang for moustache, and that these chaps are therefore in the process of sprouting a 'little mo'; hence the renaming of last month as Movember; witty people those Canadians.

So, you may well be asking what all the fuss (or fuzz?) is about. It involves the recognition that 35,000 men per year develop prostate cancer. It is the second most common cancer in men, with a 1-in-13 lifetime chance of developing it. 90% of cases occur in men over the age of 60, and there is a 2.5 times greater chance of developing it if there is a family history of prostate cancer.

That makes for some cheerful reading, doesn't it? However, before you decide all is lost, there are certain things you can do to help reduce your individual risk or improve your chance of responding successfully to treatment. Preventative measures include adopting the healthy lifestyle we keep hearing about, which means eating less saturated fat, meat and dairy products; all of which adversely influence the risk of prostate cancer.

The next action is not to ignore any urinary symptoms. Whilst problems with urinary flow and middle-of-the-night 'calls of nature' are familiar to many older men, do not ignore such issues, and certainly do not ignore the presence of blood in the urine: go and have a chat with your GP. Not all of these symptoms suggest prostate cancer, and (except for bleeding) may be caused by age-related growth of the prostate. However, your GP may recommend a blood test and possibly a scan; neither test being unpleasant to have.

Oh, and how is your sex life, chaps? According to Italian scientists, a healthy sex life makes men live longer. Apparently, sexual activity reduces the risk of heart disease and diabetes, and helps to avoid prostate problems.

So, gentlemen, although the month of Movember is now over, still give consideration to your prostate and go to it! I will leave you to decide whether that means growing a winter moustache; you may find some of the alternative activities are more enticing...

(This article was first published in the Scunthorpe Telegraph on Thursday 25th November 2010)

Literary GP Wins Poetry Award

2010-11-28T07:29:00.002Z

The Scunthorpe Telegraph coverage of the Fathom Prize can be found at:

http://www.thisisscunthorpe.co.uk/whereyoulive/barton/tonic-win-poetry-prize/article-2936608-detail/article.html

Living Means Moving

2010-11-28T07:27:00.002Z

'RUN FOR YOUR LIVES!

Well, perhaps you can afford to relax for a few moments more and read on before carrying out my first instruction. However, before explaining, I would like to carry out a small experiment, for which I need your assistance.

I want you to turn to the person next to you and check that the person is your 'nearest and dearest', for if they are not I cannot be held responsible the consequences of your next actions.

Now I want you to grasp that person's tummy just above the waistline and tell me how much you can pinch. If it is less than an inch, then you possibly have a 'lean mean fighting machine' as a partner. However, if there is a roll of fat several inches thick, then we might have a problem; if you need more than one hand to do the squeezing then, without question, we have a really big problem. Do not be fooled by his or her claims that it is 'muscle'; if you can squeeze it, it is not muscle, it is fat, and it is making your nearest and dearest very unhealthy, and will probably shorten their life expectancy.

Right, having established the reality of the situation, let me give you a few facts, and then I will explain how you can help me save a few lives, make our population healthier, reduce the cost of the NHS, and allow me to retire early for the want of any patients to see.

Inactivity increases the risk of developing more than six major diseases and, according to the Department of Heath, affects 60-70% of the adult population at a cost to the tax payer of £8.3 billion. Add in some other figures: 24% of adults are affected by obesity (£16 billion), 9% affected through misuse of alcohol (£20 billion) and the 20% who suffer through smoking (£5 billion), and the cost to our economy is astonishing: lifestyle issues cost us £50 billion per year.

That shows the size of the cost to our pockets. However, what about the cost to our health? Well, by taking a little more exercise (and I am not talking about a lot), we can reduce our risk of heart disease by 10%, stroke by 20%, diabetes, bowel cancer and osteoporosis (fragile bones) by 50% each, and the risk of breast cancer declines by 30%.

The official recommendations are to exercise for 60 minutes each day if you are a child, and 30 minutes five times a week if you are an adult; and it doesn't take very much – a good brisk walk is a good starting point, and for those less capable, how about discovering what tai chi is all about?

If your intention is to accept my invitation of a few weeks ago and attend my 120^th birthday party, you have got to slim those waistlines. Now is the time to get going. At the very least start walking for your lives – and start today!

(This is article was first published in the Scunthorpe Telegraph on Monday 15^th November 2010)

Who Cares, Wins

2010-11-23T07:11:00.003Z

'You're not from round here, are you doctor?'

Those words were frequently heard during my early days in practice in North Lincolnshire. Considering that I am a Kentish Man, I happily accept that the enquiry was pertinent and showed a considerable degree of perspicacity on the part of my Lincolnshire patients (unless it was my accent that gave the game away?). Some people would put the question down to nothing more than an innate sense of curiosity. However, for me, it was an indication that I was being welcomed into my new community, and that my interlocutors were simply showing that they cared. After all, the Oxford English Dictionary does define the verb 'to care' as 'to feel concern, interest, affection or liking'.

That the inhabitants of North Lincolnshire are caring people came home to me in another way one dark winter's evening whilst I was visiting a patient in a rougher part of town. On my way to the house, I was vaguely aware of some young men lurking in the shadows and felt a little uneasy about their possible intent. Upon departing the house, I was suddenly joined by another, rather scruffy, young man who was also a patient of mine. Sensing that I might indeed be in some degree of danger, he said 'looks like you've got a problem sir; stay with me and you'll be alright'. With that he safely escorted me the fifty or so yards back to my car. That young man was caring for me.

Such thoughts led me to think about the Prime Minister's concept of the 'Big Society', and how that fits in with the idea of caring. For a 'Big Society' to work, local people must care about the people and communities where they live. If they do not care, then the Big Society cannot work.

Of course, we already have a familiar group of carers within our society. They are the armies of family members and paid carers who look after people, young and old, who through frailty or disability are unable to look after themselves. However, I would like to suggest that we are actually all carers; each and every one of us, whether we realise it or not. For example, when was the last time you put an elderly neighbour's dustbins out, assisted with someone's shopping, offered up your seat, held a door open to let another pass, gave someone a lift in your car, or simply smiled at a stranger in the street? I am sure that you can think of many other examples. Each of these individual acts shows that we care.

Now that winter is approaching, many people will have difficulty with basic daily chores. Who, therefore, will you seek to help? By performing at least one act of caring every day we can together make 'care' the foundation of the Big Society in England; that way everyone wins.

After all, as my story shows, we all sometimes need care.

(This article was first published in the Scunthorpe Telegraph, Wednesday 10th September 2010)

Fathom Prize

2010-11-17T07:39:00.002Z

This morning finds me still delighted and surprised at having won the Fathom Prize for poetry last evening, with my poem 'My Neighbour's Lawn'.

Th competition, billed as Northern Lincolnshire, Hull and the East Riding of Yorkshire's 'foremost literary competition', was judged by the poet Frances Leviston MA (whose anthology, Public Dream, was shortlisted for the T.S. Eliot Prize, the Forward Prize and the Jerwood-Aldeburgh Prize).

An anthology, Fathom 10, is available from The Ropewalk, Barton upon Humber, North Lincolnshire (www.the-ropewalk.co.uk), price £5.

A Poem For Remembrance Sunday

2010-11-14T10:43:00.003Z

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 to 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.

Gold Dust, Hens Teeth and Audiences with the Pope

2010-11-12T21:06:00.003Z

Have you had difficulty getting an appointment with your GP recently?

Yes, I thought that might be your answer. I won't tell you how many of my own patients tell me that it is easier to find gold dust, spot hens teeth or see the Pope than to get an appointment with me. Indeed, one enterprising patient threatened to book an appointment for every Monday morning and then put them for auction on E-bay. I suspect there are many similarly accused doctors harangued by politely disgruntled patients, so you are in good company. However, having established that fact let me ask another question:

Do you fancy hearing about a local scandal?

I knew the answer to that one as well; so here goes. Do you know that last month in North Lincolnshire one GP was paid to do nothing for the entire month? I hope you are astonished as I was when I found out. Just think of all that wasted tax-payers' money. Does that incense you? Good; I am pleased. Now, before you start to harangue your local MP over this flagrant wastage of NHS money, let me explain.

In my practice we waste two hours per doctor per month because some patients do not keep their appointments. If the same applies to all 110 GPs in North Lincolnshire, the wastage amounts to 1,320 lost appointments per month, or the equivalent of one doctor in the county not working for almost six weeks.

Now, if that isn't bad enough, think of another fascinating statistic. In England, every month one lucky GP wins the NHS Lottery and is given the next 36 years off; yes, that's right: full pay for no work. Honestly, it's true! It happens every month; twelve doctors per year are paid by the tax payer for a full working career to do nothing. I told you it was scandalous gossip I was about to impart.

Actually, I am not really telling you the truth; but the reality is almost the same. If you extrapolate the earlier figures for time wastage in North Lincolnshire to the 30,000 (full-time equivalent) GPs in England, then each month 60,000 hours of GP time are wasted by missed appointments; that's 360,000 appointments. If all those hours were allocated to one GP, it would be the equivalent of that GP not having to work for just over 36 years; and that happens every month, hence 12 lucky GPs per year, at a cost to the tax-payer of some £1.2million per year.

So, next time you cannot get an appointment with your GP, or the NHS cannot afford some part of your treatment, don't start by blaming the doctors, the managers or even the MPs; first ask yourself when it was that you, or a friend of yours, last missed an appointment with your GP.

As for me, I need to get my blood pressure checked. I think I'll go and register with that GP who has nothing to do this month.

(This article was first published in the Scunthorpe Telegraph, Friday 5^th November 2010)

All Change Please

2010-11-04T06:11:00.002Z

'All changed; changed utterly: A terrible beauty is born.'

You might recognise the lines, taken from the poem 'Easter 1916' by the Irish poet, W. B. Yeats. It was written in response to the Easter Rising in Ireland in 1916. Whilst the poem bears only a metaphorical relevance to my topic today, I find that as I grow older those two lines increasingly resonate for me; especially in a time when change seems to be occurring on a daily basis.

Change is something which our human nature tends to avoid if possible. We feel comforted by familiarity and repetition. Normality is a state of equilibrium, where everything is just as it ought to be and nothing happens to offend that sense of well-being. However, the modern world is not like that, and perhaps it is idealistic to think that life ever was. I am sure that the Romans, Tudors, Victorians, Edwardians and so forth, all saw changes happening which caused unrest. Utopia is, after all, a mythical land.

So change happens, and somehow we have to deal with it. For some people, the rate of change is too fast for them to easily adjust to the new circumstances. Life changing events are the worse culprits: separation, divorce, redundancy, bankruptcy, house repossession, or the death of someone close. Such experiences are stressful, causing anxiety, loss of sleep, irritability, palpitations, mood changes, loss of concentration, hopelessness and depression.

Sometimes, the changes are positive in their nature, but no less unsettling. For example, I started studying medicine thirty years ago. However, the medical world I now inhabit is nothing like the one I entered in 1980; is certainly different from the one attending my birth in 1960; and the latest NHS reorganisation will ensure that it will be a very different organisation I retire from. Apart from structural changes, each week brings news of medical advances, making it harder to keep on top of my professional knowledge. This week alone informed us of a genetic cause for depression, a new screening test for prostate cancer, a 'breakthrough' screening test for bowel cancer, and new drugs for breast and ovarian cancer; all encouraging news, but no less unsettling for a professional trying to make sense of it all for his patients.

So, somehow, we need to turn change round to be positive and life-enhancing; to make it a time for new opportunities; a time to take a fresh look at how we do things and how we lead our lives. 'Who Moved My Cheese' (by Spencer Johnson, published by Vermilion) is a small and very readable book about dealing with change. It is a simple parable for modern times and I would recommend it to everyone who is affected by change of any sort. Change brings the need to adapt; this book reminds us that we are significantly empowered with the strength and ability to do so.

After all, somewhere out there, life is still beautiful.

(This article was first published in the Scunthorpe Telegraph, Thursday 28^th October 2010)

St John Ambulance - The Difference

2010-11-01T06:54:00.002Z

For an important video, which may save the life of a family member or friend, go to:

http://www.youtube.com/stjohnambulance

You need to know...a life could depend on it.

A Century and Not Out

2010-10-29T06:48:00.002+01:00

'Who wants to live forever?'

Those words are, if my quinguaginarian brain remembers correctly, lyrics from a song by Queen. For readers who have the pleasure of being under thirty, it probably seems that you are going to live forever. However, for those of us who are middle-aged or beyond, reality sooner or later sinks in; the truth is we have used half of our innings.

Or have we?

Consider your reaction to being told, at the age of fifty, that you have seventy years to go. You would probably greet such news with scepticism. After all, doesn't the Bible speak of 'three score years and ten' being man's allotted time? Well, the Office for National Statistics (ONS) would beg to differ. In a recent report, the ONS says Britain will have some 90,000 people over the age of 100 by the year 2034. Already, we know that there are several people living at the age of 115, and the oldest life on record is that of a French woman who died at the age of 122 in 1997.

Now, let me put that into perspective. The year 2034 is only 23 years away, and 90,000 people is approximately 60% of the population of North Lincolnshire. At least some of us fifty year olds may therefore not have reached middle age yet.

There is, of course, much in the way of current national discussion regarding what the retirement age should be (or whether we should have one at all), and whether the country can afford everyone's pensions. However, I would like to offer another thought for you to consider. If you were told today that you have a pretty good chance of becoming a supercentenarian, what would you want to do with all that extra time? How would you wish to enrich your added years with activity rather than be restricted by illness or infirmity?

I cannot answer the first question for you. However, in respect to the second, now is the time to start preparing by getting those lifestyle excesses sorted out (you know the ones; you don't need me to spell them out for you). For my part, I have so many interests to pursue that I am setting my sights on reaching at least 120. You are therefore cordially invited to my birthday party in 2080 (but do bring a cutting from this newspaper to prove eligibility).

(This article was first published in the Scunthorpe Telegraph, 20^th October 2010)

To Wake or Sleep?

2010-10-23T08:16:00.003+01:00

'To sleep – perchance to dream!'

At least that is how Shakespeare's Hamlet voiced his feelings on this important aspect of health. I have no doubt that his view would continue to find many modern-day supporters. However, how does such leisurely sentiment fit along side the Chancellor, George Osborne's recently expressed wish that we might all work an extra hour for the good of England?

Assuming that, for some of us, the proposed extra hour of work reduces time asleep, how might that impact on our health? It has long been known that sleep deprivation causes an increased risk of high blood pressure, diabetes and depression. Recent statistics also indicate a greater risk of heart disease and of dying younger. Furthermore, we might be heavier in the process, as reduced sleep reduces the ability to burn off fat. Sleep deprivation is also a safety risk; causing 'microsleeps', where people spontaneously 'nod off' for brief periods and thereby run the risk of causing accidents whilst operating machinery or driving vehicles.

Meanwhile there is no doubt that sleep is a necessity in order to allow the body to regenerate cells and heal damaged tissues, revitalise the immune system, organise our memories, and improve our energy levels, apart from just making us feel happier.

However, for those of us who find difficulty staying in bed, all is not lost. Whilst the usual recommendation for an adult is seven to eight hours sleep per night, a report in Sleep Medicine recorded that, in a survey of 450 women over a period of fourteen years, those women who sleep between five and six-and-a-half hours were more likely to be alive than those who had been managing the recommended seven or eight hours per night.

This brings me to another Tory statesman (Disraeli), who is reported to have said: 'there are three kinds of lies: lies, damned lies and statistics'. What, then, is a person to believe? Personally, I subscribe to the poet Felix Dennis's concept that our task is to find the most agreeable way to fill the gap between being born and dying. If you wake naturally after only five or six hours sleep, do not fret; instead rejoice that you have that extra hour to make use of for the betterment of England. For, as A.E. Housman wrote in the 'Shropshire Lad': 'Up, lad: when the journey's over there'll be time enough to sleep'.

(This article was first published in the Scunthorpe Telegraph, Wednesday 13^th October 2010)

Whither the Local NHS?

2010-10-22T07:00:00.003+01:00

We live in exciting times.

At least we do if the government's announcements in respect to the National Health Service are to be believed. Primary Care Trusts are going to be abolished; supposedly meaning less money spent on bureaucracy and managers, and more money for front line health services. Best of all, GPs are going to be given control of a large part of the budget. Surely that has all got to be good? Well, many people thought so at first. However, the reality is now beginning to sink in, and the initial promises do not look so sparkling.

The NHS is an institution that many of us have known and taken for granted during our entire lives. We are accustomed to the freedom of visiting our GPs without worrying about the cost. Neither have we had to give thought to the price of the investigations, prescriptions, or operations which might be necessary. In short, we have benefitted from a health service that many other countries have looked upon with envy.

Times, however, are changing, and the changes will affect us all. Along with many other public services, the NHS has to take a long hard look at its finances. Many GPs have understandably taken the view that our job is to look after people's health; how it is all paid for is someone else's problem. No longer can that be the case. Local GPs are already working together in anticipation of the change 2013 will bring, and the message is daunting. We simply cannot afford everything we do.

Which begs the question as to what the NHS is really for? How prepared are we to discontinue specific services, reduce the level of prescribing for some drugs, or see waiting times become longer for certain operations? It is a debate which successive governments have shied away from, preferring the delusion that the NHS can afford to do everything. The truth is it cannot, and the general public needs to know that. The public equally needs to be involved now in shaping the local services for the future. Bringing the money nearer to those who spend it means greater responsibility. However, the responsibility belongs to everyone, not just the local doctors.

After all, whilst we are often thought to work miracles, when it comes to a lack of cash, I am afraid we are not magicians.

(This article was first published in the Scunthorpe Telegraph, Wednesday 6th October 2010)

A Schizophrenic Pen

2010-09-26T20:32:00.002+01:00

Thumbing through the latest copy of The Author (the house journal for the Society of Authors), I discovered a website called 'I write Like' (www.iwl.me). In order to discover whose style one is unknowingly emulating, you enter a few paragraphs of your own prose into the site and, hey presto, it caters to your writer's weary ego by coming up with some literary giant.

I entered the first two paragraphs of my novel and found that my style is decidedly akin to Dan Brown. A pretty promising start, I thought.

That was until I tried the second chapter, and found that I had inexplicably become Agatha Christie. However, by the middle of the novel, the great Dame had left the stage and H. P. Lovecraft had taken over.

Confused (or rather 'bemused'), I decided to enter a few paragraphs of an award winning short story from a few years ago, and discovered that I had once been a James Joyce write-a-like.

At least, rather akin to Tony Blair, I should in due course be able to get my work onto several different shelves in Waterstones.

So that is all right then...I think...

Reflections of a Tourident

2010-04-23T06:41:00.002+01:00

The following article first appeared in Pissouri Contact 46, 10 October 2009 (http://www.about-pissouri.com)

It is possible (albeit unlikely) that the Oxford English Dictionary will one day include the following entry:

tourident
–
noun. 1 a person who is new to, and still learning about, a community, but who owns and occasionally resides in a property within that community. 2 a cross between a tourist and a resident.

My wife (Linda) and I are touridents in respect to Pissouri, having taken possession of our new apartment in the village in the spring of this year, and only managing three short visits thus far. However, there are advantages in being in such a position.

One benefit is that Pissouri is still an open book to us. We know what the picture on the cover looks like, and have read the blurb on the fly-leaf. However, we have thus far only progressed through the first few chapters of the contents, and most of the story is yet to reveal itself to us. Some characters appear on a regular basis, there are constant introductions to new ones, and many more exist, of whom we have only heard snippets and have yet to physically meet. Meanwhile, we are gradually treated to two unravelling storylines, where the historical meets the contemporary; tradition meets modernity; Cypriot meets newcomer; different cultures interact. The result is a plot worthy of that classic English novelist, Thomas Hardy, and just as enjoyable.

One aspect which is very evident to us is that Pissouri is a community. It is not just a collection of disparate individuals, who happen to live near to each other (as is often found in cities). Furthermore, Pissouri is a friendly community, consisting of individuals who know each other, who live and work together, who share interests and visions, who depend upon each other, and who strive to achieve collective goals for the better of the society in which they reside. That is the outward face of Pissouri. For the new-comer, whether it is the casual day-tripper, or the tourident, Pissouri has the appearance of a congenial family.

However, like all extended families, there are naturally disagreements, arguments, irritations, clashes of personalities and, inevitably, a few 'black sheep' whose actions are unpleasant and disturbing. Linda and I have now 'read sufficient pages' of the narrative, to understand some of these issues. However, far from spoiling the 'picture postcard' image of Pissouri, these issues make Pissouri even more genuine; even more of a community; even more of a family. Perhaps surprisingly to some, therein lies the village's strength. Families must learn to live with each other and make allowances for the likes and dislikes of individual members. Where there are differing points of view, compromises have to be reached and harmony restored. That is the richness of family life. Without such interaction, relationships are bland and nothing is achieved. Diversity of thought should bring people closer together in order to find and develop the common ground. That is, I believe, what is happening in Pissouri, and has probably been happening for many years past. The rich tapestry which is the modern Pissouri is the summation of all that has gone before. The beauty is that every now and again, someone will twist the kaleidoscope and the picture will shift slightly again, bringing new dimensions to what is already priceless.

My thoughts will probably say nothing new to those members of the collective community of Pissouri who were either born in the village, or who have been resident for many years. However, as a tourident, we are looking at the community with a fresh set of eyes, and what we see is, overall, a power for the good. Linda and I feel that we have recently married into a new extended family. We are slowly getting to know how the family 'ticks', but what we have learned thus far is that Pissouri is a friendly and welcoming community, and one to be valued. It is a community we are glad to have joined.

And remember, when the word 'tourident' does enter the Oxford English Dictionary, it was here that you first read it!

Cerebral Tai Chi.

2010-03-24T07:00:00.003Z

'Travel can be one of the most rewarding forms of introspection.'

So wrote Lawrence Durrell in his 1957 book, Bitter Lemons of Cyprus. He later described the necessary travelling companions in order to achieve this utopia; namely, loneliness and time, declaring them as 'those two companions without whom no journey can yield us anything'.

He was, of course, writing about his time in that wonderfully complex, Mediterranean retreat otherwise known as the Birth Place of Aphrodite. Indeed, it is where I am now writing, accompanied by a welcoming, though yet still cool, morning sun; its rays reflected by the expanse of yellow wild flowers and intensely luxuriant grasslands which rise behind my home here. The only sound is that of sparrows in a nearby carob tree, interspersed by the distant call of a wood-pigeon, and the soft mewing of a ginger cat, which has seated itself expectantly on the terrace outside my kitchen door, and which now stares back at me in the hope that I have something more exciting on offer than the occasional man-made 'meow' I return to it in the spirit of trans-cultural friendship.

Durrell is a writer I immediately warmed to. His work speaks of a man who understands the enormity of the mundane, the intrinsic value of indolence, the desirability of solitude, and the wealth of material residing just out of reach within the grey cells of one's mind, just waiting to be freed by the onset of some melancholically-induced cerebral exercise.

Cyprus is an island which allows for all of that. It is impossible to ignore the whispers from centuries past that filter through the rocks, like vapours through the pores of a living, yet antiquated, historical tome. 'Listen to me,' the land murmurs; 'listen and feel; listen and learn; listen and understand.'

So I listen, alone and unrushed. I allow the sounds of nature to filter through the labyrinth of neurones which somehow act as the repository of my thoughts; I let the rocky terraces speak to me of the island's origins and the tales of centuries past, laid down within it like seams of history, layer upon eventful layer, and I feel my mind tuning in to that same wavelength which endeared itself to Durrell, as it has to so many writers over the centuries. Yet, as I do so, my thoughts stretch, not just back down the monumental ages belonging to this island, but laterally across to the other side of the world, to the Caribbean Sea, where I sailed less than two months ago, and where, alone and with all the time in the world to muse, I cerebrally travelled back not just centuries, but through millennia, to the time of the world's earliest existence. It was a cathartic moment, and one which I tried to capture in a haiku:

Wave laps against wave:

wind's primeval voice echoes

from the start of time.

That, I believe is precisely what Durrell understood could be achieved from travelling introspectively, with time and solitude as one's companions. It is achieved through bouts of unmoving contemplation; that splendid quality the Moslems know as kayf. It requires no more than the gentle stretching of the grey cells. However, the reward is immeasurable.

Reggie Tyrwhitt Illustrations

2010-02-17T05:26:00.002Z

The North Lincolnshire market town of Barton upon Humber has seen many illustrious names over its long and distinguished history. Names such as Isaac Pitman (inventor of Pitman's shorthand), Samuel Wilderspin (pioneer of infant education), Ken Harrison (cartoonist of Desperate Dan fame), and Chad Varah (founder of the Samaritans) are just a few of such illuminaries in the town's annals.

Now, we have another star continuing to keep Barton on Humber firmly on the map as home to men of distinction. Without further ado, allow me to introduce Reggie Tyrwhitt, a man to whom the pencil is but a sixth digit of his right hand; a man who will faithfully portray your family castle (whether it be Georgian townhouse, country retreat, or resplendent folly) in splendid reproductions of lead, ink and watercolour; a man who will capture the idiosyncrasy of your dinner party, the foibles of your shooting party, or the disgrace of your golfing match in less than the time it takes for you to reach for a pencil-sharpener...

Reggie Tyrwhitt, who has the distinction of having exhibited at the Hungerford Gallery, is now available to illustrate (at a very reasonable price) your greetings cards, postcards, book-plates, invitations, menus and letterheads, etc. in a unique style of your choosing.

Take a peak today at his website and start planning your new stationery for 2010!

Reggie Tyrwhitt Illustrations
http://www.reggietyrwhitt-illustrations.co.uk

Now, who do I know who could illustrate my next poetry collection....

Misprint of the Week

2010-02-13T16:50:00.003Z

The cruise company, P&O, take pride in the presentation of all aspects of their service. However, I thought that the following announcement, printed in the ship's daily newspaper (Horizons) during my recent cruise on Artemis, was taking their concern for the welfare of their passengers just a little too far:

'Lifts
We are pleased to advise that the spare parts for the aft lift has arrived onboard and repairs will commence forthwith. Between now and Barbados all ship's lifts will also undergo survey and safety inspections, which means that all ship's lifts will be subject to interruptions in service from time to time. Every effort will be made to minimise disruption. We apologise for any incontinence caused.'

My imagination keeps conjuring up a picture of passengers attempting to climb the stairs with their legs crossed...

All Things are Relative

2010-02-09T05:56:00.002Z

Mr Bargewick is not a man known for his sense of humour; at least not by me within the timeframe of the twenty years during which he has been a patient of mine.

I am uncertain as to whether his origins are truly of Lincolnshire descent, or whether, some seventy something years ago, he was hewn out of North Yorkshire limestone and then transported to the territories south of the Humber River. What is very evident is that he doesn't like communicating. Once called from the waiting room, his face assumes the appearance of a foreboding, craggy outcrop of fissured rock. Couple that with his verbal ability to articulate each word as though it was meant to be the first syllable of the next, with the resulting sound drawn out into rambling sentences devoid of punctuation or, indeed, any discernable structure, and all delivered at a volume that makes an earth worm sound positively noisy, and you will start to have some idea of the character of the man I am alluding to.

One thing is for certain: I have never before seen him smile. It took a recent, prolonged cold snap, with snow falling over several days, for me to see that a sense of humour, albeit dour, lay beneath the rugged exterior. However, first I must tell you about the weather.

Like much of the United Kingdom, Lincolnshire has just seen its heaviest snow falls for some thirty years. Over a couple of weeks, each day had seen new layers added to those of previous days, causing considerable inconvenience to everyone, and not least to those living in rural areas. Mr Bargewick is one such person, living in a village six miles from the market town. The fact that he had been able to get to the surgery on time for his appointment was commendable, and I made a suitably appreciative comment.

"Aye," he mumbled. "It's been a long time since we've had such a sharp frost."

Momentarily speechless, I turned to the window, beyond which the wall was surmounted by a layer of snow some six inches thick. Returning my gaze to my patient, I shook my amused head, and replied:

"When I was in Ireland last year and happened to be soaked by a deluge which the locals dismissed as nothing more than a 'slight mist', I thought then that I had heard the best of understatements. However, yours beats that hands down. That, Mr Bargewick," I continued, gesticulating to the view beyond the window, "is six inches of snow...it is not a 'sharp frost'!"

I grinned with incredulity, and an amazing thing happened. Mr Bargewick's face burst into a broad smile and for the first time in twenty years, I heard him give a deep chortle of laughter, as though even he was amused at the dryness of his own wit.

In life, some nuts are harder to crack than others. People are much the same. Some wear their emotions on their sleeves, whilst others have solid defences. It has taken twenty years to find a crack in Mr Bargewick's hard exterior. However, it was definitely worth the wait, as it is unique moments like that which add to the delight of general medical practice.

Epicurea - Our Holiday Apartment in Cyprus

2009-09-14T06:40:00.004+01:00

Newly furnished, our apartment in Cyprus is now available for short vacations or for that longer period to escape the English winter!

Idyllically situated in the traditional village of Pissouri, Epicurea is only five minutes drive from Pissouri Bay, and fifteen minutes from two first class golf courses (Aphrodite Hills and The Secret Valley). Photographs of Epicurea and Pissouri can be found at:

www.holidaylettings.co.uk/rentals/pissouri/100324

Book Review - The Time Traveler's Wife

2009-08-23T07:32:00.003+01:00

The Time Traveler’s Wife
Author: Audrey Niffenegger
Published 2004
Vintage £7.99 ISBN 0 099 46446 2

For doctors who are troubled by the concepts of post viral fatigue syndrome and fibromyalgia, The Time Traveler’s Wife may present a slight difficulty. However, if the reader suspends disbelief and is prepared to go with the flow, then this book offers an extraordinary tale along the lines of The Time Machine meets Gone With The Wind.

The story is about the relationship between the principal characters, Henry and Clare.

Henry, a librarian, has a rare genetic disorder called Chrono-Impairment. The condition causes him to be repeatedly transported into his past or future, with little warning or control over when it happens or where he goes.

‘It feels exactly like one of those dreams in which you suddenly realise that you have to take a test you haven’t studied for and you aren’t wearing any clothes. And you’ve left your wallet behind.’

For me, that paragraph most aptly portrays the nightmarish condition Henry is subjected to.

As a chrono-displaced person, Henry first meets his future wife, Clare, in a meadow behind her family home, when he is thirty-six and she is six years old. From such a beginning, an extraordinary love story develops and they subsequently marry when Henry is thirty and Clare, now an artist, is twenty-two.

The book charts the complexities of their relationship, with the narrative being alternatively provided by the voices of Henry and Clare as they describe the pain, torment and uncertainty of the unpredictable periods of separation that puts an unfathomable strain on their marriage. The reader is drawn into their story as they relate the desperate quest to find a genetically engineered cure for Henry’s affliction and their heart-rending attempts to have a child.

At first, I found the whole concept disorientating and was left struggling for terms of reference in respect to Henry’s time travel. However, once I stopped referring back to previous chapters, in an attempt to form some type of time-line, and simply accepted each chronological change as stated, then the book became much more enjoyable.

The Time Traveler’s Wife is the first novel by Audrey Niffenegger, herself an artist and a professor of writing in Chicago. The American connection is given away by the spelling of the title. References to various items no doubt familiar to the average American citizen may cause difficulties for many British readers; for example, I still have no idea as to what I would be receiving if I ordered ‘duch wursts and spaetzle’ in a restaurant. However, such references are far enough apart as to avoid causing distraction from the story itself.

I am neither a fan of science fiction or romantic novels. That said, I easily read this over one wet weekend. The success of the tale can be measured by the fact that it sometimes made me laugh aloud, whilst other parts were poignant enough to bring a lump to my throat. It is an extraordinary story, which remains in one’s mind long after the book is finished. I thoroughly recommend it.

Post script:

The film of the book is now in UK cinemas. I saw it last night and found it to be a sound representation of the original book. Normally, I would recommend that a book is read before seeing a film. However, this one does a good job of standing alone on the big screen. Despite being familiar with the story, my emotions were still disrupted as the film progressed, which I guess is a sign of a good tale...

Empty Rhetoric

2009-04-30T17:45:00.003+01:00

When Gordon Brown became Prime Minister, I wrote the following poem, based on his own words. I think the verdict is now indeed 'empty rhetoric'!

Choleric Musings
(On the day Gordon Brown became Prime Minister)

‘I have heard the need for change.
…now let the work of change begin.’

Footage of journeys along The Mall;
political metamorphosis by Royal Assent.
Traditional photo-shoot at number 10
of this nation’s primary (Scottish) gent.

‘I remember words…which matter a great deal today:
“I will try my utmost”.’

Forgive a somewhat jaded view
from a veteran of decades past.
Successive governments have promised as much;
will your offerings be the ones to last?

‘I will build a government that uses all the talents.’

Are you capable of bringing stability?
Will your changes be climacteric?
Will patients see improvements they seek?
Are your sound-bites empty rhetoric?

© Copyright 2007 Dr Robert M Jaggs-Fowler

The Magic Flute in Fifty Words

2009-04-13T07:04:00.003+01:00

A few years ago I accepted the challenge of describing a named opera in no more than fifty words. It is not an easy task! However, the result is shared below:

The Magic Flute

Romance parallels Masonic ritual.

Through luminary initiation and the assistance of three genii, ophidiophobic, muted, magic-flautist Tamino and lovelorn, tipsy, campanological Papageno rescue suicidal Pamina from the debauched Moor, Monostatos, and unite her with Tamino. Papageno discovers his feathery amour, Papagena; Sarastro is pardoned and the evil Nocturnal Queen banished.

I now challenge you to try your own hand at one!

Happy Easter

2009-04-12T07:39:00.002+01:00

A very Happy Easter to you all.

May the Christian spirit of peace, harmony, love, trust and understanding be with you now and for always, whatever faith you profess.

Our World depends on it.

The Late Lord Slynn of Hadley

2009-04-10T21:28:00.002+01:00

The former Law Lord, Lord Slynn of Hadley, died on the 7th April 2009, at the age of 79 years.

Lord Slynn was a lawyer with a vast intellect. Between 1981 and 1988, he was Britain's advocate-general at the European Court of Justice in Luxembourg, followed by four years of being a judge at the same court. He was elevated to the House of Lords in 1992, where he served the English judiciary for several years, being involved in many difficult cases including the debate over whether General Pinochet should be extradited to Spain to stand trial over alleged crimes of genocide; a decision regarding which, Lord Slynn dissented from the Lord's majority.

Lord Slynn was also a gregarious man with a shrewd sense of humour. He went to great lengths to put those around him at ease, and never lost the opportunity to attend a good cocktail party, where he would be a much sought-after guest.

I first met Lord Slynn when he became the Prior of the Priory of England & the Islands of the Most Venerable Order of the Hospital of St John of Jerusalem. Within a short space of time, and true to his temperament, I was made to feel like a long-standing friend.

He will be sadly missed.

The New-Style Musings of a Literary Doctor

2009-04-05T11:09:00.002+01:00

Welcome to the fresh new look for Musings of a Literary Doctor.

All the previous posts are still available. However, after three years of blogging, the style was beggining to look a little dated. So, here we are - a new look, with lots of new posts coming soon!

Don't forget to sign up for automatic updates as new posts are added, and please feel free to add comments. It is good to have a debate on some issues.

Travel with James Tusitala

2009-04-05T08:44:00.003+01:00

Following a year of travel writing for www.beabritdifferent.com, I have decided to run with my own travel site.

Travel with James Tusitala can be found at www.travelwithjamestusitala.blogspot.com.

Do come along for the journey...there are plenty of seats on the transport!

Twittering on...

2009-04-04T08:31:00.002+01:00

Following a year of blogging distraction, I am about to upgrade this site and rekindle the 'musings'. So watch this space!

Last year's 'distractions' included a regular slot on www.beabritdifferent.com, a travel website expounding all that is best about England for the USA tourist. My posts are still there (all 144 of them), so catch them whilst you may!

The year also saw the publication of my first collection of poetry. A Journey with Time is available through all internet book sellers, or directly from me at a discounted price - just e-mail me and ask!

Meanwhile, 'Musings' has ventured off into Twitterland...still very much the new boy and learning the ropes. However, a few rudimentary 'feeler' posts are out there, and hopefully I will be able to upload a photo soon (a problem with Twitter Bugs - nasty little things!) Anyway, if you are also in Twitterland, do add me in. Just look for 'James Tusitala'

Publication of Collection of Poetry

2008-09-23T06:55:00.004+01:00

Well, there comes a time when a pseudonym has to be revealed for the person behind it! This is one of the moments...

This month sees the publication of my first collection of poetry.

A Journey with Time

is available in both hardback and paperback versions and is currently available from:

http://stores.lulu.com/JaggsFowler

In a few weeks, it should also be appearing on Amazon and Waterstones.com

For a taster, here is the blurb from the jacket:

" 'A Journey with Time' is Robert Jaggs-Fowler's first collection of poems, the subject matter drawing on his love of nature, travel, books and music, as well as exploring the more intense emotions of love and loss. At times amusing, often poignant, 'A Journey with Time' reveals the inner workings of a sensitive human being who is in touch with far more than just life's daily toil."

If you are kind enough to buy a copy, please do feel free to come back to me with any comments.

Thought for the Day

2008-09-22T06:53:00.000+01:00

The un-examined life is not worth living.

Socrates

Thought for the Day

2008-08-08T16:09:00.002+01:00

'The reasonable man adapts himself to the world: the unreasonable one persists in trying to adapt the world to himself. Therefore, all progress depends on the unreasonable man.'

George Bernard Shaw

Thought for the Day

2008-06-24T06:55:00.001+01:00

'What is life but a series of inspired follies?'

Henry Higgins
Pygmalion

Thought for the Day

2008-06-04T09:19:00.001+01:00

The only thing necessary for the triumph of evil is for good men to do nothing.

Edmund Burke

Headhunted!

2008-04-29T06:31:00.002+01:00

From little acorns...

As a result of my 'Postcards from...' series on here, I was recently invited to join a group of people writing about England for the American tourist market. Naturally, I was keen to be involved and the site has been up and running for a while.

My remit is to talk about life in the North of England. My postings can be found at www.BeABritDifferent.com Look under 'Friends' and click on the posts of James Tusitala.

Associated with the above, I can additionally be found on Facebook and Myspace...so, please come and say hello, leave a few comments, write on my wall and...most importantly, don't forget to add yourself as one of my friends!

See you there!

Projection Word Drops

2008-04-20T08:30:00.002+01:00

I have recently been approached by a group of American educationalists with a view to reproducing some of my writing on their new website, Projection Word Drops. As the administrator says in his introduction to the site, their concept is based on the idea that:

'Sincere and true words have undeniable impact, just like a drop of water hitting the water surface. The ripples can go further all around. Ripples are generated as an effect, but it is the drop itself that drives them.'

I am only too pleased to be involved with anything which spreads my writing to knew readers and thought that you, too, might wish to have a look at the site. It can be found at:

http://worddrops.visionsprojection.com/mainpage/

Thought for the Day

2008-04-18T17:00:00.004+01:00

Why I write...

I like to dance my pen on the soundtrack of my thoughts.
Nash Suleiman

Do we face the Decline and Fall of the Western Empire?

2008-03-29T18:34:00.003Z

For the past week, I have been contemplating some words of Dr Rowan Williams, the Archbishop of Canterbury. In his Easter Sermon, he said:

“…we as a culture can’t imagine that this civilisation, like all others, will collapse and that what we take for granted about our comforts and luxuries simply can’t be sustained indefinitely.

To all this, the Church says, sombrely, don’t be deceived: night must fall."

Dr Williams is frequently berated in the common press for speaking in an obscure style. However, for once, his message is loud and clear. Life, as we in the Western world know it, cannot continue forever.

There are comparisons and lessons to be learned from both the Roman Empire and the French Revolution.

The Roman Empire was once the most powerful Empire the world has known. Not only was it powerful; for at least the ruling elite, life was luxurious. With villas built in the Classical style and surrounded by art, sculpture, music, good food and wines, those fortunate to be amongst the wealthier citizens of Rome must have felt that life had never been so good. For approximately 1000 years, Rome was paramount. Then, as history now shows, night fell for the Romans; the Roman Empire started to shrink and the Barbarians overran Rome.

In the years before 1789, France was essentially a feudal society. The nobles were wealthy, possessed large estates, and had a life of luxury compared to the peasant workers who toiled in their fields and who provided for the needs of their ruling class. Whether one believes the Marxist view that it was inevitable that the growing class of bourgeoisie would overthrow the aristocracy (and Monarchy), and that in time the working class would overthrow the bourgeoisie, or whether one takes a more post-modernist view of history, what is clear is that the time of the ‘haves’ and the ‘have nots’ could not continue forever. At some stage, a degree of re-balancing of wealth had to take place. The French Revolution may have been the mechanism, or it may have just been a speeding up of events that had been happening in small ways for some time and would have reached a climax at some later, albeit inevitable, stage.

Today, those of us who have the privilege of living in the western world can all too readily be blinded to the reality of life in other parts of the world. Even with images of poverty, starvation, war, and human suffering transmitted to our televisions, we are in danger of allowing the television to sanitise the real effect on us. It is as though such things are not really happening; our lives go on as normal, we have plenty of food, clothes and warmth, our oil supplies are plentiful, we are healthy (or at least well-cared for when we are not) and nobody is waging a direct war against us. Many of us can find enough spare money to go on holiday; sometimes more than once per year. Life has never been so good.

Yet, are we not at risk of the same complacency that once beset the Roman and French aristocracies? Is it not simply a matter of scale? Instead of Rome or France, read ‘Western World’. Instead of ‘aristocracy’, read ‘westerner’. For, I would argue, there is a comparison to be drawn between the attitudes of the Roman and French aristocracies to the subjects of their respective empire or feudal estates, and those of us ‘westerners’ in our attitude to the nations poorer than us, but whose inhabitants toil for meagre return in an effort to sustain our insatiable demand for luxury. For example, where would we be without the cheap workforces of China, who produce so much of our every day commodities? Or, for that matter, the agricultural labourers who supply our tea and coffee for less than subsistence wages?

I recently read an article in Source (the Church and Community Magazine for the Parishioners of Upper Nidderdale, North Yorkshire) which gave the following statistics:

‘If you have food in the refrigerator, clothes on your back, a roof overhead and a place to sleep, you are richer than 75% of this world. If you have money in the bank, in your wallet, and spare change in a dish, you are among the top 8% of the world’s wealthy.

If you have never experienced the fear of battle, the loneliness of imprisonment, the agony of torture, or the pangs of starvation, you are ahead of 700 million people in the world.

If you can attend a church without fear of harassment, arrest, torture, or death you are envied by, and more blessed than, three billion people in the world.

If you can read this message, you are more blessed than over two billion people in the world who cannot read at all. If you own a computer, you are part of the 1% in the world who has that opportunity.’

I can add to those statistics by something I read in a nature reserve exhibition. That, to bring the world’s population to the same standard of living enjoyed by the average person now living in North Lincolnshire, we would need the natural resources of another four or five Earths.

Insisting on supermarkets operating ‘Fair Trade’ policies is a start. Insisting that wholesalers do not import clothes from factories known to use child labour is commendable. However, such action is not going to solve the ultimate problem. We need to face up to the fact that our lifestyles in the western world are unsustainable. How long will it be before the population of China, for example, demands the same standards as those we enjoy? How will the world’s resources then meet the demand? Indeed, how can our own demands then continue to be met?

We must not be blind to the precarious nature of our western civilisation’s existence. As a country looking out at the world (rather than in respect to our internal politics), we (in the United Kingdom) are largely right wing, conservative and reactionary. A vast proportion of the world is, or has the potential to become, quite the opposite: left wing, radical, reformative, and revolutionary. We cannot rely on these factions being contained forever – but who can blame them when the time comes for them to demand an equality of existence?

Western civilisation is the modern-day aristocrat facing a growing unease amongst the countries of the poorer classes. It is time that we awoke to the reality before us. The 18th century philosopher, Rousseau, expounded the notions of the ‘Social Contract’ and the ‘General Will’; ideas that featured heavily within the minds of the French Revolutionaries. Perhaps we need our world’s leaders to start negotiating the same concepts, but on a worldwide basis – now, before the matter is beyond us?

It is a ‘fact of history’ that all empires fall. When, then, the decline and fall of the Western Empire? Just as Classical Greece saw its Dark Age, Western Europe has also lived through its own Dark Ages. However, the Archbishop of Canterbury was quite correct when he said:

“…don’t be deceived: night must fall."

Without a 21st century Enlightenment in respect to the world’s resources, and a reality check on the disparity between living standards, the western world may yet have its most significant Dark Age to come.

I'm Dreaming of a White Easter

2008-03-23T08:45:00.003Z

I am sure that it has happened before, but I cannot off-hand remember when. However, Easter morning has dawned with a blue sky and two inches of snow here in the Yorkshire Dales.

A beautiful sight which offers a freshness which is very fitting for the day of the Resurrection of our Lord.

Happy Easter!

A Lexicographic Curiosity

2008-03-23T08:19:00.007Z

On the 25th March 2006, I posted to this blog an article named 'Word of the Week - Megalotic'. Little did I think that this one word was going to become a major source of interest to our friends in Japan.

Like many blogs, I have a site-meter attached. This enables me to monitor how many hits the blog receives, how long people stay on and how many pages are read. An additional feature, which I find particularly fascinating, is that it tells me which part of the world the reader is in and, finally, how they got to my blog in the first place; for example, did they stumble across it by accident when searching for something in Google, or did they specifically enter the site name.

Over the past two years, it has become increasingly obvious that readers in Japan search on the word 'megalotic' and thus come to this site. Some even enter 'Dr Tusitala - Megalotic' as their search words.

The mystery to me is why this should be. The word megalotic is not an everyday English word and certainly took me a while to figure out what it might actually mean. (See the original posting for my answers to that). So why are the Japanese so interested in the word?

If anyone has an insight to my little conundrum, please do post a comment.

A Maundy Thursday Tale of Hope

2008-03-22T15:47:00.001Z

Arriving at our cottage in the Yorkshire Dales, late in the afternoon, we discover a note from the housekeeper informing us that the vacuum cleaner has stopped working. A slight understatement, as none of the electrical sockets work, meaning everything (with a plug attached) has stopped working. A quick assessment of the fuse box confirms a tripped RCD. Further analysis reveals that it re-trips whenever anything is switched on anywhere.

Now, what is the likelihood of finding an available electrician at 5 pm on Maundy Thursday in a village where I hold no bargaining power as a doctor; or, for that matter, an electrician who can affect a repair before the end of the long Easter weekend? About the same as finding a GP surgery open on a Saturday morning, I would say. The immediate future was looking bleak.

Undaunted, I ring a number on an advert in the local Parish magazine. Amazingly, a man answers. I explain the situation and make the tentative request that he might be able to help me.

‘I’ll be straight round,’ he says, and hangs up.

Somewhat amazed, I tell my wife that the cavalry is on its way. True to his word, he arrives within five minutes and proceeds to spend the next three hours finding the fault, isolating it, and giving us back a power supply.

The young man is a saint disguised as an electrician. My faith in human nature is restored, but somehow, after he has left with my profuse gratitude, I cannot help feeling guilty for not opening my surgery on Saturday mornings any more…