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
Thursday, September 15, 2011
Wednesday, August 31, 2011
Hope – A Foundation for Happiness
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.)
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.)
Wednesday, August 24, 2011
Is Medicine Society's Nemesis?
‘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)
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)
Saturday, August 13, 2011
Quote of the Day
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
Alan Bennett on libraries of a lifetime
http://www.telegraph.co.uk/culture/books/8696077/Alan-Bennett-on-libraries-of-a-lifetime.html
Friday, August 12, 2011
Thought for the Day
‘Poetry can save nations and people.’
Czesław Miłosz (1911 – 2004)
Polish Poet Laureate & winner of Nobel Prize for Literature
Czesław Miłosz (1911 – 2004)
Polish Poet Laureate & winner of Nobel Prize for Literature
Thursday, August 11, 2011
Quote of the Day (2)
Medicine stands in his way. He would have been a much finer writer if he hadn't been a doctor.
Count Leo Tolstoy
Count Leo Tolstoy
Quote of the Day
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
Anton Chekov
Wednesday, August 10, 2011
Time Out
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.
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.
Thursday, July 28, 2011
Between Art and Science Sits the Patient
‘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.
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.
Friday, July 08, 2011
Being Human
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
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
Friday, July 01, 2011
How Useful is the Establishment of a Duty of Care for our Armed Forces?
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
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
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