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)
Friday, December 30, 2011
Friday, December 23, 2011
A Medical Miscellany
Christmas: a strange occasion when time seems to slow whilst people enjoy a few days of enforced relaxation and normal routines are put on hold. For some (including myself) it can induce a mild anxiety. Being used to a life-style that is frenetic, I greet the Christmas break with trepidation. The unease comes from the sudden indecision as to what to do with days free from packed surgeries, medical meetings and deadlines. It seems an opportunity too good to waste on relaxation. With all those hours to fill with something of personal interest, letting them seep through my fingers with nothing to remember but too much food, drink, television, party games and company…well, yes ok I admit it, bah humbug!
Nonetheless, I usually manage to rescue myself from the horrors of compulsory socialisation by diving into the calming pages of a good book. With any luck, Father Christmas will have squeezed the odd tome or two down the chimney, and I can pretend to be entering the Christmas spirit by playing with my favourite presents. As books are my favourite presents (closely followed by malt whisky, in case anyone is interested), such a ploy means escaping into a different world altogether (clever, eh?).
So what might a doctor read at Christmas? We all vary of course. However, one section of my library reads like a collection of the medical ghosts of Christmas Past, with each book reminiscent of a different year. Dr Zhivago by Boris Pasternak is one of my all-time favourites; a heady mix of dashing doctor and anguished poet, with a lashing of passion thrown in. Does that remind you of anyone? Well, one can dream.
Another firm favourite is The Story of San Michele by Axel Munthe; the classic and absorbing memoir of a 19th century Swedish doctor who, via the high society of Paris, built a villa on the island of Anacapri. A.J. Cronin’s The Citadel is another classical ‘must’; whilst Ask Sir James by Michaela Reid is a fascinating tale of Queen Victoria’s physician. Will Pickles of Wensleydale, by John Pemberton, returns us to the ordinary with the story of a GP from North Yorkshire whose research helped in understanding the spread of infectious disease, and who was a founder of the Royal College of General Practitioners.
Patrick Devlin adds some intrigue in Easing the Passing, as he relates his account of being the judge at the 1957 trial of Dr John Bodkin Adams, a forerunner of Dr Shipman. Alternatively, John Berger’s A Fortunate Man is another classic story of a country doctor; or there is always A Ring at the Door, providing the personal experiences of George Sava, a Harley Street surgeon of the 1930s.
Reminiscent of one of my recent columns is a 1953 book entitled A Doctor Heals by Faith, by Christopher Woodward; not that I could let the General Medical Council know that I have been reading that one. The Doctor by Isabel Cameron is in a similar league, albeit fictitious, and featuring a Doctor of Divinity rather than medicine. The book, a Scottish classic in the early 1900s, sold 240,000 copies.
For those with a military interest, The Red and Green Life Machine by Rick Jolly is a Royal Navy surgeon’s absorbing account of the bravery of medical personnel in a field hospital during the Falklands War. Finally, and to balance the last, no reading list should be without some humour, and Richard Gordon provides just that with his Doctor in the House series of uproariously funny tales from the wards.
I could go on (as indeed does my collection of medical literary miscellanea). However, I am sure you have mistletoe to hang and presents to wrap. Speaking of which, I can see a least one book-shaped parcel with my name on, alongside something that could easily be a bottle of malt whisky. I think I’ll just position them next to this armchair in preparation. With that, a very happy and healthy Christmas to you all.
(First published in the Scunthorpe Telegraph, Thursday, 22nd December 2011)
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)
Tuesday, December 20, 2011
In Praise of Eccentricity
‘Where have all the flowers gone?’
It was a question posed to a crowded lecture hall of final year medical students twenty-six years ago by a much respected consultant physician and lecturer at the Charing Cross Hospital Medical School, London. His name was Dr P B S Fowler, although I think that is where any tenuous personal connection ended. As we were about to set forth into the world of medicine as fully fledged doctors, Bruce Fowler was about to retire from the NHS. A huge man, who always wore an academic’s black gown when addressing the students, he was an entertaining lecturer and could fill an auditorium to over-capacity regardless of the subject of his lecture. On this particular occasion he took as his theme the demise of doctors with individual characters, lamenting the modern trend for medical schools to manipulate new undergraduates into identical clones. Those who initially showed promising signs of individuality were systematically humiliated by the teaching methods of the day, until they succumbed to a life constrained by the need to conform to the rules of professional conduct.
Of course, Britain has always been a country of eccentrics; possibly containing far more per head of population than many larger countries. The history books are full of them. Relating to behaviour considered to be unusual or odd, eccentricity is often found in the company of the artistically creative and the intellectual, and frequently invokes the concepts of genius and madness; as Mr Pickwick remarked in Charles Dickens’ Pickwick Papers, ‘Eccentricities of Genius, Sam’. This failure to conform to society’s norm is one often loved and admired from a distance, but can be quite disturbing to close members of the family. A former patient of mine was a man of great character, quite unconcerned by the community’s occasional disapproval of his behaviour to the point of being a local eccentric. I praised his individuality to his son one day, whose reply was illuminating: ‘Characters are wonderful people, as long as you don’t have to live with them’. Having an eccentric in my own family, I found myself warming to his words.
So what makes someone an eccentric? In a 1995 study of ‘sanity and strangeness’, Dr David Weeks and Jamie James concluded that the principal characteristics an eccentric possesses are: non-conformity, creativity, being motivated by curiosity, idealism, an obsession with one or more hobbyhorses, an awareness from early childhood of being different, higher than average intelligence, a tendency to be opinionated and outspoken, a love of solitude, and a mischievous sense of humour. Do you know anybody like that? I suspect that younger readers are more likely to say yes, as eccentrics are nearly always older than ourselves, and of course we never recognise eccentricity in our own behaviour; after all, for an eccentric it is the rest of society who has got it all wrong.
I was reminded of Bruce Fowler’s lecture recently by a wonderful coincidence of timing. Sadly, in August this year he died, albeit at the age of 90. His obituary appeared in the BMJ on the 29th October. It just so happened that the Ancient Order of Eccentrics was reformed on the very same day, with eccentric guests travelling from all over the British Isles to attend a banquet in Lincoln. First founded over two centuries ago, the Eccentric Club exists to celebrate ‘Great British eccentrics and original thinking, flying in the face of the bland modern world’. I am sure that Dr P B S Fowler would be overjoyed to know that the flowers he once lamented are in fact alive and blooming in the 21st century. If only I was an eccentric, I would be tempted to become a member.
(First published in the Scunthorpe Telegraph, Thursday 24th November 2011.)
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.)
Saturday, December 10, 2011
Fiction Today, Reality Tomorrow?
How many readers remember the television programme ‘Tomorrow’s World’? The presenters’ mantra on this forward looking weekly survey of the cutting edge of scientific development could almost have been ‘today’s science fiction is tomorrow’s reality’. In many cases that has indeed been the case, especially if you consider the modern technology behind mobile telephones, computers, satellite navigation, the ability to carry around hundreds of books on a Kindle, MP3 players that can store an entire music collection, cloning Dolly the sheep, the space shuttle, micro-surgery, and so.
Such thoughts recently took my mind back to a book I read when I was fifteen years old. It was called ‘Colossus’ by D.F. Jones. Published in 1966, the book was hailed as a ‘horrifying instalment of the man versus machine competition’ by the New York Times, and ‘hellishly plausible’ by the Sun. Colossus was about man creating the ultimate machine; a computer (as we would now call it) about the size of a large room, which took on its own personality and assumed responsibility for the defence of the free world. It was captivating stuff for a teenager in a pre-computer era; so much so that I still have the aged paperback in my library.
I was recently reminded about Colossus when two separate headlines caught my attention and connected my thoughts to a column I wrote last year, when I invited you all to my 120th birthday party in 2080 (Scunthorpe Telegraph, 20 Oct 10). The first headline was ‘Breakthrough brings human cloning a step closer’ (The Daily Telegraph, 6 Oct 11); the second was ‘by 2040 you will be able to upload your brain…’ (The Independent, 7 Oct 11). Ah! I can almost hear the penny dropping with your realisation as to where this preamble is taking us…
Suspend your disbelief (and possibly your cerebral discomfort) for a moment and consider this: scientists have developed a technique called somatic cell nuclear transfer, whereby they take the nucleus from a cell of a piece of human skin and transfer it to an egg cell. A wave of a magic pipette later and you have an embryo; and in theory, just like acorns and oak trees, from little embryos big people could grow. Now, needless to say, various international ethical committees are not about to allow some mad scientist to grow a real-life soft-tissue version of Frankenstein’s monster; nonetheless, the whiff of the possibility of replicating your own body is there on the borders between today’s scientific fiction and tomorrow’s reality.
However, what use is a personalised clone if it doesn’t really think like you? Well, a scientist called Ray Kurzwell may have the solution. He believes that by the end of the 1930s we will have the ability to upload the entire contents of the human brain to a computer; thereby salvaging, in Kurzwell’s words, ‘a person’s entire personality, memory, skills and history’. Kurzwell is internationally respected by senior scientific figures and his work is taken very seriously. Whether that uploaded personalised database is then installed into a mechanical android or a real-life soft-tissue clone, the fact is the end result is as near to immortality as our present mortal frames will ever get.
Now, returning to my stated intention of living to 120, I will be eighty in 2040; just about the right time to take on a youthful transformation for my second innings, therefore I shall be making contact with Kurzwell in the near future to book my place at the front of the queue. So, to all those of you who diligently saved my column from the Scunthorpe Telegraph of the 20 October 2010 as proof of your invitation to my 120th birthday party (and I know for a fact that some of you have done so), well done and I will see you in January 2080. As for the rest of you cynics, I am sure the editor may have a few back copies he will let you have…at a price, of course. Immortality doesn’t come cheaply.
(First published in the Scunthorpe Telegraph, Thursday, 17th November 2011)
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)
Wednesday, November 30, 2011
Pessimism or Realism?
Amongst family and friends I am well-renowned for being an early riser, with a willingness to extol the virtues of making use of the time between 5am and 7am to an effect more rewarding than sleeping. However, this morning my newspaper colleague, the Honourable Columnist for ‘Strictly Speaking’, kept me in bed for an extra hour. Such is the stuff of rumour and gossip. However, before the editor makes room on the front page for a lurid exposé, let me explain that I simply awoke thinking about something my fellow correspondent recently wrote about the NHS. In his article on Thursday 27th October, Hugh Rogers expounded on why he felt confident about the future of the NHS, stating that in this respect ‘pessimism has no place’.
Whilst I am a person of strongly held views, I am always willing to consider the possibility that I have got something wrong. With this is mind, I lay awake pondering my recent proclamations within this column in respect to the current changes the NHS is being subjected to in the form of the Health and Social Care Bill 2011, asking myself whether I have been too pessimistic.
The answer can perhaps be drawn from a trawl of recent news articles regarding GPs (bearing in mind that the majority of medical care in the UK is carried out in general practice and not in hospital). According to a BMA survey, the majority of GPs believe the relationship of trust between them and their patients will be damaged by the NHS reforms. Commissioning will also bring a greater workload to GPs, who are already disenchanted trying to deal with an excessive workload and an administrative nightmare. Additionally, new work makes it harder to fit everything into a ten minute consultation slot, especially as a great deal of the work GPs now do used to be done in hospitals. One answer is to recruit more GPs. However, the evidence suggests that fewer young doctors are being attracted into general practice (this August there was an 11% fall in doctors accepted onto GP training courses compared to 2009); on top of which it takes ten years to train a GP from scratch, so increasing medical student training may help in a decade’s time, but doesn’t answer today’s problem. Then we have the suggestion that the government wants to do away with practice boundaries, so patients can see a doctor anywhere they wish. This may be handy for minor acute illnesses, but would be difficult and potentially dangerous for complex issues, apart from making it hard to predict demand for some popular practices.
What about the patients’ perspective? Well, I think everyone knows how hard it is to get an appointment with a GP at present. I am sorry to tell you that the forecast shows that it is going to get worse; a large percentage of GPs over the age of 50 years are actively looking at taking early retirement or going part-time. The reason is low morale, four years of seeing GP pay decrease year on year, government threats to the NHS pension, and a totally skewed work-life balance. Personal health budgets should also raise patients’ concerns. 50,000 people will get personal budgets over the next three years, with a view to rolling it out to more thereafter. These budgets will initially apply to patients with complex medical problems. So what happens when your personal budget runs out? After all, the changes are not just to make the NHS a more efficient service for patients; they are also to reduce the overall cost to the nation. This is further evidenced by the ‘care crisis’ induced by the one fifth cut (£1.3 billion) in government funding for nursing homes at a time when the elderly population is expanding.
I agree with Hugh Rogers that as a nation we tend to triumph at times of adversity. However, I don’t think I am being pessimistic in my expressed views. The evidence is out there and we are unwise to ignore it. Honesty and truth does not equate to pessimism; it is called being realistic.
(First published in the Scunthorpe Telegraph, Thursday, 4th November 2011)
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)
Monday, November 21, 2011
First Amongst Equals - A Tribute to a Former Colleague
I like to think that it is a rare individual who cannot name one person who has influenced their life. Most of us can probably name a parent or teacher. However, just occasionally somebody comes along who is more than just influential; someone who is inspirational and whose memory lives on as a person against whom we measure our actions.
I have several such mentors; most of whom are oblivious to their role in shaping my personality and actions. The first in medical terms was a doctor who was my immediate senior when I was a houseman in a Devon hospital. His unfailing courtesy, diligence and attention to detail made him stand out from all other doctors I had come across during my training. His name was Dr Assad Al-Doori, and he was an Iraqi. Over subsequent years, I have often thought of Assad and hope that I have incorporated some small measure of him within my own practise of medicine.
Until recently, there have been few doctors who have measured up to Assad’s standards. Then I had the fortune to meet a doctor some twenty years my junior, who subsequently became an associate within my practice. Such was his dedication to his patients that one year ago we offered him a partnership, recognising that he would be a tremendous asset to our community. He embodied the very attributes I had recognised in Assad: unfailingly kind, gentle, polite, thoughtful, and dedicated to the art of medicine, the care of his patients and the teaching of young doctors. He was an untiringly hard worker who thought of himself last of all.
His name was Dr Imran Arfeen. He was from Pakistan and he was a devout Muslim. It was his Islamic faith which strongly guided his principles and actions and, alone in his consulting room, he would snatch moments of his busy day to incorporate his ritual of prayer. To observe Ramadan, he worked non-stop throughout the day in order to overcome his hunger. Imran was inspirational and influential; holding long conversations with me regarding the comparative values of Islam and Christianity, the Koran and the Bible. I discovered from Imran far more about how the two religions overlap than I had previously discovered. Imran also quietly and gently reminded me on numerous occasions of the reason why we practise medicine – to serve the poor and sick. My colleagues now tell me that I was not alone in benefitting from his wisdom and humility.
I write of Imran in the past tense as, shortly after being offered a partnership, he was diagnosed with a terminal illness. He died two week ago. Throughout his illness, his courage and fortitude remained inspirational. Taking strength from his faith, he never lost hope and fought an heroic battle. Insisting that work was best for him, few of his patients knew that he was receiving chemotherapy, and was in effect more gravely ill than many of those he was treating.
Ironically, on the day he died, the practice received a letter addressed to Imran from a patient who is a retired Church of England priest. The letter is an outstanding testimonial to Imran’s attitude, beliefs and character; extolling his work as a doctor. It was meant as a private letter, but sadly not one Imran was to read. If he had, I am sure that we would never have known about it; such was his self-effacement.
No parent should ever suffer the grief of losing a child. It is equally true that no doctor should see a younger colleague succumb to a fatal illness. However, Imran was a devout Muslim amongst Christians, the most Christian of Muslims, and medically the first amongst equals. He taught us all something of value and his humanitarian legacy will live on as we endeavour to serve our masters the poor and sick.
(First published in the Scunthorpe Telegraph, Thursday, 3rd November 2011)
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)
Monday, November 14, 2011
Thought for the Day
Nothing in life is to be feared - it is only to be understood.
Marie Curie (1867-1934)
Physicist & chemist
Marie Curie (1867-1934)
Physicist & chemist
Crossing the Line (Part 2)
Last week I wrote about the need for doctors to adopt a holistic approach to caring for patients, reflected on the General Medical Council (GMC) guidance on religion, and finished with the historic connection between priests and doctors.
Last month a Kent GP was accused of ‘crossing the line’ when he asked a patient whether he had ‘considered Christianity’ as a means of psychological support. The patient was apparently willing to listen (BBC News, 22 Sept), but later told his mother that the GP had said that he ‘just needed Jesus’. The mother reported the GP to the GMC. Following a disciplinary hearing the GP was given a formal warning, which he has appealed against and the case will now go to a public hearing. The appeal is yet to be heard. However, it does raise many important issues; not least the manner in which patients interpret what is said within consultations. We all know of patients with incurable problems who, after the GP has gone through the long-term management plans of (say) pain relief, physiotherapy, occupational therapy, home adaptations, diet and exercise, tells his family that ‘nothing can be done’; which is not quite the message the GP had in mind.
However, there is also the issue of whether a GP is wrong to raise the subject of religion. The GMC stated that the Kent GP ‘crossed the line’, meaning the GP moved from acceptable to unacceptable practise. So what happened to the holistic approach to caring for a patient? This is where I believe that the medical profession is confused and acting illogically. On one hand, the GMC has announced that it is ‘tightening up’ the guidance on religion in practice (Pulse Today, 5 Oct), by making it a duty for GPs to consider patients’ ‘religious, spiritual and cultural history’, whilst simultaneously castigating a GP for having that very discussion. Unless a GP can openly explore a patient’s views, how are the requirements of the new GMC duty to be met? The conundrum is added to by a recent Health Foundation study, which states that doctors should adopt the role once taken by a ‘local priest’. I cannot see the GMC warming to that report.
So what of other views? The Department of Health issued guidance earlier this year warning against ‘proselytising’, stating that it is the role of the NHS Chaplaincy Service to meet patients’ spiritual needs. Fine, but when did you last see an NHS Chaplain in your surgery? Many doctors have told the British Medical Association that they want the right to pray with their patients without fear of being suspended; whilst the co-director of Patient Concern has stated that patients often welcome the offer of a prayer as a ‘warm and kind thought’. Understandably, the National Secular Society has the counter view that health and religion should not mix.
Holistic care means precisely what it says. The key point amidst all of this is for a doctor to be sensitive to a patient’s views, regardless of what they may be. Patients need doctors to be human beings and to consider them likewise; for some this occasionally means the need to include spiritual matters within a consultation. However, until the GMC, RCGP and BMA agree how doctors can approach such matters, doctors will find themselves between Scylla and Charybdis; damned if they do and damned if they don’t consider patients’ religion. One thing is certain: extracting the spiritual component from medical care produces a large hole in ‘holistic’.
(First published in the Scunthorpe Telegraph, Thursday 27th October 2011)
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)
Friday, November 11, 2011
The Remembrance Day Parade
As he walked up to the rostrum,
silence round him fell;
and whilst he gazed upon the steadfast ranks,
emotive lines began to tell.
Too many lives were lost before today:
young men and women – yesterday’s youth.
They were the cheques we drew to pay
for the blinded search for fallacious truth.
You are the inspired; the fortunate few
who have lived through to this day:
the ones who now must tell the world
to find a better way.
It is the charge of those who live
beyond vanquished dreams of many men,
to find the strength to forgive;
to learn and love as best you can.
And in so doing, let us ensure
a sense of remembrance, not of rage;
may this quietude beyond the war
turn pugnacious soldier into reflective sage.
Thus, he stood upon the rostrum as
the silence round him fell,
and gazed upon the steadfast ranks
of those returned from hell.
© Copyright Robert M Jaggs-Fowler 2011
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
Monday, November 07, 2011
Crossing the Line (Part 1)
Being a doctor, and particularly being a GP, is a complex process. It is not enough to simply spend five or six years at medical school, followed by four years or more in hospitals and general practice as a junior doctor. Neither is it enough to have a list of qualifications, or to have worked in your own practice for decades. Nor is it sufficient to hold a licence to practise, read all the recent research, apply all the latest guidelines, pass an annual peer-conducted appraisal, or be revalidated by the General Medical Council (GMC) every five years.
According to the Royal College of General Practitioners’ guidance ‘medicine…is based on a set of shared beliefs and values, and is an intrinsic part of the wider culture’ (Being a General Practitioner, 2010). For centuries, doctors have been exhorted to consider the ‘physical, psychological and social’ aspects of their patients’ health needs. This is called taking a holistic approach and, according to the RCGP guidance, requires caring for the person in the context of their ‘personal values, family beliefs, family system, and culture in the larger community’. This, of course, is the ‘art’ of medicine, rather than the science. The RCGP guidance acknowledges that ‘the holistic approach…admits that people have inner experiences that are subjective, mystical (and, for some, religious), which may affect their health and health beliefs’.
The GMC ethical guidance is equally of interest. In the booklet Good Medical Practice, the GMC states that patients' ‘personal beliefs may be fundamental to their sense of well-being and could help them to cope with pain or other negative aspects of illness’. It also recognises that ‘all doctors have personal beliefs which affect their day-to-day practice’, and advises a doctor that ‘if carrying out a particular procedure or giving advice about it conflicts with your religious or moral beliefs…you must explain this to the patient and tell them they have the right to see another doctor’. The GMC guidance also states that a doctor ‘must not express…personal beliefs, including political, religious or moral beliefs, in ways that exploit (a patient’s) vulnerability or that are likely to cause them distress’. What the GMC does not state is that a doctor is barred from expressing personal beliefs in any way or at any time during consultations, or indeed at any other time.
The holistic approach is not new. Throughout my career I have often expressed the view that modern GPs are ‘part physician, part priest and part social worker’. The second aspect of that statement is in recognition of the diminishing impact of the parish priest within local communities. (I accept and respect the fact that communities with a faith system based on something other than Christianity may still have a stronger daily role for their religious leaders). However, in communities where the population would once have been regular church attenders, many of the problems now brought to a GP are issues where a person may once have sought advice from the parish priest. That acknowledgement brought me very close to becoming a non-stipendiary priest some twenty years ago; a move which would have seen me officially wear the combined mantles of ‘white coat and dog-collar’. Such a move is not new; before Hippocrates, priests were also the physicians of the day, and prior to the advent of scientific medicine, laws regarding health and the practice of healing rituals were largely laid down within religious texts (the Bible’s Book of Leviticus being a prime example).
Next week I will explain how all of the above is topical, why I think the medical profession is confused and acting illogically, and why I believe such muddled and contradictory thinking is not good for doctors or patients.
(First published in the Scunthorpe Telegraph, Thursday, 20th October 2011)
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)
Tuesday, November 01, 2011
A Spiritual Uprising
Only on Halloween in the UK could The Telegraph have made such a wonderful typographical error.
In their article published on the 31st October 2011 regarding the resignation of the Dean of St Paul's Cathedral, Richard Alleyne, Victoria Ward and Martin Beckford wrote as follows:
'The Dead of St Paul's had pushed hard for the church hierarchy to back legal action by the Corporation of London to remove the 200 or so tents from St Paul’s churchyard.'
(http://www.telegraph.co.uk/news/religion/8861089/St-Pauls-branded-laughing-stock-as-Dean-Graeme-Knowles-resigns.html)
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)
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