The Dawn of a New Renaissance

Within the past week an avid reader of this column kindly let it be known that her husband calls me ‘Renaissance Man’. For someone whose internet blog describes himself as ‘an aspirant polymath’, such an accolade was very flattering indeed. For a few hours I basked in the delusion that I had finally joined the ranks of Leonardo da Vinci, Frances Bacon, Galileo and other erstwhile figures, until my wife recognised the danger symptoms and rescued me by the simple reminder that I still hadn’t accomplished the task of getting the flat battery out of her MG, and had yet to remove a radiator from the wall without the need to call an emergency plumber.

With my feet firmly back on the ground and putting my practical failings to one side, I attribute my interest in so many areas of life to my time spent at one of the country’s foremost grammar schools (St Olave’s in Kent). An Ofsted inspector recently described the school as having ‘a focus on scholarship and cultural enrichment with a vibrant approach to intellectual curiosity’; another said ‘it is a school which aims at success and succeeds’.

A major aspect of life at St Olave’s was the sense of competition. Competition ran through every activity of the school as much as ‘Brighton’ runs through Brighton Rock. If you were not competing to ensure that your ‘House’ won the most points in that academic year, you were striving to be in the 1^st rugby team, squash team, tennis or fives team. In between the omnipresent sports fixtures, you polished up your musical scales in order to secure your place in the school orchestra, brass band, wind ensemble, jazz band, barbershop quartet, choir or whichever musical group was performing in the near future; and amidst all of that, you aimed to ensure that your academic grades would secure you a place at one or other of the country’s top universities. Quite simply, you aimed to be the best…at everything. What is more, it was always understood that you had either ‘succeeded’ or you ‘hadn’t succeeded yet’. Failure was not recognised. Everything was possible.

The 2012 London Olympics has profoundly demonstrated the sense of endeavour portrayed by an enormous number of people; men and women who, day in and day out, have pushed themselves to the limit to excel at their sport; to be the best. Often, during the long hours of training, the only driving competition has come from the inner strength and desire to beat their personal best; to excel for the shear unadulterated joy of achieving something worthwhile.

If we think we have already witnessed drive and enthusiasm, the London Paralympics is sure to make us think again. I have no doubt that in one week’s time we will witness human endeavour beyond the personal comprehension of many. If the Olympics have been inspiring, let the drive and enthusiasm of the Paralympics teach or remind each one of us that success is all about competing with, and overcoming, our own personal limitations; whatever they may be.

As one commentator reflected, the Olympic Games have shown that there is nothing we (the British) cannot do well if we set our hearts and minds to it. The re-introduction of a sense of competition to school life is an important component of future adult success; whether it is on a national or international level, or simply for personal satisfaction. Ultimately, we can all be 21^st century Renaissance people if we wish to. Now, wouldn’t that tell the world a thing or two about the British?

(First published in the Scunthorpe Telegraph, Thursday 23^rd August 2012)

Art for Heart and Mind's Sake

‘When I was a child I spoke as a child, I understood as a child, I thought as a child; but when I became a man, I put away childish things.’

So wrote St Paul in his letter to the Corinthians. For the majority of us, such is the case with most aspects of our child and adult lives. However, in my case there was a flaw in the process and it is called ‘art’; or to be more precise, the ability to draw and paint. Words were never a problem; neither was music; but as a child I was lost with a pencil or a paint brush. Throughout my adult life, I have found it difficult to break away from the childish representation of a tree or house that I learned to draw when I was about three years old. It may have worked for L S Lowry, but I am not even sure that I can reach his standard of depiction. 

It was therefore a great honour and an eye-opener to spend twelve days recently in the company of five of the world’s greatest living artists; to study their work, listen to them speak about their styles, watch them at work, and to receive the occasional tuition from them. In no particular order, they were Viktor Shvaiko, Bill Mack, Michael Godard, Gary Welton and Adam Scott Rote. If you are not already familiar with their work, I recommend spending some time looking at their official websites in order to gain a deeper perspective on what I am writing about. What you will see is that they all have very different and distinctive styles. Some of them have additionally had very difficult and troubled pasts (as reflected in the books, ‘Journey to the West’ by Shvaiko, and ‘Don’t Drink and Draw’ by Godard).

Watching them work, they make it all looks so easy. However, all five men are masters of their art and have spent decades at perfecting their styles. Nonetheless, there is much to be learned from them, and the greatest lesson I brought away with me is just how cathartic the process of producing a piece of art can be. It doesn’t matter whether it is a simple pencil sketch, an abstract colour-filled vision, or a moulded lump of clay; it is the process of producing the end-product that is of immense personal value.

Art Therapy has long been an unsung hero in the world of medicine. Funding for such treatment is often very limited, and the ability to access formal courses is frequently restricted to a few places through psychotherapy departments. That aside, it forms a valuable resource for the treatment of many different types of disorders, from depression and post-traumatic stress disorder, to autism and other complex communication disorders. Artists may be interested in the website of the British Association of Art Therapists (www.baat.org); alternatively, Wikipedia provides an article of general interest on the subject (www.en.wikipedia.org/wiki/Art_therapy).

For me, fine art will no doubt prove to be an elusive skill. However, after my time recently in the company of the aforementioned five men, my eyes have been opened to the benefits art in general has to offer for even the most juvenile of artists. As the Swiss painter, Paul Klee (1879- 1940) said ‘Art does not reproduce the visible; rather, it makes visible’. As a doctor, and from a psychological perspective, I can only concur.

(First published in the Scunthorpe Telegraph, Thursday 9^th August 2012.)

The Rise and Fall of the Silly Season

August has long been known as the silly season in terms of newspapers publishing low-key or humorous stories to fill the otherwise empty news columns. This year, possibly owing to global warming, the season started early, with the publication of articles at the end of July trumpeting research promoting the Polypill.

The Polypill was first postulated in 2003, so the story is not exactly new.  The pill contains three drugs to lower blood pressure and a statin to lower cholesterol (amlodipine, losartan, hydrochlorothiazide and simvastatin for those who are interested). The concept is to make the Polypill available without prescription, at a cost of 50p per day, encourage everyone to buy it and thus halve the number of people who die of cardiovascular disease.

Now, that sounds like a meritorious aim; a magical pill to halve 200,000 deaths per year in the UK. So where are the flaws in this argument? Well, to start with, to gain that saving effect everyone, I repeat, everyone in the UK would have to take the Polypill; all 56.1 million of us according to the 2001 census. That is 56.1 million annual monthly sales to save 0.1 million lives. Making the assumption that some sensible person out there has patented this latest version of the Polypill, then that is a lot of profit for the pharmaceutical industry.

Then, of course, there are the side effects of the medication. Anyone who has been prescribed some of the constituent medicines will know that side effects are common. I grant you that most are minor, but nonetheless, many are inconvenient and sometimes very troublesome. Swollen ankles, gastric upset, urinary frequency, impotence, muscle pain and weakness, rashes, confusion and memory loss are just a few of the unwanted features. It is therefore bad enough trying to comply when your doctor believes that you need to consider such therapy; does anyone truly think that those who have not identified themselves as unwell or at risk will put up with such effects? I suspect not.

And what about lifestyle? Where does the enthusiasm for five portions of fruit and veg per day, low fat and low calorie foods, reduced meat consumption, reduced alcohol consumption, stopping smoking, exercises at least three times per week, and reducing weight to sub-obesity levels fit in? All of them are no longer necessary, or so it would seem. Forget the healthy lifestyle and simply pop a pill every day to compensate. A late 16^th Century proverb declared that ‘the age of miracles is past’. Apparently, the declaration was premature.

In 1995, Ivan Illich published a book called Limits to Medicine. It was subtitled ‘Medical Nemesis: The Expropriation of Health’. In his book, Illich declared that ‘the medical establishment has become a major threat to health’. He was concerned that ‘the disabling impact of professional control over medicine has reached the proportions of an epidemic’. He was prescient to say the least. With the advent of the Polypill, we all become patients at the stroke of a medicine licence.

Not convinced that my cynical approach is the correct one? Then let me ask you a question. Would you subscribe to the idea of underpinning every house in the country in order to stop a few subsiding? I suspect not, and with that I rest my case.

Hopefully, autumn will come and the silliness will be forgotten for another few years. Meanwhile, I am off for a good walk in the fresh air, followed by a healthy fish dinner and, just perhaps, a small glass of red wine.

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

Style Matters

For William of Wykeham, the 14^th Century Bishop of Winchester and Chancellor of England, the proverb ‘Manners Maketh Man’ became his motto. Later, in the early 15^th Century, another proverb developed to the effect of ‘Clothes make the man’. Moving forward to the 20^th Century, the English novelist, Angela Carter, writing in Nothing Sacred (1982), said ‘Clothes are our weapons, our challenges, our visible insults’.

What then, would any of the subscribers to these historic notions make of the appearance of many of our professional men and women in the 21^st Century? In particular, what does the dress of today’s doctors say about them and their attitudes to life, medicine and their patients?

Here, I must declare not only an interest, but a strong prejudice which, to those who know me, hopefully speaks for itself. Archaic notion though it may be, I subscribe to the idea that appearances matter. The 18^th Century provides us with another proverb to illustrate the case: ‘First impressions are the most lasting’, the saying goes.

As a younger person, a doctor for me (and I speak of male doctors in the main here), was somebody who at the very least wore a jacket and tie. Suits were once de rigeuer for daytime wear for hospital consultants and Harley Street GPs; with tweed suits and jackets the domain of particularly the rural GP. Evenings and weekends on call required, at the very least, that other scarce item in today’s young man’s wardrobe, a sports jacket.

However, my view is rapidly becoming an anachronistic one. Hospital doctors have witnessed their crisp white coats resigned to the recycling bin, as uninformed policies have blamed long sleeves for hospital-acquired infections, and ‘bare below the elbows’ has been become the enforced rule. Ties now dare not show their face in the hospital clinical setting, as though these and cuffed shirts were the enemy rather than the failure by administrators to ensure that their hospitals were regularly cleaned, and staff  remembered the simple expedient of washing their hands between patients.

So, how do you see your GP? Does it matter to you that he or she is in faded jeans, a slogan-bearing tea-shirt and training shoes; with straggling hair and, for the men at least, a couple of days growth on their chins? With allowances made for cultural differences (though the fact that such consideration should change our perception is witness to our fickleness), does it matter that your male doctor has a studded nose and ears, your doctor of either sex sports a lip ring, or medics of either sexes are happy to bare their strange and often indecipherable tattoos?

Laying my cards on the table, I think that it does matter. Standards of dress are slipping and, in my view, with that landslide of slippage goes a major chunk of professionalism. Doctors need to inspire confidence; wining the patient across at the very start is a major step towards assisting them with their complaint. The way a doctor dresses says a lot about their standards, attitudes and, in turn, how thy might apply those same principles to the care of their patient.

The early 20^th Century proverb states that ‘you can’t judge a book by its cover’. However, next time you are confronted by a scruffy looking doctor, you might wish to remind them that style does matter, and patients shouldn’t be made to feel insulted by the appearance of their physician. After all, if book covers really don’t matter, would publishing houses spend so much time, effort and money making them look so good?

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

The Dying Keats (Book Review)

Author: Brian Livesley. Published by Matador, 2009

ISBN 978-1848761-711

The Dying Keats was written for the 20^th Biennial Keats’ Memorial Lecture in 2009. With 50 years of experience of caring for the elderly and the dying, its author, Professor Brian Livesley, has successfully researched and crafted a succinct argument for improved medical care for the dying; drawing on the distressing death of the 19^th century poet and apothecary, John Keats, in order to illustrate how doctors so often fail their dying patients.

Keats died at a young age from tuberculosis. Denied drugs such as opium to ease his terminal suffering, he experienced distressing symptoms up to his death; causing him to describe his final days as ‘this posthumous life of mine’. Livesley describes this as the ‘Keatsian Experience’ and compares it to euthanasia in the truest sense of its meaning; that being ‘a good and comfortable death’.

As the author points out, it is astonishing that today’s care of the terminally ill is often little better than that experienced by Keats; believing this to be due to the reluctance of doctors to consider death as a diagnosis that requires treatment, and reminding us that ‘dying should be a humane experience for us all’. A thought-provoking read for all clinicians.

(First published in Pulse Today, July 2012

http://www.pulsetoday.co.uk/main-content/-/article_display_list/14263504/book-review-the-dying-keats-a-case-for-euthanasia-by-brian-livesley)

So much for the Money; what about the Care?

The Government recently published the latest Social Care White Paper; which starts to address the problem of financing the care of elderly people. In outline, there will be a scheme whereby those receiving care will not be forced to sale their homes to pay for that care. Instead, they will be eligible for a council loan, repayable from their estate after death. With implementation postponed until 2014, the detail has yet to be revealed. However, if the recent Health & Social Care Act is an illustration, the ultimate Act stemming from this White Paper will be a hotchpotch of compromise, inadequately thought-through process and a few nasty surprises, which will fall short of appropriately addressing the real issues.

One of the real issues for me is not so much the money, but the quality of care. Having to sell one’s home to pay for care in a residential home may be emotive, but ultimately someone has to pay. After all, money is only a tool to obtain what we desire. When we are elderly and infirm, what we truly need is the security of knowing someone is properly looking after us. Sadly, for many people, that quest is an impossible one; particularly the closer we get to dying.

The physician and author, Dr Brian Livesley, addresses this issue in his book ‘The Dying Keats – A Case for Euthanasia?’. Livesley uses his 50 years of medical experience of caring for the elderly and combines it with a well-researched thesis about the circumstances of the death of the poet John Keats.

Keats, also a doctor, died in 1821 from tuberculosis at the age of 26. Well-aware of the availability of drugs such as opium, it is therefore an irony that he was deprived of medicines to relieve the distress of his final days. So distressing were his symptoms that Keats described the concluding period of his life as ‘this posthumous life of mine’; something Livesley describes as the Keatsian Experience.

Sadly, the Keatsian Experience is still endured. In 2008, 54% of the complaints about hospitals were related to the lack of care at the time of someone’s death. As Livesley states, dying should be a humane experience for us all. That the reality for many is so different is a sad indictment of the so-called ‘caring professions’. At the heart of the matter is the failure to treat dying as a clinical diagnosis requiring action.

The term ‘euthanasia’ is today frequently used as a synonym for assisted-suicide. However, the origin of the word is very different and means ‘a good and comfortable death’.  Keats lacked carers skilled in providing him with a good and comfortable death. Without those skilled carers, all the money in the world is meaningless to those in their twilight days if they are not being appropriately looked after.

So the message to the Government should be that the Keatsian Experience has no place in our time. Of course the problem of funding the provision of care in our final years needs to be sorted. However, the quality of care also needs to be considered. Getting the quality right from the moment we first need care will help ensure our closing days are also right. Without that, the Social Care Act will be yet another 21^st century political failing, and one we will all potentially suffer from as a consequence.

(First published in the Scunthorpe Telegraph, Thursday, 19^th July 2012.)

Be Careful What You Wish For

I do not normally consider myself to be a pessimist; although readers of this column may think otherwise, bearing in mind the inches of concern I have expressed over the past year in respect to the future of the NHS; I call the latter realism.

No, I am for all that, an optimist. I rejoice as each day dawns, regardless of the weather, the day of the week, or the latest damage the Department of Health might bring forth. I search for that hidden moment, event or experience that will bring a frisson of pleasure and make that day all the more worthwhile than the simple delight of being alive.

However, on three separate occasions recently, I have felt concern when others have felt joy. All three occasions have revolved around scientific ‘breakthroughs’; events which, as a scientist, I should be hailing with enthusiastic delight rather than guarded pleasure.

The first concerned the report that researchers have successfully predicted the entire genetic code of a baby. The process was fairly simple, and involved nothing more invasive than a saliva swab from the father and a blood test from the pregnant mother. ‘Magic!’ as a performing magician might say.

Being able to predict a baby’s genetic code means that it is now theoretically possible to screen unborn babies for some 3,500 disorders; which then raises the next question of what to do once we know that there is a problem. The morals and ethics of such investigations, along with the expected increase in the number of abortions, are far too complex for a short newspaper column. However, the vision of a future of designer babies does make me uneasy.

The second ‘breakthrough’ was the knowledge that it is now scientifically possible for women to store a small sample of ovarian tissue, and then have small pieces re-implanted over time in order to maintain their fertility beyond the age currently dictated by nature. Of course, the same process also delays the effects of the menopause. The latter may be welcomed by many women, and I do not blame them. However, does society really want or need childbearing by mothers in their 60s and 70s, or beyond? I will leave you to ponder your answer to that question.

Finally, quantum physicists have been rejoicing in the discovery of the long-postulated Higgs Boson, or ‘God-particle’ as it has been popularly known. This elusive particle apparently explains the force that holds the Universe together and enables stars and planets to exist. The discovery has evidently clarified one of the great mysteries of science and the world. It is one which will undoubtedly lead to other great advances in science, although exactly what is presently uncertain. Nonetheless, I feel that we should temper our excitement with a degree of caution, for mankind has not always been good at putting great scientific discoveries to the best of use.

If designer babies and fecund octogenarians do not as yet ring any alarm bells for you, then the Higgs Boson should. If you ask me why, I am not sure that I can presently give an erudite answer. However, I experienced the same pang of pessimism when reading about all three of these discoveries. The 18^th century clergyman-writer, Charles Caleb Colton, wrote ‘the greatest fool may ask more than the wisest man can answer’. In this context, I am not certain whether I am the wisest man or the greatest fool. However, I have no doubt that we should be very careful as to what it is we wish for.

(First published in the Scunthorpe Telegraph, Thursday, 12^th July 2012.)

The Delusional Art of Statistics

 ‘There are three kinds of lies: lies, damned lies and statistics.’

The quote is attributed to the 19^th century British Prime Minister, Benjamin Disraeli. What, I wonder, would he therefore make of the new iPhone app called ‘GP Ratings’, or indeed the expansion of statistical data now available on the Department of Health’s website, NHS Choices (www.nhs.uk)?

Statistics are only helpful if they compare like with like, compare data that is meaningful, and are sourced from unbiased data. Sadly, the aforementioned App and website fall down on all three counts, being drawn from a fundamentally flawed annual review called the GP Patient Survey. As a result, practices are now given a score out of ten based on patient experiences.

Now, speaking as a GP and from a personal basis, I have nothing I wish to hide from my patients or my peers. I strive to be the best GP I can. However, I am not, and can never be, perfect. That I frequently fall short of perfection is down to many different factors; an increasing number of which are totally outside of my control (lack of funding for the NHS, inflated Governmental and patient expectations, the number of hours in the day, imperfect therapies, and the mysteries of health and life that are yet to be answered by science, to mention a few). I therefore do not mind my work being compared to another GP, as long as the comparisons are fair and meaningful. Sadly, there is very little of that within the Government’s new ratings system.

Many writers in the medical press have condemned the new scores as simplistic, lacking detail and running the risk of overwhelming patients with unhelpful information. They are quite right. In many important areas, such as how well a doctor manages chronic or life-threatening illness, the information provided does not allow for meaningful judgements. Instead, the main comparisons are on factors such as how easy it is to obtain an appointment at a convenient time and how long one waits in the waiting room.

Not for one moment am I saying that these issues do not matter; of course they do. However, I would rather wait for an hour to see a doctor who is going to take my problem seriously, diagnose me accurately, treat me appropriately, explain the details to me in language I can understand, and, somewhere amongst all of that, show me a little compassion, than be whisked in and out on time, but left feeling that my issues have not been properly addressed.

Unfortunately, many of the issues the Department of Health measures doctors against are ones which are easily managed if one works in a well-resourced private institution, but will always be wishful thinking for large, underfunded, overloaded, NHS practices whose staff are trying to juggle the complex demands of patient care with training medical students and new GPs, commission local NHS hospital services, balance the NHS budget, and contribute to numerous other demands from the world of medical politics. Read the data by all means, but treat it for the crude information that it is. If it is of little use to me, in my capacity as the medical director for a Primary Care Trust, then I seriously question what real use is it to you as patients.

As Albert Einstein once said, ‘Not everything that can be counted counts, and not everything that counts can be counted.’

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

The Importance of Good Communication

Communication, according to the Oxford English Dictionary, is the action of sharing or exchanging information or ideas. What the dictionary does not say is whether communication includes the concept of understanding the message the informant intended to relay. Without adequate understanding the message being communicated is lost or misconstrued, sometimes with unintended consequences.

Of course, there are those who would claim that the opposite is also of value. Some might argue that misleading communication is an art well exercised by politicians to meet their own ends. As the American author Lionel Trilling said, ‘where misunderstanding serves others as an advantage, one is helpless to make oneself understood’. Examples of that were certainly seen last week during the battle over NHS pension arrangements.

However, the language used to communicate a message is equally important as the ideas being expressed. A favourite expression of mine is ‘words mean what words say’. Naturally, it is a paramount prerequisite for good communication that both the communicator and the listener understand the meaning of the words being used. I assume that Tim Loughton MP, was not being deliberately misleading last week when he said ‘I shall be speaking about it more fulsomely later.’ Referring to a report on missing children, he probably meant to give the impression that he would speak ‘in detail’ or ‘at greater length’, and that is possibly what most people took to be his meaning. However, the word ‘fulsomely’ is ambiguous. Properly interpreted as ‘lavishly’ or ‘extravagantly’, it can also convey ‘insincerity’ to the point of being insulting. To some listeners, his message would therefore have been received in a completely different manner to that which he probably intended.

Doctors need to be good communicators if patients are going to understand the health issues being discussed. For the majority of patients, there is no point in the doctor hiding behind erudite phrases, words in Greek or Latin, or medical jargon full of acronyms, if it is hoped that the message will be understood. According to recent studies, 43% of Americans have a literacy standard below that necessary to understand health issues (see www.nchealthliteracy.org for more details). In the United Kingdom, the figure is thought to be around 12%; although these figures assume that the message is being conveyed in a language suitable in respect to its origin, dialect, complexity and accuracy as befits the recipient. The phrase ‘health literacy’ is increasingly being used in reference to such matters.

‘LSD? Nothing much happened, but I did get the distinct impression that some birds were trying to communicate with me.’ The poet, W H Auden, was clearly speaking of his experience of using an hallucinogenic drug when it said that. Nonetheless, for many people, even the most caring of doctors can leave them feeling confused and uncertain. For them, a trip to see their GP or specialist may be as equally puzzling as Auden’s encounter with his feathered friends.

The problem is not just about whether someone can read and write, or whether they speak the same ethnic language as the doctor; our population is increasingly an aged one, and even very intelligent people start to lose cognitive ability as they get older. Defined by the World Health Organisation as ‘the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions’, health literacy must be taken into consideration and appropriately addressed if we are to achieve the desired health outcomes for our communities. Doctors must remember that patients will not always say that they do not understand; for their part, patients must not be ashamed or intimidated, and must tell the doctor if they do not understand what is being said. Getting the health communication wrong can be costly to the individual and society, in terms of deteriorating medical conditions, more expensive medical treatment, prolonged hospital stays, and increased risk of death.

That said, the French poet Charles Baudelaire once declared that ‘It is by universal misunderstanding that all agree. For if, by ill luck, people understood each other, they would never agree.’ Perhaps that is an apt statement for tautologous political circles, but not one for an effective health service. Unlike Sofia Coppola’s film, health messages should never be lost in translation.

(First published in the Scunthorpe Telegraph, Thursday, 28^th June 2012)

Standing up for more than a Principle

The medical profession is not usually considered to be a militant organisation. Frequently  coming high on the list of those members of society who the public holds to be honest, reliable and worthy of respect, doctors are generally considered to have a learned and caring vocation, whose voice is willing listened to with politeness and interest, even if only out of curiosity. In turn, the profession usually recognises and appreciates this esteemed status and, through the General Medical Council’s code of conduct, does much to ensure that the public trust is not undermined.  

That today, the 21^st June 2012, has been declared a day of industrial action by doctors is therefore of great significance. Of course, ‘industrial action’ is not necessarily the same as a ‘strike’; but the mere fact that it is happening at all is of great importance, with all the implications that it has to threaten the aforementioned public good-will.

The official reason given for the industrial action is the Government’s recent action in respect to the NHS pension scheme; action which effectively renegades on negotiations and an agreement in 2008 which was supposed to ensure the future viability of the pension scheme. Be that as it may, there is much more behind the situation than is immediately apparent. However, before I expand on the unwitting testimony, it is worth clarifying a few misconceptions that the Government is keen to promulgate.

First, the NHS pension scheme is not funded by the tax payer. The scheme is supported by its members; the doctors, nurses, ancillary staff and administrators who make the NHS work. The ultimate pension is in effect deferred pay, and has historically been on decent terms in recognition of the lower pay and substantial good-will of health workers; many of whom spend years of arduous training and contribute many unpaid hours to the good of society.

Second, is the fact that the NHS pension scheme currently returns a surplus of around £2billion per year to the Government; money that the Government then happily puts into the general coffers. Despite this, the Government argues that the situation is not sustainable and that, with the rising number of retired members, the scheme will not be able to support itself in future. However, that is what the negotiations of 2008 were all about. At that time, the medical profession, along with most healthcare workers, willing worked with the Government to bring about changes which would secure the inherent viability of the scheme and avoid it becoming a drain on the tax-payer. Nothing has changed since then to undermine those calculations; not even the change in the economy. Instead, the Government is set on unashamedly fleecing the NHS pension scheme whilst hiding behind flawed arguments and shameless lies, and that is what has angered the medical profession.           

Nonetheless, the institutionalised theft of people’s pensions is only the final straw of the unbearable load that has broken this particular camel’s back. As a body, doctors are tired of successive Governments meddling with the NHS, introducing badly thought-through policies, ignoring the profession’s opinion, increasing the workload to unsustainable levels whilst inappropriately raising public expectation of what should be achievable, and then publicly blaming the doctors for when it all goes horribly wrong. The profession is exhausted by inflated demands, frustrated by the focus on irrelevant outcome measures, weary of being the scapegoat, and demoralised by the determined destruction of the NHS. The theft of people’s hard-earned pensions is just a small part of this Government-built mountain of unrest.  

Today, for the first time in almost 40 years, some doctors will stop doing routine work for 24 hours. Urgent patient care will continue, and no patient should suffer as a consequence. That said, many of us will carry on as normal, strongly supportive of the need for action, but unable to put our own well-being ahead of those we have trained to help and serve. No doubt the Government will again ignore us and the popular press will vilify us. However, the population as a whole should take note. When a venerable profession is moved to such extremes, there is something very wrong with our world in general and its politicians in particular.

(First published in the Scunthorpe Telegraph, Thursday, 21^st June 2012.)

Humble Pie and Drawn Swords

One of the biggest rewards for any writer is knowing that the end product of hours spent slaving away in a draughty garret is actually being read by someone. I was therefore heartened to receive feedback from two eagle-eyed readers a couple of weeks ago, who noticed that Henry V (1386-1422) could not possibly have been responsible for the Apothecaries Act of 1815 without, as one put it, receiving divine intervention. How right you are, and you have my apologies for a spot of poor editing. What I had intended to convey was that, in order to suppress the quacks, Henry V issued a variety of decrees which ultimately became enacted, during the reign of George III, in the form of the Apothecaries Act of 1815.

Having now returned from an evidently much needed vacation, I am reminded of the words of Alfred, Lord Tennyson, who wrote ‘For man is man, and master of his fate’. Sadly, his optimism would seem misplaced today when it comes to the fate of doctors, with another of his lines being more apt: ‘So all day long the noise of battle rolled’. So it would seem from the recent headlines in the medical press. For example, GP Business informed us that Andrew Lansley is ‘launching his charm offensive’; surely a multi-layered contradiction in itself.

Elsewhere we are told that the Secretary of State for Health says ‘GPs have an ethical duty to cut costs’. Now, of course we understand that finance needs to be considered, but for us medical chaps that rather awkward ethical duty to treat patients keeps cropping up and getting in the way, Mr Lansley; but I guess that isn’t a concern that troubles you too much, as long as the budget breaks even. Whilst we accept the need for transparency in the way tax-payers money is spent, I am equally sure that tax payers do not want to be sold short when it comes to receiving the best treatment for their illness. If what I can offer my patients doesn’t equate to what I would find acceptable for a member of my family, then I am not fulfilling my primary role as the trusted physician. It is no coincidence Mr Lansley, that, when placed in alphabetical order, patients come first, physicians next and politicians last; and thus it should be so in terms of providing care.

Whilst I have been away, it has also been decreed that ‘practices must provide online booking by 2015’. Now, that is one where I am sure the proven ability of the NHS to come up with suitable computer software and associated security will not be found wanting. I jest of course. Seeing is believing, but I wouldn’t hold your breath just yet.

That the Department of Health has agreed to a 20% rise in GP training places by 2015 is obviously good news at face value. Nonetheless, it will take a further four years for those doctors to come out of the system as fully-fledged GPs. At present, the number of GPs is down to 1999 levels. With 8% of GPs leaving the NHS in 2010, 22% now being over 55 years, and consultations set to rise to 433million per year by 2035, there may be light at the end of the tunnel in terms of training, but it is still presently a very dark place at the coal-face, and that needs to be promptly addressed to avert a significant manpower crisis. So, unless something is done now to attract trained GPs back into the NHS, or to stop us older ones from running with the remnants of our sanity for the exits earlier than necessary, the current national shortage of GPs will continue for the next decade.

The one delightful piece of news ironically comes from an obituary for a paediatrician in the USA, who only retired at the age of 103. She died in April at the grand age of 114, which lends a hearty boost to my much-publicised intention to hold a 120^th birthday party in January 2080. Keep that date in the diary; though at this rate, I may have to couple it with a retirement party. 

(First published in the Scunthorpe Telegraph, Thursday, 7^th June 2012.)