Out of the Frying Pan into the Fire

Stagecoaches were the main means of long-distance travel before the advent of the railways. Drawn by horses, each journey required regular stops to change the tired horses for fresh ones. Travelling at slow speeds (4-7 mph), a lot of effort was involved just to cover short distances. Indeed, it could take an entire day’s journey to travel from Barton upon Humber to Boston; a long, arduous journey without any meaningful change of scenery.

Last week saw the Prime Minister change many of his horses in a mid-term re-shuffle of the Cabinet. Amongst the ministers put out to grass was the former Secretary of State for Health, the Rt Hon Andrew Lansley. Vaunted as the architect of the Health & Social Care Act 2012, many would prefer to see him cast as a demolition man rather than a designer; in this case, the destruction of the National Health Service. Having spent almost nine years holding a health portfolio (the first six in Opposition), it is astonishing that he so spectacularly failed to understand that the National Health Service works better as a functioning whole rather than as fragmented bits. After all, who in their right mind buys a jig-saw puzzle ready made up, dismantles it into 1,000 pieces, and then stands back to admire the result?

That, however, is what Andrew Lansley has managed to bring about after nine years of studying the NHS. Albeit rickety and demanding high-maintenance, what was once a functioning and coherent service is now lying in broken chunks scattered over the landscape. The irony is that Aristotle understood the principle as far back as the 3^rd century BC, commenting that ‘The whole is better than the sum of its parts’. Integrated health care is something clinicians have desired for many years. Yet, the concept of co-ordinated, comprehensive and seamless care has been laid to waste by a Secretary of State who was deluded into thinking he understood the complexities of life at the forefront of health care. For someone who holds a degree in politics, it is astonishing that he was unable to assimilate the lessons of the past, and in particular the Porritt Report of 1962 which stated ‘We have concluded that in future one administrative unit should become the focal point for all the medical services of an appropriate area’. That was what the now terminally-ill Primary Care Trusts were for.

The Prime Minister’s change of horses has produced Jeremy Hunt as the new Secretary of State for Health. Hunt is on record as holding controversial views on health care, which do not exactly encompass Aneurin Bevan’s vision of free-at-the-point-of-use medical care for everyone. A failed exporter of marmalade, Hunt is clearly the right person to pull the NHS on to its final stage of destruction.

The only real hope of rescue is a change of government with the next election when, as one senior NHS executive said to me recently, another major reform will be needed to stitch the NHS back together again. Perhaps the French novelist, Jean-Baptiste Karr had it right when he wrote ‘Plus ça change, plus c'est la même chose’; the more it changes, the more it is the same thing. After all, even after a long arduous journey, the Wash still looks a bit like the Humber.

(First published in the Scunthorpe Telegraph, Thursday 13^th September 2012)

Thought for the Day

'Faith need not be unacceptable to contemporary culture, and contemporary culture need not be unacceptable to faith'

Paul Tillich (1886-1965)

Thought for the Day

'To study theology is to set out on a voyage of discovery that is at times enriching, at times challenging, but always profoundly interesting.'

Alister E McGrath (2011)
From the Preface to Christian Theology - An Introduction

In a Motivational Mood

Continuing with my theme of the Olympics and Paralympics serving as motivators to those who for some reason psychologically feel unable to achieve something with their lives, I watched with interest as Professor Stephen Hawking opened the Paralympics with an opening ceremony designed to ‘celebrate the possibilities that lie within us all’, as the brief for the artistic directors was phrased. 

Tapping those inner possibilities is not something we are always good at; either as individuals or as adults with a responsibility to do precisely that in respect to our younger members of society. I still remember the moment my headmaster informed me that, in his opinion, I would never become a doctor. I could so easily have been discouraged at that first hurdle, spent my time at university reading the Classics and be running a bookshop by now. I could also have been dissuaded of my heart’s desire when, in the 4^th year at medical school, a general surgeon pompously informed me that I was wasting my time by wanting to enter General Practice. Fortunately, my well-polished rebellious streak came to the fore on both occasions and I ploughed my own furrow with a focused determination.

However, not everyone can be so self-motivated. It is then that such reservations need to be overcome by those who recognise the untapped potential. It was with those thoughts in mind that I recently listened to BBC Radio 4’s programme ‘Lewis’s Return Home’. Based on the life of the writer Ted Lewis (author of the book behind the famous film, Get Carter), it told the story of how, when a pupil at the Grammar School in Barton upon Humber, Lewis was taken under the wing of his schoolmaster, Henry Treece. Treece, in his own right a celebrated poet and author, recognised the artistic talent within Lewis and persuaded both him and his parents that the Hull Art College was the place for Ted to go. From there, Ted Lewis began a writing career and, as the saying goes, the rest is history.

The story was far different for Nicholas McCarthy. McCarthy only has one hand; he was born without his right hand. At school, his head teacher told him that ‘having one hand would always hold him back and it was better not to waste his and other people's time’. The comment was made in respect to McCarthy’s desire to learn the piano. Not to be daunted, McCarthy taught himself to play the keyboard. Last month he graduated from London’s prestigious Royal College of Music. Last week, he played as part of the paraorchestra, Britain’s first disabled orchestra. Next month he embarks on a tour as a concert pianist, starting with the Fairfield Halls in Croydon. (McCarthy’s remarkable story and the opportunity to watch and listen to him play can be found at www.bbc.co.uk/news/uk-england-surrey-19179499).

Teachers such as the headmasters both I and Nicholas McCarthy were exposed to have no place in the lives of children. Demotivation is the last thing young people need. Every child should have a Henry Treece at their elbow, seeing the hidden potential and driving them forward to achieve what is in their hearts and minds, regardless of the hurdles they might face along the way. ‘Celebrating the possibilities that lie within us all’ is what the London Paralympics was focused upon. It should become everyone’s mantra for life.

(First published in the Scunthorpe Telegraph, Thursday, 6^th September 2012)

The Frustrating Field of Human Endeavour

As a doctor, I have realised that people broadly fall into three categories when it comes to illness and disability. The first consists of those who are so severely ill or disabled that they require assistance with all activities of daily living. They are unable to perform even the most minor task. They need and deserve all the assistance that medicine, social services and society as a whole can provide to ease their misfortune.

Then there are those who, regardless of how severe their diagnosis is, shoulder the burden and carry it with aplomb, determined that they will continue to live as actively as they possibly can. They overcome psychological and physical burdens, as well as social prejudices and discrimination, to make their lives fulfilling. They are largely uncomplaining, being appreciative of everything done to lighten their load. They strive to meet everyday challenges, including working for as many hours or days they can manage. They do not expect to be totally kept by the nation on benefits, and instead earn money and pay their tax as well as any able-bodied person. They are a credit to themselves and to humankind.

Finally, there is the opposite group to the aforementioned. They usually have some genuine illness or disability (although some do fabricate their condition), but they magnify their symptoms and wear their suffering like a badge for all to see. Regardless of how capable they remain, they consider themselves to be totally incapable of work for even a reduced number of hours per week.  These are people who are quick to blame others, including the medical profession, for their misfortune in life. They also believe that society owes them something and that it is their right to live on state benefits. The fact that they still have a functioning brain, or the use of their arms, or can sit even if they cannot stand for long (and so on) is immaterial to how they see themselves and their ability. In their eyes they are totally disabled and incapable of contributing to their own care or to society as a whole.

It is this third group that I admit to professionally finding the most frustrating. With such people, there is a part of me that wants to confiscate their unnecessary walking stick or crutches, shake them by the shoulders and tell them to get a life. As a reader, you will know someone like that. You may even recognise yourself as one of this group.  To such people let me say that I know you are often in pain, or have difficulty with your heart, lungs, bowel, bladder, or a limb or two, and that life is not always easy; but it is not impossible. Life is also precious; a once-only gift and you are wasting yours.

Dr Ludwig Guttmann shared the same professional exasperation when he was put in charge of a spinal unit at Stoke Mandeville Hospital in 1943. Refusing to allow his colleagues or his patients to see people with disability as totally incapable, he strove to make patients focus on what they could do rather than what they could not. As a result, the Paralympics was born. This week we will watch with awe, pride and fascination as men and women show how they have overcome enormous difficulties and suffering to excel and make something of their lives. As you watch, ask yourself one question. If they can do it, what is stopping you from achieving more than you currently imagine you are capable of doing? 

(First published in the Scunthorpe Telegraph, Thursday, 30^th August 2012)

Thought for the Day

'We must...resist the doctrines of progress and emancipation that undervalue the task of helping one another to live well and truthfully with situations when, frequently, there are no cues or answers. This is the task of the pastor which early Christians termed 'sustaining'...'

Elaine Graham (1999), 'Pastoral Theology: therapy, mission and liberation?'
Scottish Journal of Theology, p. 448.

Thought for the Day

'In nothing do men more nearly approach the gods than in giving health to men.'

Cicero.

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)