Literary GP Wins Poetry Award

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

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

Living Means Moving

'RUN FOR YOUR LIVES!

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

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

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

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

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

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

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

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

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

Who Cares, Wins

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

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

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

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

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

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

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

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

Fathom Prize

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

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

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

A Poem For Remembrance Sunday

The Remembrance Day Parade

As he walked up to the rostrum,

silence round him fell;

and whilst he gazed upon the steadfast ranks,

emotive lines began to tell.

Too many lives were lost before today:

young men and women – yesterday's youth.

They were the cheques we drew to pay

for the blinded search for fallacious truth.

You are the inspired; the fortunate few

who have lived through to this day;

the ones who now must tell the world

to find a better way.

It is the charge of those who live

beyond vanquished dreams of many men,

to find the strength to forgive;

to learn and love as best you can.

And in so doing, let us ensure

a sense of remembrance, not of rage -

may this quietude beyond the war

turn pugnacious soldier to reflective sage.

Thus, he stood upon the rostrum as

the silence round him fell,

and gazed upon the steadfast ranks

of those returned from hell.

© Copyright Dr Robert M Jaggs-Fowler 2008

Gold Dust, Hens Teeth and Audiences with the Pope

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

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

Do you fancy hearing about a local scandal?

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

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

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

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

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

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

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

All Change Please

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

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

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

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

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

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

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

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

St John Ambulance - The Difference

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

http://www.youtube.com/stjohnambulance

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

A Century and Not Out

'Who wants to live forever?'

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

Or have we?

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

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

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

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

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

To Wake or Sleep?

'To sleep – perchance to dream!'

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

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

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

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

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

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

Whither the Local NHS?

We live in exciting times.

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

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

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

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

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

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