‘The woods are lovely, dark and deep, but I have promises to keep, and miles to go before I sleep.’
The words of the poet Robert Frost will ring true for many readers who stretch the working day into the dark hours whilst others sleep. However, not even the most hardened workaholic or insomniac can run in the fast lane without the occasional pit stop. Our bodies are influenced by a circadian rhythm, whereby we experience a dip in our state of alertness twice in every twenty-four hours. This produces a state of sleepiness at some stage during the afternoon, bringing the urge to ‘cat nap’. The good news is that research has shown that the performance of those who sleep for less than six hours at night and then power-nap during the day is as good as those who sleep for longer at night. Indeed, a post-lunch nap improves work performance into the afternoon and early evening.
The circadian rhythm is influenced by how hungry we are. Our bodies have a mechanism whereby the brain keeps us alert when we need food; a mechanism which switches off when we have satisfied our hunger. That is a second reason why the urge to nap in the afternoon is irresistible for many, and explains why we have trouble sleeping when we are hungry.
However, our body-clocks have a greater influence than just affecting our state of alertness. The author Ernest Hemingway was showing more insight than he realised when he half-jokingly said ‘I love sleep; my life has a tendency to fall apart when I’m awake’. It is estimated that the body-clock controls some 15% of the activity of our genes; which means that disruption of the body-clock can affect a long list of bodily functions apart from sleep patterns. Our metabolism is very sensitive to such alterations, with the effect that insomnia, mood changes, heart disease, cancer and disorders of the brain can result. Because the body cannot fight infection until it recognises that one exists, we are more prone to infection at times of day when our metabolism and wakefulness is at its lowest ebb. Interestingly, research has shown that patients with septicaemia (blood poisoning) are at greater risk of dying between 2 a.m. and 6 a.m. This has in turn started scientists looking at what the optimum time is for antibiotic administration in order to fight infection with greater success.
When to give medication is also a question in respect to heart disease and high blood pressure. Both of these conditions are linked to high levels of a chemical called aldosterone. The latter is affected by the circadian rhythm, which means that drugs controlling blood pressure may be best targeted at specific times. Death in the early hours is an occurrence well known to doctors and funeral directors; and for those living near natural waterways, it is noticeable that the time of demise often occurs when the tide is out. Given the various research we are commenting on, this is perhaps not such a daft observation as previously thought.
Finally, the seasons also play a part in our well-being. Once again, research has found that blood pressure is better controlled during the summer, with the rates of heart attacks and strokes being higher in winter. This may not be just because of the cold weather, as people tend to exercise less, eat more, and increase weight during the winter. Diets during the winter months also tend to be higher in salt content.
All in all, it is increasingly clear that there are forces at play which influence us in more ways than previously imagined. Our individual lifestyle is a key factor, and armed with the knowledge of such research as above, it is open to us to take measures which may have a profound effect on our well-being. As Leonardo da Vinci said, ‘a well spent day brings happy sleep’. It may also bring health and a long life.
(First published in the Scunthorpe Telegraph, Thursday, 1st March 2012)
Tuesday, March 27, 2012
Saturday, March 24, 2012
Decisions, Decisions, Decisions...
‘An empty book is like an infant’s soul, in which anything may be written. It is capable of all things, but containeth nothing.’
So wrote Thomas Traherne in the 17th century. Sadly, a converse situation arises for many older people. We end up as a full book but, for some, the capability to do anything in a meaningful or reliable way starts to wane and mental incapacity is the result.
Whilst well, we take mental capacity for granted. Certainly as adults, we decide for ourselves what time to get up in the morning, which clothes to wear, what to eat, where to go, how to spend our money, and so on. This is called ‘capacity’. Capacity means that we can make our own decisions in our own best interests. It is something which is considered a ‘right’ and is protected in law.
By ‘mental incapacity’ we mean the inability to make our own decisions. The causes are many, although the commonest for the elderly is dementia. That said, there are also conditions which affect younger people and affect their capacity to make decisions; congenital disorders, brain damage at birth, head trauma due to accidents, brain tumours, mental illness, severe physical illness, and the effect of drug or alcohol abuse are examples.
For some people, the loss of capacity may be a temporary state of affairs; for others it is permanent. Whichever the case, the loss of capacity can have a devastating effect on our lives. During such times, we rely on those we trust to make decisions on our behalf. However, there are some decisions which even one’s next of kin cannot take without the legal authority to do so.
In 2005, a law was passed called the Mental Capacity Act. The law is intended to protect a person who lacks capacity, and thereby ensure that decisions continue to be made in that person’s best interests and in accordance with what their own wishes would be if they were still able to make decisions for themselves. Five principles underpin this law. The first is that a person is assumed to have capacity unless proven otherwise. The second is that any decisions made on a person’s behalf must be as close as possible to what that person would have wanted. The third principle is that, wherever possible, a person should be assisted in making a decision for themselves (for example, by using very simple language or a different form of communication to explain the issue). The fourth principle is that a person has the right to make unwise decisions, as long as they understand the effects of such a decision. Finally, any decision made for a person should be the least restrictive and cause the least disturbance for that person.
Capacity is tested by the application of four questions: Is the information understood? Can the information be retained long enough to make a decision? Can the information be weighed up? Can the person’s decision be communicated in some way? The answer must be ‘yes’ to all four questions to prove capacity.
If a person lacks capacity, they need someone to act on their behalf. Many people will legally appoint a person to do this. That person has ‘Lasting Power of Attorney’. However, such a person can only be appointed whilst someone still has capacity. If no such appointment has been made, the person lacking capacity is protected by the Court of Protection, which will either appoint someone to act on behalf of the affected person, or will directly make decisions on that person’s behalf. Naturally, it is better if we appoint someone we know and trust, so we should all be granting a Lasting Power of Attorney to someone whilst we still have capacity, and regardless of how old we are or whether we are currently healthy or unwell.
A helpful leaflet on capacity can be downloaded from the Royal College of Psychiatrists’ website at http://www.rcpsych.ac.uk/mentalhealthinfo/problems/mentalcapacityandthemental.aspx. Further information can also be obtained from the Alzheimer’s Society, Mencap, MIND, your solicitor and GP.
(First published in the Scunthorpe Telegraph, Thursday, 23rd February 2012)
So wrote Thomas Traherne in the 17th century. Sadly, a converse situation arises for many older people. We end up as a full book but, for some, the capability to do anything in a meaningful or reliable way starts to wane and mental incapacity is the result.
Whilst well, we take mental capacity for granted. Certainly as adults, we decide for ourselves what time to get up in the morning, which clothes to wear, what to eat, where to go, how to spend our money, and so on. This is called ‘capacity’. Capacity means that we can make our own decisions in our own best interests. It is something which is considered a ‘right’ and is protected in law.
By ‘mental incapacity’ we mean the inability to make our own decisions. The causes are many, although the commonest for the elderly is dementia. That said, there are also conditions which affect younger people and affect their capacity to make decisions; congenital disorders, brain damage at birth, head trauma due to accidents, brain tumours, mental illness, severe physical illness, and the effect of drug or alcohol abuse are examples.
For some people, the loss of capacity may be a temporary state of affairs; for others it is permanent. Whichever the case, the loss of capacity can have a devastating effect on our lives. During such times, we rely on those we trust to make decisions on our behalf. However, there are some decisions which even one’s next of kin cannot take without the legal authority to do so.
In 2005, a law was passed called the Mental Capacity Act. The law is intended to protect a person who lacks capacity, and thereby ensure that decisions continue to be made in that person’s best interests and in accordance with what their own wishes would be if they were still able to make decisions for themselves. Five principles underpin this law. The first is that a person is assumed to have capacity unless proven otherwise. The second is that any decisions made on a person’s behalf must be as close as possible to what that person would have wanted. The third principle is that, wherever possible, a person should be assisted in making a decision for themselves (for example, by using very simple language or a different form of communication to explain the issue). The fourth principle is that a person has the right to make unwise decisions, as long as they understand the effects of such a decision. Finally, any decision made for a person should be the least restrictive and cause the least disturbance for that person.
Capacity is tested by the application of four questions: Is the information understood? Can the information be retained long enough to make a decision? Can the information be weighed up? Can the person’s decision be communicated in some way? The answer must be ‘yes’ to all four questions to prove capacity.
If a person lacks capacity, they need someone to act on their behalf. Many people will legally appoint a person to do this. That person has ‘Lasting Power of Attorney’. However, such a person can only be appointed whilst someone still has capacity. If no such appointment has been made, the person lacking capacity is protected by the Court of Protection, which will either appoint someone to act on behalf of the affected person, or will directly make decisions on that person’s behalf. Naturally, it is better if we appoint someone we know and trust, so we should all be granting a Lasting Power of Attorney to someone whilst we still have capacity, and regardless of how old we are or whether we are currently healthy or unwell.
A helpful leaflet on capacity can be downloaded from the Royal College of Psychiatrists’ website at http://www.rcpsych.ac.uk/mentalhealthinfo/problems/mentalcapacityandthemental.aspx. Further information can also be obtained from the Alzheimer’s Society, Mencap, MIND, your solicitor and GP.
(First published in the Scunthorpe Telegraph, Thursday, 23rd February 2012)
Saturday, March 10, 2012
Medical War Zone
In 2000, I retired from the Royal Army Medical Corps. However, reading through this week’s medical journals, I had the distinct impression that I should be taking my uniform out of the mothballs; for it appears that a war is even now taking place; one that I am firmly embroiled in, whether I like it or not. The battle ground is the National Health Service, and it currently has several open fronts.
The most important issue is the saga of the Health and Social Care Bill, which at the time of writing has just entered the Lords for its final stage there. As readers of this column know, I originally voiced serious concerns at the content and intention of this Bill in one of my earliest columns back in 2010. At the time, I was one of the few who dared to break ranks and speak out against the Government’s plans. Many of my immediate colleagues were muttering behind closed doors, but few would pin their colours to the public mast of disquiet and dissent. However, I thought the public had a right to know what was going on. After all, the NHS is your service as well as mine and, if there are to be major changes which will adversely affect the way health services are made available and delivered to patients, then the public has a right to understand.
However, in recent months, the map of those organisations expressing foreboding and alarm at the content of the Bill has altered considerably. Despite a continued rhetoric from the Government that the medical profession is behind the plans, there is now clear evidence that the majority of the health care professions are against the Bill. Such organisations include the British Medical Association (BMA), Royal College of Nursing (RCN), Royal College of General Practitioners (RCGP), Royal College of Midwives, Royal College of Radiologists, UK Faculty of Public Health, Academy of Medical Royal Colleges, Royal College of Physicians, Royal College of Anaesthetists, and the Royal College of Surgeons. Many are calling for the Bill to be withdrawn completely, on the grounds that it will do irreparable damage to the NHS.
Of course, there has already been damage inflicted, despite the fact that the Bill has not been enacted. Even before the Bill had gone through the first stages, the Department of Health was re-organising the local Primary Care Trusts, with widespread redundancies taking place in anticipation of the Bill being passed by Parliament. These changes cannot be reversed even if the Bill now fails, as important people have been lost to the service; people with a vast experience of running the NHS. In my opinion, that in itself deserves a judicial review. It is a gross misuse of a government’s power when it brings about widespread fundamental changes well ahead of a Bill’s debate and enactment in law. It is political arrogance beyond belief.
As a distraction to the above, there is the less well-known roll out of a service called NHS 111. At its core, this is a good idea; a national number to ring when health assistance is required at times other than in an emergency (when telephoning 999 is appropriate). However, the pilots have raised serious concerns for patient safety. In all, there have been nine serious untoward incidents across four of the seven pilots, wherein potentially life-threatening delay has occurred in patients getting assistance. The view of the medical profession is that the service should not be rolled-out until it is safe. The Department of Health is, as usual, playing deaf.
Other battle-fronts include the intended abolition of practice boundaries, thereby increasing the pressure on over-stretched GP practices that already feel under siege. Then there is the significant reduction in funding for practices, a GP recruitment crisis with unfilled vacancies, the imminent GP Revalidation process, and the need to register practices with the Care Quality Commission. That is all before we mention the subject of pension fund changes.
A recent study found that four in ten GPs have emotional exhaustion, a sense of depersonalisation, negativity, and a reduced sense of accomplishment; in effect they are burnt-out. Sadly, that finding is not a surprise, but it should raise significant public concern.
(First published in the Scunthorpe Telegraph, Thursday, 16th February 2012)
The most important issue is the saga of the Health and Social Care Bill, which at the time of writing has just entered the Lords for its final stage there. As readers of this column know, I originally voiced serious concerns at the content and intention of this Bill in one of my earliest columns back in 2010. At the time, I was one of the few who dared to break ranks and speak out against the Government’s plans. Many of my immediate colleagues were muttering behind closed doors, but few would pin their colours to the public mast of disquiet and dissent. However, I thought the public had a right to know what was going on. After all, the NHS is your service as well as mine and, if there are to be major changes which will adversely affect the way health services are made available and delivered to patients, then the public has a right to understand.
However, in recent months, the map of those organisations expressing foreboding and alarm at the content of the Bill has altered considerably. Despite a continued rhetoric from the Government that the medical profession is behind the plans, there is now clear evidence that the majority of the health care professions are against the Bill. Such organisations include the British Medical Association (BMA), Royal College of Nursing (RCN), Royal College of General Practitioners (RCGP), Royal College of Midwives, Royal College of Radiologists, UK Faculty of Public Health, Academy of Medical Royal Colleges, Royal College of Physicians, Royal College of Anaesthetists, and the Royal College of Surgeons. Many are calling for the Bill to be withdrawn completely, on the grounds that it will do irreparable damage to the NHS.
Of course, there has already been damage inflicted, despite the fact that the Bill has not been enacted. Even before the Bill had gone through the first stages, the Department of Health was re-organising the local Primary Care Trusts, with widespread redundancies taking place in anticipation of the Bill being passed by Parliament. These changes cannot be reversed even if the Bill now fails, as important people have been lost to the service; people with a vast experience of running the NHS. In my opinion, that in itself deserves a judicial review. It is a gross misuse of a government’s power when it brings about widespread fundamental changes well ahead of a Bill’s debate and enactment in law. It is political arrogance beyond belief.
As a distraction to the above, there is the less well-known roll out of a service called NHS 111. At its core, this is a good idea; a national number to ring when health assistance is required at times other than in an emergency (when telephoning 999 is appropriate). However, the pilots have raised serious concerns for patient safety. In all, there have been nine serious untoward incidents across four of the seven pilots, wherein potentially life-threatening delay has occurred in patients getting assistance. The view of the medical profession is that the service should not be rolled-out until it is safe. The Department of Health is, as usual, playing deaf.
Other battle-fronts include the intended abolition of practice boundaries, thereby increasing the pressure on over-stretched GP practices that already feel under siege. Then there is the significant reduction in funding for practices, a GP recruitment crisis with unfilled vacancies, the imminent GP Revalidation process, and the need to register practices with the Care Quality Commission. That is all before we mention the subject of pension fund changes.
A recent study found that four in ten GPs have emotional exhaustion, a sense of depersonalisation, negativity, and a reduced sense of accomplishment; in effect they are burnt-out. Sadly, that finding is not a surprise, but it should raise significant public concern.
(First published in the Scunthorpe Telegraph, Thursday, 16th February 2012)
Friday, March 09, 2012
Who Do You Think You Are?
‘Are you the poet?’
It was an interesting question; especially as it was posed towards the end of an entirely unrelated conversation. Well, it was towards the end of a medical consultation to be precise. I admit that it took me a little by surprise; not least because this heretofore unknown patient somehow knew that I write poetry. However, being something of a pedant, the question immediately raised further questions, particularly in respect to how I answered my inquisitor.
For example, the obvious difficulty for me was my patient’s use of the definite article. By using the word ‘the’, the implication was that there existed only one poet, which clearly wasn’t true if the question is taken in the context of the wider world of writing. However, to my knowledge, none of my medical colleagues in the surgery writes poetry, so the answer could be in the affirmative if that was the intended focus of the question.
The second conundrum was based on the concept of when is a person one thing as compared to another? For example, I think of myself as a doctor regardless of whether I am seeing patients or not. But am I a writer when I am not writing; or a poet when I am not physically writing poetry? Furthermore, can I be a doctor, a writer and a poet all at the same time? In our society, we tend to define ourselves and others by the person’s employment. So, for example, once a baker retires, he becomes ‘retired’; he is no longer a ‘baker’, and very rarely a ‘retired baker’. The fact that he is no longer baking tends (rightly or wrongly) to render the skill redundant when it comes to describing the person. So you can now see how such a small question can inadvertently lead me into a minefield of indecision in respect to giving a truthful answer.
Another question which now stumps me is ‘Where are you from?’ Until a few months ago, I would assume that the question was an enquiry into where I started life, in which case I would instantly reply that I am a Kentish Man. However, thanks to a research unit based in Cambridge University, I now have difficulty in answering even that seemingly innocuous question.
It is all Dr Peter Foster’s fault. He is the director of a research programme called Roots for Real (www.rootsforreal.com), which analyses a person’s mitochondrial DNA (mtDNA) and Y-chromosomal patterns and correlates the findings to a database linking modern-day man to the earliest of humans stepping out of Africa and, more specifically when, on their subsequent journey, their DNA mutated to its present-day form. The science is complex but fascinating, and I will leave you to read more on the website should you so wish. However, the upshot is that my Y-chromosomes (inherited through my father) originated 10,000 years ago from an area now known as northern Italy, at about the time of the last ice-age. As for my mtDNA (inherited through my mother’s maternal line), that is firmly centred on Crete and dates back some 40,000 years ago (yes, one of my great great etc. grandmothers knew Neanderthal Man). Furthermore, the same mtDNA has been identified in the remains purported to be those of the disciple, St Luke; thus making him a distant relative. St Luke, of course, was also a physician. So, when someone asks why I became a doctor, at least I can now honestly say that it is ‘in my genes’. However, it brings a whole new meaning to the question ‘who do you think you are?’ To answer honestly, I now need to know whether to take my reference from 52 years, 10,000 years or 40,000 years ago; for I now seem to be a Kentish Greco-Italian of an indeterminate age.
As for the original question, ‘are you the poet?’ I admit that I took the easy route. After a moment’s deliberation, I smiled and simply said ‘yes’.
(First published in the Scunthorpe Telegraph, Thursday, 9th February 2012)
It was an interesting question; especially as it was posed towards the end of an entirely unrelated conversation. Well, it was towards the end of a medical consultation to be precise. I admit that it took me a little by surprise; not least because this heretofore unknown patient somehow knew that I write poetry. However, being something of a pedant, the question immediately raised further questions, particularly in respect to how I answered my inquisitor.
For example, the obvious difficulty for me was my patient’s use of the definite article. By using the word ‘the’, the implication was that there existed only one poet, which clearly wasn’t true if the question is taken in the context of the wider world of writing. However, to my knowledge, none of my medical colleagues in the surgery writes poetry, so the answer could be in the affirmative if that was the intended focus of the question.
The second conundrum was based on the concept of when is a person one thing as compared to another? For example, I think of myself as a doctor regardless of whether I am seeing patients or not. But am I a writer when I am not writing; or a poet when I am not physically writing poetry? Furthermore, can I be a doctor, a writer and a poet all at the same time? In our society, we tend to define ourselves and others by the person’s employment. So, for example, once a baker retires, he becomes ‘retired’; he is no longer a ‘baker’, and very rarely a ‘retired baker’. The fact that he is no longer baking tends (rightly or wrongly) to render the skill redundant when it comes to describing the person. So you can now see how such a small question can inadvertently lead me into a minefield of indecision in respect to giving a truthful answer.
Another question which now stumps me is ‘Where are you from?’ Until a few months ago, I would assume that the question was an enquiry into where I started life, in which case I would instantly reply that I am a Kentish Man. However, thanks to a research unit based in Cambridge University, I now have difficulty in answering even that seemingly innocuous question.
It is all Dr Peter Foster’s fault. He is the director of a research programme called Roots for Real (www.rootsforreal.com), which analyses a person’s mitochondrial DNA (mtDNA) and Y-chromosomal patterns and correlates the findings to a database linking modern-day man to the earliest of humans stepping out of Africa and, more specifically when, on their subsequent journey, their DNA mutated to its present-day form. The science is complex but fascinating, and I will leave you to read more on the website should you so wish. However, the upshot is that my Y-chromosomes (inherited through my father) originated 10,000 years ago from an area now known as northern Italy, at about the time of the last ice-age. As for my mtDNA (inherited through my mother’s maternal line), that is firmly centred on Crete and dates back some 40,000 years ago (yes, one of my great great etc. grandmothers knew Neanderthal Man). Furthermore, the same mtDNA has been identified in the remains purported to be those of the disciple, St Luke; thus making him a distant relative. St Luke, of course, was also a physician. So, when someone asks why I became a doctor, at least I can now honestly say that it is ‘in my genes’. However, it brings a whole new meaning to the question ‘who do you think you are?’ To answer honestly, I now need to know whether to take my reference from 52 years, 10,000 years or 40,000 years ago; for I now seem to be a Kentish Greco-Italian of an indeterminate age.
As for the original question, ‘are you the poet?’ I admit that I took the easy route. After a moment’s deliberation, I smiled and simply said ‘yes’.
(First published in the Scunthorpe Telegraph, Thursday, 9th February 2012)
Monday, March 05, 2012
Revisiting the Expert Patient
‘Generally, society deals with death in a near hysterical manner, viewing practically every death as a tragedy and bereavement as an illness requiring healing.’
Such is the view of Blair Robertson, an NHS chaplain (BMJ, 14 Jan 12). His words were interesting to read as, in the same week, I had taken the topic of dying as the subject for this column. Society’s response to death is hardly surprising when we read of the remarkable lives of people such as Professor Stephen Hawking, the famous cosmologist, and author of the best-seller, A Brief History of Time. Only one week previously an article appeared in the national press informing the world that Prof Hawking was too unwell to deliver his 70th birthday speech (Telegraph, 9th Jan 12). Of course, Prof Hawking is always too unwell to deliver any speech, owing to a condition called motor neurone disease. In reality, any speech he has is electronically composed letter by letter, and then delivered by him using his cheek muscles to operate a voice synthesiser.
Prof Hawking is a wonderful example of how people with long term conditions can still lead remarkable lives. The fact that he has even seen his 70th birthday is a modern-day miracle. Although we tend to use the verb ‘to suffer’ in order to describe the process of living with a chronic condition, Prof Hawking is an example of how people can lead fulfilling and enjoyable lives despite their condition. I am sure that suffering does come into the equation, but so too does a life of satisfaction and pleasure. The trick is to know how to turn around the perception of unavoidable misfortune and pull from life a positive outlook and a sense of well-being.
Last year, I wrote about a new course available in North Lincolnshire. At the time, NHS North Lincolnshire was looking for ‘Expert Patients’; volunteers to train to deliver the course known as the Expert Patient Programme. Now, having seen the satisfactory completion of the first course, patients wishing to participate in future courses are being asked to put their names forward. Delivered during one afternoon per week over a six week period, the course is aimed at people living with long-term conditions. Note that I use the term ‘living with’ rather than ‘suffering from’, for that is indeed what this course is aimed at bringing about. It teaches the skills of self-management and action planning, how to deal with pain and extreme tiredness, how to coping with feelings of depression, the skill of relaxation and how best to exercise, tips on healthy eating, the need for communication with family, friends and health professionals, and last but no means least, how to positively plan for the future.
Writing in the Times Literary Supplement in September last year, the writer and poet Hugo Williams described his reaction to his need for dialysis to treat his kidney failure. Given the choice of dialysing on a daily basis at home or visiting the hospital four days a week, Williams chose the latter on the grounds that it would offer him the chance to ‘pretend to be still in the old free world’. That was his way of trying to ‘live with’ his condition rather than allowing it to take over his entire life. I have no doubt that both Williams and Prof Hawking would fully approve of the Expert Patient Programme.
Christopher Hitchens is another writer who I am sure would have given his seal of approval to the course. Sadly, he died last December. However, true to his inimitable self, and in spite of various tubes and other paraphernalia attached to him, he insisted on being propped at his desk during his final days and finished writing an article just hours before his own ultimate deadline. Hitchens amply demonstrated Prof Hawking’s exhortation: ‘Remember to look up at the stars and not down at your feet. However difficult life may seem, there is always something you can do and succeed at; it matters that you just don’t give up.’
(First published in the Scunthorpe Telegraph, Thursday, 2nd February 2012)
Such is the view of Blair Robertson, an NHS chaplain (BMJ, 14 Jan 12). His words were interesting to read as, in the same week, I had taken the topic of dying as the subject for this column. Society’s response to death is hardly surprising when we read of the remarkable lives of people such as Professor Stephen Hawking, the famous cosmologist, and author of the best-seller, A Brief History of Time. Only one week previously an article appeared in the national press informing the world that Prof Hawking was too unwell to deliver his 70th birthday speech (Telegraph, 9th Jan 12). Of course, Prof Hawking is always too unwell to deliver any speech, owing to a condition called motor neurone disease. In reality, any speech he has is electronically composed letter by letter, and then delivered by him using his cheek muscles to operate a voice synthesiser.
Prof Hawking is a wonderful example of how people with long term conditions can still lead remarkable lives. The fact that he has even seen his 70th birthday is a modern-day miracle. Although we tend to use the verb ‘to suffer’ in order to describe the process of living with a chronic condition, Prof Hawking is an example of how people can lead fulfilling and enjoyable lives despite their condition. I am sure that suffering does come into the equation, but so too does a life of satisfaction and pleasure. The trick is to know how to turn around the perception of unavoidable misfortune and pull from life a positive outlook and a sense of well-being.
Last year, I wrote about a new course available in North Lincolnshire. At the time, NHS North Lincolnshire was looking for ‘Expert Patients’; volunteers to train to deliver the course known as the Expert Patient Programme. Now, having seen the satisfactory completion of the first course, patients wishing to participate in future courses are being asked to put their names forward. Delivered during one afternoon per week over a six week period, the course is aimed at people living with long-term conditions. Note that I use the term ‘living with’ rather than ‘suffering from’, for that is indeed what this course is aimed at bringing about. It teaches the skills of self-management and action planning, how to deal with pain and extreme tiredness, how to coping with feelings of depression, the skill of relaxation and how best to exercise, tips on healthy eating, the need for communication with family, friends and health professionals, and last but no means least, how to positively plan for the future.
Writing in the Times Literary Supplement in September last year, the writer and poet Hugo Williams described his reaction to his need for dialysis to treat his kidney failure. Given the choice of dialysing on a daily basis at home or visiting the hospital four days a week, Williams chose the latter on the grounds that it would offer him the chance to ‘pretend to be still in the old free world’. That was his way of trying to ‘live with’ his condition rather than allowing it to take over his entire life. I have no doubt that both Williams and Prof Hawking would fully approve of the Expert Patient Programme.
Christopher Hitchens is another writer who I am sure would have given his seal of approval to the course. Sadly, he died last December. However, true to his inimitable self, and in spite of various tubes and other paraphernalia attached to him, he insisted on being propped at his desk during his final days and finished writing an article just hours before his own ultimate deadline. Hitchens amply demonstrated Prof Hawking’s exhortation: ‘Remember to look up at the stars and not down at your feet. However difficult life may seem, there is always something you can do and succeed at; it matters that you just don’t give up.’
(First published in the Scunthorpe Telegraph, Thursday, 2nd February 2012)
Monday, February 27, 2012
Doctor on Patrol
As a doctor, one of the delights of living within a rural area is the strong sense of being part of that community. A large number of the local inhabitants know the doctor, and the doctor usually has a fairly good idea as to who you are, as well as often knowing your parents, children, cousins, aunts and so. A stroll up the High Street becomes punctuated by nods, smiles of acknowledgement, fleeting conversations and other casual greetings. A ‘big fish in a small pond’ perhaps, but in a world where we live in an increasingly large ‘global village’ it can be an enjoyable sense of belonging.
However, there is a downside to the local pseudo-celebrity status afforded the country doctor. If one is not careful, walking to a meeting with the local solicitor at his office becomes an al fresco surgery; a quick trip to the supermarket can turn the aisles into a gauntlet of patients ceasing the moment to quiz the doctor about their latest symptoms or acquaint him with the outcome of their hospital appointments; an evening with one’s wife at a restaurant can even be interrupted by enquiries about blood test results from diners or waiters who also happen to be patients. One memorable day, whilst standing in the queue at a bank, the chap in front started to inform me of the lump he had recently detected in his nether regions. His hands were quite graphic in illustrating the size and whereabouts of the problem; a display which attracted curious and amused attention from others in the bank. His opportunism was brought to an abrupt halt when I politely suggested that he could either drop his trousers and I would take a look there and then, or alternatively he could make an appointment to see me in the surgery.
However, all of this is about to change if the Department of Health gets its latest wish granted. The NHS Future Forum, a sort of health ‘think-tank’ for the government, has made the recommendation that all healthcare professionals should ‘make every contact count’ to promote health. According to the forum, doctors should miss no opportunity to quiz their patients about their lifestyle, advise them on their diets, and counsel them to reduce alcohol consumption, stop smoking, reduce weight and take more exercise; as if we haven’t already been doing that for years.
Nonetheless, according to the government, it should be the role of doctors to ‘make use of contact with patients wherever appropriate’. So, the table may be about to turn folks. If trying to consult your doctor in a public place is acceptable to you, no doubt you will not mind if we wave an admonishing finger as you enter the wines and spirit aisle, have a quick review of the contents of your trolley at the checkout, or make ‘tut tut’ noises when you order a particularly creamy, sugar laden pudding on your evening out for dinner. Perhaps larger medical practices could start local ‘community doctor patrols’, making the round of fish and chip shops and other takeaway outlets at lunchtimes. One can see the scenario now: ‘No, Mrs Smith, with your obesity, uncontrolled diabetes and high cholesterol you really shouldn’t be ordering that large portion of chips. Put it back and let me introduce you to the salad bar down the road.’ Like young boys in danger of being caught scrumping by the village policeman years ago, patients will start placing lookouts at the door of the cake shop, and furtive shouts of ‘Psst! Watch out, the doctor’s about!’ could become commonplace.
Alternatively, we could all agree to act reasonably and live in respectful and tolerant harmony with each other. As a doctor, I will keep my comments regarding your less healthy habits to the confines and privacy of my consulting room if, when we meet in the street, the shops, a restaurant or the bank, you promise to talk to me about anything other than the state of your arthritic knees, the quality of your phlegm and the difficulty with your bowels. Paraphrasing Ecclesiastes (chp.3), there is a time and place for everything, despite what the government says.
(First published in the Scunthorpe Telegraph, Thursday, 26th January 2012)
However, there is a downside to the local pseudo-celebrity status afforded the country doctor. If one is not careful, walking to a meeting with the local solicitor at his office becomes an al fresco surgery; a quick trip to the supermarket can turn the aisles into a gauntlet of patients ceasing the moment to quiz the doctor about their latest symptoms or acquaint him with the outcome of their hospital appointments; an evening with one’s wife at a restaurant can even be interrupted by enquiries about blood test results from diners or waiters who also happen to be patients. One memorable day, whilst standing in the queue at a bank, the chap in front started to inform me of the lump he had recently detected in his nether regions. His hands were quite graphic in illustrating the size and whereabouts of the problem; a display which attracted curious and amused attention from others in the bank. His opportunism was brought to an abrupt halt when I politely suggested that he could either drop his trousers and I would take a look there and then, or alternatively he could make an appointment to see me in the surgery.
However, all of this is about to change if the Department of Health gets its latest wish granted. The NHS Future Forum, a sort of health ‘think-tank’ for the government, has made the recommendation that all healthcare professionals should ‘make every contact count’ to promote health. According to the forum, doctors should miss no opportunity to quiz their patients about their lifestyle, advise them on their diets, and counsel them to reduce alcohol consumption, stop smoking, reduce weight and take more exercise; as if we haven’t already been doing that for years.
Nonetheless, according to the government, it should be the role of doctors to ‘make use of contact with patients wherever appropriate’. So, the table may be about to turn folks. If trying to consult your doctor in a public place is acceptable to you, no doubt you will not mind if we wave an admonishing finger as you enter the wines and spirit aisle, have a quick review of the contents of your trolley at the checkout, or make ‘tut tut’ noises when you order a particularly creamy, sugar laden pudding on your evening out for dinner. Perhaps larger medical practices could start local ‘community doctor patrols’, making the round of fish and chip shops and other takeaway outlets at lunchtimes. One can see the scenario now: ‘No, Mrs Smith, with your obesity, uncontrolled diabetes and high cholesterol you really shouldn’t be ordering that large portion of chips. Put it back and let me introduce you to the salad bar down the road.’ Like young boys in danger of being caught scrumping by the village policeman years ago, patients will start placing lookouts at the door of the cake shop, and furtive shouts of ‘Psst! Watch out, the doctor’s about!’ could become commonplace.
Alternatively, we could all agree to act reasonably and live in respectful and tolerant harmony with each other. As a doctor, I will keep my comments regarding your less healthy habits to the confines and privacy of my consulting room if, when we meet in the street, the shops, a restaurant or the bank, you promise to talk to me about anything other than the state of your arthritic knees, the quality of your phlegm and the difficulty with your bowels. Paraphrasing Ecclesiastes (chp.3), there is a time and place for everything, despite what the government says.
(First published in the Scunthorpe Telegraph, Thursday, 26th January 2012)
Wednesday, February 22, 2012
Ars Moriendi
Ars Moriendi (The Art of Dying) was a medieval book first published around 1415. The author was an unknown Dominican friar, who subsequently became a bestseller for some 200 years. The book gave the lay person instruction in respect to understanding death, how to prepare for it, and how to think and behave at the time of death (whether yours or someone else’s).
‘I have often seen the most difficult cases make a beautiful death’, said the priest in Brideshead Revisited. Evelyn Waugh’s novel of the same name as its later ITV adaptation by John Mortimer gives considerable time to the build-up, preparations for, and subsequent death of Lord Marchmain. The scenes are tender and peaceful, with humour interlaced with religious angst, and ultimately contain a deep poignancy. The messages contained therein are not necessarily for everyone, although it does demonstrate one way to prepare well for death.
Nonetheless, not all of us can have a Chinese drawing room, an antique and regal four-poster bed, an army of servants and a coterie of aristocratic attendants to assist us from this world. Happily, we can still hope to have ‘a beautiful death’, whether it be in the Roman Catholic sense of finding ultimate Grace, or overtly atheistic. For most people in the modern century, death does not come suddenly. In a 2010 essay published in the New Yorker, the author Gawande quotes a doctor working in an American intensive care unit as saying ‘I am running a warehouse for the dying’. For many people death is now, up to the ultimate point, a medically controlled process.
The 16th century philosopher, Francis Bacon, argued that the purpose of medicine was to preserve health, cure disease, and prolong life. The concept of controlling the ultimate process of dying in order to render the inevitable a peaceful and painless process (both physically and psychologically) is, I believe, something to which Bacon would not have demurred. However, he might have been less impressed with the recent publication of the report by the Commission on Assisted Dying, wherein the current laws regarding assisted suicide are debated and challenged.
Many readers will be familiar with the Dignitas Clinic in Switzerland where, in the last few years, 76 Britons are known to have ended their lives. There is sadness in the fact that a few feel forced to travel to a foreign country to die in unfamiliar surroundings and away from family and friends. It is therefore understandable that there is a call for a change in the English law in order to legally allow assisted suicide in Britain. Nevertheless, desirable though such a debate may be for some, it is not a debate many doctors feel ethically or morally able to participate in. Indeed, the British Medical Association refused to attend the Commission’s hearings. Some would argue that doctors should be involved in the debate. However, many feel that would, de facto, give credence to the topic. Medicine may be many things to many people, but most doctors did not train to kill people or assist them in killing themselves; preventing suffering whilst letting nature take its course is a very different process to that which the Commission is now publicly debating. It is a debate which is beyond a ‘right to die’, for we all have no choice in that matter. The difficulties for doctors are manifold and multiple, including the question of how to tell when someone has less than a year to live, and how to be sure of a patient’s true capacity to make such irreversible decisions when depression, fear of the unknown, and family and social pressures may also have an influence in their decision making?
‘Oh build your ship of death, Oh build it! For you will need it. For the voyage of oblivion awaits you’, wrote D. H. Lawrence. Quite so; preparing mentally and physically for death is to be commended and encouraged. Knowledge of the existence of death encourages us to delight in living and savour each waking moment. ‘I’m alive; it’s all that matters,’ were the words of a terminally ill friend. Doctors should be helping people to live with their illness, not to die. We change the law to the ultimate risk of us all.
(First published in the Scunthorpe Telegraph, Thursday 19 January 2012.)
‘I have often seen the most difficult cases make a beautiful death’, said the priest in Brideshead Revisited. Evelyn Waugh’s novel of the same name as its later ITV adaptation by John Mortimer gives considerable time to the build-up, preparations for, and subsequent death of Lord Marchmain. The scenes are tender and peaceful, with humour interlaced with religious angst, and ultimately contain a deep poignancy. The messages contained therein are not necessarily for everyone, although it does demonstrate one way to prepare well for death.
Nonetheless, not all of us can have a Chinese drawing room, an antique and regal four-poster bed, an army of servants and a coterie of aristocratic attendants to assist us from this world. Happily, we can still hope to have ‘a beautiful death’, whether it be in the Roman Catholic sense of finding ultimate Grace, or overtly atheistic. For most people in the modern century, death does not come suddenly. In a 2010 essay published in the New Yorker, the author Gawande quotes a doctor working in an American intensive care unit as saying ‘I am running a warehouse for the dying’. For many people death is now, up to the ultimate point, a medically controlled process.
The 16th century philosopher, Francis Bacon, argued that the purpose of medicine was to preserve health, cure disease, and prolong life. The concept of controlling the ultimate process of dying in order to render the inevitable a peaceful and painless process (both physically and psychologically) is, I believe, something to which Bacon would not have demurred. However, he might have been less impressed with the recent publication of the report by the Commission on Assisted Dying, wherein the current laws regarding assisted suicide are debated and challenged.
Many readers will be familiar with the Dignitas Clinic in Switzerland where, in the last few years, 76 Britons are known to have ended their lives. There is sadness in the fact that a few feel forced to travel to a foreign country to die in unfamiliar surroundings and away from family and friends. It is therefore understandable that there is a call for a change in the English law in order to legally allow assisted suicide in Britain. Nevertheless, desirable though such a debate may be for some, it is not a debate many doctors feel ethically or morally able to participate in. Indeed, the British Medical Association refused to attend the Commission’s hearings. Some would argue that doctors should be involved in the debate. However, many feel that would, de facto, give credence to the topic. Medicine may be many things to many people, but most doctors did not train to kill people or assist them in killing themselves; preventing suffering whilst letting nature take its course is a very different process to that which the Commission is now publicly debating. It is a debate which is beyond a ‘right to die’, for we all have no choice in that matter. The difficulties for doctors are manifold and multiple, including the question of how to tell when someone has less than a year to live, and how to be sure of a patient’s true capacity to make such irreversible decisions when depression, fear of the unknown, and family and social pressures may also have an influence in their decision making?
‘Oh build your ship of death, Oh build it! For you will need it. For the voyage of oblivion awaits you’, wrote D. H. Lawrence. Quite so; preparing mentally and physically for death is to be commended and encouraged. Knowledge of the existence of death encourages us to delight in living and savour each waking moment. ‘I’m alive; it’s all that matters,’ were the words of a terminally ill friend. Doctors should be helping people to live with their illness, not to die. We change the law to the ultimate risk of us all.
(First published in the Scunthorpe Telegraph, Thursday 19 January 2012.)
Sunday, February 12, 2012
An Open Apology to India's Kinsfolk
It is a sad but astonishing fact that a seemingly harmless comment can escalate to something far more than was ever intended. Nonetheless, that is precisely what happened to me this week, with the end result that I have inadvertently offended many people, when I would not have dreamt of deliberately causing offence. It is therefore that I now use this blog to issue an open public apology to anyone sleighted by my comments.
The punishment for me has been the accusation that I am racist, when I am truely nothing of the kind; a statement I am absolutely sure that everyone (of any nationality) who knows me would have no hesitation in supporting, and which other articles of mine would bear testimony to.
Perhaps I may be permitted a few lines to place in perspective and try to explain what I said and meant.
Last week, The Times of India (5th Feb 2012) published an article quoting Mr Pranab Mukherjee as saying in the Rajya Sabha that India did not need British aid, stating that the money was 'peanuts'. This was further reported in the British press as being forced onto India by the UK Government, as the latter was desperate to win a fighter jet contract from India; a contract that has, of course, since gone to France.
Understandably, there are many in the UK who cannot understand why our Government persists in giving such aid, when the Indian Government has rejected it; especially when the UK economy is in a perilous situation, and many of us are being taxed to a very high level in order to assist the UK's recovery. As an example, see today's Sunday Telegraph: http://www.telegraph.co.uk/comment/letters/9075195/India-should-no-longer-qualify-to-receive-British-foreign-aid.html
When I read the comments from Mr Mukherjee, I placed a comment on Twitter which said something along the lines of 'India rejects UK aid. Good. Please now reduce my tax so that I can spend it in the UK'. This was sent by me via Twitter to the Downing Street Twitter site. The thrust of this was not meant as an insult to India, but a call on the UK Government to stop mistakenly spending our tax where it was not needed or wanted, and to allow us to personally start having a little surplus to spend in the UK and assist our own economy.
However, several readers misunderstood my stance and made various comments to which I attempted to reply within the confines of short Twitter messages. The points I tried to make were:
i. That if India didn't require UK aid, then we shouldn't be trying to force that aid onto India. To do so is insulting to India.
ii. That to try and manipulate India by the giving of aid in the hope of acquiring the Tornado contract was in itself offensive, and suggested that the UK government was acting in some 'pseudo-colonial manner'.
iii. I also pointed out that many respected people within India were on public record as saying that the provision of aid was undermining attempts at bringing real reform to attitudes within India amongst the wealthier classes, and that what was really needed is for the wealthier Indians to start suporting the poorer members of Indian society, as happens in other wealthy nations. This is on the back of India becoming an increasingly prosperous country, with a Gross Domestic Product expected to exceed that of the UK within the next few years.
So, what I was trying to do through Twitter was reiterate what was already a view being expressed within the Indian Government and by various Indian people. None of those comments were meant to be offensive to India in any way whatsoever, and it was therefore to my great dismay that they were perceived to be so.
Having realised that my words were being misunderstood, I immediately removed them from my Twitter site, so as not to inadvertently cause more distress. However, it is my understanding that they have since been repeated in Indian blogs. Of course, I have no way of knowing how I am quoted, and whether my comments have been altered. Neither, am I able to directly respond to those sites as I do not know where they are. Hence, I am presenting this article in the hope that those who have felt offended might now better understand the context of what I was saying, and be reassured that I truely did not mean any offence to India or its people.
I have had the pleasure and privilege of travelling in India, and have nothing but admiration for the beauty and history of the country. I also have the pleasure of working on a daily basis with many colleagues who were either born in India or are of Indian descent. They are respected colleagues who I treat as nothing less than equals. I can therefore only repeat now, as clearly as possible, my apology to anyone who I inadvertently caused offence, and hope that they will direct others similarly offended to this article in the hope that they too will understand that I meant no ill.
Yours with respect and in peace.
The punishment for me has been the accusation that I am racist, when I am truely nothing of the kind; a statement I am absolutely sure that everyone (of any nationality) who knows me would have no hesitation in supporting, and which other articles of mine would bear testimony to.
Perhaps I may be permitted a few lines to place in perspective and try to explain what I said and meant.
Last week, The Times of India (5th Feb 2012) published an article quoting Mr Pranab Mukherjee as saying in the Rajya Sabha that India did not need British aid, stating that the money was 'peanuts'. This was further reported in the British press as being forced onto India by the UK Government, as the latter was desperate to win a fighter jet contract from India; a contract that has, of course, since gone to France.
Understandably, there are many in the UK who cannot understand why our Government persists in giving such aid, when the Indian Government has rejected it; especially when the UK economy is in a perilous situation, and many of us are being taxed to a very high level in order to assist the UK's recovery. As an example, see today's Sunday Telegraph: http://www.telegraph.co.uk/comment/letters/9075195/India-should-no-longer-qualify-to-receive-British-foreign-aid.html
When I read the comments from Mr Mukherjee, I placed a comment on Twitter which said something along the lines of 'India rejects UK aid. Good. Please now reduce my tax so that I can spend it in the UK'. This was sent by me via Twitter to the Downing Street Twitter site. The thrust of this was not meant as an insult to India, but a call on the UK Government to stop mistakenly spending our tax where it was not needed or wanted, and to allow us to personally start having a little surplus to spend in the UK and assist our own economy.
However, several readers misunderstood my stance and made various comments to which I attempted to reply within the confines of short Twitter messages. The points I tried to make were:
i. That if India didn't require UK aid, then we shouldn't be trying to force that aid onto India. To do so is insulting to India.
ii. That to try and manipulate India by the giving of aid in the hope of acquiring the Tornado contract was in itself offensive, and suggested that the UK government was acting in some 'pseudo-colonial manner'.
iii. I also pointed out that many respected people within India were on public record as saying that the provision of aid was undermining attempts at bringing real reform to attitudes within India amongst the wealthier classes, and that what was really needed is for the wealthier Indians to start suporting the poorer members of Indian society, as happens in other wealthy nations. This is on the back of India becoming an increasingly prosperous country, with a Gross Domestic Product expected to exceed that of the UK within the next few years.
So, what I was trying to do through Twitter was reiterate what was already a view being expressed within the Indian Government and by various Indian people. None of those comments were meant to be offensive to India in any way whatsoever, and it was therefore to my great dismay that they were perceived to be so.
Having realised that my words were being misunderstood, I immediately removed them from my Twitter site, so as not to inadvertently cause more distress. However, it is my understanding that they have since been repeated in Indian blogs. Of course, I have no way of knowing how I am quoted, and whether my comments have been altered. Neither, am I able to directly respond to those sites as I do not know where they are. Hence, I am presenting this article in the hope that those who have felt offended might now better understand the context of what I was saying, and be reassured that I truely did not mean any offence to India or its people.
I have had the pleasure and privilege of travelling in India, and have nothing but admiration for the beauty and history of the country. I also have the pleasure of working on a daily basis with many colleagues who were either born in India or are of Indian descent. They are respected colleagues who I treat as nothing less than equals. I can therefore only repeat now, as clearly as possible, my apology to anyone who I inadvertently caused offence, and hope that they will direct others similarly offended to this article in the hope that they too will understand that I meant no ill.
Yours with respect and in peace.
Sunday, February 05, 2012
Saturday, February 04, 2012
Training to go Through the Keyhole
I am not usually a competitive person, at least not in respect to other people; although I do constantly compete within myself, striving to attain new goals and improve personal standards. However, my sense of isolated self-confidence took a thorough beating over the course of the New Year weekend. Indeed, ‘beating’ is probably not the correct word; I was, without an iota of doubt, comprehensively thrashed.
Finding myself in the position of ‘opponent’ for a game of glorified skittles, and then watching shamefaced as my challenger scored one ‘strike’ after another compared to my own one or two pins, was a humbling experience. The completion of my ignominious defeat was a round of golf, wherein I bounced from one bunker to another (when I wasn’t in the rough or hitting trees), whilst my competitor took hole after hole for a double-bogey (that’s two over par for the uninitiated). The problem was that I have never really mastered the art of ten-pin bowling or golf. Indeed, I have never previously played golf; the nearest I have been to a tee being a romp in the rough as a teenager (trying to find lost balls to turn into cash), and the occasional quick dash across a green as an adult, whilst negotiating an awkwardly placed public footpath.
There is worse to come, for I have more terrible confessions to make than the above. Not only was my opponent female (if you will allow me to be sexist in defeat), but she was considerably younger than my five decades. Indeed, she hadn’t quite reached her first decade. Oh, okay, I confess it; she was only four years old. There, I am totally chastened now; my morale has well and truly sunk below the horizon. I was decisively beaten by a debutante from a kindergarten.
By now you may well have guessed that all may not be what it seems. In truth, we were playing with games on a Nintendo Wii, with a television screen being the nearest we got to a bowling alley or the big outdoors. ‘Shame’, I hear you cry. However, before you castigate me for encouraging a child to waste valuable development time in front of a television screen, allow me to offer you the following for consideration.
In my daytime profession of medicine, the technical skills required in an operating theatre have changed beyond all recognition. Minimally invasive (keyhole) surgery has been one of the most radical changes since I qualified. No longer is there a need to operate through large open wounds for many procedures; including unblocking coronary arteries, repairing torn knee ligaments, removing gall-bladders, or taking a peek inside a bladder or the bowel. Instead, the surgeon often stares at a television screen whilst manipulating various gadgets, the ends of which have disappeared down small holes in the patient. Often life-saving miracles are seemingly performed by remote control.
The skills required to perform such procedures are feats of dexterity; dexterity which I clearly lacked whilst trying to salvage my ego from the skilful attack of a four-year old. The real problem for me is that I became an adult when such computerised games were in their infancy, and I have never made up for that short-coming. By comparison, today’s children are masters of such technology. Whilst I am the first to agree that children should regularly get outside in the fresh air for a spot of healthy exercise, I also have no doubt that they should be allowed to spend time in front of televisions and computer screens, playing entertaining computerised games. At such times, what they are really doing is learning valuable skills of dexterity and spatial awareness which may serve them very well in their professional adult lives. Achieving a balance between the two extremes is important, but I suggest that computer games are not necessarily the childhood evil they are often painted to be.
As for my four-year-old opponent, after the game of golf she went off to play with her toy doctor’s trolley. Who knows, perhaps I have just been witnessing a future brain-surgeon in the making.
(First published in the Scunthorpe Telegraph, Thursday, 12th January 2012)
Finding myself in the position of ‘opponent’ for a game of glorified skittles, and then watching shamefaced as my challenger scored one ‘strike’ after another compared to my own one or two pins, was a humbling experience. The completion of my ignominious defeat was a round of golf, wherein I bounced from one bunker to another (when I wasn’t in the rough or hitting trees), whilst my competitor took hole after hole for a double-bogey (that’s two over par for the uninitiated). The problem was that I have never really mastered the art of ten-pin bowling or golf. Indeed, I have never previously played golf; the nearest I have been to a tee being a romp in the rough as a teenager (trying to find lost balls to turn into cash), and the occasional quick dash across a green as an adult, whilst negotiating an awkwardly placed public footpath.
There is worse to come, for I have more terrible confessions to make than the above. Not only was my opponent female (if you will allow me to be sexist in defeat), but she was considerably younger than my five decades. Indeed, she hadn’t quite reached her first decade. Oh, okay, I confess it; she was only four years old. There, I am totally chastened now; my morale has well and truly sunk below the horizon. I was decisively beaten by a debutante from a kindergarten.
By now you may well have guessed that all may not be what it seems. In truth, we were playing with games on a Nintendo Wii, with a television screen being the nearest we got to a bowling alley or the big outdoors. ‘Shame’, I hear you cry. However, before you castigate me for encouraging a child to waste valuable development time in front of a television screen, allow me to offer you the following for consideration.
In my daytime profession of medicine, the technical skills required in an operating theatre have changed beyond all recognition. Minimally invasive (keyhole) surgery has been one of the most radical changes since I qualified. No longer is there a need to operate through large open wounds for many procedures; including unblocking coronary arteries, repairing torn knee ligaments, removing gall-bladders, or taking a peek inside a bladder or the bowel. Instead, the surgeon often stares at a television screen whilst manipulating various gadgets, the ends of which have disappeared down small holes in the patient. Often life-saving miracles are seemingly performed by remote control.
The skills required to perform such procedures are feats of dexterity; dexterity which I clearly lacked whilst trying to salvage my ego from the skilful attack of a four-year old. The real problem for me is that I became an adult when such computerised games were in their infancy, and I have never made up for that short-coming. By comparison, today’s children are masters of such technology. Whilst I am the first to agree that children should regularly get outside in the fresh air for a spot of healthy exercise, I also have no doubt that they should be allowed to spend time in front of televisions and computer screens, playing entertaining computerised games. At such times, what they are really doing is learning valuable skills of dexterity and spatial awareness which may serve them very well in their professional adult lives. Achieving a balance between the two extremes is important, but I suggest that computer games are not necessarily the childhood evil they are often painted to be.
As for my four-year-old opponent, after the game of golf she went off to play with her toy doctor’s trolley. Who knows, perhaps I have just been witnessing a future brain-surgeon in the making.
(First published in the Scunthorpe Telegraph, Thursday, 12th January 2012)
Men's Talk
Whilst the Christmas festivities are still in our minds, I thought we would start January with one of those cracker-style questions. What do the Book of Psalms, Sir David Frost, the European Commission, Loyd Grossman, the Irish Republic, the Chancellor of the Exchequer, and His Royal Highness the Duke of Edinburgh have in common?
The comedians amongst you will think of all sorts of answers. However, this particular quiz question has a serious message, especially if you are a man. (Ignore the female reader who just remarked that all men are jokes, and keep reading for the important bits).
As we have just had an important religious festivity (that might come as a surprise, but we’ll not go there today), I will start with the Book of Psalms from the Bible’s Old Testament. ‘But ye shall die like men’, reads verse 6 of Psalm 82. I doubt whether the writer of that particular psalm had the concept of 21st century public health in his mind. However, unknown to the author, it was a prescient statement with great modern-day significance.
But back to the quiz; have you got the answer yet? Perhaps Loyd Grossman can help. Grossman was the location presenter of the 1980’s TV game ‘Through the Keyhole’, hosted by Sir David Frost. One of his catch phrases, as viewers were about to be shown around a celebrity’s house, was ‘let’s go through the keyhole’. Ah, I can hear the penny dropping. Yes, you are quite right; the Duke of Edinburgh has recently undergone cardiac surgery; being the recipient of a minimally invasive technique, commonly called ‘key-hole surgery’. (Yes, I know the links are a bit corny, but I did liken this article to the standard found in Christmas crackers.)
So that leaves us with the European Commission, the Republic of Ireland and the Chancellor of the Exchequer to pull into the conundrum. Since you have done so well by reading up to this point, I will quickly quell your mounting sense of suspense. Towards the end of 2011, The European Commission published a report called ‘The State of Men’s Health in Europe’. Apparently, of all the European countries, the Republic of Ireland is the only member which has a national men’s health policy; all the rest treat men the same as women and children. Unfortunately, a ‘one size fits all’ approach doesn’t do men any favours, as working age men have significantly higher death rates than working age women (210% higher, in fact; not quite what the psalmist had in mind, but he was right, nonetheless).
Flawed life-styles are not the only reason for men’s greater mortality rates; although smoking, obesity, high-fat diets, excess alcohol and a lack of exercise are important causes of coronary heart disease. Road and workplace accidents are also significant issues. The fact that men do not make best use of health services and health-related programmes as much as women is also a contributory factor. (A good example is the fact that only 42% of patients participate in cardiac rehabilitation after a heart attack, bypass surgery or angioplasty; although I am afraid that Prince Philip’s example of attending a shooting-party lunch does not count as cardiac rehabilitation).
Finally, why should the Chancellor of the Exchequer be concerned about all of the above? Well, it is estimated that by 2060, there will be 24 million fewer working age men across Europe. That is a lot of lost tax revenue. There will also be 32 million more men (mainly not working) over the age of 65 years; a fact that should exercise both the Chancellor and the Secretary of State for Health. Perhaps we should be lobbying our MPs for a ‘men’s health policy’, rather than let the Government spend valuable resources on re-arranging the deckchairs on the Good Ship NHS. ‘Equality for Men!’ – now, there is a good slogan for 2012. As for me, I think I might pop over to the Irish Republic for a spot of masculine pampering.
(First published in the Scunthorpe Telegraph, Thursday, 5th January 2012)
The comedians amongst you will think of all sorts of answers. However, this particular quiz question has a serious message, especially if you are a man. (Ignore the female reader who just remarked that all men are jokes, and keep reading for the important bits).
As we have just had an important religious festivity (that might come as a surprise, but we’ll not go there today), I will start with the Book of Psalms from the Bible’s Old Testament. ‘But ye shall die like men’, reads verse 6 of Psalm 82. I doubt whether the writer of that particular psalm had the concept of 21st century public health in his mind. However, unknown to the author, it was a prescient statement with great modern-day significance.
But back to the quiz; have you got the answer yet? Perhaps Loyd Grossman can help. Grossman was the location presenter of the 1980’s TV game ‘Through the Keyhole’, hosted by Sir David Frost. One of his catch phrases, as viewers were about to be shown around a celebrity’s house, was ‘let’s go through the keyhole’. Ah, I can hear the penny dropping. Yes, you are quite right; the Duke of Edinburgh has recently undergone cardiac surgery; being the recipient of a minimally invasive technique, commonly called ‘key-hole surgery’. (Yes, I know the links are a bit corny, but I did liken this article to the standard found in Christmas crackers.)
So that leaves us with the European Commission, the Republic of Ireland and the Chancellor of the Exchequer to pull into the conundrum. Since you have done so well by reading up to this point, I will quickly quell your mounting sense of suspense. Towards the end of 2011, The European Commission published a report called ‘The State of Men’s Health in Europe’. Apparently, of all the European countries, the Republic of Ireland is the only member which has a national men’s health policy; all the rest treat men the same as women and children. Unfortunately, a ‘one size fits all’ approach doesn’t do men any favours, as working age men have significantly higher death rates than working age women (210% higher, in fact; not quite what the psalmist had in mind, but he was right, nonetheless).
Flawed life-styles are not the only reason for men’s greater mortality rates; although smoking, obesity, high-fat diets, excess alcohol and a lack of exercise are important causes of coronary heart disease. Road and workplace accidents are also significant issues. The fact that men do not make best use of health services and health-related programmes as much as women is also a contributory factor. (A good example is the fact that only 42% of patients participate in cardiac rehabilitation after a heart attack, bypass surgery or angioplasty; although I am afraid that Prince Philip’s example of attending a shooting-party lunch does not count as cardiac rehabilitation).
Finally, why should the Chancellor of the Exchequer be concerned about all of the above? Well, it is estimated that by 2060, there will be 24 million fewer working age men across Europe. That is a lot of lost tax revenue. There will also be 32 million more men (mainly not working) over the age of 65 years; a fact that should exercise both the Chancellor and the Secretary of State for Health. Perhaps we should be lobbying our MPs for a ‘men’s health policy’, rather than let the Government spend valuable resources on re-arranging the deckchairs on the Good Ship NHS. ‘Equality for Men!’ – now, there is a good slogan for 2012. As for me, I think I might pop over to the Irish Republic for a spot of masculine pampering.
(First published in the Scunthorpe Telegraph, Thursday, 5th January 2012)
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