Friday, 31 December 2010

O death where is thy sting?

2011 sees the 400th anniversary of the Authorised version of the Bible (also known as the King James version). There are many phrases which even now feature in everyday speech-the blind leading the blind, sign of the times, and lots  more. One of my my favourites is, O death where is thy sting?

As we come to the end of another year it's perhaps not inappropriate to think about one of the few unmentionables in our culture-death. In today's Guardian newspaper there is a leader which begins,

In these final days of the year, many will fall to thinking of those lost in the course of it, from the famous – John Dankworth, Jean Simmons, Michael Foot, Charles Mackerras and Beryl Bainbridge have been among the conspicuous departed of 2010 – to the recently dead among their own families and friends.
How we deal with the prospect of death in some ways defines us. As a Christian believer I don't pretend that at times the thought of my own death doesn't unsettle me, and yet I have a fundamental conviction that because Christ conquered death I too can have great hope beyond the grave.

I've been reading John Newton's letters to his adopted daughter whilst she was at boarding school,
'You sometimes intimate that you are afraid of death, I wonder not at it. For you are a sinner and I hope to see you a believer, and then you will not greatly fear it, while it is at a distance, and whenever it is comes very near you will not fear it at all. Mr Harris and is gone and so is Mr Campion, and neither of them was more afraid of death, than you would be afraid of a coach that should stop at the gate and take you home to us. Jesus died to make death safe and comfortable to us'
The coach at the gate? A lovely thought.

That most secular of publications, The Guardian,  ends its editorial which had mostly been concerned with an interesting guest feature on the BBC Radio 4 Today programme  about cemeteries, with the rather surprising thought,

Ms Athill and Mr Naughtie were guided round Highgate by a volunteer, herself in her 80s, one of those who in graveyards great and small across the land have redeemed past neglect and made these rewarding places in which to wander, to meditate and to be serious.
 Wandering, meditating and being serious about death is not a forté of our culture.

Thursday, 23 December 2010

The Nativity

Just watched the final episode of The Nativity on BBC. It was truly beautiful. Catch it on iPlayer in the next 5 days before it's too late!

Cannot remember the last time I was so moved whilst watching the tv. The story of the incarnation is so familiar to me and I was taken aback by the power of it all.

Veiled in flesh the Godhead see
Hail the incarnate deity
Pleased as man with man to dwell
Jesus our Emmanuel

Tuesday, 21 December 2010

'I counted then all out and I counted them all back'

I was sad to hear today of the death of the journalist Brian Hanrahan who died yesterday at the age of 61 years of colon cancer.

In the early days of the Falklands conflict he was based on HMS Hermes when a number of Harrier Jump jets left on a sortie. Government restrictions prevented him giving any real detail of the mission but he was able to provide wonderful reassurance by coining the phrase, 'I'm not allowed to say how many planes joined the raid, but I counted them all out and I counted them all back'. It was an inspired choice of language and eventually found its way into the Oxford Book of Quotations.

Words really do matter. Communication skills are absolutely vital not just for journalists but also for doctors. Over many years I taught communication skills to undergraduate medical students at the Royal Free Hospital school of medicine (Now UL!!). They were often underwhelmed by the subject and found it rather soft and of somewhat secondary importance to the glamour of transplants and implantable defibrillators. How I wish I could have fast forwarded their careers 20 years. Much of the stress of being a doctor can be obviated by anticipating patient's concerns, explaining procedures and prognoses well, choosing language carefully and being a first class listener. All this and more under the rubric of communication skills.

Patients will forgive a wrong injection, a wrong diagnosis and perhaps even failed treatment, but seldom forgive rudeness, insensitivity and thoughtlessness. When a formal complaint is made against you, you'll wish taken communication more seriously.

Wednesday, 15 December 2010

'When I'm 64'

Pensioner moi??
Every once in while we have humbling experiences  Sometimes our pride catches us out and at others its just our folly. Our self image is a powerful force which varying in intensity between different people, determines our mood, our daily activities and our generosity amongst many other characteristics. For some of us it can be over-inflated.

I was humbled last weekend when upon entering a car park I was greeted by a friendly attendant with the words, "only two pounds for you mate-we've got to look after our pensioners...this government won' I will."

Now for some of you this would have been a relief-saving a quid-but at the tender age 57 summers (well actually 56 summers, but 57 years-I was born in Autumn!), I was briefly mortified. Surely I don't look like a pensioner? Why it was only a minute ago that I was at school. And I'm so well preserved!  It must surely have been the flat cap and the unshaven appearance?

Well, whatever it was, this dear chap thought I was further down the road than I imagined I was. And in many ways we all are. So get your botox, go to the gym and wear 'young people's clothing' (one of my female work colleagues commented derisively about Pamela Stephenson on Strictly Come Dancing, 'she's a 60 year old dressing like a 30 year old'!!) if you must, but the years will roll on if you are spared. Somebody somewhere will call your bluff eventually.  And certainly our maker and creator,whom we must all face, is not fooled and we must all pass his way.

I was reading this morning some of the most well known verses in the Bible and yet again the beauty and wonder of God's sacrificial love struck me,
God so loved the world that he gave his one and only Son that whoever believes in him shall not perish but have eternal life John 3.16

I may age in this life, but because of the Christ  who went to Calvary via Bethlehem I need not 'perish'.

Sunday, 12 December 2010

Terry Jones, Teresa May and Jesus

Terry Jones came to the attention of the UK first by threatening to publicly burn a copy of the Koran. He has now been invited to speak at a rally of the English Defence League in Luton. And just yesterday he and his church attracted yet more attention by encouraging his member to protest outside the funeral of Elizabeth Edwards the wife of former vice-presidential candidate John Edwards. She died just a few days ago at the age of 61 years. She was a noted gay rights and anti Iraq war spokeswoman.

Terry Jones is a Christian pastor and yet his approach to those he disagrees with is not Christlike. Take a look at this short video of pastor JD Greear whose sentiments I share

Ask Anything Friday 12-10-10 from The Summit Church on Vimeo.

Wednesday, 8 December 2010


Thirty years ago today John Lennon was shot dead outside of his New York apartment in the Dakota building.

Being a boomer baby I grew up with his music, and the Beatles are still a staple for me to enjoy and listen to. John Lennon was in many ways a genius with enormous artistic talent. Perhaps his most famous composition is Imagine. And yet like much aspirational poetry I'm not sure how well the lyrics stand up to scrutiny.

Imagine there's no heaven
It's easy if you try
No hell below us
Above us only sky

Haunting and beautiful in their way, but the lyrics lead us nowhere. The implications are that there is some utopian world which exists only whilst we are alive on earth and which is spoiled by religion and rescued only by a brotherhood of man. But even in his own life there was no real brotherhood of man, with tensions especially between him and Paul McCartney.

OK 'religion' screws alot of people up. But I would want to argue that Christianity should be distinguised from religion. The essence of religion is a code of behaviour required of the adherent to appease a god or  in some way merit divine favour. The sheer relief of the Christian gospel is that in its essence it is good news of what God has done for us (not what we do for him) in sending his only Son to die in our place and bear the judgement that our sins deserve.  So the Christian life is one of gratitude, not 'trying to be good'.

Check out this site to explore Christianity further. Use the zoom button to make the text easier to read-and make sure it's full screen-it's worth the effort!

Thursday, 2 December 2010

I've not seen it all before

I've worked in general practice for 30 years and frequently seek to reassure patients who are about to show me something that they would rather keep hidden that, "I've seen it all before".  I realised this week that that is far from the truth as I was consulted by a young mother who was concerned about her 13 month old who had managed to eat half of a cigarette. My instinct was to immediately reassure her, but upon reflection, reading and consulting the national poisons line, I changed my tune.

Nicotine in tobacco is a toxic alkaloid called solanine (the same toxin as occurs in deadly nightshade and the green of potatoes exposed to the sun). Ingesting nicotine chemical results in a build up of the  neurotransmitter called acetylcholine. At lowish doses it causes nausea, vomiting and palpitations and at higher dosages may cause delirium, paralysis and death! Apparently ingesting 5 cigarettes or half a cigar is enough to kill an adult!

Fortunately my patient recovered apart from a few hours of vomiting. I've lots to learn yet.

Wednesday, 1 December 2010

The other RAC

Thanks to my friend Trevor Yorke who sent me the link to this 'random act of culture'.

He tells me that the organ at Macy s has 25,000 pipes compared to the one at The Royal Albert Hall which 'only' has 9,999 pipes!  You never know when such knowledge will come in useful.

And for the background to the Macy's organ story-go here (after the ad)

Saturday, 27 November 2010

Tiger Tiger burning low

One year ago today Tiger Woods drove into a fire hydrant outside his Florida home. Although he wasn't seriously damaged physically his reputation has been tarnished and his marriage to Elin Nordengren is over.

As he tries to rebuild his life,  former sponsors such as AT&T , Accenture and Gatorade have ditched him, whilst Nike, Procter and Gamble and Tag Heuer have 'de-emphaiszed' him. I'm not aware of ever having been de-empasized, but it doesn't sound too good.

After King David committed adultery and murder, he turned to God with great sorrow and a longing to know forgiveness. The Psalm he wrote at that time is a remarkable document. It begins simply and poignantly,
'Have mercy on me O God according to your steadfast love' Psalm 51.1
Paul Tripp has written a very helpful book reflecting on this Psalm, called Whiter then snow. Here's his reflection on verse 1.
Sinners and unafraid 
The older you get the more you move from being an astronaut to an archaeologist. When you're young you're excitedly launching to worlds unknown. You have all of the major decisions of life before you and spending your time assessing your potential and considering opportunities. It's a time of exploration and discovery. It's a time to go where you've never been before and to do what you've never done. It's a time to begin to use your training and gain experience.
But as you get older, you begin to look back at least as much as you look forward. As you look back, you tend to dig through the mound of the civilization that was your past life, looking for pottery shards of thoughts, desires, choices, actions, words, decision, relationships, and situations. And as you do this, you can't help but assess how you have done with what you have been given.
Now let's think about this for a moment. Who would be so arrogant and bold as to look back on their life and say, "In every possible way I was as good as I could have been?" Wouldn't we all hold some of those pottery shards in our hands and experience at least a bit of regret? Wouldn't all of us wish that we could take back words that we have said, decisions that we have made, or actions we have taken?
Here's what all of this means: If you and I are at all willing to humbly and honestly look at our lives, we will be forced to conclude that we are flawed human beings. And yet we don't have to beat ourselves up. We don't have to work to minimize or deny our failures. We don't have to be defensive when our weaknesses are revealed. We don't have to rewrite our own histories to make ourselves look better than we actually were. We don't have to be paralyzed by remorse and regret. We don't have to distract ourselves with busyness or drug ourselves with substances. Isn't it wonderful that we can stare our deepest, darkest failures in the face and be unafraid? Isn't it comforting that we can honestly face our most regretful moments and not be devastated? Isn't it amazing that we can confess that we really are sinners and be neither fearful nor depressed?
Isn't it wonderful that we can do all of these things because we have learned that our hope in life is not in the purity of our character or the perfection of our performance. We can face that we are sinners and rest because we know that God really does exist and He is a God of:
  Unfailing love,
  Great compassion
  Because He is, there is hope-hope of forgiveness and new beginnings!  
Yes we really can fully acknowledge our sin and failure and yet be unafraid.
Thank God he neither ditches  nor de-emphasizes us.

Monday, 22 November 2010

Generous justice

Many Christians like me have a very individualistic view of Christianity, a sort of, 'I'm ok, I am forgiven by God, Jesus Christ is my Saviour and I'm guaranteed a place in heaven'. A caricature perhaps but more than a grain of truth I suspect.

In the church I am a part of we have nearly finished an 8 week course on Sundays and in our home groups called the Gospel In Life. It's been exhilarating and very provocative. The essence of it is that the gospel, or good news from God about what he has done to set the world right, cannot be reduced to, 'believe this and you'll be ok', but rather is,  
the good news that through Christ the power of God’s kingdom has entered history to renew the whole world. When we believe and rely on Jesus’ work and record (rather than ours) for our relationship to God, that kingdom power comes upon us and begins to work through us.” – Tim Keller.
OK that takes a fair bit of unpacking, and the course attemts to do that. This week we looked at the huge Biblical emphasis of God's concern and action for the weak, the poor and the vulnerable.  It's a subject Tim Keller has written about in his book Generous Justice. It's a massive subject and has complexity within it. I was helped however by one of our members, Chris Almond, who was interviewed in our evening meeting. Having worked with Tear Fund, he reminded us of just how much  the Bible has to say on this, and also that we must not hide behind the complexities of the subject but trust Christian organisations like Tear Fund and Micah Challenge who help us understand matters of trade justice and inequalities and urge us to take action such as  writing to our MPs, protesting peacefully, reviewing our own western consumer lifestyle or engaging in local social or political action.

Most telling for me was Tim Keller's comment in the DVD that, we may think we have a close relationship with God, but if we have no concern for the poor and vulnerable in society, and if we don't back that up with action, we may well be fooling ourselves. Our pastor Ray Evans had preached similarly from James' letter in the morning meeting. Perhaps we really don't believe that faith without works is dead.

Wednesday, 10 November 2010

Core stability

Whilst washing up the breakfast dishes (!!) last Sunday morning I was listening to Radio 2 and Aled Jones' Good morning Sunday. Across the display screen of my digital radio scrolled the words, 'celebrities discuss the spiritual side of their lives'.  Is it possible to just have a spiritual side?

When I reflect on Christianity and the God I have come to believe in, I find it hard to imagine that he could just occupy a spiritual side of my life. The creator God made known to us through the pages of the Bible and through the natural world and our own consciences and supremely through the historical person of Jesus of Nazareth, is not a mere local deity with limited dimensions. Indeed in Old testament times when Solomon was contemplating building a temple for this God, he struggled with the immensity of it all,
But who is able to build him a house, seeing heaven and the heaven of heavens cannot contain him? who am I then, that I should build him a house, save only to burn incense before him? 2 Chronicles 2.6

That seems an appropriate response, and is why I struggle with the concept of a  spiritual side. When a person becomes a Christian 'a number of remarkable things take place both in heaven and in our bodies' (thus begins The Fight a truly excellent book on the christian life written by John White). That's a tantalising intro, but gives some indication of the  immensity of true Christian experience.

For God to live within us can never be a sideline, a someone fitted in around other more pressing interests.  Our relationship with Christ is at the core and everything springs from that. It's the essence of what we have been learning together at my church over the last 6 weeks  in a course from Tim Keller of Redeemer Presbyterian Church New York City, called The Gospel in Life.

A friend of mine who has been lately coming to our church wrote to me after last Sunday's meeting,
I was struck by a comment (was so struck by it that I cannot remember the exact words although it made the point that, as Christians, we should not have a 'spiritual side' but a we should have a spiritual core) at the evening service of a community church last night. The general theme of the service was 'work'. I don't seem to engage with topics that stray away from simple 'understanding Christianity' or 'living the Gospel' as these ones talk to me the most. Like some kind of spiritual Dragon's Den panellist "let me tell you where I am", I would currently be unable to define myself.... I was a Christian and when push comes to shove I might just write down 'C of E' on a form because...well I always have and its short and fits in the box.I strayed away from church around the age of 18 although I suspect that I strayed from God and the Gospel some time before that. I have returned to the physical church but perhaps not entirely spiritually... although I am making ground.

I have been trying to squeeze my spiritual journey around these things to fill this jar when in fact what I probably need to do is to try and make the centre of this jar my spiritual journey and let it sort of run in and around the other parts of my life but certainly not exclude religion from the facets of my life but let it embrace them, sort of binding them with a purpose and some motivation.

He's a grown man so I won't say out of the mouth of babes and sucklings!

Tuesday, 9 November 2010

One week late

Last weekend I cycled down to Bedford embankment to enjoy the Autumn colours. I took the camera and realised that I was probably about one week late since there had been some fairly strong winds over the preceding days which had resulted in a number of the trees shedding quite a proportion of their leaves. Still it's been a beautiful Autumn, and even one week late it was still a great sight.

Tuesday, 2 November 2010

Haiti, cholera and Carnaby Street

The Broad Street Pump memorial
How sad to hear the recent news from Haiti. What suffering the people have endure. And now cholera.

Sadly it took a very long time for the Victorian medical establishment to accept that cholera was a water born infection.  So many theories were advanced for both its causation and cure in mid Victorian Britain from the truly ridiculous to the sublime. One doctor who wrote in to The Lancet calling himself, a tobacco smoker’ suggested that smoking gave excellent protection against cholera, first, by relieving the mind from that most depressing agent, fear, and secondly by 'neutralising the miasm and disgusting noxious effluvia’ in other words purifying the air.

Of causation the ideas  were legion. One medic suggesting that it was the new railways changing the magnetism in the vicinity. The Board of Health set up by the government advised that , ‘vegetables, salads and pickles’ were to be avoided at all costs, leading the Lancet to proclaim, ‘grown up men and women tremble at the Brussel sprout or a gherkin!’.

Thankfully John Snow’s painstaking work was eventually recognised and the contaminated water theory was accepted as fact. I’m somewhat proud of my association with John Snow for he was a product of Westminster Medical School, which alas is no more having been gobbled up first with Charing Cross and then finally by Imperial. I thoroughly enjoyed reading his story and the develoment of his theory in The Medical Detective by Sarah Hempel

His Broad Street pump research and the famous map which is known to epidemiologists the world over is his great legacy. Broad Street no longer exists but the original site of it is only a handful of yards from Carnaby Street. There’s a memorial there now and it’s worth seeing.

Thank God for individuals who are willing to stand against the accepted view. With an explosion of guidelines somewhat suffocating today's doctors, we could do with a few more John Snows. Although of course his work wasn't just a reflection of a maverick temperament, but the result of dedicated and laborious research. 

Painstaking dogged research is so important, as is a willingness not to toe the party line (everyone including Florence Nightingale) and espouse the miasm theory prior to Snow. At a recent GP update course (which I thoroughly enjoyed and heartely recommend) we were reminded that it’s ok to deviate from national guidelines as long as you are aware of the guidelines and give good reasons for doing what you do.

Thank God for modern methods of re-hydration and antibiotics. Lets hope and pray that te suffering of the people of Haita will be short lived.

Thursday, 21 October 2010

The John Bunyan trail

Last weekend and a free afternoon whilst my wife was away for the weekend I decided to take a walk starting from our house and make the most of the the Autumn sun. Having been on a Silva navigation course in Derbyshire the other week I thought I'd practice my map reading skills! Pete Hawkins did suggest that the best way to gain confidence was to walk in you own locality when you are always confident of where you  are.

Part of my route took me along the John Bunyan trail. I must say there wasn't  much in the way of signage and nor have I be able to find out much about the route's association with John Bunyan-who remains  Bedford's greatest claim to fame (unless you prefer the R101 airship or Paula Radcliffe). He wrote the masterpiece which is Pilgrim's Progress-a book which is remarkable for having always been in print since it was written 1677.

I took a slight detour when I got to Bromham stopping off at the Bromham Swan for a pint of my favourite ale-Green King's Abbot Ale whilst I settled down in front of a log fire to read a portion of a lesser known work of John Bunyan-The heavenly footman. Written in 1698  it has a brief description of the Christian doctrine of justification which teaching had played such a crucial role in the Reformation. This is how Bunyan puts it,
'a man is forced to suffer the destruction of his own righteousness for the righteousness of another. This is no easy matter for a man to do; I assure you it stretcheth every vein in his heart before he will be brought to yield to throw himself wholly upon the righteousness and obedience of another man... this is the first thing'.

Now Bunyan is speaking about Christ and ceasing to count on our own achievements. What a joy it is to rely upon and put my trust in another (or throw myself as Bunyan would say) who is Christ,when it comes to how I stand before God.  None of us measure up, no amount of religious activity will help us climb the ladder to a holy God.  I can live at peace with myself and with God because of someone else's goodness and sacrifice. It does't seem fair does it. No wonder John Newton called it Amazing Grace.

Tuesday, 12 October 2010

It's boring being a GP

'GPs just see sore throats and issue sick certificates'. It's a popular view of the great British public. Not greatly disimilar from some hospital consultants who caution their juniors not to waste their skills on general practice (I have a mole in the hospital in the form of my FY2 daughter Hannah!!).

Well I had a quiet duty morning today seeing only 10 patients-here they are.

Patient No 1. A 55 year old lady with a 4 week history of left periorbital pain with associated watering of the eye. Probably Cluster migraine- a rare and nasty form of migraine
Patient No 2. A 47 year man with a recent diagnosis of depression. Its come completely out of the blue since he admits he's a classic 'rugby type' into a fast paced life. We discussed his insomnia and the journey he is now embarking on.
Patient No 3. A 36 year old lady with a herpes simplex rash in her cheek. She's getting married in 2 weeks so anxious to look her best.
Patient No 4. A 75 year old man with a past history of pleurisy 50 years ago, 'I nearly died', worried about his cough. He left with reassurance and a 'delayed script' for antibiotics.
Patient No 5 A 36 year old mum with a sore throat-for the last 12 hours-ok, ok we do see some.
Patient No 6. A 50 year old professional musician with 38 hours of shortness of breath. He's got a loud systolic murmur, tachycardia and abnormal ecg. Probably mitral valve disease. Normally fit guy, off to hospital he goes.
Patient No 7 A 35 year old lorry driver who comes to discuss the mri scan of his neck. He has numbness in his arms and may need surgery.
Patient No 8 A 25 year old with pain on swallowing. He has small aphthous ulcers on his posterior pharynx. No previous history. Possibly viral. But not tonsillitis!
Patient No 9 and 10  Oh dear...I've forgotten already!

Variety is indeed the spice of life.

Wednesday, 6 October 2010

'The lion will lie down with the lamb!!'

Take a look at this extraordinary video shot in Kruger national park. It's full of surprises. Not sure that it fulfils may aim of 'enjoying creation' but it certainly gives you something to think about. Make sure you keep watching till the end..

And one day the lion will lie down with the lamb!

For a shorter rather amusing version of the video from Japanese tv look here.

Tuesday, 5 October 2010

Jack the lad

Last week we enjoyed a relaxing time in Castleton in the northern Peak District.  Walking down Mam Tor it was great to see a number of paragliders enjoying the thermals swirling above us.  As we were near the bottom we caught side of one of the paragliders juts having landed. It was Jack from Sheffield.
Sheffield Jack
He was pleased to tell us that he had just completed his 800th flight at the tender age of 82 years (having taken up the sport when he was 66 years of age). He was full of life and had no intention of slowing up.

Yes I guess he is fortunate with his health and well being, but it always difficult to know how much of a person's current state of health is simply a random occurrence and how much results from that person's lifestyle and the multiple factors that contribute to our risk of illness, which of course includes our family history. Jack was liberal with his friendship towards us-in fact it proved a challenge to get away...

One factor that is known to contribute to well being is 'connectedness'. That surrounding of oneself with and the giving of oneself  to,  other people, some of whom we would call 'friends' of various degrees of closeness. One of the factors contributing to my own dear mother's well-being  (she is 84 years old today) has been her warmth and hospitality to so many people over the years. Loneliness and isolation can literally kill us but friendship, both freely offered and freely received immunises us to some degree against a variety of ills.

Being a Christian believer provides wonderful friendships and being part of a healthy church family really adds to that. Of course I realise that not all church families are as healthy and health giving as they might be, and not everyone who has lots of friends will be fit enough to paraglide at 82 years, but maybe it  makes the probability  more likely.

Any way Jack has inspired me to plan for my sixties!

By the way take a listen to a great sermon here on 'spiritual friendship' by Tim Keller

Thursday, 23 September 2010

Churchill and smoking

A beautiful early autumnal day yesterday and a first visit to Chartwell the former home of Sir Winston Churchill.  The lovely grounds and the stunning views over the Weald of Kent were matched by the fascination of walking though the house where Churchill spent so much of his time.
Chartwell looking across the croquet lawn

Churchill is of course most famous for his leadership during the second world war, but he also had proved himself a perceptive judge of future possibilities,  particularly when he had continuously warned of the danger of Nazism throughout the 1930s.

In Lord Moran's somewhat controversial diary account of the life of Churchill between 1940 and 1965, he records an entry,
February 24, 1953 Yesterday the PM spat up a little blood, so this morning I packed him off, vigorously protesting, to be X-rayed. I am sure nothing will be found, for he is just now in terrific form.
PM.: 'What is this they are saying about smoking and cancer of the lungs?'
Moran: 'It is not proven'
PM.: 'You always give me a careful answer'
Moran: 'You have smoked all your life, and I have never tried to make you give it up.' 
A smile lit up his features.
Lord Moran we regarded as one of the most eminent physicians of the day. He was clearly unimpressed by the work of Sir Richard Doll who in 1950 had published a large study in the British Medical Journal with the conclusion, "The risk of developing the disease increases in proportion to the amount smoked. It may be 50 times as great among those who smoke 25 or more cigarettes a day as among non-smokers." 

Fortunately Sir Richard Doll persisted and published again,  four years later in 1954, the British doctors study, a study of some 40,000 doctors over a 20 year period which confirmed his previous suggestion, based on which the government issued advice that smoking and lung cancer are linked.

Perhaps Lord Moran should have listened to his formidable patient. As Sir William Osler had noted decades before, 'listen to the patient, they are telling you the diagnosis'.

Thursday, 16 September 2010

The old ones are the best

I seem to be following a theme this week of appreciating the 'old ways'. It's not so much that progress is inherently bad, but that with each development and modernisation something is lost.

I thought about that this week when one of my patients made reference to another who lives in the same community where I work. Were the two related? What was the connection? One of the great benefits of the old 'Lloyd-George' notes (which were first introduced into this country around in 1911 during the pioneering Liberal government and its introduction of a National Insurance Act, a kind of precursor of the NHS) was that names on the outside of the notes were hand written and would show the original surname of married women (and indeed sometime multiple surnames!!), which often enabled me to make a quick connection between two patients  for whom a link had not previously formed in my mind. It would often prove a great help.

Similarly a millisecond look at the thickness of the overflowing notes immediately conveyed an intimation that here was a patient with much medical history-or contra-wise here was someone who virtually never attended the doctor whose complaint perhaps merited particular attention.

Something I really miss is looking at the handwriting of the previous GPs and admiring the hastily drawn anatomical sketches to summarise the local of the patients pain. Somehow a few words of fountain pen written prose seem to convey so much more that  misspelt computer entries. I think my last Lloyd-George entry was about 2002-in Olney we hung on as long as we could-and I bemoan its passing.

Monday, 13 September 2010

I'm fashionable at last!!

Its taken a while but culture has finally caught up with me. I'm not good at reading the weekend fashion pages but according to my daughters I am 'right there'. So take a look at the brogues...

They are a thing of beauty and I gather they are all the rage. I will have to confess however that I have owned this pair (I do have the left one as well) since July 22nd 1978! I bought them whilst Liz and I were on our honeymoon in the Lake District and they came from a shop in Penrith. I was told that if I looked after them that they would last me a lifetime. It was a little unnerving to be told this when I was 24 hears old!

So now they are fashionable, previously they were just a little quirky, old-manish and just plain expensive. But I must have seen their potential when I bough them!

When it comes to practising medicine there is still much to be said for the 'old ways' and for not despising teachers from the past. What they said then might have great benefit for the practice of medicine now. Take theses words of Sir Robert Hutchinson from the BMJ in 1928,
Don'ts for diagnosticians
1. Don't be too clever
2. Don't diagnose rarities
3. Don't be in a hurry
4. Don't mistake a label for a diagnosis
5. Don't be too cock sure
6. Don't hesitate to revise your diagnosis from time to time in a chronic case. 
To fail to value the past is what C S Lewis describes as 'chronological snobbery' and I guess we all fall for it at times.

Tuesday, 7 September 2010

More on Hawkins and the universe

Further to my link to John Lennox's article on Steven Hawkins' latest pronouncements about God, I came across an interesting piece by Dr James Anderson who is a Scot working in the USA and who specialises in 'philosophical theology'!! He comments on the quote from Hawkins' book which many of our papers picked up on,
"Because there is a law such as gravity, the Universe can and will create itself from nothing. Spontaneous creation is the reason there is something rather than nothing, why the Universe exists, why we exist.It is not necessary to invoke God to light the blue touch paper and set the Universe going."

To which Anderson replies..
"If Hawking thinks there is some law or principle that explains the very existence of the universe, he must have in mind a metaphysical law rather than a physical law. Unless I’m much mistaken, the law of gravity is a physical law. It appears that Hawking intends to leave behind physics (a subject on which he is eminently qualified to speak) and enter the realm of metaphysics (a subject on which he has no particular expertise, so far as I know). It’s more than a little ironic therefore to find Hawking declaring on the very first page of his new book that “philosophy is dead.” If philosophy is dead, why is Hawking now turning his hand to philosophy? No, philosophy is in very good health, despite its frequent mistreatment at the hands of scientists"
It's well worth reading the entire comment here. It's pretty heady stuff, but the conclusion I do understand,

Unfortunately even the best physicists aren’t immune to embarrassing themselves when they turn their hands to metaphysics — and they’re most at risk when it comes to religiously controversial topics.

Monday, 6 September 2010

Help! I'm a friend of the earth.

My wife Liz and I had a very enjoyable walk around the grounds of Woburn Abbey last weekend. It really was lovely, starting off from the Georgian village of Woburn and walking though and around the deer park. It's not that far, maybe about 6 miles, but it took us about three and a half hours.

What slowed us down was the blackberry picking!  We'd done the walk before and wish we had been prepared. So this time  with our plastic bags in the rucksack we managed 14ozs between us. I only had my iphone but  took this picture of a speckled wood basking in the sun.

It turned out into a real friend of the earth day. Later we picked a large marrow from our garden, followed by some potatoes, runner beans and tomatoes.

Since I've been a towny all my life I cant help but be a tad pleased with myself (sadly according to my daughters, not an unfamiliar situation)! Perhaps it's an an age thing, but there's  something rather satisfying and yet simple about just being out and about enjoying the countryside and eating food grown in our garden or foraged from the hedgerows.

Although it can easily be misused, the statement from the Bible that, 'God has given us all things richly to enjoy' (1 Timothy 6.17) has much depth to it. Perhaps some of us Christians have been slow to appreciate the sheer magnanimity of God in giving us this amazing, albeit fragile and wounded earth-a thought that has been greatly stimulated in me by reading Julian Hardiman's book, Maximum Life. It's a great read encouraging us to live all of life for the glory of God. The earth is indeed charged with the grandeur of God (with thanks to Gerard Manley Hopkins).

Friday, 3 September 2010

'It must be true..I read it in The Daily Mail'

Not a week goes by without a patient presenting me with a cutting from the Daily Mail. If it's not castigating GPs for being overpaid and lazy it's raising hope with a 'medical miracle' story that is overblown and usually unhelpful.

So today a helpful article by Professor John Lennox, a mathematician from Oxford University. He takes to task his fellow academic Professor Stephen Hawking, he with the brain the size of the planet who has overcome a significant medical disability to be one of the most noted scientists of this generation.

Hawking apparently states that the laws of physics are all we need to explain the origin of the universe in his new book The Grand Design. But Lennox differs and explains his thinking as both a scientist and a Christian

But, as both a scientist and a Christian, I would say that Hawking's claim is misguided. He asks us to choose between God and the laws of physics, as if they were necessarily in mutual conflict. 
But contrary to what Hawking claims, physical laws can never provide a complete explanation of the universe. Laws themselves do not create anything, they are merely a description of what happens under certain conditions. 
What Hawking appears to have done is to confuse law with agency. His call on us to choose between God and physics is a bit like someone demanding that we choose between aeronautical engineer Sir Frank Whittle and the laws of physics to explain the jet engine.  
That is a confusion of category. The laws of physics can explain how the jet engine works, but someone had to build the thing, put in the fuel and start it up. The jet could not have been created without the laws of physics on their own  -  but the task of development and creation needed the genius of Whittle as its agent. 

Similarly, the laws of physics could never have actually built the universe. Some agency must have been involved.
Do read it all here

Wednesday, 1 September 2010

Grave's disease

Don't panic this isn't an essay on hyperthyroidism. OK so Robert Graves 1796-1853 the Irish surgeon did first describe a case of goitre with exopthalmos in 1835 and subsequently bequeathed his name to the condition associated with an overactive thyroid.  Like his fellow Irish medical colleague Abraham Colles (1773-1843), after whom the wrist fracture is named, he was buried in Mount Jerome Cemetery in Dublin. I've never been there but I did visit Highgate Cemetery in London last weekend.

I'd intended to visit it since 1975 when as a student I lived in Highgate for a year-but never got round to it. Karl Marx is said to be the most famous inmate and author Beryl Bainbridge was buried there just last month, and in between there are thousands of the great and good and unknown. Some people might perhaps find guided tours of a cemetery rather morbid but it proved to be anything but, especially because of an real enthusiast who was our guide.

And why should doctors visit cemeteries? I hesitate to repeat the old aphorism about us burying our mistakes, but there is something salutary about realising the inevitability of death and the multiple stories that lie behind each name on a gravestone. And it  was pointed our many times by our guide was how seldom the graves are visited by relatives to tend to them.

As a GP in a small market town I have walked around the rather beautiful little cemetery of Olney a few times. I am transported back over the nearly 30 years of my practice as I read name after name of former patients. Their stories flashing into  my mind. Its a sort of post mortum ward round!

With many GPs working in a sessional capacityin differing practices and many not living in or anywhere near their patch, such experiences of walking round a local cemetery seeing name after name of former patients with which they are familiar will become a rarity. It's just one more nail,in the coffin (woops, sorry) of traditional family medicine which I regret.

Friday, 27 August 2010

Art attack

I've had a slow burning interest in art since taking a course in Art Appreciation in my final year of sixth form (whilst otherwise wading though A level Biology, Chemistry and Physics).

About 3 years ago I did an evening class in A level Art-but didn't take the exam (coward that I am!!) which opened my eyes to the history of architecture and sculpture amongst other things.

I'm 57 years old and feel that I must have lead a sheltered life. There is just so much to admire and enjoy. Of course not everything described as 'art' is beautiful (I seem to recall from the evening class the difficulty of defining it), but thank God there is so much that I would describe as beautiful and even awe inspiring.

As part of my new found artiness I recenlty joined the Royal Academy as a friend. So today I went with my wife Liz to the current exhibition Sargent and Sea.  It was lovely.  I just don't get how artists do it. Just look at the swell in this picture.

It's amazing. By the way the exhibition ends 26th September.

Thursday, 19 August 2010

Leading a full life

I will have mentioned The Valley of Vision before. A quite lovely collection of Puritan prayers compiled by Arnold Bennett in the 1970s. He was an Anglican clerygyman who retired to live in Clapham near to Bedford where I live and in 1988 I visited him one afternoon. We had a lovely time discussing books and the Christian life. He subsequently wrote a charming letter to me which I keep in my copy of his book.

The Valley of Vision has known a real resurgence in recent years and according to some comments at another blog has sold over 200,000 copies in the USA alone.

This morning I read his prayer on The Gospel. It closes with these words,

Your Son is our only refuge, foundation,hope, confidence;
We depend upon His death,
         rest in his righteousness
         desire to bear his image;
May his glory fill our minds,
         his love reign in our affections,
         his cross inflame us with ardour.
Let us as Christians fill our various situations in life,
                    escape the snares to which they expose us
                    discharge the duties that arise from our circumstances
                    enjoy with moderation their advantages
                    improve with diligence their usefulness
And may every plave and company we are in be benefited by us.


Wednesday, 18 August 2010

Walking round the neighbourhood

I only live a 20 minute walk from the town centre but more often than not take the car-usually justified by the need to carry shopping home. But I'm that the other day I walked.

Coming back along the close where I live I saw one of my near neighbours in his garden. I stopped and chatted and he told me that a very close friend of his young son had been killed in a road accident just days before.  It was a terrible blow for this young lad and of course for the family of the dear girl who had so tragically been killed.

Amongst other thoughts that struck me as I walked the few years to my own house was the fact that I would have probably never heard about this sad news had I not walked past  my neighbour's house. And more than that I wouldn't have able to share in some small way in the grief of this family.

Neighbourliness is underrated as contributing to our health and well-being and in turn is reduced by our dependance upon cars and the short dash from our front doors to our car doors, which provides no opportunity for interaction with others.

With growing concern over the fate of the planet, here's another reason to try to reduce car journeys. Walking around your neighbourhood increases community which in turn contributes to well being. I guess that's what adds to benefit dog walking. It's not rocket science. Those feet wee indeed made for walking.

Tuesday, 10 August 2010

Crossing the legs

How I miss paper notes. Although computerised record keeping has many advantages, how I miss the ability to skim quickly through the notes. If well kept (ok not always the case)-so much information could be gleaned so quickly. But another disadvantage is the habit of spending as much time looking at the computer as looking at the patient.

Where you look when seeing a patient really does matter. A rather jovial patient of mine asked me to look at a skin lesion just beneath her axilla last week. After satisfying myself of it's benign nature I then went on to reassure her at some length. She smiled an said, "Do you realise you've been talking to my armpit for the last minute!"

Recently I saw a gentleman in his late sixties who had been vaguely off color for the past few months. Nothing all that specific, and indeed when i saw him a few months ago i wondered if depression was the problem. However I intently looked at him as his wife recounted her recent concerns. It was then that he crossed his legs.

It was as though it was in slow motion. And then I noticed the reduced facial movements, and then the fine right hand tremor. A prompt referral to the neurologist and a diagnosis I suspect forthcoming.

But it all started with looking.

Friday, 6 August 2010

"I'd like to speak to my doctor"

I was chatting with a lady the other day who is not a patient at our practice. She told me that she had phoned her surgery to ask to speak to her doctor. Not necessarily immediately, but sometime in the next day or so. Would the doctor ring her back?  My friend received a straightforward reply, 'No!' It transpired that the doctor wasn't available on the day of the request. Indeed when pressed the receptionist said that the doctor wouldn't ring back because she was 'in and out over the next few days'. And anyway 'our doctors don't ring patients back'.

Eventually my fiend was told that she could ring at 4.23pm in 4 days time and speak to 'a doctor'. There was no guarantee of which doctor it would be,  but that was the only way of 'speaking to the doctor'.

I despaired when I heard this. Why make it so difficult to access the doctor?  There are multiple things that patients may want to chat about over the phone. I returned about  20 phone calls to patients today. Some were anxious about symptoms so I have squeezed them into surgeries in the next few days. Some wanted to discuss blood results, some wanted clarification about medication  and there were various other queries. OK I had a busy day, taking these phone calls as well as doing surgeries and reading/writing letters and doing other paperwork, but it was good to provide a service.

Us doctors really should put ourselves in our patient's position sometimes and realise how frustrating some of our behaviour is. With the Daily Mail on our case I fear we only have ourselves to blame. Of course some patients will abuse open accessibility, but even then it shouldn't be impossible to discuss it and come to a compromise. I fear that constantly moaning about the conduct of patients blinds us to our own deficiencies. It's good to talk.

Wednesday, 4 August 2010

First day at the coal face!

This is our youngest daughter Hannah.  Today is her first day as an A&E doctor at Bedford Hospital. Having worked for one year as a Foundation doctor she is now a 'senior' house officer.

Up until now Hannah has spent much of her time carrying out the wishes of more senior doctors. So now begins the daunting task of making her own decisions about patient's diagnoses and treatment.

I have to say I've been impressed with Hannah's commitment and conscientiousness (two words generally absent from my school reports). Old doctors like me tend to generalise about the modern young doctors and their 9-5 mentality, but Hannah has proved me wrong.

It gives me hope that if I'm spared I'll be well cared for by the medical profession in my old age. If only I could count on the NHS being preserved. I really hope so.

All the best to her.

Convicted by the nails

In her very helpful booklet TheWay of Jesus, Beccy Pippert quotes Martin Luther as saying, 'we carry  his nails in our pockets'. She was trying to help a friend see that all of us contributed to the death of Jesus on the cross. 'All of us are responsible for the death of the only true innocent who ever lived. It wasn't murder though, Jesus gave his life as a gift.'

I couldn't help but think of this when I was speaking to a Trading Standards Officer last week. He told me of an elderly lady who had been fleeced by some rogue traders who had charged her several thousand pounds for replacing supposedly damaged rafters in her roof. All they had done was made alot of banging noise in the loft whilst merely nailing one needless piece of wood to the old rafters. However they had been caught and punished. And the story of how they were caught was fascinating.

After the crime had been discovered, the official had been able to trace the retailer who had sold the nails in the loft. And more than that, he had been able to trace when the nails had been supplied to the retailer and when they had been sold. But even more amazingly he had been able to track down the CCTV footage of the actual sale of the 'guilty' nails. The criminals had been convicted by their nails!

And so each of us played our part in the death of Jesus. It shold move us to worship. In the words of the worship song
I'll never know how much it cost
to see my see upon that cross
 We are all convicted by the  nails in our pocket.

Monday, 19 July 2010

Aunty Gwen 100 hundred years not out

Last week my Aunty Gwen was 100 years old.  She still  lives alone in her little bungalow and her neighbours kindly put on a street party for her-it was lovely. Here she is enjoying the party.
Doesn't look bad does she?

Life is very precious and a long life is a great gift. Although of course for many ageing is quite a challenge and caring for an ageing relative can be very wearing. And then, sadly many die 'prematurely'. This current life can have many joys, but ultimately in 'ageless' universe,  it's just so short, 

I'm so relieved that the resurrection of Jesus gives me great hope of a renewed world, expressed in the timeless words of the book of Revelation (from the King James version) chapter 21
 Tom Wright  (currently Bishop of Durham) is a fine theologian and speaks and writes helpfully on the resurrection. It's not as unbelievable as you may think. Take a look at this very short video

Tuesday, 13 July 2010

How Great Thou Art

Last Sunday I went to Bedford Pentecostal Church with my wife Liz. It was a nostalgic and lovely time since it was the church where we both became Christians whilst in our teens.

We sang the well known song How great thou art to start the day and although I have sung this song many times, I found myself strangely moved. Especially by the words of the third verse
'And when I think that God his son not sparing, sent him to die. I scarce can take it in. That on the cross, my burden gladly bearing, he bled and died to take away my sin'  
I had never quite thought about Jesus gladly bearing the weight of my sin.  But as I stood and listened to others singing I recalled the words from the New Testament letter to the Hebrews, 'who for the joy set before Him, endured the cross' (Hebrews 12.3). Believe it or not, the Lord Jesus experienced joy in paying the price for my sin. And of course for yours too!

When it comes to giving, whether our time or talents or money, we are often rather reluctant. Thank God for a saviour who generously and gladly gives. He puts us to shame-but still welcomes us.

Amazing grace!

'It's only words, and words are all I have..'

'Drink 6 cups of water today' is better than saying, 'Drink more fluids'. So saith the Oxford Handbook of Clinical medicine.

When doctors think about communication skills they are usually thinking about the way that we use words to speak to patients. But what about the words that patients use when speaking to us?

Many a time I've been alerted to an unknown fellow medic or health professional by them slipping in to the conversation phrases like, 'I think I've got a uti' or 'what do my bloods show?' or 'what do you make of this lesion?' Words that just give away some experience or knowledge.

Today I was taken aback by a wonderful 87 year lady of French extraction whose English is imaculate but whose accent is wonderfully French. When disucssing her cough she told me that it was difficult to  expectorate. I really don't think that anyone in my 32 years as a doctor has ever siad that to me before. I commended her for the excellentchoiceof words and she smilingly said, 'well it's from the Latin, I learned Latin for 7 years.'

Indeed as I pondered with her I dredged up my 3 years of Latin and just about worked out that the ex means something like from or out of, and of course pectus must mean chest, as in 'look at his pecs'!! I'd never thought of it before. Not exactly a Nobel prize winning disocvery, but just one of the many happenings in the life of a family doctor that makes life and work so vaired and enjoyable.

GPs don't have a huge amount of hi-tech at their disposal, but words remain a vital tool and are like the pen, are still mightier than the sword!

Saturday, 10 July 2010

Christianity and Environmentalism

Climate change, sustainability, environmentalism, global warming, and so go the various buzz words we hear so much if.  What is a Christian believer to think?

For an excellent talk and a surprising angle on how God is committed to the earth he has made, listen to this talk entitled Can faith be green? by Tim Keller, pastor of Redeemer Presbyterian Church in New York City.

Thursday, 8 July 2010

More reading in Croatia

One of the first 'grown up' books I remember owning is a small hardback translation of the New Testament. It was J B Phillips New Testament in Modern English. My mother has lovingly inscribed my name and address in the frontispiece, David Bartlett 5 Mareth Road Bedford 1965. 5 Mareth Road, the house I was born and lived in for my first 17 years.

J. B Philips began his work of translating the New Testament (NT) into modern English whilst a young curate in a South London parish during the second world war. His youth group struggled with the King James version, so Phillips set about the task of bringing the language up to date, giving one morning of every week to the work. He started in 1943 and completed the NT in 1946.

It's not particular well known today although certain phrases within it have found their place, of note is his translation of Romans 12.2 ;
Don't let the world around you squeeze you into its mould, but let God re-mould you from within, so that you may prove in practice that the plan of God for you is good, meets all his demands and moves towards the goal of try maturity'.

Whilst in Croatia I have enjoyed reading Phillips' translation of Mark's gospel alongside some comments by the translator, it's called  Peter's portrait of Jesus, and it's well wroth getting hold of a second hand copy.

In writing about the incident in Mark 1 where Jesus is confronted by a man who is, 'in the grip of an evil spirit', Phillips comments,

Mark is at pains to point out that various spirits of evil recognise the power of  Jesus in our cleverness nearly all of us reject the idea of possession by an 'evil spirit'. All can be explained by psychology etc. But the deep set evil that spoils our common life cannot so easily be explained away.

And then when speaking of the subsequent verses when Jesus speaks to the afflicted man, 

Jesus speaks in a sharp rebuke, and,  if we take the Greek word literally, he tells  the evil spirit to 'be muzzled'. It is not a polite expression and I must say I was tempted to translate it by the modern slang, 'belt up'!

I've enjoyed reading the thoughts of a translator grappling with the text-and not just any old text. As Phillips recounted in his book describing the translation process, 'it's been rather like being an electrician rewiring an old house without being able to turn off the electricity at the mains'.

The New Testament is that powerful. If it's been a while since you picked it up and read it why not  get yourself a modern translation like Phillips, or the more readily available NIV translation and give it a go. You might be 'shocked'!

A message from the other side

No, not that side! But thank God got through surgery ok yesterday. And thanks to all for love support and prayer.