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.

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.