Monday, 26 December 2011

Nativity

Just re-watched The Nativity aired by BBC 1 last Christmas. It's beautiful. Please catch it on DVD.  In the meanwhile quickly get onto BBC iPlayer-the last 5 or so minutes are truly magical as the shepherds and magi come to worship the 'new born King'-think it's only available for 5 more  days.

Here's the trailer

Thursday, 15 December 2011

Gambling and Christmas

Interesting stuff from Roy Hattersley in today's Daily mail.

There is something incongruous about promoting gambling as a family friendly activity. And indeed there is a marked contrast between Christmas and gambling. At Christmas the infinite God became small. In gambling it's the dream of turning something small into something outlandishly large.

Hatteresley does not hold back from criticising his own party,

Supporters of the law which promoted the creation of mega-casinos — and the related decision to allow gambling adverts on television — will argue that, in a free society, men and women should be at liberty to spend their money as they choose. That’s true.
But that does not detract from the obvious truth that some freedoms are corrosive to the good society and, although they should be allowed, should not be encouraged.
And the decision to promote gambling as a weapon in the war against economic decline — shamefully taken by a Labour Government — is an affront to the idea of Britain as it was and as it ought to be.
Once upon a time, we built our greatness on engineering and textiles, shipbuilding and steel. We made railway engines for the world, our ships carried cargoes across every ocean and — even in more recent times — we aspired to play a major part in the information technology revolution.
The idea that our country will benefit from encouraging people — some of whom cannot afford it — to feed small change into slot machines is an affront to the memory of what we used to be. And, more important, it holds back — rather than encourages — the regeneration that we desperately need.

Wednesday, 14 December 2011

'You sound just like my beautician'

Patients never cease to amaze me with their varied comments to me.

Today I was trying to help a 49 year old lady find some good motivation to give up smoking. It's well recognised that fear of illness does not seem to motivate, hence the ineffectiveness of health warnings on packets of cigarettes.

Taken from google images and demonstrating the striking effect of smoking
So I chose to go with the fear which is so strong with so many of us in our botoxed, youth orientated culture-vanity and ageing! Smoking has significant ageing effects on the skin and it's not too difficult to see the changes without the need to ask or smell the tobacco.


I'm not sure if was flattered or not as she parted with a,  "you sound just like my beautician".

Tuesday, 13 December 2011

For unto us a child is born

Last Sunday as part of our Handel at Advent series at Grace Community Church,  I spoke form the Old Testament prophet Isaiah's words in chapter 9.

'For unto us a chid is born, unto us a son us given. And the government shall be upon his shoulder. And his name shall be called, Wonderful Counsellor, the Mighty God, the Everlasting Father, the Prince of pPeace.'

I mainly focused on the 'Wonderful Counsellor.' Take a listen here if you'd like.

Our assistant minister Martin Salter did a great job of finding some lovely you tube clips to go with it. Please watch below a theatre company from Vienna doing a very original version-it's magical.

Wednesday, 7 December 2011

Side effect of the day

The more I prescribe medication the more I realise that side effects play a huge part in patient's lives. Many of us  forget to think about side effects when patients consult  us. When I do think to take time to ask patients it's surprising what I hear.

Yesterday a patient with migraine told me that she had stopped her Topiramate some weeks before. She had been troubled by overwhelming urges to throw herself off the escalator at the local shopping centre. She had read in the drug packet literature that suicidal ideation could be a problem with the drug. Since stopping it, her rather bizarre urges had completely disappeared.

Fortunately she had worked this out herself and can now safely go to Milton Keynes to shop! If the motorist should always, 'think bike' I guess the doctor would be well advised to frequently' think drugs'.

Monday, 5 December 2011

Mary Stanford

Just back from few days near Rye in Sussex. Lovely part of the world and all new to me.

Whilst in a bookshop read the story of the Mary Stanford lifeboat disaster of 1928 (it was only a short book but got so engrossed that read the whole thing-I guess I should have bought it!). It's a truly tagic tale of duty, heroism and selflessness. And made all the more awful by the fact that the attempted rescue was unnecessary since the crew of the stricken vessel had already been rescued by another vessel.


You can read a detailed account here.

I visited the memorial in the churchyard at Rye Harbour. It was bleak and cold and sadly a rather forlorn place. Seventeen men lost their lives including a father and two sons. I guess being a landlubber I rather take the RNLI for granted, but thank God for people willing to risk their lives to save others.

It seems that sacrifice is built into the fabric of what it means to be human. Whether a mother's love, a soldiers bravery or a lifeboatman's (or woman's) instinct.

Friday, 2 December 2011

Menin Gate just before the Last Post
Really enjoyed a day trip to Ypres (leper) in Belgium the other day with my good friend Mark. The whole area is somewhat hallowed ground with nearly 60,000 British and Commonwealth names  inscribed on the imposing Menin gate. And theses are 'only' those who died and have no known resting place. There are literally thousands more commemorated in cemeteries large and small all dotted around Ypres. Every night at 8pm the traffic is stopped  and the buglers play the Last Post. Since 1928 it has been played every night (apart from during the Second World War when the Germans stopped it). I quite expected that there would be a dozen or so the night we were there, but we counted about 300 and apparently there's often up to 1000 people!


Mark at Tyne Cot pill box
Just outside Ypres is Tyne Cot cemetery, the largest and most visited war cemetery in the world. We visited it just before dusk when it was bitterly cold and which somehow contributed to the ambience of being at the place where such sacrifice took place and where it is commemorated.  There are about 12,000 graves here and another 24,000 names of those with no known grave. There are three German pill boxes still within the cemetery and they are a poignant reminder of conspicuous bravery. A number of VCs were awarded in capturing similar such defences.

At Noel Chavasse' headstone 
For me paying a repeat visit to the headstone of Capt Noel Chavesse was the most poignant. He was the only man to be awarded two VCs during the First World War. He was a doctor originally from Liverpool and he was also a committed Christian believer. His father who was the Bishop of Liverpool wrote with heavy heart to Noel's brother Bernard telling him of Noel's death. They are brave and faithful words.

You will have heard by this time that our dearest Noel has been called away.... Our hearts are almost broken, for oh! how we loved him. Your dearest mother is pathetic in her grief, so brave and calm notwithstanding. But again and again, we keep praising and thanking God for having given us such a son. We know he is with Christ, and that one day - perhaps soon -we shall see him again. What should we do in such sorrow as this, if we could not rest on the character of God, on his love, and wisdom and righteousness....


Monday, 28 November 2011

Leonardo,queuing and a surprise

Day off today so thought I'd take a chance at seeing the amazingly popular Leonardo da Vinci exhibition in London. I had been slightly scared off by the exorbitant prices of tickets on ebay and the prospect of a long wait and an unsuccessful outcome. But so glad. I made the effort.

Firstly the queuing experience was remarkably enjoyable! I arrived at 9am and didn't get my tickets till 12.05-and that for a timed entry at 2.30pm!! But the company around me just made the time fly by.

Firstly there was Chris. he was there when I arrived and was rather gently remonstrating with a 'queuing official'. "You've no idea how angry I am", he repeated several times. The dear chap had got up at 4 am, or was it 3am? and caught the bus from Bristol. He knew he would que but didn't realise it would be for a timed ticket for later in the day. Having offloaded on the official he then phoned his wife and repeated that she had no idea how angry he was.  I couldn't help but comment to him that for someone unspeakably angry he seemed very calm. "not on the inside" he corrected me. He proved to be a splendid que companion.


And then there was Nic and Trixie (or was it Tilly-oops so sorry). Now they were great fun and put up with endless stories from me. I must have bored them to death. But they kept coming back for more-or rather once they had started queuing there was no escape for them. Nic does 'something in IT' and Trixie is a hospice nurse. I've got a lot of time for the hospice movement and I'm sure she does a fantastic job. She also has real gravitas. At one point after we had been queuing for over 2 hours she formally announced that here feet were now 'officially cold'. I'd never quite thought of things like that before.

And Leonardo? Yep impressive. He loved human beings and to paint the human form and grapple with displaying the emotions. The surprise? I think I enjoyed the queuing as much as the exhibition! My dear daughters already think I'm odd and if they read that last sentence it will confirm their diagnosis. But real live human beings are certainly as interesting as the Leonardo's drawings and paintings

Friday, 25 November 2011

Better late than never

I'm thinking of  editing the 'about me' section of my blog!

I note that I've said that I am middle aged. This was written in 2007. I wonder at what point I will admit to myself that I am 'late' middle aged?

Wednesday, 23 November 2011

Don't just do something, stand there!

Examining a 6 month old with bronchiolitis the other evening reminded more just how important observation is in the practice of medicine. By that I mean that in practical terms  there is very little the general practitioner can offer in this situation, other than careful assessment of the degree of respiratory distress and careful advice to the parent of the signs to watch closely for.

Prescription medicines just don't make any difference, whether it be steroids, antibiotics or bronchodilators. The only thing I have up my sleeve is admission to hospital with all the facilities of close supervision, oxygen and the option of iv fluids.

It was just good traditional GP. I arranged for a partner to review the infant again the next morning. There was a slight reduction in respiratory rate and the fluid intake had improved. I'm sure recovery will be steady from now. OK we didn't do anything, but close observation and parental education was crucial.

Non flashy, 'inexpensive', effective medicine.

Tuesday, 22 November 2011

Catching up

Today at the tender age of 58 summers I have finally begum to read The Lord of the Rings. It was first published just a few months after I was born and seems to have been a staple of my people my age. Bout time I caught up. What else did I miss?

So here goes...


Monday, 21 November 2011

Lady Gaga and Children in Need

So far the BBC Children in Need campaign has raised more than £26 million. That is just wonderful. However I wouldn't judge the entire enterprise quite so positively.

Last week as part of it's Children in  Need broadcasting there was  a concert from Manchester with Lady Gaga first up immediately after 8pm performing with her troupe of superfit dancers. She is some performer. But sadly it just seemed so inappropriate before the agreed 9pm watershed. It was typically erotic and sensual and so very sadly unsuitable for the many thousands (millions) of very young girls and boys who were no doubt watching.

Most of our culture bemoans the over-sexualising of young girls. The 'growing up too quickly' that most parents regret.  As a family doctor I'm all too aware of young teenage girls and boys and the increasing incidence of chlamydia infections (with potential long term consequences of infertility),  eating disorders, and self harm.

I'm afraid I believe that the BBC is horribly hypocritical in raising money for the needy children and young people whom they are partly responsible for creating. Is there is a proven link between young children watching erotic performances and emotional and sexual unhappiness through their teens? I can't pretend to know whether the academic study has been done, but such broadcasting surely does not help.

Friday, 18 November 2011

It's better to give than receive

John Lewis is an impressive retailer. Their 2011 Christmas add is clever with it's emphasis upon giving rather than receiving. No doubt their hope is that we will go along to John Lewis to buy our gifts from them, but for all the sentimentality the truth of those ancient words of Jesus, 'it is more blessed to give than receive' holds good.

Monday, 14 November 2011

The meaning of marriage

Marriage isn't easy. Anything from Tim Keller is worth reading. Here's a preview of his new book, The meaning of marriage with Tim and his wife Kathy.

penguinbooks on livestream.com. Broadcast Live Free

Friday, 11 November 2011

The biggest threat to the NHS?

When asked in last week's BMJ what the biggest threat is to the NHS, Sir Richard Thompson stated quite simply, obesity.


Now Sir Richard is not a Daily Mail columnist, nor even a pr man for Rosemary Conley. He is the current President of the Royal College of Physicians and a former physician to her majesty Queen Elizabeth 2nd.

It seem staggering that something, at one level so simple, and yet so complex and pervasive, should be putting all of our health and well-being at risk. For we all need the services of the NHSat one time or another and there really is a finite financial pot of money. The problems start young. One in three children leaving primary school is overweight.

In 30 years of general practice I've been disheartened so much by patient's inability to lose weight and/or keep it off. The answer? Well I know of no magic bullet. I'll just make a few suggestions that I think are supported by some experience and evidence:-

1. Develop a positive attitude-happy people find it easier to control their eating. (Happiness is a subject for another time!)
2. If you are able take up slow running  (or at least walking), but do it for an hour 3-4 times per week. (Not enough time? That's for another time!!). Or get a pedometer and see how many steps you take each day. Aim for 10000.
3. If you can exercise have a goal-a half marathon or even a marathon-raise money for charity.
4. Drink more water through the day.
5. Have low fat bars at home for when you feel like snacking.
6. Use smaller plates for your meals.
7. Cut down your alcohol consumption-it it's wine-but  more expensive stuff!
8. Think of your children-would you smoke in front of them? Aim not to be obese in front of them!

Yikes-it's beginning to sound like a moral crusade. It's just so sad that so  much of our ill health is self inflicted. And that's before we talk about the risks of obesity, cancer, diabetes, heart disease.......

Tuesday, 8 November 2011

Put-downs

Hopefully it's only the fictional Doc Martin who indulges in put-downs with his patients. Many patients are sufficiently anxious about seeing their GP without making their visit harder. Nonetheless at times it's a great  temptation.

When the keen meat-eating G K Chesterton greeted the passionate vegetarian  George Bernard Shaw he stated, 'to look at you anyone would think a famine had struck England'. Shaw was quick to reply to the decidedly rotund Chesterton, 'to look at you anyone would think that you have caused it.'


Saturday, 5 November 2011

'Seek first to understand then to be understood'

'Seek first to understand then to be understood'.

According the Stephen Covey in his classic book, The 7 habits of highly effective people', 'Most people do not listen with the intent to understand, they listen with the intent to reply. They're either speaking or preparing to speak'.


As a GP I sometimes think that I am  like The interpreter from John Bunyan's Pilgrims Progress. I have to interpret what the doctor said in out-patients, or what the doctor said after the endoscopy (whilst the patient was still sedated), or what the doctor meant in his letter to me about the patient which is full of medical jargon (and faithfully copied to the patient-I'm not a fan of this practice!).

So I need to listen well and understand what the patient's concern is before I dive in with my explanation. It's the old, 'ideas, concerns expectations' which is such a valuable way of appreciating how I can best help the patient in front of me.

Wednesday, 2 November 2011

Maximus in minimus ('great in little things', to you and me)

Exactly 223 years ago today, John Newton wrote to his nearby friend Thomas Bull.
My dear friend,
You are a better expositor of Scripture than of my speeches—if you really inferred from my last that I think you shall die soon. I cannot say positively you will not die soon, because life at all times is uncertain. However, according to the doctrine of probabilities, I think, and always thought, you bid fair enough to outlive me. The gloomy tinge of your weak spirits—led you to consider yourself much worse in point of health than you appear to me to be.
In the other point I dare be more positive, that, die when you will—you will die in the Lord. Of this I have not the least doubt; and I believe you doubt of it less, if possible, than I, except in those darker moments when the evil humor prevails.
I heartily sympathize with you in your illnesses—but I see you are in safe hands! The Lord loves you—and He will take care of you. He who raises the dead—can revive your spirits when you are cast down. He who sets bounds to the sea, and says "Hitherto shall you come, and no further," can limit and moderate those illnesses which sometimes distresses you. He knows why He permits you to be thus exercised. I cannot assign the reasons—but I am sure they are worthy of His wisdom and love, and that you will hereafter see and say, "He has done all things well!"
I do not like to puzzle myself with second causes, while the first cause is at hand, which sufficiently accounts for every phenomenon in a believer's experience. Your constitution, your situation, your temper, your distemper, all that is either comfortable or painful in your lot—is of his appointment! The hairs of your head are all numbered. The same power which produced the planet Jupiter—is necessary to the production of a single hair! Nor can one your hairs fall to the ground without His notice—any more than the stars can fall from their orbits! In providence, no less than in creation.He is maximus in minimus. Therefore fear not—only believe. Our sea may sometimes be stormy—but we have an infallible Pilot, and shall infallibly gain our port!

Monday, 31 October 2011

Seven billion people and euthanasia.

Today I hear that the world population has now reacher 7 billion. What a challenge for us all to think through the issues of feeding and caring for such a vast number of people.

I hope it doesn't add fuel to the debate on euthanasia or rather assisted suicide as it is increasingly presented as. My thoughts turned to this subject today whilst caring for a very elderly lady who was dying at home. It occurred to me that rather than simply pronouncing myself an opponent of euthanasia, I should agree that as many people as possible should have a 'gentle and easy death' (which is actually the dictionary definition of euthanasia). That is why the hospice movement is so importnat. What I am opposed to is assisted dying.

There are many arguments against it, not least the fear that the frail elderly may have of 'being a nuisance' and sitting on large sums of money that their younger relatives would like a slice of. And what about society's general view of frailty, disability and there just being too many of us. I fear that we, as a race,  are just not to be trusted. Legalising assisted dying will in time open the flood gates. It will affect our valuing of one another as precious human beings, and assisting someone else in their suicide demeans us.

An article form The Scotsman last year at the time of Margo Macdonald's assisted suicide campaign in Scotland had this to say,
Lawmakers and activists would have us believe that the right to die is something the government should protect and every individual should be able to exercise. These two rulings (see the context and full article here) suggest the individual is not always free to do as he or she chooses. Why? 
Because human dignity always trumps autonomy, and the best interests of society sometimes outweigh the interest of the individual.It is time for Scotland to see that autonomy is not the bedrock of a decent society. Far more important is the fundamental principle that all human lives have an intrinsic worth, value and meaning whatever the circumstances.
Everyone has dignity, and we as a society will lay solid foundations for the future by voicing our support for this dignity and rejecting the belief that some lives are unworthy of life and should, therefore, be ended.
Amen to that.


Sunday, 30 October 2011

Because you're worth it

At Grace on Sunday evenings we are thinking about the impact that Jesus Christ has had on the history and culture of our world. Although largely marginalised in Western Europe, his influence has been immense. Whether it be in the field of learning (think the formation of great universities like Oxford and Cambridge), or virtues like humility (so undervalued in the ancient world) or the dignity of all human beings (followers of Jesus have lead the way in campaigning for the rights of children, for the abolition of slavery and for the care of the dying, amongst many other causes).

No doubt religion and Christianity have sadly got many blemishes in their history, with current issues of money grabbing TV evangelists and abusing priests amongst other blights on the name of Jesus. But such things cannot fairly be laid at the door of Jesus himself about whom no-one has ever seriously doubted his integrity and genuine love for those he met.

Last week I gave the talk on dignity. It wasn't a particularly stunning bit oratory, but I tried briefly to point out that the Bible teaches the extraordinary fact of all human beings being made in the image of God and that Jesus in his public life time and again showed just how valuable all children women and men are to God.

Just this week there has been various stresses in our family, chief amongst them being the sad loss of my sister in law Sue to cancer. She was Biddy's sister and much loved by her. When Biddy met with friends for a prayerful time of support his week, they all sang the old hymn Fight the good fight. I've thought much about the words of the verse
Faint not nor fear his arms are near, He changeth not and thou art dear 
Yea, we are indeed 'dear' to God. Infinitely loved and special to him. And not loved because we are loveable! Indeed God demonstrates his own love for us in that while we were still sinners Christ died for us (Romans 5.8)

Friday, 21 October 2011

Being a Christian in the world

Great little article published this week in Christianity Today adapted from a sermon by John Stott on how Christians can influence society for good.

He concludes
Do you want to see your national life made more pleasing to God? Do you have a vision of a new godliness, a new justice, a new freedom, a new righteousness, a new compassion? Do you wish to repent of sub-Christian pessimism? Will you reaffirm your confidence in the power of God, in the power of prayer, of truth, of example, of group commitment—and of the gospel? Let's offer ourselves to God, as instruments in his hands—as salt and light in the community. The church could have an enormous influence for good, in every nation on earth, if it would commit itself totally to Christ. Let's give ourselves to him, who gave himself for us
The whole thing is worth a read and think

Thursday, 20 October 2011

The burning house!

An interesting website and project here.  Foster Huntingdon a 23 year old American has undertaken a six month venture collecting photographs of possessions that if the chip pan went up, people would rush around and hold to their chest as they ran out.

It concentrates the mind as to what is really of value to me. Interestingly it's not the possessions that cost the most in financial terms that make the cut. What would you keep? Here's a couple from www.burninghouse.com





Monday, 17 October 2011

"We are all worms!"

Winston Churchill did not lack self-esteem. As he is reported to have said, 'We are all worms. And I do believe I am a glow worm'.

At out church we are doing a series in the Sunday evening meetings about the impact of Jesus upon history and culture. How little the vast majority of us realise the effect Jesus has had. Take humilty for example. We generally hold it up as a virtue-but it certainly was not so within the culture that Jesus lived and taught in. Take a listen to an excellent talk by our ministry assisstant Martin Salter who drew on material presented originally by John Ortberg.

Monday, 10 October 2011

The Listener

Some years ago there was an excellent magazine called The Listener. For a while I read it regularly and enjoyed the articles reflecting on the previous week's radio as well as book reviews and previews of upcoming programmes.

In some ways I think The Listener would be a good epithet for a family doctor. Most days I think that being a doctor is challenging and at times, even difficult. But occasionally the simplicity of the practice of medicine strikes me. In last week's BMJ the President of the Royal College of Psychiatrists, Sue Bailey, was asked what characteristics and skills make a good psychiatrist. Echoing Tony Blair and his emphasis on education, she responded, 'Listening, listening, listening'.

Just recently two patients have come to discuss with me the content of letters they had received detailing a recent consultation with a hospital doctor and which had been addressed to me. Both were horrified by the content which contained frank inaccuracies. 'I didn't say that, where did he get that idea from, wasn't he listening?' Both patients were fed up and not a little angry by the apparent failure to listen well.

I still struggle to remember so much of the detail of anatomy and physiology and pharmacology, at times it seems beyond my waning intellectual powers. But I can still be a good listener.

Friday, 7 October 2011

Music and Passion

I'm so glad that my parents encouraged me to play the piano and arranged for me to have lessons from the age of nine to about fifteen. I've never stopped playing and even now play most days. What extraordinary power beautiful music has.

Benjamin Zander, music director of the Boston Philharmonic orchestra has a wonderful ability to covey something of the power of great music.

Take a look at this TED talk



Thursday, 6 October 2011

Apples, Steve Jobs and George Bernard Shaw

Sad to hear the news that Steve Jobs died today after a long  cancer illness.

Somewhat co-incidental that BBC's quote of the day is about apples...
If you have an apple and I have an apple and we exchange these apples then you and I will still each have one apple. But if you have an idea and I have an idea and we exchange these ideas, then each of us will have two ideas. GEORGE BERNARD SHAW (1856-1950)
Not entirely sure what to do with that, but I guess it says something about teamworking, generosity and ....apples!


Wednesday, 5 October 2011

Talk to me

Really enjoyed listening to a short Radio 4 programme today. Part of a series, The Call, in which Dominic Arkwright talks to people who have taken or made life-changing phone calls. Today's episode was called The Answerphone and featured Mark Craig who kept all the messages on his answer machine for over 20 years. It was really surprisingly moving. Don't know how long it'll be BBC iPlayer so catch it asap here.

Mark Craig turned his years of messages into a short film which you can see here. I must warn you that the language is coarse at times in the early part of the film and it is does spoil it somewhat, but the latter part is very moving, especially as we hear messages from his dad who was to die later. The messages of condolence were  simple and real. As I reflect on the loss of my dear mum whose 85th birthday it would have been today, how much I wish I could hear her voice, and some of the many messages she has left on call minder over the years (sadly erased after the statuary 28 days).

The whole concept is a bit of reminder of what we lose in the rush of life, with so little time to 'stand and stare'. Somehow Facebook doesn't quite convey the pathos and joy of life in the way that the natural human voice does. Written letters have all but disappeared, and yet there remains something special about receiving one. Perhaps they just imply more thought, more care.  How much we lose by not physically putting pen to paper and writing to each other. And indeed what is lost by the immediacy of emails and text messages.


Monday, 3 October 2011

Living life to the full

Really enjoyed an excellent study day last weekend  led by Professor Chris Williams who is professor of Pyschosocial Psychiatry at the University of Glasgow. He is a brilliant communicator and specialises in the application of cognitive behavioural therapy (CBT) to a wide variety of situations.

Most helpfully he has developed a self help web site www.livinglifetothefull.com which The Times has recognised as one of the top 4 mental health web sites. In addition he has written a number of helpful booklets, covering such subjects as low mood, anxiety, problem drinking, giving up smoking, eating disorders and much more. There's some details of these and more on his facebook page here.

Anxiety can be an overwhelming experience and I am so glad for these wonderfully helpful resources both for sufferers and those who try to help them.

Saturday, 24 September 2011

Spiritual spectacles

Anglican John Newton shared a delightful correspondence with neighbouring baptist minister Thomas Bull.  Newton was warm spirited towards other Christians despite denominational differences;
'You will find Mr Crawford a man to your tooth, but he is in Mr Wesley's connexion. So I remember venerable Bede, after giving a high character of some contemporary, kicks his full pail of milk down, and reduces him almost to nothing by adding, in the close, to this purpose, "But, unhappy man, he did not keep Easter our way." A fig for all connexions say I, and say you, but that which is formed by the bands and ligaments the Apostle speaks of in Ephesians 4.16.
Therefore, I venture to repeat it, that Mr Crawford though he often sees and hears Mr Wesley, and I believe loves him well, is a good man, and you will see the invisible mark upon his forehead if you examine him with your spiritual spectacles' 

7th July 1778 Olney


Tuesday, 20 September 2011

Watch a talk on 'The Praying Life'

Helping Your People Discover the Praying Life

A very helpful talk by the author of The Praying Life-one of my favourite books. Simple, profound, honest and powerful. Paul Miller is a self-effacing character with a disarming manner. Really worth watching.


"My face leaks when I eat"


My patient seconds after munching a cheese
sandwich -note the glistening 'sweat'!
(patient consent given for photo)

I've mentioned patient's opening lines before, and this morning's offering was one of the more interesting ones.

Her complaint was that, within seconds of eating,  the sideburn area of the right side of her face  became wet and indeed would drip down the side of her neck.

It transpired that in 1984 she had had a benign growth removed from her right parotid gland. The small scar on her face confirmed that. The previous surgery was the clue to what was going on.

During the healing process after the surgery the nerve supply to the remnant of the parotid gland her re-grown and was now innervating her sweat glands. When I discussed the problem with a local ENT consultant he told me that the problem was previously more common. Surgeons are now aware that this can happen and are careful to insert a layer of fascia between the parotid remnant and the skin to prevent the re-growth of the auriculo-temporal branch of the trigeminal nerve from reaching the sweat glands. The nerves that had once fired off to produce saliva were now stimulating the inappropriate production of sweat!

Apparently it's called Frey's syndrome name after Lucja Frey a Polish female neurologist who sadly died during the Holocaust. It results in gustatory sweating such that even the anticipation of food can produce the 'sweaty face'.

And what to do about it? Well either a powerful deoderant (my patient wasn't keen on that) or Botox injection. Apparently just one of two may lead to long term benefit. Still I have to confirm with my PCT whether the good old NHS will fund it. I would say she deserves it. Who wants to drip sweat on their steak?

As I've said before, it's boring being a GP!


Saturday, 17 September 2011

Christianity Explored

Great looking new web site from Christianity Explored. If you're not sure what you think about Christianity-take a look www.Christianityexplored.org

"The Christian ideal has not been tried and found wanting; it has been found difficult and left untried." G.K Chesterton



Friday, 16 September 2011

The garden of Eden...in Bedford

Just finished reading Octavia, Daughter of God:The story of a female Messiah and her followers. It tells the story of clergyman's wife Mabel Barltrop, who in the early years of the 20th century came to believe that she was to be  the world's saviour, since in her eyes Jesus had not done enough in dying on the cross because sin and suffering still prevailed.

The book is a fascinating piece of social and religious history which has been of particular interest to me since most of the activity of the book is centred on Bedford, the town where I grew up and still live. Living in and around Albany Road, a pleasant residential area of Bedford near the embankment, Mabel's followers gathered and gradually bought up several large properties throughout the 1920s. They created a garden between some of the properties that they really believed would be the renewed Garden of Eden.

Their beliefs were a very strange mix of Christian (especially of the Anglican variety since all the followers remained members of the Church of England) orthodoxy (eg belief in the physical return of Jesus Christ) and extremely unorthodox beliefs such as God being a foursome (as opposed to a trinity), with Mabel making up the four! Indeed Mabel was remaned Octavia because her followers believed she was the '8th prophet' (don't ask me who the other seven were-except Helen Shepstone who was the 7th-'a South African spiritualist who believed that she received frequent messages about the Second Coming of Christ from St Andrew and spirit guides'!!)

It's a salutary tale of misguided religiosity with an especially sad end to Ocatvia who died in 1934 aged 66 years from complications of diabetes.  And since 'the whole raison d'etre of the Society is to get together those who will not die-those who are predestined to live'-her death was problematic. Indeed her followers gathered in her bedroom waiting for a resurrection  after she died, only conceding the inevitable when post mortem changes were becoming unpleasant after 4 days.

For a Christian like me it's a reminder that there is nothing inadequate about Jesus Christ and what he accomplished, but also how personal opinion and impressions from God have to be tested against the specific teaching and broad sweep of the Bible and also in consultation with other believers committed to the sufficiency of Scripture. I think one would have to say the the Panaceans were simply odd and I don't believe that followers of Jesus today should be known as such, on the contrary the apostle Paul exhorts Titus to 'make the teaching about God attractive in every way'. Attractive and challenging but not weird.

Dementia and divorce

Big debate in US over comments made about the legitimacy of divorcing a spouse with dementia on one of the blogs I follow. There are significant criticsms from those who feel that the Christian gospel is compromised by such a concession. Although I agree with the criticism I felt that one aspect had been forgotten. To see the article and follow the comments go to Justin Taylor.

My comments to the blog (and I guess you need context for them to make sense!!)
Yes I agree that Pat Robertson’s judgement in the matter of divorcing a spouse with dementia is profoundly biblically wrong, but…..please be cautious in your attitude towards those who may be exhausted emotionally, physically and spirtually by caring for (or giving up to other’s care) a severely affected spouse.


I have worked as a family doctor for 30 years and have seen the overwhelming sadness and anguish that such a situation brings. Yes, correct false teaching but remember to be ‘kind to one-another, tenderhearted and forgiving…remembering that we do not have a High Priest who cannot be touched with the feelings of our infirmities’

Tuesday, 13 September 2011

Rugby and Rembrandt

Part of the enjoyment of watching rugby on the tv is to listen to insightful commentary from the likes of Brian Moore. Alas ITV has gone for Phil Vikery for the World Cup matches. He's truly useless. I'm glad that a Telegraph writer feels the same,
'Now. Vickery, it scarcely needs to be said, was not selected as one of ITV’s expert rugby analysts on the basis of his devastating acuity. He’s a World Cup winner, a national hero and hugely experienced. And as he showed during England v Argentina on Saturday morning, he tells it like he sees it: Nick Mullins: “What’s going on in that scrum?”
                    Vickery: “I don’t know.”

                    If the art of commentary is silence, Vickery is its Rembrandt.

"Are you any good with things you don't understand?"

Such was today's greeting from one of my cheerful patients.

As a GP I inhabit a world of many medically unexplained phenomena. The textbooks next to my desk just don't seem to explain the unique individual sitting in front of me whose constellation of symptoms is ill-fitting for any known syndrome. Gone are the days of simply sending the patient away with 'it's all in the mind' ringing in their ears.

The fact remains that there is just so much we do not know and understand. Indeed rather counter-intuitively I remember being taught that there is an inverse relationship between the size of a medical text book and valuable knowledge of the condition written about. In other words the bigger the book the less we know!

'Medically unexplained' at least has some humility about it. Frustrating I know but at least neutral in its assessment.

That isn't to say that there's nothing I can offer. General principles are always worth considering. Try to get more and better sleep, look at your work-life balance, try to exercise regularly, eat healthily, lose weight, cultivate friendships, do random acts f kindness and be generous-none of these are likely to make the condition worse.

And what about Christian faith? The current onslaught against Christianity by Dawkins et al implies a kind of omniscience of the new atheists which I prefer to reserve for the creator God.

Sunday, 11 September 2011

Oh no, Doc Martin's back

I read in the Radio Times that Doc Martin is back on our screens next week. The all knowing, medical encyclopaedia who is now a GP in coastal Cornwall, has somewhat fallen from the heights of being an  'eminent' surgeon in London (pity those surgeons in London who are not eminent).

It's hopelessly inaccurate although quite fun to watch. General surgeons are certainly knowledgeable in their chosen field, but are completely out of their depth when dealing with general medical problems.  Having said that,  GPs are frequently criticised for not knowing enough about various conditions.

I noticed on the Migraine Action website their concern that doctors have so little training in migraine. In fact their comment was misleading. To speak of how much time is spent as an undergraduate learning about certain illnesses is quite irrelevant to a qualified doctor's subsequent management of that same condition. In training to be a GP it is at least 2 years after qualifying before one even begins to make management decisions, and even then the decisions are closely monitored by senior collegeues for a further 3 years.

I meet a fair number of GPs each year in my role as an appraiser and the vast majority are conscientious and give considerable time to ongoing professional development and learning. It's disheartening to read so frequently that GPs need more training in migraine, depression, Crohn's disease, Aspergers, asthma, diabetes, meningitis, prescribing, commissioning, lupus (thanks to House!!)...Of course we need good knowledge of all these and much more, but consultant colleagues are there for the simple historic reason of being consulted! When I'm not sure I want quick access to a specialist colleague. It's a great shame that in so many areas of medicine expert colleagues are becoming harder to reach-not necessarily through fault of their own, but through the ungainly 'choose and book' with the resulting break down of long established relationships between consultant and GP. In some specialities such as psychiatry it's virtually impossible for a GP in my area to get a consultant opinion.

I must find out where Doc Martin trained.

Tuesday, 6 September 2011

Big society and Christians

Tom Wright the former Bishop of Durham had an interesting short piece in The Spectator recently. It's excellent stuff on what contribution Christians  (in the context of the article predominantly Anglicans) make to the 'Big Society'
Saying that Jesus is now in charge, still more that the church is the agent of this project, has been rubbished for generations. The litany is familiar, though interestingly limited and repetitive: crusades, the Inquisition, witch-burning and so on. No church worth its salt will deny that it has made huge mistakes. We still say ‘forgive us our trespasses’ every day, only wishing that others would join us in this penitence. But the reason the anti-Christian brigade point out the Church’s failures is that, just as in Marxist totalitarianism the state replaces God, making it atheist de jure and not simply de facto, so in secular democracy the state attempts to replace the Church. That is why the Church is pushed to the margins, told to mind its own spiritual business and not to get involved in international debt or the treatment of asylum-seekers. As we survey the result — crooked politicians, bent coppers, bloated bankers, spying journalists — it may be time for the church to be more humbly confident in getting on with its proper vocation, leading the way in the true Big Society, bringing healing and hope at every level.


Read the rest here

Thank you for the cross Lord

Thank You for the cross Lord
Thank You for the price You paid
Bearing all my sin and shame
In love You came
And gave amazing grace

Thank You for this love Lord
Thank You for the nail-pierced hands
Washed me in Your cleansing flow
Now all I know
Your forgiveness and embrace
Worthy is the Lamb
Seated on the throne
Crown You now with many crowns
You reign victorious
High and lifted up
Jesus Son of God
The treasure of heaven crucified
Worthy is the Lamb
Worthy is the Lamb

Saturday, 3 September 2011

Nigglements

I learn so much from patients. Just yesterday I was greeted by a cheerful bus driver patient who wanted to discuss his various 'nigglements'. It struck me immediately as a wonderfully appropriate word for a combination of niggles (ie symptoms which are a nuisance and may well not indicate serious disease), and ailments, which are conditions probably previously diagnosed and 'simply' need managing.

Some GPs may want to take a hard line on the 'one problem only per consultation'. I really don't find that necessary nor helpful. Indeed it can be very difficult for patients to disentangle their nigglements and that's one of the reasons I'm there as a general practitioner. OK at times a further consultation may well be a good idea, but first do the disentangling.



Friday, 2 September 2011

My grief observed

Just over 50 years ago C S Lewis wrote the little masterpiece A grief observed in which he grappled with his own emotions and faith in reaction to the loss of his wife Joy Gresham. He fiercely expresses his doubts about God,  and it does contain unsettling language for a Christian believer. But doubts expressed are not resented by God but neither are they left to dominate us.

In a small aside from a recent sermon on Genesis 15 by Tim Keller preaching about God's promise to Abraham to provide him with multiple progeny, Tim says,
'Churches in which it's unsafe to doubt create skeptics...because if you're unable to be open about your doubts you get no answers. On the other hand living in New York city, secular sophisticated culture assumes that anybody who has any kind of certainties about faith at all is a naive rube. Its considered to be sophisticated to be doubtful any everything, who knows anything. So you have modern culture which makes doubt a virtue and some church cultures which make doubt a no-no and then you have.......God and the Bible...gentle with those who doubt, but never accepting that that's a place that you can live forever'


Mum at her Easter table just 3 weeks before she died
I mention these things because today is exactly three months since my dear mother passed away. Mum was a Christian believer and was 84 years of age, and died lovingly cared for in a hospice, so in many ways I haven't experienced the anger and desperation of Lewis, but rather uncalled for sudden moments of sadness and of  emptiness and of a wishing mum was there to tell some fairly ordinary piece of information to. I reflect upon her committed love for her family and so many others and of course I wish I had done more for her. Helping my sister clear mum's lovely warm home has been one of the saddest activities of my life, but how touched I have been to find evidences of my thoughtfulness everywhere.

O death where is thy sting?



ps I had to look up 'rube' too-a country bumpkin!!



Saturday, 20 August 2011

Dying at home

The Doctor Sir Like Fildes 1887 Tate Gallery
Most people no longer witness the death of a relative at home. The Victorian scene so often described by Dickens, and still experienced in many homes throughout the 1920s, has faded from memory. Even modern GPs seldom care for patients thought the final stage of dying. The hospital and the hospice sharing the spoils.

I would say that to  make yourself available to the patient and her family, where a death is to be expected, is a worthy consideration. And with the advent of mobile phones, no longer is one housebound waiting for patients to call, or expecting one's spouse to man the home phone whilst the doctor drives around with a bleep.

I say this because a few months ago I gave my mobile phone number to the family of a patient of mine dying at home form advanced malignancy. I explained that they could call me any time of the night or day, but I made it clear that I might not be able to attend depending upon my circumstances. As it happened they called me about 3am on a night when I had moments earlier taken a call from my sister advising me that my mother had just been admitted as an emergency in the local hospital.

I visited my now deceased patient. Confirmed the death and spent a few brief sympathetic moments with the family. Just this week I received a touching note from them expressing their thanks. In this week's BMJ Iona Heath writes a typically thought provoking piece on consent for cardiopulmonaty resuscitation. Suggesting that opting in for resuscitation has much to be commended for it, rather than the current opting out-which leads to many awkward conversations between doctors, patients and their relatives. She discusses the place of 'do not attempt resuscitation (DNAR)' orders and the inappropriate behaviour which professionals engage in when attending an expected death. I was struck by this helpful paragraph,
When patients are dying at home, an unfortunate cascade effect can come into play. Relatives and friends are coping well and managing to provide just the kind of gentle care that most of us hope for in our dying days, but to people unfamiliar with death the last moments of life can be distressing and frightening. In this situation, all too often the carers will seek support by calling an ambulance, and this becomes ever more likely with the decreasing availability of a familiar primary care or palliative care professional out of hours(my emphasis). Once the ambulance is called, the paramedics are obliged to attempt resuscitation, however inappropriate. Guru and colleagues documented that 10% of cardiac arrest calls in Toronto were to patients with pre-existing terminal illness, and in 63% of these the relatives asked in vain for resuscitation not to be attempted.5 The authors conclude that the carers of terminally ill patients should be specifically advised not to call an ambulance and to be given information on other sources of emergency support. (Read the rest here)
Most GPs do  not care for many patients dying at home each year. Give the family your mobile number. It's just a tiny bit of traditional family practice that will mean so much to the grieving family in the months and years ahead. And will cement your relationship with them throughout your career-assuming you're not going to change practice every 5 minutes.


Wednesday, 17 August 2011

State of the nation

'They who should be praying, or too many of them, are disputing and fighting among themselves Alas! How many professors are more concerned for the mistakes of government than for their own sins'
Thus writes John Newton from Olney, Frebruary 1778 to his good friend William Bull of Newport Pagnell.

Tuesday, 16 August 2011

There's prayer and there's....prayer!

Sometimes when I lead the service at our church I write it out rather than prayer extempore. This is how I began last Sunday, with the riots and world unrest in mind,
Dear Father God we bow in your presence this morning and come to you in the name of Jesus. We do not deserve the great mercy and love which you have shown to us and which is offered to us day by day. Thank you that,
‘the steadfast love of the Lord never ceases, His mercies never come to an end’
Dear Father we praise you for your true greatness, and for the majesty and beauty of your character. We praise you for Jesus Christ-he who is fully God and fully man-the one who stepped down into our world, to bridge the vast gap between us and you. Read the rest here

I guess that prayer does contrast rather with this prayer, prayed before the  Nascar Nationwide series race 2011. I hesitate to say 'enjoy',



Friday, 12 August 2011

Looting in a rich's man's world

How sad and indeed frightening the recent disturbances in England have been. What should a Christian think and do?

I don't have any special wisdom but I find Mike Ovey's comments quite helpful,
'A Christian explanation could begin with one of the more sensible secular comments. These are "consumer society riots", says Dr Paul Bagguley, who is a sociologist at Leeds. This is very perceptive. It points clearly to the consumerist, acquisitive nature of the looting, and it hints that these are the kind of riots that a consumer society (and let's not forget, that's all of us) has. It hints that this is the kind of riot you expect from members of a consumer society, not from those who refuse to be part of it. That does not allow me to say the looters are totally alien or other, or even "enemies of society" in a straightforward way. The looters are committed to the consumer society. They're "us", not simply "them".'
It's worth reading the rest here although I do think he is somewhat patronising about a Christian response which consists of care, concern and presence which he briefly mentions. And prayer doesn't get a mention.

However the subject of consumerism and it's negative effects are going to have to be faced. A book I read a year or so ago called Affluenza is a powerful indictment of a society which glorifies wealth and possessions  (eg Chris Evans and his multiple Ferraris) effects such inequalities breeds.

As a Christian I need to grapple with my innate tendency to acquire possessions and the powerful and yet subtle grip that they can have over me. As Jesus said, 'And why worry about a speck in your friend's eye when you have a log in your own?'


Tuesday, 9 August 2011

More difficult people..

With the horrible rioting going on in England just now I continue to reflect upon the dignity of all people-a belief which is hard to hold onto when so many people are intent on mindless violence.

Nonetheless dignity is something we all have as human beings made in the image of God with 'bestowed worth rather than acquired worth'..for more on this watch a very helpful talk from John Ortberg here...

Thursday, 4 August 2011

Difficult people...

I've already referred to a wonderfully helpful talk that John Stott gave in 2006 reflecting upon his many years of Christian ministry. I can't help but make comparisons with the challenge that faces me daily in my work as a GP. Not all patients are likeable, some are ungrateful, and a few are downright awkward. Many are just a little wearying.  But Stott's reflections upon the words of the apostle Paul recorded in Acts 20.28, Keep watch over yourselves and all the flock of which the Holy Spirit has made you overseers. Be shepherds of the church of God, which he bought with his own blood, are so thoughtful,
'If the Father the Son and the Holy Spirit are all committed to care for the people entrusted to us, should we not be committed to their care as well?'
Although the patients on my list are not exactly my 'flock', as a follower of Christ myself, and believing that God has placed his image in all men and women, I do have a similar responsibility.

Stott goes on,
'When I see 'difficult' people queuing up to speak to me after my sermon, I speak to them before that reach me, in my mind
"What a precious person you are. How valuable you are to God: Father, Son and Holy Spirit. It is a privilege for me to be involved in your care."
I find this extememly effective. it changes my attitude towards them immediately...I recommend it to you.'
And so to tomorrow's busy surgery....


Pick up a penguin

I've just so enjoyed reading The Penguin Lessons by Tim Michell. It really is a lovely read. Whilst travelling to Argentina to teach i...