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 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


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!

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.