Saturday, 28 January 2012

Me..make mistakes??

A 'friend' kindly sent me a link to this TED talk on doctors and their mistakes. It's certainly worth a watch.


There is a balance to be struck in this. Yes,  as a human being I will make mistakes and as a doctor I should strive not to make them.  For some doctors who have an over-developed conscience the ongoing guilt can be hard to bear and at the other extreme there is an easy acceptance of one's own frailty that must be challenged.

In my work as an appraiser it is my responsibility to discuss any complaints made against the appraisee in the previous year. They are mercifully few but I am generally uneasy with the doctor who shrugs them off too easily. Alas occasionally the complaint was far from fair and it has lead  to much soul searching and stress not only for the doctor but also his or her family.

Yes we must face up to our mistakes (and contra the talk, I think many of us do discuss our mistakes with colleagues-that's one of the great reasons for informal regular coffee times in practice life), but I'm not sure that being too open and frank about the inevitability of mistakes is helpful. One unfortunate outcome is the practice of defensive medicine which in it's own way can do harm-although strictly speaking no mistakes have made. I guess that;s for another time...

Monday, 23 January 2012

"You can't play pooh sticks on your own"

Today a lively 84 year old tells me that last year he climbed Kilamanjiro. This he did in memory of his wife who had died and to raise money for a dementia charity.

Still lively, he tells me of a recent walk over some water meadows near Olney and to a bridge over the river. Whilst loitering there he contemplated playing pooh sticks but decided that it's not much fun on your own. Fortunately just as he was about to give up a nun passed by. '"Do you fancy a game of pooh sticks", my rather precocious patients asks her. "Oh yes that would be great fun".  And so they played.

What on earth are elderly people doing playing pooh sticks?

As George pointed out, 'it's no fun playing on your own'

And so I recall the handful of patients I saw today whose fundamental problem is loneliness.  With increasing relationship and marital breakdown, loneliness is a fact of life for many people. There's much evidence to suggest that loneliness is associated with poor health and negative health outcomes. I'm not sure how to legislate against it, but it reminds me that there is yet another question to ask the patient whose non specific symptoms baffle me. "Would you say that you are lonely?"

 I think if asked with sufficient care and timing and with a suitable silence after asking, it may open up possibilities of practical help and advice.

Friday, 20 January 2012

"I regret some of the things I wrote as a young man"

Some telling words from historian Paul Johnson on this morning's Desert Island Discs-one of my favourite radio programmes, and now wonderfully availably via it's podcast.

Paul Johnson was speaking of what he had written about Anthony Eden, the Prime Minister during the Suez crisis. "I now understand the pressures that politicians are under, and Eden was a sick man...."

Since for some years I have no longer been called the 'young doctor' in my surgery, I grow in appreciation for what the wisdom of age can bring (not that it always does!). So often as a young person we just lack understanding of a broader, fuller view of matters, which inevitably limits our judgement.  Radical, exciting ideas are a necessary accompaniment of youth, but giving youthful opinion too much clout in our culture will inevitably lead to misjudgement.

As one of Job's adviser's says, in the oldest book of the Bible,
"age should speak; advanced years should teach wisdom" Job 32,7

Wednesday, 18 January 2012

A dodgy thermometer

Interesting to see a young babe tonight with a high fever, or rather without a high temperature. Mum had just acquired a thermometer, ordered from the internet and her 7 week old baby had a fever at 39 degrees.

That sort of temperature in a babe of that age causes me some anxiety. However history taking suggested a perfectly well babe. Feeding voraciously, sleeping normally, responding to mum and happily asleep when examined. The temperature when taken by me was 36.4 degrees. I double checked with a colleague's thermometer-same 36 degrees temperature. Conclusion..a well babe with a poorly thermometer!

How important it is that the old clinical skills are maintained in the contemporary practice of medicine when so much technology at our disposal.  OK a thermometer isn't exactly a PET scanner, but the principle's the same.

Sunday, 15 January 2012

Greener grass

'It's not that the grass is greener on the other side. The grass is greener where you water it'

Great quote from Mark Greene and his booklet 'The Great Divide'. He's pasionate about heping Christian live as disciples in 'all of life'.

Take a look at his inspiring short talk at the Cape Town conference in 2010.


Friday, 13 January 2012

John Stott memorial

St Pauls today in the sun,
from the Millenium bridge.
It was a real privilege to be at the John Stott memorial service in St Pauls's cathedral today. A beautiful and grand setting for a humble and yet hugely influential Christian believer and teacher. I found the service very touching and felt really quite moved in many parts of it.

From Mark Green's passionate challenge to continue the vision of John Stott to integrate faith and work and to be salt and light in society, to the tributes from representatives of South America, Asia and Africa, and the beautiful rendition of Make me a channel of your peace, and to the stirring words of Timothy Dudley-Smith. It was impressive.

Dudley Smith is no spring chicken at 85 years, but he spoke clearly and boldly of the need for faithfulness to the gospel and of witness to Christ as Lord of Lords and King of Kings. We had great seats and singing the last hymn, Lord for the years your love and kept and guided, and looking down from our seats in the balcony on Dudley-Smith the author of that hymn, and Michael Baughen, the composer of the tune, was just great. I felt inspired by these senior believers to live my Christian life wholeheartedly for whatever time is left to me.

Interestingly one of my heroes, Tim Keller gave this address at the memorial in the US to John Stott. 



Tuesday, 10 January 2012

The missing shrapnel

Last week we were burgled. We had been enjoying a lovely family holiday in Norfolk when I took the phone call from one of our neighbours. The house had been well and truly 'visited' with not a cupboard or draw left un-emptied.

 In my study was a box that my mum had put together after my father's death containing various memorabilia from his days in the army during World War 2. In that box was another box, very small and containing some tissue paper within which was a very small piece of irregular material. It was shrapnel and had previously been lodged in one of my dad's legs. It was now missing.-the shrapnel that is.

Dad had gone over with the invasion force as part of Operation Overlord. I believe he entered northern France on D-day plus 2 or 3 and was soon wounded whilst fighting near Falaise. I never got the detail from dad, but I know he was wounded (I believe as a result of friendly fire) and was shipped back to the UK for surgery and convalescence and he subsequently guarded POWs.

I've no idea why our burglars should have taken dad's shrapnel. I guess they must have thought it valuable, wrapped up as it was. They will have a nasty surprise when they take it to a jewellers. I'm sure it's just a fragment of concrete from a building.

Without that shrapnel I might not have existed-for who knows, perhaps my dad, had he survived to take part in the recapture of France, might have been fatally wounded. But being wounded in the non fatal way that he was, saved him.

Burglaries bring home to you the relative importance of possessions. It's certainly not a pleasant thing to have your home invaded, nor possessions stolen, nor a level of untidiness created that even two teenage daughters had never managed. But I thank God that there are some things that can never be taken away.

The Long Walk

It's always a bit chancy to give someone a book. A little like recommending a restaurant. Will others like it? Will the service be as go...