Thursday, 26 April 2012

George Bernard Shaw

Enjoyed a quick visit to Shaw's Corner in rural Herefordshire this afternoon. Now a National Trust property. The only person ever to have won a Nobel prize and an Oscar. They are both displayed in the drawing room-first time I've seen such in the flesh.

The Irish dramatist lived to be 94 and died at home in 1950.

Of his many notable quotes, how about,
'The man with a toothache thinks everyone happy whose teeth are sound. The poverty-stricken man makes the same mistake about the rich man.'

More worrying is,
Every man over forty is a scoundrel!
Guilty as charged.

Tuesday, 24 April 2012

"You always say that"

Am I boring and predictable? It seems some of my patients think so. When I meekly ask the next patient, how are you? He merely replies, 'You always say that'.  I'm not entirely sure where to go with this one. I sometimes try, "How ya's it going...or wasting my time again?", but I just can't remember what I said the previous time, so I stick with, 'how are you'?  Perhaps I should have a code which I add on the computer to remind me which of my standard greetings I used?

A similar problem of forgetfulness arises with my barber, or should I say stylist-he certainly has to be more creative as the available number of hairs declines. Sometimes he charges me £10 sometimes £8. And he always says the same thing,  'How's the family? how's your wife? How's work?' I don't recall every reprimanding him.

Perhaps it's my fear of being boing. Many years ago I was on a preaching weekend at which each of us had to give a short presentation on a few verses of text from the Bible. The trainer for the weekend commended me afterwards and said, "Yes, thanks David.....bit obvious wasn't it"? Being obvious has worried me ever since!

I was reminded of this today whilst reading a column in the BMJ by one of my favourite writers, Theodore Dalrymple. Writing about The boredom of everyday life, he writes,

Anton Chekhov (1860-1904) was a doctor who in his story 'The Teacher of Literature' wrote of a teacher called Ippolit Ippolititch.  Ippolit is a completely unimaginative man who never in his life says anything other than what everyone already knows. When he eats, for example, he solemly declares that, 'Man cannot live without food.' When a colleague marries, he says to him, 'Hitherto you have been unmarried, and now you are married and no longer single.' Even when he is delirious, he is incapable of other than the dullest banalities. Just before he dies, he mutters, 'The Volga flows into the Caspian sea....Horses eat oats and hay'.

I won't start to berate football commentators, but I am reminded of an idea form Becky Pippert and her book on evangelism, Out of the Saltshaker (still a great book); For God's sake make yourself an interesting person! No pressure then

Time and tide...

Some great teaching at my church this past Sunday.

In the morning Ray Evans began a new series on Time-listen out for the fascinating stats at the beginning of the talk. It's really good to know 'our times are in His hands'.

In the evening Martin Salter continues his look at Ecclesiastes, that most enigmatic book of the Old Testament. Is working worthwhile? Does all the blood sweet and tears just fall to the ground?

Take a listen to both on the church downloads page here. Or sign up for the podcast.

Friday, 20 April 2012

Did Jesus lead a balanced life?

Really enjoying Doing God's Business by Paul Stevens

'As I read the gospels I am convinced that Jesus did not have a "balanced life" with everything scheduled and poised, as some have proposed. At times he could not eat because of the press of  activity. But Jesus did lead a disciplined life  (my emphasis). He had times of fasting, whole nights given over to prayer, and special times of intercession (Luke 22.32). But most evident is his pattern of engagement and withdrawal-what we might call the 'mixed life'. In John 6.15 we have a brief reference to this practice when people were about to take him by force and make him king. Luke tells us that  "(Jesus) would  withdraw to  deserted places and pray" (Luke 5.16). In Mark 6.45 we have the strange, even shocking words, "he dismissed the crowd." The crowds did not leave him of their own accord. He sent them away, saying, "no" to the sick, guilt-ridden and demon-possessed whilst he want to be alone with the Father. For Christians the need of the world is not the call of God. The call comes from God and we will need to withdraw frequently and regularly from compulsive need-meeting to hear the voice of God.
Crucial to living the 'mixed life' is knowing that we are beloved of God, that God takes delight in us, and that we do not have to do anything to gain God's love and approval....'Jesus played to an audience of one' (the Father). This contrasted with the Pharisees...Many leaders in business, politics and religion, are deeply insecure, and out of that insecurity, they base their leadership on the search for  one of three things: power, intimacy or status. The ultimate solution for this is living in the delight of God (Is 42.1). We will not know this deep within ourselves without reflection, prayer and hearing the word of God.'

Great stuff.

Wednesday, 18 April 2012

Parry's dictum

'It is more important to know what sort of patient has the disease than what kind of disease the patient has'

And thanks to a Welshman (ok, ok...) by the name of Caleb Parry who trained for medicine in Scotland, and practised in Bath, England for this great quote.

One of the problems with population based, evidenced-based medicine, is that it takes little account of the 'sort of patient' one is trying to help. I realise now that a tacit acknowledgement of this dictum informs so much of my practice of medicine. Why do I see two apparent similar patients of similar age and same gender with the same problem, and yet treat them so differently? It's all thanks to Parry.

Monday, 16 April 2012

Oxfam's new direction

I'm a big fan of the work that Oxfam does. However the Oxfam shop in Olney is surely taking diversification a little too far in  branching out into lingerie and bedtime stories for insomniac children.

Saturday, 14 April 2012

Death on the ice

Just read a great fictionalised account of Scott's Terra Nova expedition to the Antarctic, Death on the Ice by Robert Ryan. An excellent read if naturally tinged with the sadness of the inevitable outcome. I particularly enjoyed the scene setting and background history of Titus Oates the only army representative at the pole.

Scott's wife Kathleen comes across as a fascinating and strong character behind Scott himself. There is a superb recreation of the perilous journey of the Terra Nova from New Zealand to the pole. Quite frankly that journey alone makes heroes out of the team. Overloaded (the Plimsoll line being painted over!) and facing mountainous seas, how they managed to convey all their kit as well as the horse and dogs, is remarkable.

The heat-breaking discovery of being beaten to the pole is told with understatement, as is the final trudge into blizzards of the returning polar party. The end for Scott, Wilson and Bowers is told with a brevity that somehow leaves one wanting more, but of course the final hours are inevitable conjecture with only Scott's diary and final letters to go on.

The interspersing of actual quotes form journal diaries and letters works well. Despite having read a number of related non fiction books, this added to my appreciation of what these men accomplished, and left me  humbled at the stoicism and patriotism of men from the Great War generation who seem a different breed from Englishmen of today. Our 'heroes' are sportsmen and women, pop stars and movie stars, Simon Cowell and Strictly dancers....don't get me going.

The Titanic and the Inverse care law

One hundred years ago today the RMS Titanic struck an iceberg on her maiden voyage from Southampton to New York. She sank the next day with the loss of 1,514 people. Of particular interest is who died and who survived.

Out of 324 first class passengers, 214 survived. Out of 708 third class passengers, only 181 survived. And when gender is considered it's noteworthy that in first class 97% of the women survived against 33% of men. In third class 47% of women survived but only 16% of men. I guess there are a number of variables here, not least the position on the ship and their proximity to lifeboats, but they are still telling statistics.

Just over 40 years ago a GP called Julian Tudar Hart coined the term the inverse care law.  He described the observable fact that the availability of good medical and social care tends to be inversely related to the needs of the population served. Of course it's impossible to know the complete story of why the first class women mostly survived but the third class women didn't, but I know in medical practice how naturally we doctors tend, generally subconsciously, to give more attention to those of higher social standing. I'm not just referring to private medicine here. Perhaps the more articulate, well presented patient just asks more questions or expects greater explanation. Whatever, it's still something I'm well aware of in my own practice and try to resist it's subtle force.

The church I am a part of is made of a spectrum of people from all walks of life. I thank God for that. One of the beauties of the Christian gospel is the levelling influence of the cross of Christ. All are given equal 'attention' by God in his grace. All are welcome, all find acceptance not because of their ability, nor even because of their inability, but rather because of the 'wideness of God's mercy' and the perfect offering of Jesus Christ.

Wednesday, 11 April 2012

Hockney's sermon on the mount

In the final exhibition room at the Bigger Picture exhibition at the Royal Academy there are several versions of Hockney's Sermon on the Mount. He'd got the idea from  a painting which he had seen at the Frick collection in New York. It's by a little known French artist called Claude Lorrain.
Claude's original (and rather dark) version

One of Hockney's versions
Commenting on his own version Hockney said that he had been inspired by Claude's use of depth in the picture. Whist most paintings have depth in the centre of the picture, thus drawing the obsever into it, and the near point around the edges, Claude's had reversed that.  The near point is the impressive mount from which Christ is depicted as teaching.

I guess it's an unintentional comparison, but how true to Christ's teaching. Indeed as  Tim Keller puts it, Christ's teaching from the mount is about an 'upside down kingdom'. Christ reverses the world's values, the weak are strong, the hungry are fed and the poor are rich.

Take a listen to the last 8 minutes of Keller's sermon,  Upside-Down KIngdom

Monday, 9 April 2012

David Hockney

I was blown away by the David Hockney exhibition at the  Royal Academy in London today. Perhaps I shouldn't have mentioned it since it closes today! I'm not sure such a vast collection has been brought together before.

One of Hockney's hopes is that we might learn to look at the natural environment  around and see. Having moved back from  LA,  Hockney revels in the changing light and colour of the seasons. If there's one thing you can say for the UK, it is that we certainly have contrasts-indeed we have seasons-and sometimes all four in one day.

When Hockney  reflects upon landscapes he notes that it has been said that there is nothing new that a painter could do with such a subject, but on the contrary Hockney's view is that the landscapes around him just need to be looked at and interpreted in different ways. Interestingly this is the thesis of cognitive behavioural therapy, which notes that circumstances may be identical for different people but what matters is how the event or circumstance is seen and hence interpreted. It's the differing interpretations that lead to differing responses, whether of anxiety, or sadness or nonchalance, amongst others.

'For the beauty of the earth, for the beauty of the skies, for the love which from our birth, over and around us......Father unto you we raise this our sacrifice of praise'

Sunday, 8 April 2012

Resurrection day

Because there's no resurrection without a cross, first this beautiful song from Townend and Getty..

Because of Christ's resurrection...
And we are raised with Him
Death is dead love has won Christ has conquered
And we shall reign with Him
For He lives Christ is risen from the dead

Friday, 6 April 2012

"I thirst"

Powerful words from Jesus just before He died. Having previously refused the wine mixed with gall as a sedative, he now cores in anguish for his thirst to be quenched. F.W. Drake sees significance is this acknowledging of human anguish by the God-man Jesus.

'"I thirst".....this is a word for us-His blessing upon pain, given from the cross to tell us that He bore it, that He understands it, that He can sanctify it.....suffering comes into the Christian life, not as the particular punishment of individual sins, but as the common heritage of all mankind.
To read more of his insights on pain and suffering in the Christian life, read on here.

The wondrous cross

Good Friday and a time for reflection, thanksgiving and especially,  for 'pouring contempt on all our pride'.

Wednesday, 4 April 2012

The second opinion.

It's a time honoured and perfectly reasonable request-the patient asks for a second opinion. There are many reasons why the request may be made.

  • A dysfunctional consultation
  • A lack of confidence in the opinion given
  • Limited treatment options
  • A doctor who is unable to make a diagnosis
  • A condition and treatment so serious that the patient wishes to be sure of their options
  • and so on....
However what is increasingly happening in out-patients and general practices up and down the country, is that the patient wishes to see the same doctor only to be told, that the doctor has left the department, moved onto another practice, is unavailable for whatever reason, or that although the doctor may well be in the clinic, it will be pot-luck whether the named doctor will see them.

There is so much to be said for continuity. A growing confidence in the doctor, an increasing understanding of the context of the patient, and an ability to follow up differing treatment options amongst others.

I've just recently read Mark Greene's latest book entitled, The Best idea in the world-How putting relationships first transforms everything. It a great read and very pertinent to the idea of continuity. Although written from a Christian perspective (it is based on Jesus' teaching that the greatest commandments are to Love God and love your neighbour), it has much to say about relationships in the world of politics, commerce, family, and medicine.

On politics, 
The primary role of politicians is to create conditions in which people can flourish as whole human beings...we have pursued a form of capitalism that is much more concerned with economic growth than it is with social impact.
In our high mobility, high turnover culture most of us have fewer friends than our counterparts 50 years ago, and we are much more likely to live more than half an hour's drive away from relatives. And much less likely to work in the same company for 10 years, never mind our whole lives. Continuity builds trust...
I would suggest that there is much to say for doctors remaining in their posts as long as possible. Traditionally GPs would stay in the same practice for their working lives, in my own practice this is likely still to be the case. Hopsital consultants used to do the same, now they move around. It's all s unsettling for patients.

I've writtten  a short summary of The Best Idea, take a look here..

Easter, resurrection and Derren Brown.

Along with many others skeptics,  Derren Brown dismisses claims about Jesus's resurrection from the dead as fictitious. I guess if anyone could recognise a  hoax it would be him! But hang on a minute, there are certain facts worth taking into account before joining in the chorus of, 'it's all a load of fairy tales'.

Take a look at two short videos of an interview with Australian historian John Dickson



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.