Thursday, 29 November 2012

'Once was lost but now found'

Yippee! My wallet which had been lost/stolen last weekend was returned to me today by a lady fromKempston  who had found it on the floor of Sainsburys. She didn't want to hand it in since she felt unable to trust that it really would be returned to me! Hence her welcome knock on our door this afternoon. Bless her heart.

Written in 1779 by John Newton,  Amazing Grace is perhaps one of most famous hymn of all time.  The hymn tells the story of the grace of God which had reached the former slave ship captain and turned his life around. Newton acknowledged that he 'once was blind', but that now 'I see'!  Worse he was once lost, but now he is found.

Becoming a Christian is not just a matter of being convinced intellectually of the truthfulness of Christianity's claims, nor even is it taking part in religious practices. Although intellectual credibility is not absent from Christian theology, and regular religious practices can be very helpful in sustaining one's Christian life. However  the New Testament suggests that having faith in Christ necessitates an opening of the eyes, to see in this one life of Jesus Christ, the true meaning of life. To realise that in this one death the wages of sinfulness are fully paid. And to see in this one resurrection the certainty of a new heaven and a new earth beckoning beyond the grave.

To become a Christian is to be truly 'found'. It is to realise that in the midst of a happy healthy life and close relationships, one can still be truly lost. There can be a sensed lostness which nags away at us in times of solitude or sadness. There comes a realisation that it is possible to gain the whole world and still lose our soul.

Amazing grace how sweet the sound
That saved a wretch like me
I once was lost but now am found
Was blind but now I see.

Wednesday, 28 November 2012

Little questions

One day I must compile a list of questions which have proved surprisingly fruitful in my GP career. Just this week three little questions have helped.

1. For neck ache. Ask if the patent if they are wearing varifocals. Discussing this with a patient this week who spends many hours each day on a computer, we discovered the problem. To use the reading part of the lens at the base of the glasses, one needs to extend the neck and look down. This results in a uncomfortable posture which puts strain on the extensor muscles causing their fatigue and acheyness. The answer? Buy some reading glasses.

2. For sciatic leg pain. Ask the patient (if male) where he keeps his wallet. If kept in the back pocket and many hours per day are spent in the car, there's likely to be considerable pressure to the sciatic nerve resulting in the pain. The solution? Keep your wallet in a front trouser pocket.

3. For the patient with chronic pain. Ask the patient how he/she manages to cope with the relentlessness nature of it. I saw a patient today who has had chronic pain for two years. He has seen multiple doctors,  none of whom has expressed an interest in the effect of the pain on the person's overall well being. All the questioning  has been of a descriptive nature concerning the character of the pain, not the consequence of it. A simple comment by me to the effect that it must be very difficult to cope with the pain,  was met by an almost embarrassing degree of gratitude by the patient as if I had just invented modern medicine. A bit of humanity can go a long way in the practice of medicine.

Tuesday, 27 November 2012

Depression 18th century style

Good old John Newton was a faithful friend to William Cowper in his frequent bouts of depression. Newton was no primitive when it came to understanding the nature and effects of a depressive illness. I've often reflected on Cowper's serious episodes of depression and wondered how much benefit he would have got from modern day anti-depressants. God alone knows why in His wisdom and providence the discovery of anti-depressant medication came 150 years too late for Cowper.

Writing to a friend in 1793 just 7 years before Cowper died at the age of 69 years , Newton wrote,
Nervous disorders, which some people know not how to pity, appear to me to be the source of the heaviest affliction (a wounded conscience only excepted) to which mortals are subject; they change the appearance of everything around us. They open a door to dark temptation, and often seem to load the mind with guilt for what is involuntary and unavoidable.  The pressure upon the spirit prevents the sufferer from taking comfort in anything.
I would judge that such sentiments give lie to the suggestion that Newton was insensitive to Cowper's depression.

Monday, 26 November 2012

Why The Who and many of my patients are wrong.

In the 60s Roger Daltry belted out, 'Hope I die before I get old'.  Many of my old patients lament to me, 'Don't get old'. I confess that my standard reply is, 'Surely it's better than the alternative?'

It set me thinking about being an 'older' doctor. It seems to me that there are multiple advantages.

1. After careful consideration of a patient's problem, if I say that I don't know what the diagnosis is, the patient is generally more likely to accept my opinion on the assumption that if an experienced doctor doesn't know, then maybe their problem is truly 'unknowable'. A young doctor would be less likely to get away with such uncertainty.

2. The older I get the more medical investigations I have had. Worried about a colonoscopy? Been there done that. Apprehensive about an MRI-it's not so bad. Afraid of an aneasthetic? Just enjoy the peace and quiet, etc etc.

3. As one ages so one experiences  more and more of the slings and arrows of outrageous fortune. It's likely you will have experienced at least some bereavements, so offering comfort to others is not done purely in a theoretical way.

4. It's quite likely that you will have brought up (successfully or otherwise!!) children. The sighing parent can't pull rank  and complain about sleepless nights (especially if you are old enough to remember the pre-1996 days when regular nights and weekends on-call was a feature of general practice. Getting up in the night for for your own children AND other people's!

5. You may have been blessed to having surviving, albeit aged,  parents, and understand some of the pressures of being 'in the middle' (aged parents above and uni student children 'below').

6. If you have kept a lively interest in lifelong learning you will have built up a store of patients and patient experiences which come to you in a flash when confronted by an enquiring patient today.'Yes I have seen it before....', sometimes brings  degree of reassurance.

7. If a cock sure junior hospital doctor is condescending and rude, you have the option of speaking to his/her consultant whom you may well have come to know socially. (Sadly this last point has been greatly negated by the ubiquitous and iniquitous choose and book system).

8. If you are fortunate to have a stable patient population, you have a store of shared experiences with patients and their families, which facilitates management of current problems, and greatly enhances the enjoyment of the consultation.

9. Rather self important 'executive' types of patients are less likely to intimidate you.

10. You just accumulate more of life-interests, general knowledge, hobbies, travel, all to broaden topics of discussion with patients.

I'm sure my 28 year old GP registrar daughter could counter all of these with the benefits of youthfulness. I just don't think she would 'win'!

Thursday, 15 November 2012

Active Listening

As a GP it's vitally important that I master the skill of listening. So here's a snappy little video from the people


In his excellent book, Two Minute Talks to Improve Psychological and Behavioural Health, John Clabby, advises that we need, 'a genuine commitment to listen with an interpersonal comportment that reflects this'. To that end he advises counsellors, doctors etc to...

Active listening, where the advisor energetically paraphrases the client's thoughts and feelings, demonstrating that listening and not merely hearing is going on.
Posture, which is such that the advisor is also seated, relaxed, directly facing the client, perhaps leaning in, and the muscular comportment is steady and calm.
Language used, which is in everyday language, free of jargon, and in a quantity that allows for the majority of the words in a dialogue balloon to belong to the client.
Use of the eyes, which is such that the advisor, to the extent that it is culturally appropriate, listens with their eyes, and looks directly,  respectfully and mutually comfortably at the client.
Sound of the voice, where the voice tone is used like a musical instrument to convey a full range of compassionate-sounding to a business-like tone, based on the current need.

Yep, that's APLUS to help us remember

Bedford's blue plaque.

Walking into Bedford this morning I was delighted and surprised to see a blue plaque at number 15 Lansdowne Road, recalling the birthplace of Aspley Cherry-Gerard, the antarctic explorer. He had been part of Scott's ill-fated Terra Nova expedition and had been one of those who had found the dead bodes of Scott, Wilson and Bowers. They had found them November 12th 1912,  exactly 100 years ago this week.

Scott and his four man team had set out on their final push for the South Pole January 4th 1912.  And it was April 1912 before the remaining expedition members allowed themselves to conclude that there was no prospect of Scott and his team returning alive. With the Antarctic winter upon them, it was not until October 1912 that a team including Cherry-Gerard searched for the Scott team to discover their fate. They found the frozen bodies of Scott, Bowers and Wilson along with their diaries, records and geological specimens. Cherry-Gerard was deeply affected by the find and in many ways never got over it.

Cherry-Gerard safely retuned to England where he developed a depressive illness that he never fully recovered from. It's likely that he suffered what we now know as Post-Traumatic Stress Disorder. He was able to write, 'The worst journey in the world', a book which recounted his extraordinary and almost fatal trip with Bowers and Wilson to Cape Crozier to secure an unhatched Emperor Penguin egg. He married in 1939 and died in 1959. It is said that he chose not to have any children for fear of passing on mental illness to them.

Bedford gets fairly short shrift from the likes of Lonely Planet and the Rough Guides, but it's good to know that it has an association with that most iconic event in British history, the tragic 'race' to the South Pole of 1912.

Monday, 12 November 2012

God sings over me!

Good to be reminded last night by our assistant pastor Martin,  of those beautiful words from the old testament prophet Zephaniah 3.17.

The Lord thy God in the midst of thee is mighty; he will save, he will rejoice over thee with joy; he will rest in his love, he will joy over thee with singing.

I still love the old King James version that I recall from my youth.
Having held both my daughters when they were first born I appreciate a little of what God our Father is said here to experience as he 'sings over me'. It's too incredible to imagine the great creator and ruler of all things taking such delight in such a messed up person as me-but so he does.

Matt Redman put these words to music some years ago, and here's Robin Mark's typically beautiful version. Enjoy.

Sunday, 11 November 2012

Nothing in my hands I bring

I'm enjoying reading excerpts from Luther sermons on the gospels, taken from Praying the gospels with Martin Luther: Finding freedom in Love

These words accompany his sermon on Matthew 9.18-26, 'A girl restored to life and a woman healed'.
For this reason the Lord is pictured to us in today’s Gospel, mingling among the people, drawing all the world unto himself by his friendliness and comforting doctrine so that they may cling to him with their hearts, depend upon his goodness, and hope to receive from him both spiritual and temporal treasures. Nor do you see him take anything from those he heals and helps; yea, he receives nothing from them but scorn and mockery, as we shall hear. (Vol. 5:328–343)

Tuesday, 6 November 2012

The limitations of screening

I mentioned a little while ago that there is a growing body of medical opinion that's trying to bring some sanity to the screening juggernaut. Good to see that my daily read (The i newspaper) has picked up on it today.

Under the heading, Trust me I'm a doctor, it mentions the new website, which expresses concerns over the widespread use of  private screening and goes on to say,
The disadvantages and risks of the screening are downplayed, say campaigners. Companies avoid any discussion of false positives and false negatives, which are inevitable with virtually all forms of screening, as well as the implications of finding conditions that are best left "unfound".

Complaints have been lodged with the Advertising Standards Authority, and in some cases rulings have made companies amend their claims. While it remains illegal in the UK for prescription pharmaceuticals to be marketed directly to consumers, screening services are not subject to the same limitations. "In fact, screening is sold as something any responsible person, concerned about their health, would go for," says Glasgow GP Margaret McCartney, author of a new book The Patient Paradox, which includes a questioning look at screening of all types. "The potential hazards of private health screening are real – and a lot of the patients I see simply can't afford £130 anyway. A person's own doctor is usually in a far better position to offer unbiased information and the chance to discuss the need for investigations, and to give support."

In 2009, Which? magazine found none of the private screening companies visited offered written information about possible downsides, and there was worrying variability in the results, depending on the company.

In October this year. I tested the system myself, calling Life Line screening's free advice phone number as a consumer. I asked twice very clearly during my call if there was any disadvantage, downside, or risks, with any aspect of the screening, and I was assured on each occasion there was not. 'Really, there's nothing to be worried about at all,' came the reply.

Belated thoughts on Halloween

I guess I've been brought up with a fairly negative view of Halloween, and indeed have been largely ignorant of its origins.  So I was interested to read a piece by the Aussie John Dickson about Halloween.  It's worth a read in full, but  here's his concluding thoughts,

So, is Halloween today ‘evil’? Sure it is, if it involves the glorification of things satanic; even worse if it trivializes the Devil. And there’s nothing good in the festival if it revolves around playing nasty pranks on neighbours who forgot to buy sweets. Beyond that, a community dress-up involving opening our doors to each other and giving treats to kids in fancy dress is a lovely idea. It might even build friendships in a society hungry for community.

For my part, I am sad that Halloween no longer has much to do with honouring the faithful departed and learning from their example. But that shouldn’t stop believers from making it so. The AnglicanBook of Common Prayer of 1662 has the perfect Halloween prayer: “And we also bless thy holy Name for all thy servants departed this life in thy faith and fear; beseeching thee to give us grace so to follow their good examples, that with them we may be partakers of thy heavenly kingdom.”

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.