Monday, 31 August 2015

Doing leadership differently

Hit the ground kneeling is the unlikely  title of a surprisingly helpful and short book on leadership. Written by  Stephen Cottrell, the current Bishop of Chelmsford, it proposes a rather different approach to the average thrusting, self confident view of leadership. Although written from a Christian perspective it has much relevance for leaders in any context.

Our wonderful and yet ailing NHS is in much need of good leadership and I  suggest that members of CCGs and other GP colleagues would gain much benefit from taking time out to read and allow the ideas in this book to bed down and influence their working pratices.

Take chapter one and Jumping off the bandwagon. The language may not be classic Harvard Business School, but so what?
'Creativity is usually cultivated in the soil of contemplation. The ability to act decisively (and correctly) often arises from a well of is said that during difficult meetings that ran late into the evening Abraham Lincoln lead his cabinet outside and bid them contemplate the night sky for a few minutes. He would then share with them his knowledge of the make up of the galaxies, reckoning that when they were put in touch with something beyond themselves, they would be better able to deal with the business in front of them.'
How crazy it is that our MPs go on debating into the night, and making poor decisions as a result. How sad it is that the average GP spends no time at all just thinking. The 10 minute consultation is just too short for the myriad of undifferentiated problems that many of our patients present with. I suspect that mich of the increasing stress between doctors in partnerships arises from lack of contemplation and reflection. Partnership meetings are squeezed between surgeries or held in the evening when everyone is tired. No wonder stress in GPs is leading to the ultimate response of more and more tragic suicides. You just want to scream that the emperor has no clothes. Stressed doctors are not good doctors.

Of course there are no easy answers, but somehow as a nation we need to adequately fund primary care giving its frontline nurses and medics time to think and reflect and replenish. Sadly it seems the decision makers are type A driven personalities who plough on and over others, creating mayhem all around them and ironically not caring for their fellow workers who are expected to deliver the care with targets at the forefront, and the individuality of the patients at the rear.

We need a reapplication of the good old Green Cross Code, Stop, look, listen, if GPs and other health care workers, are to survive.

Saturday, 29 August 2015

Assisted dying yet again

A very helpful article this week in the Spectator on yet another attempt at legalising euthanasia (or 'assisted dying' which is the latest euphemism for providing the means for a person to terminate their life prematurely, since euthanasia had become a toxic word).

It is a helpful article since it is written from an atheist perspective. There's no particular virtue in that fact other than to hold a view which is consistent with Christian convictions is somehow regarded in contemporary thinking as flawed. But everyone has convictions based upon something! It just so happens that secular Western culture at this time in history has decided to deride any views based upon faith, no matter how rational.

So Douglas Murray writes,
'The principal objection to euthanasia is a slippery-slope argument — and many people profess to disdain such arguments. Nevertheless, anyone doubting the slipperiness of this slope should consider the places where euthanasia is already legal.'

He then recounts the experience in Holland, Belgium and Oregon.  Quite frankly the precedents there are worrying. 'The Falconer bill is based on legislation passed in the American state of Oregon 20 years ago, but its timing could hardly be worse. Just this week, one of Oregon’s most senior doctors, Professor William Toffler, declared the legislation a ‘disaster’ which has, among other things, led to ‘a profound shift in attitude toward medical care’ and fundamentally changed the relationship between doctors and patients.'

There are so many reasons why the situation should stay as it is. There are so  many potential unintended consequences, including a lessening of the value of those with disabilities, growing pressure on the frail elderly to 'do the right thing' when the costs of their care are rising and the grandchildren need a deposit for their first house, and the acknowledged downgrading  of the excellence of palliative care, which all agree is so much better here then Holland and Belgium.

For these and many other reasons, please leave the matter alone.

Thursday, 2 July 2015

Are you sure you don't like poetry?

Now that's what I call poetry...looking forward to seeing this amazing guy perform in Norwich Cathedral soon.

And what about the 7892  prayers of his grandparents, (8 min 21 secs)?

Tuesday, 23 June 2015

Life in the GP trenches

"If I take too long to think about the impossibility of what I'm trying to do, I'll be defeated by it" Tim Cahill on the challenge of being a writer.

So according to my BBC radio 4 listen on my way to work, there is yet more advice on how to be a GP. Apparently in the UK we have 1000 more deaths from cancer than we should have relative to our European partners. So NICE has come up with the answer, refer more more people more quickly for 'tests'. Oh deary me, has anyone who comes up with these pronouncements ever worked full time for many years in general practice?

One thing that make GP the challenge that it is, is managing an ever increasing tendency to medicalise all of life, with concurrent absence of family support and 'common' sense. By which I mean that our newspapers and medial generally are full of 'conditions' waiting to deprive us of healthy life. No part of life is free. Holiday ailments, stress in the workplace, cholesterol, obesity, GM foods, shyness, ageing, pregnancy, every part of life is out to get us. And since we all live miles away from parents and grandparents (especially the latter who were used to dealing with problems themselves, since a phone call to the GP at night may have meant a 400 year walk to the nearest phone box-well it did for my granny, I remember walking with her!), no sensible advice is on hand.

So as a GP still remain a gatekeeper of the NHS, desperately holding  my finger in the dyke of spiralling costs, trying to reassure that not every symptom needs close attention and 'tests', and that when a patient has consulted me they have 'seen someone' (as in the patient who requests to 'see someone', ie  a specialist, who by definition has a limited view of things, after I have spent 20 minutes reassuring the patient about their problem). And yet on the other hand the advice to refer more and more patients into a system that is already clogged.

Ah well, retirement looms!

Monday, 22 June 2015

Holiday reads-Shackleton!

I really love the chance to get stuck into some good books whilst on holiday. I recently managed five, all rather different, whilst lounging in the sun and shade. First up, one of my heroes.

Shackleton By Endurance we Conquer by Michael Wilson.

I'm a big fan of all things Shackleton and have enjoyed reading previous accounts of the remarkable Endurance expedition and especially the rescue of the guys left at Elephant Island. Leadership insights from Shackleton in the book Shackleton's way has been a previous favourite.

This relatively new biography (2014) is a great read. It provides a rounded picture of the man who was able to overcome truly hopeless odds in the extremis of polar exploration, but he was plainly just never able to settle into 'normal life' away from the pole. His rather casual approach to family and marriage, his many business ventures and failures, his chaotic approach to money and fundraising and his rushed planning of expeditions are all well described. However although hopeless with money, Shackleton was not greedy and was frequently generous with money he could ill afford to part with. He nonetheless had a charismatic personality that lead many wealthy donors to support his various exploits.

The retelling of the Endurance journey and especially the stunning improvisation and courage shown by Shackleton and his men is brilliantly described.  To read again of the journey of the James Caird, a mere 7m long and 2m across, with 6 men on board needing to sail 800 miles across the mountainous swells of the Southern Ocean-and all in the hope that they could locate rescue ships to go back for the 22 men remaining on Elephant Island-was both exhilarating and humbling. And then the need for Shackleton, with Worsley and Crean to hike across South Georgia, with just 3 days food supply. Its stirring stuff.

Yes Shackleton was a great leader, and there are many aspects of his leadership that provide a great model for any contemporary aspiring leaders, but perhaps his ability to inspire hope rises to the surface of all his talents. Towards the end of the book Wilson reflects on the remarkable feat of saving all the men from the Endurance adventure,

If there were touches of genius about his leadership, they could be found in the way that Shackleton held together a disparate group of men in appalling conditions, making sure that disruptive cliques were not formed, and that everyone was treated equally. He never took unnecessary risk, was able to adapt to the constantly  changing circumstances, and never asked a man to do something he would not do himself. But Shackleton's supreme achievement was that he instilled hope, and the belief that they would all service.

Magnificent  book. Ok its over 400 pages, but superbly written.

Friday, 3 April 2015

Gavrilo Princip, Jesus and me

The debate continues about Gavrilo Princip and his assassination of Archduke Franz Ferdinand. To what extent was that fateful shooting on 28th June 1914 in Sarajevo really the trigger for the massive outpouring of death and destruction that was the Great War 1914-1918? Historians will tell us of the multiple events, attitudes and behaviours whether national or individual that preceded the shooting, and even now the consequence of that conflict are still with us.

When I started in general practice in the small market town of Olney in 1982 there were three patients, all spinsters still living, alone, in the High Street who had never married, and indeed had never moved away from  Olney. They had lead a single life and, they told me, all thanks to the Great War.

So many British men of marriageable age died or were injured that the students of one girls' school were warned that only 10% would marry. The 1921 United Kingdom Census found 19,803,022 women and 18,082,220 men in England and Wales, a difference of 1.72 million which newspapers called the "Surplus Two Million".In the 1921 census there were 1,209 single women aged 25 to 29 for every 1,000 men. In 1931 50% were still single, and 35% of them did not marry while still able to bear children.

On a larger scale much of  the tension that has existed between various communities across Europe throughout the last 100 years dates back to decisions made during and after the Great War, with the creation of new countries such as Czechoslovakia and Yugoslavia. And most agree that the impact of the treaty of Versailles created the ideal substrate for the rise of Hitler and Nazism.

All this from one event and one person's action.

And so on this Good Friday, one event two thousand years ago, preceded by centuries of events, attitudes and behaviours has had a staggering effect upon all of human history since. Millions of people in every country of the world have claimed allegiance to this one man, Jesus of Nazareth. And that once and for all, Good Friday event is the trigger and catalyst, with the stunning reality of the resurrection as confirmation of the power of the cross. To change destinies, to change human hearts, to bring peace and forgiveness and to satisfy the longings of the human soul.

So I say thank you for cross Lord. Thank you for the price you paid. And still this Jesus calls to one and all to follow him and receive mercy and a new power for living. This song reminds me of my early days as a new Christian in a Pentecostal church.

Wednesday, 25 March 2015

Ageing and the power of poetry

Great little poem by Wendy Cope. It would do me good to memorise and recite this before I visit the residential home where I care for a number of patients with dementia. It's called, 'Names'.

She was Eliza for a few weeks when she was a baby
--Eliza Lily. Soon it changed to Lil.
Later she was Miss Steward in the baker's shop 
And then 'my love', 'my darling, Mother.
Widowed at thirty, she went back to work
As Mrs Hand. Her daughter grew up,
Married and gave birth.
Now she was Nanna.
'Everybody calls me Nanna,' she would say to visitors 
And so they did-friends, tradesmen, the doctor.
In the geriatric ward
They used the patient's Christian names. 
'Lil,' we said, 'or Nanna,'
But it wasn't in her file
And for those last bewildered weeks
She was Eliza once again. 

Thursday, 19 March 2015

Bomber boys

A really brilliant read about a contentious aspect of the Second World War, Bomber Boys is an account of Bomber Command and later the entry of the USAAF and their offensive against Germany.
Bishop provides intimate detail of the effects of bombing on civilian populations, with especial reference to Coventry in the earlier part of the book, and later the devastating bombing of German cities, most notably Hamburg, Cologne and Dresden. He doesn't shirk from  questioning the morality of the Allied response and is fair in his treatment of 'Bomber' Harris, but the bulk of the book concerns the detail of the double lives of the crews, with hours of inactivity and poor living conditions interspersed with sudden bursts of high intensity and very dangerous operations.

Sir Arthur 'Bomber' Harris
Why any young men volunteered to be air crew is testament to the resilience and willingness to serve of a previous generation. We may respect and admire our armed forces dedicated service in modern day Afghanistan, but the relatively small number troops and even smaller proportion  of casualties currently are as nothing compared to our loses in Bomber Command.

Bishop provides fascinating detail of the day to day life of our airmen (and our fewer air women) when not on operations, and the rather sad way that their contribution to hastening the peace was often not recognised during the war. Particularly poignant is Churchill's failure to mention the contribution of Bomber Command when thanking various parts of our armed forces after victory was secured, and there is balanced material on the fallout after the war and the long battle to show gratitude, encapsulated in the erection of a statue to 'Bomber' Harris in central London as recently as 1992.

An important part of our history. Well told in an understated and interesting way.

Monday, 23 February 2015


Enjoying the company of friends, family and workmates can be one of life's richest joys, but as most of us know, conflict with others can be a joy sapping nightmare.

Last night at Grace I shared the platform with our senior pastor Ray to talk a little about the subject. I confess I was a little underprepared and spoke rather too long, but Ray made some excellent points with particular reference to conflict within a any given church family. Take a listen here.

For my preparation I re-read John Ortberg's book, Everybody's normal until you get to know them, and Mark Green's, The best idea in the world, how putting relationships first transforms everything. In addition I read Resoving everyday conflict by Ken Sande. I would enthusisastically recommend all of these and thought a couple of comments about each might help.

1. John Ortbergs book, Everybody's normal until you get to know them. As with just about all his books, clearly written with great humour and use of Scripture. I was most taken by his image of the porcupine as metaphor of how we can damage one another with our barbs,

'Our barbs have names like rejection, condemnation, resentment,, arrogance, selfishness, envy, contempt. Some people hide them better than others, but get close enough, and you will find out they’re there……we learn to survive through withdrawal and attack…we hurt (or are hurt by) those we long to be closest to…we can usually think of a number of particularly prickly porcupines in our lives..but the problem is not just them. I’m somebody’s porcupine and so are you”'
Uncomfortable to realise that I might be the source of relationship problems...we tend to think it is always someone else. There is also great teaching on the need for mutual confession and a challenging chapter on "the gift no-one wants' -confrontation.
2.  Mark Green's, The best idea in the world, how putting relationships first transforms everything.  Brilliant, succinct and practical. Key insight-because God is a trinity in relationship, and we are made in his image, then we are made for relationships. And not just a relationship with our creator God, but with people allaround us. Looking at and adapting our work and family in 'relational' ways, could result in true flourishing (or shalom as Greene loves to call it). And on forgiveness, 
'Forgiveness does not mean sweeping the issue under the carpet but rather dealing with the mess together. When we don’t forgive we build a wall against love, and it is we who are trapped behind it.’ 

3. Resolving everyday conflict by Ken Sande.   Super little book. Key insight, we are called to be peacemakers. Not just when we are directly affected but when we are aware of  conflict and can legitimately play a part in bringing reconciliation. Hence Jesus' calling of the peacemakers 'blessed' and in other parts of the New Testament, urging 'if at possible be at peace with all people', or 'pursue peace.  Peacemaking is not an optional extra. This is his commitment taken from his excellent website
'As people reconciled to God by the death and resurrection of Jesus Christ, we believe that we are called to respond to conflict in a way that is remarkably different from the way the world deals with conflict. We also believe that conflict provides opportunities to glorify God, serve other people, and grow to be like Christ. Therefore, in response to God's love and in reliance on his grace, we commit ourselves to respond to conflict according to the following principles: -
1. Glorify God
2. Get  the log out of your eye
3. Gently restore 

4. Go and be reconciled 
Check out the website.. for the details and some other helpful resources.

All three books excellent and worthy of your time. Conflict matters and is painful. Forgiveness is crucial. Peacemaking is a priority. And all to God's glory

Tuesday, 13 January 2015

Too late for Rembrandt

Yesterday I went down to London to catch Rembrandt the late works at The National Gallery before it closes in one week's time. Alas when I got there I was told that there were no more tickets for the day. Having got there I decided to take a look at a picture I had seen before.

This painting by Pieter Bruegel the Elder has long been a favourite. Although the Christ figure has a rather unattractive adult look,  the picture is so suggestive. The idea of wealthy powerful men kneeling before this child who himself was born to be King is a powerful one. Although the picture is called the Adoration of the Kings, it's recognised that Scripture calls them magi or 'wise men' from the east, nonetheless, kings bowing before the king (although apparently a helpless babe) is appropriate. However,

The Adoration of the Kings by Pieter Bruegel the Elder
'The particular gift that the Christ child is being offered emphasises his humanity; it is a vessel of golden-red grains of myrrh, which alludes to his future death and burial. The child recoils from the gift, a gesture which the artist may have intended to foreshadow Christ's moment of anguish  before he passion when  he pleaded in the Garden of Gethsemane that his father should 'take away this cup' (Mark 14.36)...the soldiers pre-figure those who tormented and nailed him to the cross; at least two of the pikes are cross-shaped...It becomes clear, then that Christ is being shown not as a Godly infant, but as a vulnerable human being who experiences as much anxiety, fear and pain as the rest of humanity. This representation of the Saviour encourages the viewer to mediate on the humility of the incarnation.' Taken from The image of Christ

Westminster Abbey yesterday
After the National gallery on a wet blowy January evening I went along to Westminster Abbey for the 5 o'clock evensong. It was a very formal affair which was a strange mix of beautiful music and ceremony. Nonetheless what struck me was the anthem taken from Psalm 71 by William Byrd, Reges Tharsis. Sung in Latin the translation is,

The kings of Tharsis and the isle offer their gifts,the kings of Arabia and Sheba bring gifts (to the Lord God.) And all the kings of the earth worship him, all peoples bow before him. (Glory be to the Father and to the Son and to the Holy Ghost.)

Reflecting upon this Christ, now no longer a helpless babe,  to whom one day every knee shall bow, including all the kings of the earth, made me think again both upon the immensity of the incarnation, and the joy and great hope that one day 'everything sad will come untrue', when our true King will be seen and known for who he is. No wonder Handel got carried away with his fabulous piece from The Messiah, ...'and he shall reign for ever and ever, King of Kings and Lord of Lords’. Just now we must wait for that day, with the mixture of joy and sorrow that comes to us all. And yet with  expectation in our hearts that one day, one day…everything will be fixed, all wrongs will be righted, and death will be no more.

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.