Tuesday, 24 October 2017

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 good? Etc. And so recently a friend gave me The Long Walk. it proved a great choice.

It tells a remarkable story of endurance, deprivation and at times great tenderness. It concerns a young Pole who was wrongfully imprisoned and sentenced for being a spy. Arrested in the early part of the Second World War, after a mock trial he was sent to Siberia to serve 25 years of hard labour.  Joined by a small band of  other escapees he set off on a 4000 mile journey on foot across the freezing wastes of Siberia, the barren intensity of the Gobi desert and the forbidding Himalayas. Along they way they are joined by young 17 year old Kristina who is also fleeing the Soviets. Her interaction with the hardened men is remarkable and touching.

They experienced all too brief times of kindness, hospitality and generosity, as their paths crossed with solitary shepherds and hunters. These times  really were wonderful examples of what theologians would call 'common grace'.

Having read he book and throughly enjoyed it a web search throws up a lot of debate around the veracity of the book (see here...although this is 'only' wikipedia ) amongst much else. I'm not in a position to judge, but I suspect that the book is probably a gathered up collection of the stories of various Polish ex-prisoners. Powerful all there same.

Yet again, just as after reading about our forbears who endured the rigours of the Great War, or those who explored Antartica at the turn of the 20th century,  I'm left humbled and wonder how well the majority of our current generation would cope with such adversities.


Friday, 13 October 2017

Noel Chavasse Double VC

I have long been in awe of Captain Noel Chavasse RAMC. He is the only recipient of two VCs awarded during the Great War. Visiting his simply marked headstone in  Brandhoek New Military Cemetery, Vlamertinge Belgium, gives little clue to his extraordinary courage other than the two small VC emblems discreetly engraved (interestingly the second VC emblem was only added in 1981).

His story is well told in Ann Clayton's biography written in 1992 and which I have just read. Like many stories associated with the Great War there is an inevitable mix of tragedy, resilience and bravery which leave one musing just how our current generation would cope with such life changing events.

I guess I'm drawn to his story because of a long term fascination with the First World (I still recall reading The first day on the Somme sitting in Bedford library in the mid 1960s), the uniqueness of the  man's exploits, his Christian faith, his work as a non combatant doctor and somehow wanting to share  the sadness of his family (especially his fiancee Grace who came so close to marrying him). This latter emotion is a curious one but is experienced by many of us when we read stories of great sorrow and tragedy in our newspapers, and in reading somehow feel we are sharing in and with those affected.

As a doctor he was hoping to be an orthopaedic surgeon, but happily joined up and served virtually from the outset of the war. He was to be away from home with his fellow soldiers for three Christmases before he was fatally wounded. His courage was most shown in the times he went into no-mans land to tend to and bring back those who had been wounded during various attacks. Some of these rescues were within twenty five yards of the enemies trenches, little more than a cricket pitch.

I'm humbled reflecting on his commitment. As a doctor for just 40 years I have seen tremendous changes in attitudes of my fellow medics to working conditions. There is certainly  no lack of hard working and devotion in many of my fellow doctors, but somehow there is also a strong seam of what I can only describe as 'office hours' mentality. Perhaps Chavasse went to the other extreme, some doctors have and still do, such that their family, health and wellbeing have suffered. Chavasse literally died because of his unstinting work ethic.  But as in all things there is a balance to be struck and I can't help but feel that despite the recognised need for doctors to have strategies to cope (i.e. build resilience), it would be good-not least for our patients sake- to meld that self care with  more of  what I can only call devotion to the patients who entrust themselves to us.

Chavasse: Double VC. Read, learn and inwardly digest. And see what you think.

Tuesday, 12 September 2017

A light touch

Just pebbles
Its great to be back in the Hebrides. Although lots of rain is forecast this week, yesterday was a pleasant surprise. So we walked from the Strand in Colonsay over to Oronsay. It's an even smaller island with a population of about 6 including a couple of RSPB rangers.

Oransay priory cross
What often strikes me when visiting here is the quality of the light. Somehow everything seems sharper and clearer (well when the sun shines anyway). Even looking down at your feet as you walk over pebbles is lovely (the pebbles not the feet!).

 The Augustinian priory dates back to the early 14th century and has had lots of changes over the centuries and is dilapidated now but is a very atmospheric place.

I guess we just get used to light pollution and when we are at home going about our regular lives we fail to notice what's beneath our feet and the sky above us, and beauty around us.

Friday, 1 September 2017

The eyes have it

I recently worked a one week locum in Scotland. All of the requests to see the doctor were triaged by a return phone call from the doctor. I've never been a fan of this system although I completely understand why it may be used in an attempt to manage workload. I have two main concerns.

1. The information over the phone is limited. This is especially an issue when trying to help patients with English as a second language. But it is also restricted in losing out on the 'extras'; that face to face conversation brings. After all what would you prefer if talking to your husband, daughter, bank our insurance company. Almost inevitably we prefer human physical contact. But in the context in a medical consultation there are particular disadvantages.

Bilateral congenital ptosis
I recall a 3 month old baby whom I saw recently. The complaint was of a cough persisting for one week. In itself this would usually not cause concern, especially if the baby was feeding ok and was generally well. But when I greeted the baby and mum as he was wheeled into my room, I recall commenting that the baby looked half asleep. 'Oh he's just woken up' was the reply. Having examined the babe and finding him perfectly well I was just about to dismiss him when it suddenly occurred to me that he still looked half asleep. Indeed his eyes were half closed throughout the consultation even though he was clearly wide awake. In fact I realised he has Congenital Ptosis. A condition in which the eyelids are partially closed and that if left untreated can lead to squint and even defective vision. He needed referral and I'm glad I saw him a phone consultation would not have helped.
2. I think it has the danger of creating an adversarial situation in which the doctor starts from the premise that they need not see the patient and the patient strives to justify the request rather than describing the problem. And of course for some patients (particularly men) it takes a fair bit of encouragement for them to seek medical help in the first place.

The telephone is indeed a mixed blessing.

Thursday, 10 August 2017

It's only words

I recall whilst a medical student being encouraged to clarify the meaning of words when taking a history from a patient. So when the patient says they have diarrhoea, what symptom are they describing? Is it very loose stools, is it going more frequently, is it one loose stool per day, or six times? In other words it needs clarifying.

I'm working for the first time in Scotland as a locum in Lochilphead 'just now', a lovely part of Argyll. And so when I ask an elderly lady how long the pain in her calves has troubled her, she confidently says, 'a wee while', and when I ask how far she can walk  before the pain starts she tells me, 'only a wee way'.  Concerned that she may have peripheral vascular disease I ask if she smokes. 'Oh yes of  course, but I gave up ' she says. 'And how long was that for'? I ask, fearing the worst....'Oh a wee while ago'.

Communication is at the heart of General practice and helping patients tell their story is a crucial skill. It may seem laborious at times, but it's essential to gently and persistently seek to understand what the patient actually means by what they say. Otherwise mistakes can so easily be made.

More and more health care is delivered by phone or even online. I'm sure some of that is helpful and appropriate, but without the to and fro of a normal, face to face conversation we may get the wrong end of the stick, leading to misunderstanding. So just speaking to patients on the phone should  be approached with a degree of caution, since we can also miss those non verbal cues which can fill out what the patient is trying to say to us (let alone the added benefits of examination). With increasing telephone triage in the NHS as it seeks to cope with increasing demand, we need to be alert to the risks.
Tarbert harbour near Lochgilphead 

Saturday, 22 July 2017

Don't lose the shock!


I was talking to a patient this week who has worked in very senior positions in a number of companies. We were discussing how new employees are in a very good position to notice quirks and faults in the new place of work. My patient said that he encouraged his new managers to take the first Monday of each month for some months, and try to view the business with new eyes, he asked them not to 'lose the shock', of their first impressions.

I've just discovered this very sweet version of the much loved (and much sung) hymn of Charles Wesley, And can it be, which I have known from my earliest days as a Christian. The new tune has enabled me to think about the words with a fresh appreciation.

It's helped me to regain some of the shock of a lovely, holy God finding it in his heart to value, accept and love me.
'Amazing love how can it be that Thou my God shouldn't die for me?'
And then that feeling off 'why me'? Which I increasingly feel as I go on my way though into 'older'(!!) age, why bother with me God? There's plenty of better material out there.
'Tis mercy all immense and free,  for oh my God it found out me'
But cometh the end and I face God,  what do I offer Him? My feeble efforts of prayer or church attendance, sermons, giving or niceness? Nope, none of that will count. Indeed I'll want to hang my head in shame for all the 'devices and desires' of my heart. But yet I'll not even approach God with my head in my hands, for I can approach Him boldly. Blimey that is a indeed a shock. Long may I feel like that.
'Bold I approach the eternal throne and claim the crown through Christ my own'.

Tuesday, 20 June 2017

Pick up a penguin

I've just so enjoyed reading The Penguin Lessons by Tim Michell. It really is a lovely read.

Whilst travelling to Argentina to teach in a private school, Tim stops off in Uruguay and stays in a friend's appartment. On his last evening he goes for a wander along the local beach whereupon he is confronted by a teeming mass of penguins, sadly all dead as a result of a carelessly produced oil slight. I say all dead, but in fact there was one feeble looking penguin just hanging on to life. It is this penguin that becomes an unlikely travelling companion for Tim. Having cleaned the penguin up (amusingly recounted by Tim), it simply would not leave his side and in consequence is 'smuggled' into Argentina and then onto the school.

It is here that San Juan (by now the penguin has acquired a name), is gradually adopted and loved, by students and staff alike. In one incident when San Juan jumps into the school swimming pool, he is joined by a student who thus far has been rather isolated and shunned because of his lack of sporting prowess, and yet who in the water swims fast and naturally in a way that leads to him swimming in the school team and gaining acceptance from peers and teachers alike.

So what's this all got to do wth life and the practice of medicine?

I think I generally underestimate just what a contribution animals can make to our lives. I'm not a particular animal lover, and I must admit they are something of a blind spot to me. As a GP I need as many tools as possible to bring relief and well-being to my patients, who often present with ill defined symptoms and impossible to classify medical conditions. they are in fact medically unexplained, and yet I suspect for many of them there is a loneliness or sadness at the root of their lives which leaves them vulnerable to all manor of physical manifestations. I wonder if a pet (ok it doesn't have to be a penguin) might be part of an answer. I recall an elderly isolated old lady living in a village near to my practice who found a reason to get up in her morning when she acquired a budgie, and another sad and poorly old lady living alone who found talking to her cats and stroking them, brought just a little meaning and joy to her life.

Being a GP over a long career, you're going to need a very large tool-box. Don't forget pets!! There's virtually no side effects, and they cost the NHS nothing (ok there's a cost to the patient), and they work. It's a win-win-win!

Take a look here http://petsastherapy.org/.

Saturday, 3 June 2017

Happisburgh-a happy borough?

Happisburgh lighthouse
It was a lovely day in Norfolk yesterday and it was good to visit Happisburgh. It's a remarkable little place on the north east Norfolk coast famed for its lighthouse (the only independently operated one England)  and the devastating effects of coastal erosion.  It's fun to hear folk pronounce the name who have never been before, it comes out something like, ''Happysborough' when in fact it should be pronounced Haze-bruh! I wonder if there is such a thing as a happy town? And what would it be like to live and work there?

Of course the reality is that depression is a profound and increasingly noted experience for very many people, causing much distress to sufferers and their loved ones. And with death by suicide affecting over 6000 people in the UK every year (it's over 40000 in the US), it is a huge public health challenge .

I was thinking of this whilst in Happisburgh since I have finally got round to reading Lincoln's melancholy-how depression challenged a president and fuelled his greatness which has sat on my shelves for a few years. It is a remarkable analysis of the life long struggle that Abraham Lincoln endured as he contended with severe bouts of depression. The book is full of insights from various psychological and psychiatric studies on the experience of depressive disorders and also the various treatments which were tried in the 19th century. Most remarkably of all it tells of why Lincoln's longstanding depression in many ways contributed to his greatness as a leader at such a pivotal point in US history. His personality is a profound contrast with that of of Donald Trump!

Lincoln's melancholy is full of so many insights its hard to know where to start, but just one sample of his wisdom, forged from his own personal struggles, and for a man so well known for his seriousness, is interesting since it's notable how important humour was to him (referred to by psychologist George Vaillant as a 'mature strategy' to combat depression).

The phrase 'coping mechanism' comes from the function served by a coping, the top of the wall that protects against the elements. Humour gave Lincoln some protection from his mental storms. It distracted him and gave him a measure of relief (it's interesting that many of our comedians also suffer with depression-my note).
Humour gave Lincoln a way to connect with people. Withdrawal is an essential feature of depression, and once withdrawn a person can grow steadily more awkward in company. Many depressives find small talk to be a Herculean effort... 
As president Lincoln was asked why he would pardon soldiers who deserted for cowardice, he said, "It would frighten the poor devils to death to shoot them".

Any contribution that might help us all understand the experience of depression and offer insights into managing it, is to be welcomed. This remarkable book does both and offers a helpful view of what one might almost call the potential 'positive effects' of depression-which of course may well be impossibly hard to appreciate whilst in the midst of a severe depression.




Thursday, 1 June 2017

Islay

At the Ardbeg distillery on a rainy day
Had an excellent few days on Islay with son in law Owen. It happened to be the whisky festival week,  Feis Ile 2017. And it was really good to hear the Coaltown Daises too.  These lassies certainly make a great sound.

Islay, like its neighbouring island of Colonsay is a magical place. I'm so glad I 'discovered' the Hebrides in my late teens when I hitch-hiked up to Iona with a bunch of mates.

The quality of the light, the freshness of the air, the pace of the island, and the natural beauty never fail to lift my spirits. And talking of spirits, Owen and I did enjoy a few drams and met some fascinating people. And it was good to visit some of the distilleries. Well Bowmore, Bruichladdich, Ardbeg, Lagavulin and Laphroiag, didn't get round all of them!

Yet another example of undeserved grace for 'God has given us all things richly to enjoy' (1 Timothy 6.17).

Tuesday, 16 May 2017

John

My dear brother John would have been 67 years old today. Alas he died at the age of 50 years nearly 17 years ago. He had been wonderfully brave and understated as he endured multiple treatments for his cancer which impacted his life so much for nearly 20 years. There are many times when I have missed having a brother.

John with Sarah

At his funeral (before I was unable to continue) I was able to say what a faithful friend he was to me. We didn't see each other often, but he was someone with whom I had grown up, and consequently knew me through and through. All of us need people in our lives who have known us from an early age, and consequently may be suitably  unimpressed by any achievements we may have made since childhood.

John was humble but surprisingly loud in conversation. No having a confidential chat in a cafe with him-everyone could hear the conversation. He was a passionate supporter of Guide Dogs for the Blind, and like me was interested in all things First World War. One of my treasured memories is of a day trip we took to Flanders when we looked around various battle sites and visited those painfully beautiful Commonwealth War cemeteries.


I thank God for him and the gentle faith he had in a hope beyond the grave. As the good old Book of Common Prayer has it,

'In sure and certain hope of the resurrection to eternal life though our Lord Jesus Christ'


Friday, 12 May 2017

Mental Health Awareness

I'm glad that this week is Mental Health Awareness week. Mental distress is horrible, and as Matt Haig writes in his memoir on depression and anxiety (Reasons To Stay Alive), 'depression is one of the deadliest diseases on the planet'.

I've had the privilege of seeing many patients over the years with mental distress and have often recommended books, in addition to counselling and medication. I thought it might be helpful to list a few of the ones I've recommended  and/or read for myself.

1. Overcoming Anxiety by Helen Kennerly.  A really good intro for learning to cope with anxiety. Its not too demanding a read and has some helpful explanation of the basics of CBT and relaxation.  It's not written by a self help guru, but a recognised authority.

2. Feeling Good by David Burns. Very helpful on understanding the negative patterns of thinking that we can fall into, such as catastrophising, jumping to conclusions etc. Ok its verbose and relatively dated but still an excellent read, again applying the principles of CBT.

3. Say goodnight to insomnia by Jacobs, and Overcoming Insomnia by Espie. Both really fine books. The first American and second British. Since disturbed sleep is so often a feature and can be a contributory cause of mental distress, it's  important to get help with this problem.

4. Manage your stress by Looker. A fabulous book that I've been recommending for over 20 years. Still the best on stress I think. Helpful before one gets too far down the spiral of distress and into more serious mental health problems.

5. Reasons too stay alive by Matt Haig. An honest and hopeful book charting the agony of mental distress and the journey out. Can be read in short bursts.

6. A darkness visible by William Styron. A classic memoir of depression.

7. Mindfulness for Health by Danny Penman. Very helpful for learning to deal with chronic pain and the stress and anxiety associated with physical illness.

There are of course many more. And some times when we are too anxious or low, its just impossible to read. So best to check them out before the darkness descends.

And yep most of us will need someone else to help us. Family and loving friends, counsellors, doctors, hairdressers (well most of them are amateur psychiatrists) etc. Don't neglect to get help. And don't forget the Samaritans.

Monday, 13 March 2017

Making real conversation possible

Most of us have heard of Westboro Baptist Church and their truly awful behaviour towards gay people. They are not alone in giving Christianity a bad name and sadly I play my part too, although I certainly don't share their hostility to gays.


This remarkable talk by a young woman who grew up as part of that church and was taking part from the age of 5 years, in protests against gay people and holding up placards that she scarcely could read let alone understand, is salutary and can teach us much.

For those of us who work as doctors it can give  an insight into how to help and relate to those patients who we may feel have wacky health beliefs. Sadly there is often hostility, frustration and impatience which rarely leads to a satisfactory consultation.

And for those of us who claim to be Christian believers and who would love others to share our convictions there are lessons here in how to approach the 'other' who does not share our views. Megan ends with 4 principles to make real conversation possible.

1. Dont assume the other person has bad intent in their beliefs and ideas.
2. Ask questions and listen well. Map the disconnect
3. Stay calm. This needs practice and patience. 'The rightness of our position does not justify rudeness'
4. Make the argument. The value of our position is not self evidently true otherwise everyone would share it.


Tuesday, 7 March 2017

Poems that make grown women cry

With Mother's Day approaching I guess this book now released in paperback, will sell well.

Last August I wrote briefly about poetry after reading some of the poems in Poems that make grown men cry. I really hope to value and read more poetry in my semi retirement.

So writing in today's I, Ben Holden, who co-athured both books with his father, writes...
'This collection continually ambushed us during its compilation..... in line with Alexander Pope's famous observation that poetry captures, 'what oft was thought, but ne'er so well expressed".'

Judy Dench's choice is so touching, 'So,we'll go no more a roving'  by Lord Byron. She tells us that her late husband used to recite this when the pair were giving performances together. However she was never able to continue if he recited this first so it always had to come last. Otherwise, 'it reduced me to tears, so much so that I was unable to continue the recital if it were my turn next.'

SO, we'll go no more a-roving 
  So late into the night, 
Though the heart be still as loving, 
  And the moon be still as bright.

For the sword outwears its sheath,
  And the soul wears out the breast,
And the heart must pause to breathe,
  And love itself have rest.


Though the night was made for loving, 
  And the day returns too soon,
Yet we'll go no more a-roving 

By the light of the moon.

Perhaps more poetry in our lives would increase our understanding of each other by in some way plumbing the depths of our human emotion and experience. I'm sure it would benefit all GPs who must surely aim to excel in emotional intelligence-if only by being aware of their own shortcomings and perhaps look to poetry to help them. The Psalms in the Old Testament wouldn't be a bad place to start either.

Thursday, 23 February 2017

A fortunate man-2

I'm continuing to read 'A fortunate man' which describes the life of an English country GP in the 1960s. I've been aware of the book since training as a GP nearly 40 years ago, but have never sat down to read it. In retrospect I think that if I am honest  the traditional, all consuming practice of medicine which is described in the book, and which I was faintly aware of, was what inspired me in a rather simplistic but genuine way when I first remember wishing to become a doctor at the age of 15 years.

The GP Gavin Francis, who is also a published author  (his fascinating book Adventures in human being is well worth a read) , writes in the forward, that the book describes, 'a celebration of a way of medicine that we have all but lost'. I'm very aware of that as I come to my last few days as a partner in general practice. So many of the memories that patients have shared recently with me have been of experiences which current GPs seldom if ever know.


And so a lady told me that 25 years ago when I was visiting her after the birth of her twins, I apparently welcomed the twins into the world and said to them that I hoped that in some small way they would make the world a better place. We no longer have the time (nor inclination`) to visit postnatally. And yet the mother still recall my words!

And then the old lady reminiscing with me of the time when I attended her husband in the middle of the night after he had died and stayed with her to drink a cup of tea and just sit and be with her for an hour. Now the patient's own GP virtually never visits at night.

And then the former neighbour who recalled that she asked me to have a look at her breathless baby one cold winter's evening, and  tells me that I packed both her and the baby in my car and drove straight to the hospital. Now sadly we would be worried about insurance and liability, we would probably call an ambulance (and what anxiously for it too arrive whilst the baby deteriorated).

Gosh how things have change. Alas GP is less fun, less passionate, less personal  and more beurocratic. No wonder the number of medical students wanting to be GPs is down. If only they could hear just a few of these sweet nostalgic stories my patients are generously recounting to me in my final days, they would realise just what a fortunate man I am and how still, if they are willing to buck, the trend it could yet be for them.

Just look at what others think of this small masterpiece
http://www.goodreads.com/book/show/52943.A_Fortunate_Man

Tuesday, 21 February 2017

A fortunate man


I've been meaning to read this book for a long time and its looks as though I'm going to finally get round to it. In many ways I think I can identify with the GP described. Yep I too have been a lucky man.

I was reminded of this when I saw a patient last week. She told me that there was something she needed to discuss and that there was no-one else that she could think of with whom she could talk. OK it wasn't strictly speaking a medical problem although I suppose that there was a loose connection. And so, hesitatingly she began.

I cannot go into the details, but suffice to say that it was a deeply personal matter that was bringing her both great joy and great sadness. What should she do? I certainly didn't have a quick fire answer and no textbook would have helped. It was just one of those situations where one felt both enormously privileged and humbled that someone should regard you worthy to pour out their hearts

As I reflect upon it I can't help but wonder whether GPs in the future will know something of the special experiences that my patients have granted me. Sharing their deep sorrow and joy and all that goes between. I'm saddened  to hear that GPs are increasingly striving to see fewer and fewer problems, regarding more and more consultations as rather trivial and somewhat beneath them. And hence the drive for 'alternative health practitioners' to take up the slack. My career would have been much the less without the many and varied 'non medical' problems brought to me. I hope I have helped in some small way.

Monday, 6 February 2017

Van Morrison poet of the ineffable.


A good friend recently suggested that Avalon Sunset was one of Van Morrison's best albums. Now he's released some 35 and I can't claim, to know them all well, but it is lovely, and one of his most 'spiritual'. One constant feature though of his albums is what one author has called the 'Poetry of the ineffable'. Blimey, sounds a bit fancy, what can the author mean? Well here's a brief go...

He certainly doesn't fit into neat categories, and would not identify with any one religion, although his lyrics often contain very overt Christian content. And what is this 'ineffable'?

'the ineffable. By its very definition it's a slippery word, one that is impossible to pin down by creedal statements or doctrinal catechisms, but Morrison has offered a number of clues that outline its general contours. It's the lost sense of innocence and peace that he hearkens back to again and again in his songs about an idyllic childhood in Belfast, Northern Ireland. It's being fully alive to the moment, attuned to the sense of wonder that can break through on even the grayest and most banal of days.' http://www.christianitytoday.com/ct/2012/october-web-only/van-morrison-poetry-ineffable.html

VM often expresses deep longings that there must be more to this life than merely eating, drinking, going to work, raising families and doing all the other stuff which comprises human life.  He's certainly a great exponent of human and romantic love, but also recognises that there is a 'greater love' that is available to all.
'there are dozens of songs, scattered throughout an immense and daunting catalogue, that speak of a life in search of God. There are moments of ecstatic bliss, of profound peace and assurance. There are moments of regret, of missed opportunities, of failure. "When Will I Ever Learn to Live in God?" (from 1989's Avalon Sunset) is not only a representative song title, but also a lament that will sound familiar to any follower of Christ. On the same album, Morrison offers his most straightforward gospel affirmation: 


Heals the sick and heals the lame

Says you can do it too in Jesus' name

And he lifted you up, and he turned you around
And he put your feet back on higher ground

Reach out for him, he'll be there

With him your troubles, you can share

Oh, you can use his higher power
Every day in any hour'  (ibid)
Never quench the quest for the 'ineffable'. Yep for many of us life is good, or even great (at least some of the time). And there is much satisfaction in human love. But that will only ever take us so far, and as  VM would say, 'when will we ever learn' (from When will we ever learn to live in God)





Sunday, 29 January 2017

Medicine, vinyl and me.

I'm so glad that vinyl records are making a comeback.  Like many of my vintage I kept all my LPs and its been great digging them out and playing them again. But surely CDs are better, and Spotify is amazing and so convenient. Yep I'll agree with that and confess that I'm a keen listener to Spotify. But why vinyl? Let me make a few suggestions,

1. The sleeve or covers are just great. Imaginative, clever and atmospheric. When I see the cover I immediately connect with the content, and even some memories of listening to it previously.
2. It's good to have the lyrics within the sleeve. For all the best music is enhanced by the words, and the words are given extra power by the music.
3. Vinyl just needs more engagement and effort and is all the better for that. Not always of course, but often enough to make it worthwhile. I have to physically and carefully place the stylus, and I have to get up every 25 minutes or so to change the side. How short they seem now in the age of streaming.
4. Many people comment that there is a clarity to the sound. I'm not sure about that although with the ear of faith I maybe just get what they are saying.
5. After a while vinyl shows its age. A certain amount crackling noise appears or even the sound of a fine scratch. Somehow it seems more authentic (ok at times annoying for all that).

Yea, but what has that got to do with medicine? Well treating patients is never just one dimensional. It's not just about the  surgery or the drugs, but it's about the whole interaction between the doctor, the patient and the whole team. And vinyl is not just about the music, but the sleeve, the lyrics and the engagement that's needed. In other words its more holistic. Recognising that the patient has a family, a past, a hoped for present and future, and that the patient has vulnerabilities that the doctor may not have and has a context that the doctor needs to know. And all so as to make the doctor-patient interaction more effective on both sides. Greater satisfaction for the doctor and perhaps an increased ability to cope with whatever dysfunction the patient is facing.

And what about the crackles? Gosh they are important. They remind us of the vulnerability and fragility of the human frame. Easily broken, sometimes irreparably so. And its good to be reminded of the vulnerability of the doctor. We are not superhuman. We do make mistakes. But where mutual trust and genuine holistic care exist, our patients are generally so forgiving.

Theses lines from the famous wedding hymn, 'Praise my soul the king of heaven', are so important to me,
'Father like he tends and spare us
well our feeble frame he knows.
In his hands he gently bears us
rescues us from all our foes'

Wednesday, 25 January 2017

There's always someone worse off.......

I was very moved watching this documentary on Netflix the other day. Most of us have a tendency to regard our lives as somehow more challenging or more significant than other people's. Occasionally we are caught  up short by a reminder that there is a big wide world out there where there is much sadness and suffering. And yet also much selfless bravery and 'common grace'.

We look for the day when 'everything sad will come untrue'. When justice will be everywhere experienced and there will be no more tears and sadness (The Book of Revelation chapter 21.4). Indeed we are told there that 'God himself will wipe away all eyes from our eyes'. An extraordinary tender and rather unexpected image to conjure with.

Most of us have Netflix these days. Go watch.

Tuesday, 24 January 2017

I have this hope



Lovely music here.

'In the flood or the fire your with me and you won't let go'

Lion

Last week with my wife Liz we went to watch the film Lion. It was wonderful. We probably go to the cinema about 6 times a year and I would say for 5 out of the 6 we leave feeling that we might have spent the evening doing something else. But not with Lion. Beautifully filmed and a story worth telling makes it a big hit for me.

The early scenes in which the young Surru and his brother Gurru steal coal from a slow moving train to try to raise some money for their impoverished mother are stunning and so believable. The young actors are quite brilliant.

Its the age old story of being lost and being found. Something we can all relate to. In many ways I guess we are all waiting to be found. Found by someone who loves us. Found by something that grips our hearts. Found by something that lifts us out of the mundane and ordinary.

'Amazing grace how sweet the sound that save a wretch like me, I once was lost but now I'm found, was blind but now I see'. 

Penned by John Newton of Olney and probably the most famous hymn in the world. Its long been precious to me, not least because for 8 years I lived opposite the vicarage where he penned those immortal words.


Friday, 20 January 2017

The wrong leg

It's an old gag. You know the one about the surgeon who visits the patient to tell him that there is good news and bad news The good news is that the bad leg is getting better, but the bad news is that the good leg has been amputated!

But my right leg has the problem!
Yesterday I went to my sports masseur. I'd been  training for the London marathon and felt my right calf 'go' a few days ago. After running for 4 miles the pain in it just grew and grew, so I had to stop and walk back. The masseur was excellent and really hit the spot. At the end he suggested I had some of those rather trendy strips of tape applied to my calf. I'm not entirely sure if I was just relaxed or in a very trusting mode, but after the strips were applied to my leg it wasn't until I got to my car that I realised that the tape had been applied to the wrong leg! The masseur had worked for all the time on my right calf and then rather absent-mindedly applied the strips to my left! Perhaps I thought there was some kind of magical transference going on.

It has made me reflect upon how trusting of the professional we all can be. And whilst trust is an essential part of the contract between patient and doctor, I do think it important that the patient should feel comfortable to ask if what is being suggested seems odd, or just simply wrong. In recent days I have heard a few stories of poor care in the NHS. And whilst it's easy to defend such events by claiming the system is under enormous pressure, I feel that whatever the stress of working in such a strained system we owe it to one another, that those off us working in the NHS should do our utmost. I've always tried to practice medicine in a way that would be good enough for my family and think it is no bad aim to bear that in mind with each and every patient interaction. Will we fail sometimes? Of course. Should we aim for perfection? Well no, because that its unattainable. But if I am a patient I do want to know  that the health worker treating me is on my side, and is willing to have an open co-operative relationship with me. I often find myself saying to patients struggling with long term difficulties, 'I'm sure we can make headway together'. Instilling hope is such an important part of medicine, and that needn't mean giving unrealistic goals, and of course the patient  has their part to play, but I do want to be alongside them cheering them on, answering their questions, empathising and sometime just being there.

Tuesday, 17 January 2017

Don't wait till the funeral

I'm closing in on my last few weeks at Cobbs Garden Surgery and I must say it's getting a bit emotional at times. What is very touching are the sweet and generous comments of patients as they say their farewells to me. I won't reproduce them here for fear of being accused of self-promotion. Moi? But they have been along the lines of thanking me for giving them time, and hope and help. Its really very kind. But it also feels a bit like a funeral. Why do I say that?
I guess the British way is to wait until the funeral before we express gratitude and praise for the deceased. But what a shame to wait till then. I think it was when my dear dad was dying that I realised the value of telling someone that you love them and to thank him for being a great dad. I'm so glad I didn't wait to give the address at dad's funeral before I was able to say what a lovely father he was.
We sadly live in a primarily complaints culture, but why not have a think, and see if you can be part of a counter-culture? Do those  you love and value know how you feel? Get a bit of Van Morrison eh?

Friday, 13 January 2017

'I fear me this-is Loneliness'.....Emily Dickinson.

She was a pretty single 42 year old lady and had spent Christmas Day, and the next 3 days entirely on her own. Just one brief phone call to her father on Christmas Day "when he was quite belligerent", was all the human contact she'd had through the season of goodwill.

Joy (not her real name) was talking to me the other day about her longstanding low grade depression. When asked how she had been over Christmas her eyes moistend  and it took a while for her to tell me. Fortunately her mood has picked up since then and she is trying to do her best to socialise in the new year.

How my priorities have changed as I've got older as a GP. When I started I was mainly concerned with what medical diagnosis I might be missing and what the best antibiotic might be for my patient, and yet the 'softer' subject of loneliness, poor sleep and lack of exercise now increasingly occupy my thinking when I'm trying to find a helpful way forward for the patient.

A recent very helpful article in the NY Times (which is very positive about the UK and the seriousness with which we are taking the problem of loneliness), points out the detrimental effect on general health that loneliness can have.


'Researchers have found mounting evidence linking loneliness to physical illness and to functional and cognitive decline. As a predictor of early death, loneliness eclipses obesity. “The profound effects of loneliness on health and independence are a critical public health problem,” said Dr. Carla M. Perissinotto, a geriatrician at the University of California, San Francisco. “It is no longer medically or ethically acceptable to ignore older adults who feel lonely 
and marginalised.'

So what to do about loneliness? Just a few random thoughts.

1. Admit that it is a problem, but not a weakness, in other words don't feel weak or embarrassed to admit it. Yes it may partly be self inflicted, but dysfunctional families (for which you cannot be held responsible), and bereavement, may have contributed.
2. Prevention is better than cure. Do your best to be welcome people into your home however humble it may seem to be to you. To my mother's great credit she was inviting various people of all ages, round for cups of tea +/- cake right until her death at 84 years.
3. Be friendly. Sounds trite, but to have friends you have to be friendly. Think about  Tim Keller's definition of friendship, a true friend, 'always lets you in and never lets you down'. You do have to 'let people in'.
3. Try to cultivate friendships across the age spectrum. I think this is particularly important for those of us who might be vulnerable to loneliness in old age. There are a variety of ways of cultivating this, from joining interest clubs such  as photography groups, or book clubs, to social gatherings like churches or political parties.
4. Contact support groups that exist to help the lonely such as the Campaign to end loneliness, there are some fabulous resources here.
5. Can you reach out to someone else who might be lonely? Maybe a neighbour or old school friend. I think at all costs we need to avoid the victim mentality that assumes that my problem is someone else's  responsibility. Of course if we are severely depressed and we just cannot raise the enthusiasm, then the the oft repeated refrain of 'go and chat to your GP" might be appropriate-if for nothing else, to exclude depression.  I'm not one of those GPs who think loneliness is not my concern. I might not be able to directly help, but I would hope that the GP can at least support you in accessing help, and if appropriate prescribing  for you.

If you're not lonely, give thanks God and perhaps reach out to someone else who is.

Monday, 9 January 2017

Doctors as patients-the countdown.

I know I've written about this before but a recent experience has confirmed to me just how important the consultation is-that which is at the heart of the practice of medicine.

I had to consult with a doctor myself last week. She was excellent. But in what way?

1. She expressed unhurried interest (how hard this is in an under-doctored NHS where all GPs have far too many patients.
2. She allowed me to tell my story without impatient and unnecessary interruptions.
3. She picked up on my personality and adapted accordingly. I enjoy humour and realise this sometimes is fuelled by nervousness. She went a certain way in responding to my humour. Neither ignoring nor going along with it too much. That is I think she got the balance right.
4. She was both professional and friendly at one and the same time.
5. I left with a feeling of confidence in her.

How vital human interaction is. This is in contrast to the modern trend of the so called 'millennials' who apparently want rapid service rather than the necessary slowing down that human contact requires. The manageress of my local excellent coffee shop tells me that hotels in Japan are experimenting with no staff at all in their hotels since all check in is automated and any queries are dealt with by FAQs online (presumably poorly paid immigrants are still changing the sheets). Freshly prepared meals and coffee brewing is also scorned in favour of speed. And then there is the crazy idea of self diagnosis and treatment on Google. Nah, people need people.

In my last few weeks in practice I want to remind myself that every interaction with the patient (the consultation) is important to them and that my sensitive human responsiveness is a necessary part of  helping the patients on their journey whether facing a relatively minor acute illness or something more long term.

Sunday, 8 January 2017

A father's love



Just love this song. It first penetrated my male emotional armour in the year 2000 when my dear brother John was dying. It spoke to me in so many ways and indeed carried me though a difficult time. Certain phrases in the song just seem to trigger an immediate sense of the sheerness goodness,  mercy and sweet kindness of God.

Father's love....as a dad myself I'm aware of the intensity of love and of any willing sacrifice needed that I would make for my girls. And God feels like that about me. Blimey.

Who am I?.....If I'm honest I vary in how grateful I am for God's love. Often I take it for granted, but sometimes-and sweet times they are too-I'm humbled and overwhelmed. Why, why, why should he love me?  Though you know all my ways, yet your love for me endures....as Tim Keller says, 'there's nothing I can do to make God love me more and nothing I can do that will make him love me less'. Phew!

King of love..Shepherd...friend......phrases all so evocative. For a king to be a friend, for one who cares for me in the same way that a good shepherd cares for his sheep. Being a Christian is not a chore but a privilege.
I praise you for your faithfulness O Lord,
And for your Father's love that never fails
Who am I the king of love may shepherd is,
who am I that you should call me friend?
Though you know all my ways, yet your love for me endures.
When I think of all the things, O I love you more and more
I praise you for your faithfulness O Lord,

Monday, 2 January 2017

The countdown

So just 56 days before I retire from practice in Olney having started January 1983. I'm not sure I can quite believe it but the days are racing away now.

Looking back at my early diary entries for January 1983 I read that a couple whom I had asked to come in to review their medication thought that I was 'experimenting on them'. And another couple delivered a hand written note to say that I was 'losing in interest in them'. Blimey,  I wouldn't have thought I would have had time to lose interest having only started in the practice a few days before. Ah well I guess I've only written about those that weren't impressed with the 'new young doctor'-a mere pup at 29 years of age!

My second day in practice saw me having 12 visits, which was unusual for then and virtually unheard of now. I'd started at 8.30am and did surgeries and visits until 10.30pm. Fortunately I wasn't called during the night.

At the end of my first week on the Friday evening some parents came to the surgery carrying in their unconscious 7 year old daughter. It transpired she was in a diabetic coma, but not having previously been diagnosed with diabetes. She survived but went on to become blind in her late teens. A pretty girl with a challenging life ahead of her.  I eventually lost touch with her when she was in her mid twenties.

As I read the memories start to come back. The tatty old surgery, the shelves buckling under the weight of medical notes and the old receptionist  who regarded me as a bit of a young upstart. Regrets?....I have a few and yet....gosh getting all sentimental. It'll be a kind of bereavement when February 28th comes but as Tennyson wrote after feeling keenly the loss of a friend,


I hold it true, whate'er befallI feel it when I sorrow most;  
Tis better to have loved and lost Than never to have loved at all.





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...