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...