Thursday, October 22, 2009


Both Moon and Pleiades are gone,
The mid-night hours crawl on and on,
And I lie down to sleep, alone.

These are not my words, but a rather rough and ready translation of a poem that speaks across two and a half millennia by the "divine" Sappho. It talks of quiet solitude, loneliness and above all of insomnia. O.K. I'm inferring the loneliness, but the rest is there, and the sentiment is a raw and immediate now as it was then. She was writing in a time when being awake in the middle of the night meant lying hour after hour in engulfing darkness, waiting out the turn of the earth, longing for either the light of dawn or the relief of sleep.

Anyone who has ever had problems sleeping will sympathize. At least now we have it a little easier. We can have light at the flick of a switch, we can divert our ears from the slow sure thump of our pulse beat with tunes on our ipod, or all night poker / roulette / bingo on the telly. We might even get back up, rifle the fridge for tit-bits, or boot up the "machine" and surf away the hours to daylight.

And for a night or two any or all of the above can be a comfort. But after longer than this, the latter day insomniac will end up feeling every bit as wretched as the poet of antiquity and the myriad fellow sufferers down the years inbetween. Small wonder then that some of our oldest remedies have been hypnotics in one form or another, or that they remain among the most commonly prescribed items even now. Yet the real remedy for our shared affliction comes more often from within. If we're not sleeping then something is preventing us, and unlocking what that is, and processing it holds the key to restoring calm and rest. That and switching to De-caff.

Easy, eh?

Thursday, October 15, 2009

Mirror mirror

Last week saw the annual ritual that was my appraisal. In past years I have tried to spice this up by soliciting buzzwords to shoehorn into the conversation. This year I thought it was time I grew up a bit, so I tried to do this one cold. My appraiser this year was a colleague from somewhere the far side of Felpersham, and a year or two older than myself. We spent an afternoon dissecting the year just gone and trying to read the runes for the year to come. As with all public servants dependent on the public purse we expect to be asked to do more with less, but we both agree we've been here, or somewhere pretty close to it before.

Overall then, not too bad, and although I missed the opportunity to inject the odd piece of inappropriate jargon or old rock lyric into the conversation, we parted on good terms, we even got round to talking about poor Albert. And I've got my buzzword for next year from the process itself. Indeed every GP in the country will have the same buzzword ever after as we progress from appraisal to licensing and re validation, and that word will be "reflection". I'm thinking of having a silver spandex suit made up for next time, or a top hat adorned with mirrors like Noddy Holder used to wear.

I know I'm getting on a bit, and I've also been known to wax a bit cynical from time to time, but the new system, in its current format (which may still change) will have us recording every educational activity we pursue at least twice, and preferably three times. First to show we did it, then to show we thought about it, then if possible, to show that when we'd thought about it we did what we thought we ought having done it, and thought about it. Clear?

It's absolutely right and proper that we hold our practice up to scrutiny, and that we try to show that we are continuing to strive to be the best that we can. I'm just not quite sure this new endlessly recursive method is entirely the best. Still it's a very small price to pay for the privilege of holding a licence to practice medicine.

The only other problem I have, is that all this professional introspection can rather become a habit, and it's starting to spill over into life outside the surgery right now. I'm discovering I've got a little way to go to becoming a zen master.

Time to dust off the old relaxation technique methinks, well after a nice fruity claret anyhow.

Tuesday, October 13, 2009

Memento Mori

I have a photo on my wall of a young man. He wears a serge uniform and a sam brown belt and stands in front of the engine of his SE5a fighter aircraft. Every now and again someone asks me who he is and I tell them. Only twice in the fifteen years he's been up there has anybody come in and told me who he is before asking me why he's on my wall.

He's no relation, though I would have been proud to claim him as one. He is my "memento mori". His presence reminds me that whatever I do, or do not do, time will march on. However much I triumph or fail in this life, in a couple of generations, or less, none of it will amount to much. In his day poor Albert was rock-star famous. The picture I have of him is one of a few iconic images that are well know to aviation historians, and yet, in fifteen years, and with all the thousands of people that have passed through my room, in that time only twice has he been correctly identified.

He tells me that all you have to do is keep turning up, climbing into the hot seat and doing the best you can until time or circumstance take it away from you. And he tells me that however important, famous or extra-ordinary I might feel, were I to come back in 50 or 100 years people would have a problem remembering I'd even been here.

It's perhaps a bit of an odd choice, but this aviator of the last century helps to keep me grounded, and at the same time, in a very small way I help to keep his memory alive. But even when neither of us are here and none can recall us, life will go on for those that come after. And this can sometimes be a comfort.

Thursday, October 08, 2009

Once upon a time...

This post is in reaction to a sudden upsurge in followers, two of whom, I think, are still in school and looking to a career in medicine. Now I know this blog has violent mood swings about the whole GP / NHS experience, so I'm a little humbled to think they might be interested in what I have to say.

So kids, if you're still out there this one's for you.

A generation ago (at least) a thirteen year old lad came to a sudden, astonishing realization. He wasn't suited for the Army as he'd always imagined -- too independent of thought and slovenly of habits. No what he wanted to do even more than blow people apart, was to learn how to put them back together again. So suddenly he had to transform from an indifferent classics scholar to a scientist. Still at thirteen not too hard to do, and so by O level he had made up enough ground to pass the sciences well enough to go for A levels. (I won't tell you my grades-- you'd laugh. But O levels really were harder than GCSE's or so I like to kid myself)

A levels on the other hand were something else again. Biology I could do. After all it's a "talky" "feely" sort of a science. Chemistry I just about grasped, but Physics was so far beyond me it was embarrasing. In the end I scraped some kind of a grade for it, but the thing that saved my bacon was a biology "Special Paper" or "S level" designed for the brightest and best candidates to really show off what they knew. Thanks to a brilliant tutor and a couple of lucky questions I aced it.

Which was just as well. I'd spent a school career mooching about in the cadets, shooting the odd rifle and fiddling with the odd radio (boys toys for the soldier wannabe) but couln't do sport, played no musical instrument and had no meaningful outside interests. I did spend a month one summer working in a Cheshire Home and learning a heck of a lot about "caring" and "disability", and I had a summer job in the NHS recycling old X-ray plates (yes I know they're all electronic now, but back "before the flood" they were proper photographic plates and could be recycled to reclaim the silver). I'd also managed to witness an autopsy thanks to my Dad, and talk to a professor of nephrology who knew my granny. And that, dear readers, was the sum total of my preparedness for the wide world of medicine. That and Alan Alda in M*A*S*H, and the "Doctor in the House" series off the telly. (You'll probably need to ask your folks-- closest I can get would be Zach Braff, which isn't all that close to be honest).

Then I went to med school, on a grant, topped up by the generosity of parents and grandparents, and five years later emerged the poised polished clinician you see before you now, and my overdraft for my five years of student life was cleared by my first paycheck.

When I look at the sacrifices this generation has to make just to be in the running to get to med-school, and at the debt they can expect to leave with on graduation I am filled with admiration that they even want to try. So to any and all of you prospective medics out there who stumble across this, I wish you all every success and hope that you have as much fun in your chosen profession as I have had thus far in mine.

Thursday, October 01, 2009

"This is the end.....

.... beautiful friend."

It's dark. Insects chirrup in the underbrush. Muffled explosions, miles off, punctuate their fretful murmurings. The night belongs to Charley.

Somewhere a jangling guitar picks out a sparse twanging tune, a handful of notes at a time. Drum and organ whisper underneath a plaintive vocal that speaks of loss, despair and dark dark urges.

Yes, beautiful friends, we are in a far from happy place, and the sense of foreboding if anything is building out here in the boonies. And I know I'm flogging the metaphor to death here, but I can't help it. Somehow Jim just speaks to me right now.

Anyhow, now that I've got your attention, I'm not really talking about a war a generation ago and half a planet away. I'm bemoaning my plight here in Ambridge as usual.

And why?

Permit me to explain.

Exhibit A; A policy statement from a health minister, repeated I believe at party conference that patients will be free to register with a GP anywhere they damn well please and bu**er the geography. Now much as I would welcome the chance to care for patients of all origins and ethnicities, registering patients domiciled on Orkney would seem a bit stupid. Yes I know busy commuters and politicians have a hard time of it prioritizing their health above their oh so important trough snouting... er, working activities, but freedom to register anywhere, I mean really have they no common sense? Anyone who has any experience of front line primary care will tell you this notion is a junkies charter. Any addict has just been told he/she is free to roam the country at will registering here, there and everywhere, and demanding that all important codeine / methadone / valium script. Even if they only manage a week's worth everywhere they register, in just one day on an average inner city bus route, they should be able to score enough gear for a month of Sundays. Bloody brilliant. Sorted! (Or so I believe the vernacular has it).

Exhibit B; Choose and Book. An IT based appointment booking system that will allow a patient to book their own appointment with a specialist they choose at a time and in a hospital of their choice. Sounds fantastic. And when it works, is fantastic. When it works. But how do you know which specialist to choose. Or which hospital to go to. If only there was somebody you could ask...

Exhibit C; Two Week Wait. Patients suspected of having a cancer diagnosis should have to wait no more than two weeks to see a specialist. Quite right too. And again, to be fair, when it works it works well. But witness a call I had today. Two days ago I made such a referral, on the same day I saw the patient concerned. Today the "Two Week Wait" clerk is on the phone declining to accept my referral. They've offered the patient an appointment but she's going to be away for a week starting 13 days from now and won't be able to take it, so please would I not refer her until she's back, in three weeks time. Only the cancer czar has told them they've got to book the appointment within 14 days and they can't..... "Now just supposing I do this, and then in three weeks when I am permitted to re-refer, you still can't give her a slot inside 14 days, what would happen?" I ask politely. "Well then we'd have to refuse your referral again." So no, sorry I'm not taking my referral back, it needs sorting.

Believe it or not there are plenty more exhibits. And that's before Gordon, or Dave, or even (should pigs take wing) Nick start wielding the axe we all know is coming.

If I'm sounding a tad cynical today I apologize, but that last little circus act has really got to me and reading the runes things are looking pretty bleak.

Still, maybe they'll look better after a cup of tea eh?

What do you think?