Some musings

http://www.desiringgod.org/articles/historical-evidence-for-the-resurrection

FOOLISHNESS – LAW AND GOSPEL

Over the last couple of weeks I have, on more than one occasion, made something of a fool of myself. Perhaps you’ve noticed! I hope so, because that was at least partly my intention when I donned a pink wig and went public with my ludicrous attempt at singing. By that, and other nonsensical endeavours, I wanted to gain your attention so that I could make you aware that there is a GP post up for grabs at my place of work. It’s important for me that people know this because it’s important for the practice that the position is filled. As such I suppose you could say that, by acting in ways contrary to social norms for the greater good of the organisation in which I work, I have been a fool for East Quay Medical Centre.

But important though it is for any potential new doctor to be aware of our job vacancy, the truth is that there are other news stories that are far more important for people to be aware of. For these continue to be difficult days, not only at an international and national level, but at a personal level too. For some these days are particularly dark, and for some the future looks darker still.

And so rather than being a fool for East Quay, I want now to follow in the footsteps of the apostle Paul who, on account of his willingness to suffer for the sake of the gospel, once described himself as a ‘fool for Christ’ [1 Corinthians 4:10]. Now don’t get me wrong, I don’t expect to be persecuted for writing this in the way that Paul was, but being open about my faith in God and my desire to follow Jesus is something that some consider inappropriate in the public square and may cause one or two others to roll their eyes and consider me something of an embarrassment. But like Paul, I am not ashamed of the gospel believing it to be the power of God for salvation for all who believe. [Romans 1:16]

So what exactly is meant by the ‘gospel’, a word that simply means ‘good news’? This is an important question to ask because the gospel is something that is often misunderstood, even by those who regularly attend church. Too many confuse the law with the gospel and end up believing that, to be right with God, they need to keep all of his commandments and only by being sufficiently successful in that endeavour will they earn their way into heaven. Now don’t misunderstand what I am saying here – God’s law is good and we should indeed strive to keep it, but the gospel is the good news that God has done something to rectify the situation when we inevitably fail to do so.

Even so, many of us do seem intent on living a life of continuous struggle. And so, not content with trying to satisfy the just requirements of God’s law, we burden ourselves further by attempting to present ourselves as better than we really are to those whose love we crave. We live in a world that constantly demands that we are awesome. And what a burden this is for those of us who know how far short we fall, who recognise our weakness and our need for help.

With this in mind I have noticed lately a tendency for some to encourage friends who are facing great difficulties with the words ‘You’ve got this’. I don’t doubt that such expressions are well intentioned but I wonder how they are received by those who feel lost, confused and powerless, those who feel out of control and are all too well aware that they haven’t ‘got it’ at all. At such times, rather than being told that we can do what we know we can’t, how much better it would be to hear that what we need to do has already been done for us by somebody who really can?

And that, in short, is the gospel. The good news is that God has done what we can not.

But what exactly has God done? To some the answer may sound like more foolishness, at least it did to those who, back in the first century when Paul was writing, considered themselves wise. But as the apostle wrote back then, ‘the foolishness of God is wiser than men, and the weakness of God is stronger than men’ [1 Corinthians 1:25]. What Paul was referring to was the cross on which Jesus was crucified. For this was an act that, despite its apparent foolishness and weakness was the means by which God wisely chose to show his strength. For violent and bloody though it was, the crucifixion of Jesus Christ was the means by which the penalty that was rightly ours was paid. It was on the cross that a righteous God’s need for justice was satisfied, and our peace with God was secured.

The law then reveals to us what God demands – demands that we cannot keep however hard we try. In contrast, the gospel tells us that dispute our sinfulness, God loves us, and sent his son into the world to save us. The gospel is the news that by living a perfect life, Jesus kept the law that we could not, it is the news that a great exchange has taken place such that we are robed in Christ’s righteousness even as our sinfulness is laid on Jesus, it is the news that, as Jesus allows himself to be crucified in our place, bearing there the punishment we deserve, we are counted right with God. Some will indeed say this is foolishness, but it is through such apparent foolishness that we have been redeemed and a great salvation has been a secured, one that, as well as guaranteeing the forgiveness of our sins, promises a future devoid of sickness, sadness and death. [Revelation 21:4].

How then should we respond to this good news. A story Jesus once told might help. This is what he said in Luke 18:10-14.

“Two men went up into the temple to pray, one a Pharisee and the other a tax collector. The Pharisee, standing by himself, prayed thus: ‘God, I thank you that I am not like other men, extortioners, unjust, adulterers, or even like this tax collector. I fast twice a week; I give tithes of all that I get.’ But the tax collector, standing far off, would not even lift up his eyes to heaven, but beat his breast, saying, ‘God, be merciful to me, a sinner!’ I tell you, this man went down to his house justified, rather than the other. For everyone who exalts himself will be humbled, but the one who humbles himself will be exalted.”

Jesus is describing two types of people. The Pharisees were the religious types who prided themselves on how well they kept the law. The one spoken of in this story seems particularly pleased with himself and clearly thinks God should be impressed with him. In contrast the tax collector, one of that group of people hated even more in Jesus’ day than they are in ours, recognises his sinfulness and, rather than trusting in his performance, appeals instead to God’s mercy and his willingness to forgive. When Jesus says it was the tax collector who was justified, he is using a word that means that it was he who was counted right before God. And so you see what Jesus is saying – since nobody but Jesus himself was truly good, it is not by keeping the law that we are saved. On the contrary, rather than reaching a certain level of awesomeness, it is by humbling ourselves before God, by recognising our weakness and our need for mercy, that we are reconciled to the God who really does love us in the way we all so long for.

I for one am pleased that this is the case because I haven’t got what it takes. The truth is I haven’t ‘got this’ – but I am glad that God has. Perhaps you will consider it foolishness on my part, but rather than pretend that I can cope, I am content to leave things in the hands of the one who really does know what he’s doing. This of course doesn’t mean that everything in this life will necessarily work out the way I would like, after all, as the old hymn goes, God works in a mysterious way his wonders to perform. Even so, in difficult days it helps me to know that, because he is good and because he is strong, what God ultimately brings about really will be for the best, irrespective of how unfathomable current circumstances might sometimes be.

And I hope this might help you too. For God can be trusted and those who do will surely find the foolishness of God really is wiser than the wisdom of man. God really does ‘have this’ and he has you too – safe in his everlasting arms.

Quote generally attributed to John Bunyan, author of ‘The Pilgrim’s Progress’

The evidence for the resurrection is well documented and a couple of links follow for those interested:

https://biblicalstudies.org.uk/article_resurrection_anderson.html

To read ‘On being confronted by the law’, click here

To read ‘The “Already” and the “Not Yet”’, click here

To read ‘Looking back to move confidently forwards’, click here

To read ‘on the FALLEN and the FELLED’, click here

To read ‘Everything is alright’, click here

To read ‘Faith and Doubt’, click here

To read ‘On NOT leaving your comfort zone’, click here

To read ‘Water from a Rock’, click here

To read ‘The Resurrection – is it just rhubarb?’, click here

To read ‘The Sacrifice of Isaac – Law or Gospel?’, click here

To read ‘Rest Assured’, click here

To read “Why do bad things happen to good people – a tentative suggestion”, click here

To read “Suffering- A Personal View”, click here.

To read ‘Good Friday 2022’, click here

To read “Easter Sunday – 2021”, click here

To read ‘Real Power’, click here

To read “Luther and the global pandemic – on becoming a theologian of the cross”, click here

To read ‘T.S. Eliot, Jesus and the Paradox of the Christian Life’, click here

To read ‘True Love?’, click here

To read “Hope comes from believing the promises of God”, click here

To read, ‘But this I know’, click here

To read ‘I’ll miss this when I’m gone – extended theological version’, click here

EAST QUAY MEDICAL CENTRE – MADNESS

Here’s a link to a job advert:

https://www.bmj.com/careers/job/158777/salaried-gp-gp-partner-6-sessions-east-quay-medical-centre/

The lyrics appear a little further down the page but here, as a test for your endurance, is a link to the song being sung.

Here’s that link to the actual job advert again:

https://www.bmj.com/careers/job/158777/salaried-gp-gp-partner-6-sessions-east-quay-medical-centre/

And you can find out more about East Quay Medical Centre here.

http://www.eastquaymedicalcentre.com/

If you know anyone who might be interested in the post, do please feel free to share!

Links to other medically themed songs can be found at the bottom of this page!

EAST QUAY MEDICAL CENTRE – MADNESS
To the tune of ‘Baggy Trousers’

Oh what fun we have
Tim, he chairs the LMC
Not my cup of tea
I say rather him than me
Then there’s Sally who
Likes to swim, and run and pedal
Won for team GB
A golden medal

EQMC, EQMC, EQMC,
EQMC, EQMC, EQMC
EQMC, EQMC, EQMC
EQMC, EQMC, EQMC,
EQMC, EQMC, EQMC

We’ve got a brand new GP Vacancy*

GP, GP, We’re so in need of you*

https://www.bmj.com/careers/job/158777/salaried-gp-gp-partner-6-sessions-east-quay-medical-centre/

ELEANOR RIGBY IS NOT AT ALL FINE

‘Eleanor Rigby
Picks up the rice in the church where a wedding has been
Lives in a dream
Waits at the window
Wearing the face that she keeps in a jar by the door
Who is it for?’

Eleanor Oliphant may be perfectly fine – but Eleanor Rigby is not. Maybe you’re not either. Because Eleanor Rigby is not alone – there are far too many like her.

The weekends don’t help. Rather than being something to look forward to, they serve only to heighten the sense of isolation that you feel as the long hours drag by with you seeing nobody from the end of one working week to the beginning of another. Hopes of ever meeting somebody and settling down seem like an unattainable dream.

And so, as the loneliness continues, the unhappiness grows. The more unhappy you become, the greater the anxiety you feel at what it would take for the sadness to end until you find, in time, that the more you long for the loneliness to end, the more you long to be alone. You wonder what the point of it all might be and conclude that there is no point at all.

Alone in your room, imagining the happiness of others, it’s easy to sing silently along to The Velvet Underground,

‘All the people are dancing
And they’re having such fun
I wish it could happen to me
But if you close the door
I’d never have to see the day again’

It’s hard to know what to do in such circumstances, not because you lack intelligence, on the contrary you have learnt well what the world has taught all too well, that isolation is good and that we all have to make it on our own.

And so, as I talk to such people, I sense them whispering, ‘I don’t know what to do’. And too often, like them, I find myself stuck, not knowing how to answer. When we eventually part, as I too abandon them to their solitude, their sadness surrounds me and increasingly it becomes my own. ‘

All the lonely people – where do they all come from?’

Loneliness, and the accompanying anxiety that is so often both its’ cause and effect, is a common problem and, to those who experience it, it is both crippling and overwhelming. And the problem is getting worse and will, I suspect, continue to do so for as long as society persists in fragmenting and we carry on being encouraged to live too much of our lives online. Because a life lived virtually is a life that isn’t quite complete – and a life that isn’t quite complete will feel, to many, like a life that is no longer worth holding on to.

Something is missing from our all too virtual lives, something has been lost. And that something is ourselves We all so long to be found.

‘Will you search through the loamy earth for me
Climb through the briar and bramble
I will be your treasure’

So run the opening lines of Johnny Flynn’s theme song to the TV comedy series ‘Detectorists’. If you haven’t seen it then do yourself a favour and give it a go. It’s about two friends, Andy and Lance, who spend all their spare time metal detecting. To be honest, not a lot happens. But as what doesn’t happen unfolds, a wonderful friendship between two people is portrayed, one which one can’t help feeling is something that is precious beyond words. Something to be envied.

In one scene Lance is talking to another character about his years of metal detecting. He says,

‘This was our escape from the rude world, the madding crowd…Do you know how often we find gold? Never. We never find it. And that’s what we’re looking for. We don’t say that. We don’t say that we’re looking for gold. We pretend we’re happy finding buckles and buttons and crap, but what we’re hoping for is gold.’

Likewise, we too all need to sometimes stop our searching for things that don’t really matter and see what of value lies right in front of us, but which we so easily overlook. Good relationships are the basis for happiness – if we have them, we are fortunate indeed. We should not underestimate their worth.

Despite having no interest in angling, another program that I have enjoyed immensely is ‘Gone Fishing’. Like ‘Detectorists’, whilst precious little takes place, we see a genuine friendship in action, this time a real one, between Paul Whitehouse and Bob Mortimer. They are long standing friends who have known what it is to support one another through the difficulties they have each known in their lives. And again, it’s genuinely heart warming to watch.

Good relationships enable us to carry on when life seems to be falling apart around us – if we have them, we need to be careful that we nurture them well. I have often thought that it is less important what we do in life than who we do it with. Friendships can and do make all the difference but they need time to develop, time that is spent together, time that our frenetic lifestyles too often don’t afford.

Given that humans are meant to live in community, it is no surprise to learn that loneliness is bad for us. It is of no surprise to anybody that individuals who experience prolonged loneliness are liable to suffer low mood and anxious thoughts. But it is not solely in terms of our emotional wellbeing that loneliness has adverse effects. Less appreciated is the fact that loneliness is also bad for our physical health with those experiencing it having higher rates of cardiovascular and cerebrovascular disease as well as poorer cancer outcomes. It has even been suggested that loneliness is as bad for us as smoking 15 cigarettes a day.

The truth is that loneliness is deadly. Furthermore there a lot of it about. Loneliness in the UK is at epidemic levels with, according to the Office of National Statistics, 2.4 million adult British citizens knowing what it is to be lonely. So if there are so many lonely people, and if loneliness is so bad for our health, why don’t we give it the same attention that we give to such things as blood pressure, smoking and cholesterol levels?

Part of the answer, perhaps, lies in the fact that, with no pill available that can take away the isolation, there is no money to be made from these individuals who live on the edge of society. And where there is no money to be made, there is no incentive for those who decide what our priorities should be to make loneliness one of things that is considered important enough to tackle.

But there is another reason. And that is that lonely go unnoticed – unless we are forced to see, they are so easily overlooked. ‘

‘Eleanor Rigby
Died in the church and was buried along with her name
Nobody came’

For me at least, far more than the physical consequences of isolation, it is this, the enduring sadness that inevitably accompanies loneliness, that concerns me most. The problem of loneliness is not, of course, one that can be solved by any single individual, it is all of society’s responsibility, but even though most of those affected will never dare to ask us for our help, we should, I think, be conscious of both the problem and it’s invasive and malignant consequences.

And so we must always keep asking the question, ‘

All the lonely people – where do they all belong?’

Because, somehow a place for them has to be found. But how?

Personally, faced with someone who is desperately lonely, I admit to sometimes hearing again the words. ‘I don’t know what to do’. Only this time it is me who is whispering them quietly to myself. It isn’t easy to find ourselves not knowing what to do, it is part of what makes it difficult for those of us who are – or were – doctors to break bad news to our patients, it’s part of what makes it hard for us to tell them that there is nothing more that medicine can offer.

But telling someone that we can’t do anything more for them as doctors doesn’t mean that we can’t do more for them as individuals – we don’t have to leave them alone just because we can’t solve their problem.

In ‘Out of Solitude’, Henri Nouwen wrote,

‘When we honestly ask ourselves which persons in our lives mean the most to us, we often find that it is those who, instead of giving advice, solutions, or cures, have chosen rather to share our pain and touch our wounds with a warm and tender hand. The friend who can be silent with us in a moment of despair or confusion, who can stay with us in an hour of grief and bereavement, who can tolerate not knowing, not curing, not healing and face with us the reality of our powerlessness, that is a friend who cares.’ ‘

‘All the lonely people, where do they all belong?’ The answer, surely, is with friends. Though it may be the case that sometimes we can do no more than be a friend who cares, a friend who cares may be all that we are needed to be.

Because, when we do what may seem to be nothing very much, that is when we may actually be doing a very great deal indeed. Sometimes we need to stop being those who disappear when they cannot help and become instead the individuals who, when they don’t know what to do, know how much it can help to simply stick around. For as long as it takes for the one who is lonely to become, perhaps, somebody’s ’very special one’, to become, perhaps, somebody’s treasure.

Listen here to Johnny Flynn singing the title song of ‘Detectorists’

Related blogs:

To read ‘An Audience for Grief’, click here

To read ‘Life after Life’, click here

To read ‘On not remotely caring’, click here

To read ‘Contactless’ click here

To read ‘The Medical Condition – or Hannah Arendt is completely fine’, click here

To read ‘The Life I Lead’, click here

To read ‘General Practice – still a sweet sorrow’, click here

THE LIFE I LEAD

Some while ago I was fortunate enough to be sat in Exeter’s Northcott Theatre to see the opening night of ‘The Life I Lead’. It was a brilliantly written play by James Kettle performed single handedly with equal brilliance by Miles Jupp.

Through a conversation with the audience, it told the story of the life of the British character actor David Tomlinson best known for his portrayal of Mr Banks, the father in the Walt Disney film version of ‘Mary Poppins’. It was a warm and gentle two hours which managed to be seriously funny as well as poignant and moving. It left those watching with a genuine affection for a man who few will have previously known much about.

I’ll not spoil it for those who may yet go and see it but, suffice to say, the play revealed that behind the genial public image, Tomlinson’s personal life, though generally happy was not without tragedy – he was a man who had to live with sadness.

Tomlinson is not alone in having to bear the inevitable sorrows that come as the years pass. Whilst continuing to live and work, attending to the everyday and endeavouring to find happiness, meaning and satisfaction, we all, to a greater or lesser extent, have to endure grief.

In that respect, the performance was made more poignant still from knowing that, as he portrayed Tomlinson so perfectly, Miles Jupp was himself carrying a grief of his own, having lost to cancer, less than a week previously, his friend and colleague, comedian Jeremy Hardy. I hope Jupp was able to enjoy performing despite the sadness he was no doubt still feeling – and appreciated the very warm applause that he received when the show was over.

If he did, then he was not so different from me who was also able to thoroughly enjoy the show, laughing frequently, despite my own ongoing sadness regarding the sudden death of a friend of mine just four weeks previously.

The evening left me reflecting once more how few lives are devoid of tragedy, that life for most is a mixture of the good and the bad and that even when sadnesses come thick and fast, happiness can still be present, intermingling alongside the sorrow.

Life then can, and does, go on, a complex mix of fortune and disaster. Such was the life that Tomlinson led, such is the life I lead and such, perhaps, is the life that you lead too.

T. S. Eliot was right when he wrote: ‘People change and smile: but the agony abides’. I saw it all the time when I worked as a GP, when a little scratching beneath the cheery facade would all too readily uncover a back story to my patients’ lives that I would otherwise never have known about and without which I could not possibly begin to fully understand their presentation.

Why did that woman burst into tears quite so readily over a relatively modest degree of back pain when she consulted that morning? What hidden pain was behind her presentation? What sorrow was she bearing, possibly alone?

It’s sure to have been there because ‘everybody hurts’.

I met Jeremy Hardy once. He was performing his stand up show in Taunton many years ago and I went to see him one evening with a friend who was simultaneously on call for a local GP practice. Those were the days when one could, if covering a small practice population as was he, risk combining an evening on call with a trip to the theatre – provided, that one was careful to position oneself in close proximity to an exit.

Predictably enough, my friends mobile went off and as he sloped out to attend to the sick, Jeremy Hardy took the opportunity to extend his routine by ten minutes with a good humoured berating of anyone who would allow their phone to ring in such a setting. My friend made it back in good time and, having enjoyed the rest of the performance, we were able to indulge in a post show drink in the bar together.

Jeremy Hardy was there too, amiably chatting with anyone who cared to spend time with him. My friend’s phone went off once more and, realising he was a doctor, Jeremy Hardy had a brief chat with us, apologising for his on stage criticism and wishing us well. He seemed to be a genuinely warm and friendly person and I am sorry that no longer entertains us with his fine sense of humour coupled with the earnestness of his politics.

Dying at the age of just 57, Jeremy Hardy no doubt also knew what it was to experience tears amid the laughter.

Sadness then, is universal, even in the happiest of lives. The causes are many, but include both the grief felt for things which are lost – the regret of the broken relationship, the missed opportunity, the faded dream – and the sorrow resulting from the fear that the future will bring no relief – the loss of hope itself. And then of course there is the sadness that results from the unhappiness of others, the misery of those we love.

Many will be familiar with the words of the psalmist who wrote, ‘Weeping may tarry for the night but joy comes in the morning’. I don’t doubt the truth of these words – even so but for some the night has already been long and the day still seems an eternity away.

Elsewhere in those ancient writings are chronicled the trials of Job and the ineffectual efforts of his comforters who needed to learn what we too must appreciate – that sometimes it is best to simply ‘weep with those who weep’ rather than to try to argue them out of their sadness or, worse still, point out to the one who is unhappy the mistakes we think they have made to bring about their misery.

Regardless of whether we believe in God, we can, I think, agree that there is wisdom here.

Regret and sadness have much in common.

In my first year as a GP Principal I recall one Sunday morning visiting a patient who had had a few days of severe diarrhoea and vomiting. He appeared sufficiently dehydrated to require admission and I requested an ambulance to attend, not immediately, as I was soon to regret, but within the hour.

There was, uncharacteristically for those days, some delay in the ambulance attending, and sadly the patient suffered a cardiac arrest and died on route to hospital.

The next day I chatted to my partners about the case. All were supportive and quick to point out that they felt that I had acted appropriately and that the outcome would likely not have been any different even if the ambulance had attended earlier.

But the response that helped me most was that of my senior partner who simply acknowledged that it was tough when things went wrong and related an incident when he had regretted a judgement he’d made some years previously.

That such an experienced and respected GP could ‘regret with those who regret” was very comforting for me.

We are all flawed – even the most experienced make mistakes – mistakes which may be regretted for years but from which, having honestly acknowledged them to both ourselves and those affected by them, we can, none the less, learn much. Perhaps it is even true to say that mistakes are in fact necessary if we are to become the more experienced and better people we desire to be.

Experience comes over time so perhaps it is older folk who recognise this most. Perhaps they are more accepting of their mistakes and are more used to knowing at first hand what it is to experience the associated regret. Just as Abraham Lincoln suggested that the old have come to ever expect sadness, so older people have perhaps come ever to expect regret.

If then mistakes and regret are an inevitable and necessary part of what it is to be human, perhaps sadness is too. Though for the most part I am happy, there is still a sadness that sits alongside my happiness – a sadness which sometimes is easier to feel. That, I suspect, is a feature of the lives we all lead.

But if mistakes and regret have the capacity to make us better people, then maybe sadness has the capacity to make us better people too.

Rather then than trying to constantly avoid sadness and, when it does make it’s inevitably unwelcome appearance, attempting to rationalise it away, perhaps we would all do well to learn to accept life’s sadness as a ‘severe mercy’ – and allow our lives to be paradoxically enriched by it’s presence.

If so, I hope I can become that wise.

To read ‘On Gratitude and Regret’, click here

Other blogs related to Films, Plays and TV Series:

To read ‘Life in the Happy Valley’, click here

To read ‘I’ll miss this when I’m Gone’, click here

To read ‘I’ll miss this when I’m gone – extended theological version’, click here

To read ‘Somewhere over the Rainbow’, click here

To read ‘When the Jokes on You’, click here

To read ‘Three Chords and the Truth’, click here

To read ‘With great power…’, click here

To read ‘An Audience with Grief’, click here

To read ‘The Dig – it’s well worth it’, click here

To read ‘Do You Hear The People Sing?’, click here

To read ‘Life after Life’, click here

To read ‘A Dream if an Antiques Riadshow’, click here

To read ‘Brian and Stumpy visit the Repair Shop’, click here

To read ‘The Great Cricket Sell Off’, click here

To read ‘I’m a GP…get me out of here!’, click here

To read ‘Mr Benn – the GP’, click here

To read ‘A GP called Paddington’, click here

To read ‘Scooby Doo and the Deserted Medical Centre’, click here

To read ‘Paddington and the Ailing Elderly Relative’, click here

To read ‘Dr Jonathan Harker and the post evening surgery home visit’, click here

To read ‘Bagpuss and the NHS’, click here

To read ‘Jeeves and the Hormone Deficiency’, click here

To read ‘Scooby Doo and the Deserted Cricket Ground’, click here

To read ‘General Practices are Go!’, click here

To read ‘A Mission Impossible’, click here

To read ‘Vanity Fair’, click here

To read ‘Measure for Measure – Appraisal formAppraisal’, click here

To read ‘Eleanor Rigby is not at all fine’, click here

To read ‘The State of Disrepair Shop’, click here

GP, GP – WE’RE SO IN NEED OF YOU!

Here’s a link to a job advert:

A successful advert should be a) eye catching, b) memorable and c) capable of generating some excitement for the thing which it is advertising. I’m not sure the above is wholly successful in those three endeavours!

And so, last week, in a desperate attempt to attract a new GP to East Quay Medical Centre in Bridgwater, I drew inspiration from the Wurzels in the hope of relaying something of the rustic charm that is to be enjoyed by any who make their home in this beautiful part of the country. [You can read of that by clicking here] Unaccountably, however, channeling Somerset’s finest musical ensemble doesn’t appear to have cut the mustard and, seven days on, the post remains unfilled! I know, unbelievable isn’t it?!.

In keeping with my Scottish roots, therefore, it’s a case of ‘If at first you don’t succeed, try, try and try again’. And so this week I’m upping my game and, rather than inflicting on you something which might be considered a little parochial, have chosen instead to offer up a more upbeat and ‘out there’ classic!

The song is entitled ‘GP’ and is a take on Blondie’s 1978 hit ‘Denis’. Below is a link to where you can hear it being sung by a special guest songstress. As you will see, though she might not have the same distinctive hair as her more famous sibling, Debbie Harry’s twin sister does possess comparable vocal talents to the aforementioned chanteuse. I am indebted to Purpley-Pinky who kindly made herself available for the recording, one which is already being heralded as superior to the version on which it is based.

Here then is the link to the performance – those who follow it do so at their own risk.

As a job advert, I think it ticks the boxes for being both eye catching and memorable and I apologise if that means you can’t something you’d rather you hadn’t seen out of your head! But I hope too that it will serve to generate a degree of excitement in the GP post that is available at the practice that was once nominated for the award of ‘Best Medical Centre situated next to a Home Improvement Retailer’ and which subsequently came second in the subcategory allocated for those who find themselves adjacent to a branch of Wickes.

And so next week I am anticipating that we will be inundated with applications. And if we’re not?… well you’ll have yourselves to blame if at some point in the future I’m forced to embarrass myself again and expose you to yet another tragic musical misadventure!

Here’s that link to the actual job advert again:

https://www.bmj.com/careers/job/158777/salaried-gp-gp-partner-6-sessions-east-quay-medical-centre/

And you can find out more about East Quay Medical Centre here.

http://www.eastquaymedicalcentre.com/

If you know anyone who might be interested in the post, do please feel free to share!

Links to other medically themed songs can be found at the bottom of this page!

Oh GP, ooh-be-do, we’re in need of you,
GP, ooh-be-do, we’re in need of you,
GP, ooh-be-do, we’re in need of you.

Come work with us, illness investigate,
Prescribe a truss, and heart sounds auscultate,
GP, GP, we’re so in need of you,

You soon will find – we are a friendly bunch,
And if we can – we gather for our lunch,
GP, GP, we’re so in need of you.

At East Quay, we are looking for a doctor just like you,
So come on, please do apply,
You’ll be so happy if we give the job to you.

J’aimerais pouvoir parler français,
Mais je n’ai pas oh la capacité,
GP, GP, we’re so in need of you.

GP, GP, the senior partners cool,
GP, GP, he never acts the fool,
GP, GP, we’re so in need of you.

Oh GP, ooh-be-do, we’re in need of you,
GP, ooh-be-do, we’re in need of you,
GP, ooh-be-do, we’re in need of you.

Oh GP, ooh-be-do, we’re in need of you,
GP, ooh-be-do, we’re in need of you,
GP, ooh-be-do, we’re in need of you,
GP, ooh-be-do, we’re in need of you.

We’ve got a brand new GP Vacancy*

East Quay Medical Centre Madness*

https://www.bmj.com/careers/job/158777/salaried-gp-gp-partner-6-sessions-east-quay-medical-centre/

WE HAD THE EXPERIENCE – BUT MISSED THE MEANING

A while back I read ‘Histories’ by Sam Gugliani – It’s a very good read relating the stories of various individuals, clinical and non clinical, who work in a hospital, and gives their differing perspectives of what takes place there. To give you a flavour, here are a couple of quotes that stood out for me and got me thinking.

‘Hospital words spun like stones across the still waters of people’s lives.’

‘We’re all victims, aren’t we, of medicine’s success’

and

‘Their voices change key when they speak to him, lengthening to a sing-song, as if his dying might be rendered in nursery rhymes.’

And then there was, ‘We had the experience but missed the meaning’. Those more literate than I will know without resorting to an internet search that it is a line from the third of T.S. Eliot’s ‘Four Quartets’ entitled ‘The Dry Salvages”. It has been on my mind since discovering this remarkable, if perhaps bleak, poem.

Drawing on a 2010 blog by Ben Myers which helped me understand the poem, Eliot seems to be saying that ‘as one becomes older’ our pasts reveal, if we will see it, a pattern in which moments of ‘sudden illumination’, those times when we are happy, are the temporary exception to the norm. They are like a ‘ragged rock in the restless waters’ which serve only to reveal that the true nature of our existence is one in which permanency is characterised by abiding ‘moments of agony’ – such is ‘the primitive terror’.

‘And the ragged rock in the restless waters,
Waves wash over it, fogs conceal it;
On a halcyon day it is merely a monument,
In navigable weather it is always a seamark
To lay a course by: but in the somber season
Or the sudden fury, is what it always was’

Eliot describes Time as both our ‘destroyer’ and our ‘preserver’. The only thing that keeps us alive is the very thing that brings about our demise. Eliot is urging us to see this deeper truth that our moments of happiness display. We have these experiences, he says, but are want to miss their meaning.

So what do I take from this as a doctor? Like moments of happiness, health too is but temporary. In due course normality will be restored and we will all succumb to the ravages of time. It will ultimately destroy us. I don’t mean that we should resign ourselves to a life of melancholic anticipation of death, but we should, I think, appreciate health for what it is – a state of being that we should value whilst we have it. Furthermore, as doctors, we should be realistic in terms of what we can expect to achieve for our patients. We are, after all, only doctors. We should make every effort to tend the sick and whenever possible endeavour to effect a cure, but just as important perhaps is how we encourage our patients to value their health as the fragile state it truly is and we would do well to consider also how we might prepare them for the inevitability of death. Colluding with patients that with the right combination of pills and sufficient attention to lifestyle death will be avoided is dishonest and, perhaps, detrimental to all our chances of enjoying the life we have.

To end on a more positive note, it should be remembered that ‘The Dry Salvages’ is but the third of Eliot’s ‘The Four Quartets’. The fourth, ‘Little Gidding‘ offers us some hope of redemption. Ironically perhaps, the reader is asked to reflect on their experience of what they have read earlier and understand that they may indeed have missed the meaning. There is redemption but it is a redemption not from, but through death.

‘What we call the beginning is often the end
And to make an end is to make a beginning.
The end is where we start from…
We shall not cease from exploration
And the end of all our exploring
Will be to arrive where we started
And know the place for the first time.’

Similarly then, might we, and our patients, know happiness, not by the avoidance of all sadness, all difficulty, but rather through experiencing hardship and sorrow in all its dreadful intensity?

Too often I make the mistake of thinking that I can only be happy when I’m not sad, and so, when unhappiness steals its inevitable way into my life, I am left feeling that I can no longer know what it is to be happy. Foolishly, before allowing myself to smile again, I insist on striving to put an end to everything that reduces me to tears, on endeavouring to put everything right.

But I simply cannot do it.

Whilst I hope for that time when all will be well, waiting until then before being happy only succeeds in leaving me a long time sad. But, though seemingly contradictory, happiness and sadness are not mutually exclusive. In some sense we cannot know what happiness really is without knowing the pain of sorrow – and sorrow requires the memory of the temporary nature of happiness.

To be truly happy then we cannot deny sadness – on the contrary we must embrace it. And we must learn that it is possible to be ‘sorrowful yet always rejoicing’. It is not that we can not be happy because we know sadness, nor that we can not be sad because there are things to be happy about. Paradoxically, we can be happy and sad at the same time.

As Leonard Cohen sang, shortly before his death, ‘There is a lullaby for suffering and a paradox to blame’.

We may have to be patient but even on the darkest nights there is the hope that there will be other better, brighter days. Days made all the more enjoyable perhaps for having known the sadness that preceded them.

Understand this and we, and our patients, may experience life – without missing its meaning.

To read an extended, more theologically minded, version of this blog, one which considers whether Eliot’s view of life is consistent with the Christian faith he professed, click here

Other related blogs:

To read ‘The Life I Lead’, click here

To read ‘General Practice – a sweet sorrow’, click here

To read ‘Eleanor Rigby is not at all fine’, click here

To read ‘The Medical Condition or Hannah Arendt is Completely Fine’, click here.

To read ‘I’ll miss this when I’m gone’, click here

To read ‘Dark Reflections’, click here

And finally, to read some thoughts on a couple of other other poems, click either on ‘The Windhover’ by Gerald Manley Hopkins, or ‘Be Drunk’ by Charles Baudelaire.

WE’VE GOT A BRAND NEW GP VACANCY

I heard this week of a community in Cornwall who have made a video of them all singing a song in the hope that it might attract a new GP to their village. Well, I thought, that seems like a good idea – one worth copying! So, since I work in a GP practice in Somerset, let me, with the help of the Wurzels, tell you that ‘We’ve got a brand new GP vacancy!’ at East Quay Medical Centre in Bridgwater.

We’re looking for a GP one who can tell
(Ooh ar, ooh ar)
When someone’s symptoms means that they aren’t so well
(Ooh ar, ooh ar)
This is guaranteed, with us you will succeed
(Ooh ar, ooh ar)
So won’t you please come doctor you got something we need

Cos we’ve got a brand new GP vacancy and if you really care
You can have your own consulting room – with a ‘wheely’ chair
We’ve got lots of patients, but one too few GPs
Cos we’ve got a brand new GP vacancy – and those who have disease

You’ll make us laugh, ha ha!

We’ll stick by you, and give you lots of support
(Ooh ah, ooh ar)
We’ll give you homemade cake – not stuff that’s shop bought
(Ooh ar, ooh ar)
With coffee every morning and tea each afternoon
(Ooh ar, ooh ar)
Better get your application in to us soon

Phwoor, we’ve got lovely practice premises an’all

The senior partner he has seen better days
(Ooh ah, ooh ar)
It won’t be long before he’s put out to graze
(Ooh ah, ooh ar)
And so you needn’t worry, grumpy though he is
(Ooh ah, ooh ar)
He’s old and grey now and you’ll have all that’s his!

We love them baby checks ha ha

We’ve got lovely practice nurses, HCAs too
(Ooh ah, ooh ar)
Our manager she is too good to be true
(Ooh ah, ooh ar)
Receptionists and admins, we all work as a team
(Ooh ah, ooh ar)
The only downside is a lass called Doreen*

Cos we’ve got a brand new GP vacancy and if you really care
You can have your own consulting room – with a ‘wheely’ chair
So stop your galavanting, there’s no need for a fuss
Cos we’ve got a brand new GP vacancy – just come and work with us

Ah you’re a fine looking doctor and we can’t wait to see you use your stethoscope!

The brave can hear a rendition of the song here – but be warned, the effect on you will be not dissimilar to that of drinking a sizeable demijohn of West Country scrumpy!

Here is a link to the actual job advert

*Doreen is one of our excellent HCA’s and, having helped me perform many a minor op, is in fact totally underserving of any tongue in cheek jibes. In fact she alone is reason enough to join us!

And if you know anyone who might be interested, do feel free to share! You can find out more about the practice at http://www.eastquaymedicalcentre.com/

GP, GP, We’re So In Need Of You*

East Quay Medical Centre Madness*

The green green leaves of home

Is it just me or does anyone else feel guilty about eating baby spinach, given how undoubtedly brief their apparently mild and tender lives must have been?

Be that as it may, today I went shopping in order to buy a bag of the aforementioned green leafed comestible. No sooner had I left the shop however, the thought struck me that a second packet was in order, this being on account of how important it is on Valentine’s Day to make an effort in terms of the quality of the gift one bestows upon one’s own true love.

And so I returned to the store and soon found myself stood once more in front of the lady who had previously taken my money. She was surprised to see me back so soon but, cognisant that I had repeated my earlier salad-y selection, excitedly expressed her belief that I was Popeye.

Somewhat embarrassed by her mistake, I endeavoured to let her down gently but in so doing it was nonetheless inevitable that I would shatter her dreams and leave her both heartbroken and bereft.

Before I went on my way, however, I was at least able to console her with the fact that, due to my undeniably muscular physique, hers was an understandable error, one that has been made by a good many others before her.

Related autobiographical blogs, some more tongue in cheek than others:

To read ‘Two of a Kind’, click here

To read ‘Two photos both alike in dignity’, click here

To read ‘We went to the animal fair, the diary of novice grandparents’, click here

To read ‘A cricket tea kind of day’, click here

To read ‘Poor Imitations’, click here

To read ‘Three times a patient’, click here

To read ‘The Life I Lead’, click here

LIFE IN THE HAPPY VALLEY

WARNING: The following blog contains spoilers – please don’t read if you’ve not yet watched all three series of ‘Happy Valley’ but think that one day you might.

It’s finally over. This week the BBC aired the final ever episode of Sally Wainwright’s excellent TV drama ‘Happy Valley’, a police procedural which stands head and shoulders above all others by virtue of the quality of Wainwright’s writing and the exceptional acting of, in particular, Sarah Lancashire and James Norton. It’s one of those programmes that you are genuinely sorry when it’s over, one that leaves you wishing you hadn’t yet watched it so that you could still look forward to enjoying it for the very first time.

This latest series has been a long time coming. Those who enjoyed the first two series which were first broadcast back in 2014 and 2016 have had to wait seven years for this final instalment. The reason given was that Wainwright wanted to wait for Rhys Connah, the child actor who played Ryan in the earlier series, to grow up so that he could continue to play the same role when older. This show of patience by those with a hit show on their hands is commendable given the inevitable temptation to cash in on the programme’s success. Furthermore, given that it could not be guaranteed that after so many years Connah would still be following an acting career, such a show of patience was not without risk. That patience though was amply rewarded by the commendable performance the young actor gave and demonstrates that it is indeed good to sometimes wait.

It was fitting then that the BBC did not simultaneously release all six episodes of series three at the beginning of January, a decision that deprived us of the opportunity to binge watch it on iPlayer over a couple of days. Instead, after waiting seven years for the series to air, we all had to wait a further week between each hour of hugely enjoying drama, something which, as well as heightening our enjoyment, served to make the programme something of a national event, something that we could enjoy all the more as a shared experience. In these days of instant everything, when all we want we expect to be delivered immediately, it’s good to sometimes have to wait.

But it’s not just the joys of delayed gratification that can be commended about the show – even it’s title is perfect. ‘Happy Valley’ is the name given by those who police the Calder Valley in West Yorkshire. This is on account of the area’s drug problem. But more than that the title gives a nod to something that is present in this series that is all too often lacking in others, namely ‘nuance’. Things in Happy Valley are never straightforward and just as they are in real life, sorrows are experienced alongside moments of happiness. Furthermore, those who live in ‘Trouble Town’* have a complexity to them that doesn’t allow us to categorise them into stereotypical personifications of good and evil.

So Ryan, the child born as a result of the rape of Sergeant Catherine Cawood’s daughter, is, as a result of his mother subsequently taking her own life, brought up in the care of his grandmother who, understandably enough, is torn between affection for her grandson and hatred for all that his existence represents. Her actions clearly reflect the love she has for him yet, when in a particularly poignant scene Ryan, now in his teens, tells her he loves her, she is unable to respond in the way we, as viewers, long for. Instead of expressing any love in return, Catherine manages only to question Ryan as to what brought on such a show of emotion. Likewise, despite her very apparent hatred for Tommy Lee Royce, the man who had violated her daughter all those years previously, and whose actions since have proven that such violence was an integral part of his psychopathic nature, in the powerful climactic scene, one senses that, as a result perhaps of her recognising that in some measure Royce is a product of his upbringing, her attitude to him softens a little and she finds himself calling him by his first name. And we who watch on, and who have been consistently appalled by all that Royce is capable of, also find ourselves accepting that the man we’ve long wished dead, isn’t all bad.

Likewise Catherine Cawood is far from being a one dimensional character. Despite her brilliance as a police officer, she is not perfect. Though we love her she is herself capable of unkindness when in one episode she is involved in a prank that results in a colleague being made to look something of a fool as a result of his perhaps over zealous belief in alien life forms. But when the individual who is a person of colour accuses her of racism, and her senior officer likens her actions to the worst forms of sexual harassment in the workplace, she is rightly indignant, recognising that, whilst all wrong doing is wrong, there are, none the less, varying degrees of wrongdoing. She recognises that lazily tarring the worst offences with the same brush as more minor infringements ultimately serves only to diminishes the seriousness of those actions that deserve our greatest condemnation.

This recognition of complexity is something that we would do well to take into our day to day lives, lives lived in a world where nuance is all too rarely appreciated. Real life issues are frequently complex and given our inability to fully comprehend all that there is to understand, we need to recognise that, rather than everything being black and white, reality exists in a kaleidoscopic world of grey. This is not to suggest that we shouldn’t ever hold strong opinions, but simply to acknowledge that even those with whom we most vehemently disagree may none the less have a point of view that is worth hearing.

Furthermore, we need to recognise that if we knew what others had experienced in their past, their behaviour that we find so hard to accept might be, not only understandable, but also similar to how we would behave ourselves if faced with similar circumstances. Again this is not to excuse wrongdoing. One’s past does not absolve anyone of the responsibility for their actions, but we nonetheless need to accept that adverse circumstances, whilst not an excuse, are frequently a factor when an individual acts badly. We should allow ourselves to be gracious to others, even as we would wish others to be gracious to us when we err in ways that we would find all too easy to justify.

All this is to say that we really do need to try to understand each other better, to communicate more effectively and listen to one other more carefully. And even though we will, on occasions, still inevitably disagree, we need to do so well. It really isn’t necessary to hate everything about an individual simply because we have differing views to them on a single issue. Left unchecked such foolishness will result in our living lives of increasing isolation and hatred as, overtime, we find that, on at least one small matter or another, we disagree with everybody we ever come into contact with and, as a result of a misplaced sense of moral outrage, our anger increases along with our loneliness.

The truth is out there, and it is of course important, but we are more likely to find it if we search for it together than if we imagine we can find it by ourselves.

It is, after all, good to talk.

* ‘Trouble Town’ is the name of the song by Jake Bugg that provides the title music to ‘Happy Valley’. It can be heard here.

Related blogs:

To read ‘When the Jokes on You’, click here

To read ‘I’ll miss this when we’re gone’, click here

To read ‘In loving memory of truth’, click here

And to read ‘Grace in a political world’, which concerns one who is infinitely gracious, which is exactly how gracious I need him to be, click here

‘The Medical Condition’ or ‘Hannah Arendt is completely fine’

Why have so many of us become so dissatisfied with our working lives?

And why have so many of us become dissatisfied with our lives in general?

Hannah Arendt (1906-1975) was a German born philosopher best known for ‘The Human Condition’ (1958). In it, if I understand her correctly, she explains her view that the way out of living a meaningless life is to bring about change through our ability to act and thus create something new.

Arendt distinguishes our ‘actions’ from our ‘labour’ and our ‘work’. ‘Labour’, she explains is simply those activities of daily living by which we meet our biological needs whereas ‘work’ she defines as that which we do within the world that imparts a ‘measure of permanence and durability upon the futility of mortal life and the fleeting character of human time’. ‘Work’ produces something abiding and is of a higher level than ‘labour’ which merely perpetuates. To Arendt, however, our ‘actions’, are what really count. It is not so much ‘what’ we are that matters but rather ‘who‘ we are – and who we are, she says, is best revealed through our words and deeds, when we go beyond our inherent selfish survival instincts and ‘act’ to bring something new and unexpected into existence.

Two key behaviours that Arendt identifies as bringing about this change are those of forgiveness and the making and keeping of promises. Forgiveness is the behaviour by which it is possible to nullify past actions, releasing others from what they have done and enabling them to change their minds and start again. ‘Forgiveness‘, she writes, ‘is the key to action and freedom‘ and ‘the only way to reverse the irreversible flow of history‘. In contrast, our ability to make and keep promises marks us out as being able to make the future different from the past. ‘Promises are the uniquely human way of ordering the future, making it predictable and reliable to the extent that this is humanly possible‘.

Arendt believes that, in order to be fulfilled, we need to be able to act in ways that advance or better society as a whole. And herein lies the clue as to why some of us may have lost satisfaction in our working lives and, perhaps, our lives as a whole.

Though we continue to seek happiness, so restricted have we become in public life, by the guidelines that we have to adhere to and the hoops through which we have to jump, that we have become like slaves who have no prospect of having genuine influence. In Arendt’s terms, we can ‘labour’ and ‘work’ – but we can not ‘act’. Furthermore, having given up the prospect of doing something that might bring about real change and thereby produce genuine benefit, we have retreated from the public sphere and been reduced to consumers who are content to amuse ourselves in private – with yet another bottle of prosecco, perhaps, and an evening spent bingeing on the latest must watch series on Netflix.

Arendt suggests that ‘under conditions of tyranny, it is far easier to act than to think‘. Such then is the consequence of a too heavy, top down, approach to medicine when conformity to guidelines is all. In such circumstances, we seek only to unquestioningly comply with what we are told we must do and, because of the fear fear of reprisal, we anxiously seek to do so perfectly. But, says Arendt, ‘In order to go on living one must try to escape the death involved in perfectionism‘. By giving up the hope of genuine autonomous action we have given up our hope of fulfilment and, with it, our hope of happiness.

Thoughtlessly striving for perfect compliance, we therefore die.

This links into another idea of Arendt – that whilst we can know much about the objective world, we fail to understand what lies beneath the surface – that which is most important. ‘What’ we are is our body, but ‘who’ we are is disclosed by our words and deeds. As doctors we may know a lot about ‘what’ our patients are – the details of their individual biological parameters – but we struggle to know ‘who’ they are – their true nature as revealed by what they say and what they do. We can only know ‘who’ our patients are by devoting more time to watching them, listening to them and learning what makes them who they are. We need to spend more time with people, both our patients and those friends and relations whom we love the most, not only for the emotional and material support they provide but also, Arendt believes, for the joy of seeing them reveal their true character.

Failure to know our patients therefore diminishes our working lives. We all risk burning out if we are concerned only about ‘what’ our patients are rather than ‘who’ they are and who they may become. But this has become ever harder as our workload has escalated, remote consulting has increased, and, as personal lists have become ever more fractured, the doctor-patient relationship has ceased to be what it once was. These, and a million other concerns, press in on us daily and thus prevent us from taking the necessary time required for us to properly get to know our patients.

Finally, then, what of ourselves. Arendt suggests that we may never fully know who we are ourselves because that is something that can only be properly observed by others, those who see us act in ways that we can not see ourselves. This is most true when we love – for love, she says, reveals ‘who’ we are like nothing else simply because it is unconcerned with the ‘what’ of the one we love. ‘Love, by reason of its passion, destroys the in-between which relates us to, and separates us from, others’

To regain our satisfaction with work, therefore, we need to change. We need to stop behaving in the way that we have been encouraged to practice, stop seeing the ‘what’ of patients and notice instead the ‘who’ that they really are. In short we need to care for our patients.

We need to stop judging them for their past mistakes and instead, by ‘forgiving’ their unhealthy habits, give them the opportunity to start again. We need to give them the hope they need in order to begin again and thus create something new in their lives. Furthermore we need to believe that patients really can change and promise them the help and support they need to avoid remaining stuck as they are.

If we act in these considered, creative and unexpected ways we really will make a difference – a difference that will also restore our own satisfaction in practicing. We must be more than simply service providers, performing our jobs according to protocol. We need to tackle head on the problems of life and think for ourselves. Because to live is not to merely survive, mindlessly comply and contentedly be entertained. The provision of ‘bread and circuses‘ is not enough for us to be happy. Rather, to truly live is to be somebody who acts and brings about the change, the new start, we all so hope for and so very much need if we are to have any chance of keeping on ‘keeping on’.

Eleanor Oliphant, the eponymous hero in Gail Honeyman’s novel captures the sense of this well.

“I suppose one of the reasons we’re all able to exist for our allotted span in this green and blue vale of tears is that there is always, however remote it seems, the possibility of change”.

Related blogs, starting with one on the dangers of perfectionism:

To read ‘Professor Ian Aird’ – A Time to Die?’, click here

Next a trilogy which, to my mind at least, form a trilogy on the subject of burnout:

To read ‘Somewhere over the Rainbow’, click here

To read ‘When the Jokes on You’, click here

To read ‘With great power…’, click here

And now some other related posts beginning with two offering more on how promises change our future:

To read ‘Hoping to maintain resilience’, click here and, for a theological take on this same question, click here to read ‘Hope comes from believing the promises of God’,

To read ‘On Not Remotely Caring’, click here

To read ‘Contactless’, click here

To read ‘Vaccinating to remain susceptible’, click here

To read ‘On Approaching One’s Sell By Date’, click here

To read ‘Eleanor Rigby is not at all fine’, click here

To read ‘General Practice – still a sweet sorrow’, click here

To read ‘We had the experience but missed the meaning’, click here

To read ‘On keeping what we dare not lose’, click here

To read ‘When good enough isn’t good enough’ click here

To read ‘It’s alright ma (I’m on GPing)’, click here

To read ‘My back pages’, click here

To read ‘Vanity Fair’, click here

WHITHER TOMORROW?

‘For all our days that tear the heart
Leave us nowhere
For all the years we left untold
Hurt, we couldn’t hold much longer’

Jessie Buckley and Bernard Butler

I don’t know if it’s because of my ever greying hair or simply the result of wishful thinking on the part of those who are posing the question, but currently a day hardly seems to go by without one of my patients asking me how long I think I’ll remain a GP. Admittedly the idea of retirement is one that is increasingly appealing given how recently, just when you thought the job couldn’t get any busier, it went and got a whole lot busier!

When I think about how many times in my career I have considered giving up medicine, it is in some ways remarkable that I have lasted as long as I have! The first time was about a month into my A Levels. Back then I was hating Physics so much that I decided to give up sciences and study History and Economics with a view to following my big brother into the bank. Thankfully, after a few wise words from my Dad, I dropped Physics and took Biology in its place. After which things got better.

And so I clambered aboard the conveyor belt of medical education and got a place at Bristol. After a wobbly first couple of terms during which time I again considered ending my medical career before it had begun and was briefly prescribed ‘Prothiaden’ which was then a fancy new antidepressant, I eventually settled into university life. But after failing to enjoy the third year and my first experience of clinical medicine, I intercalated, unconventionally late, in Psychology with the specific intention of leaving university with a degree that would offer me the possibility of a job outside of medicine. For a while I flirted with the idea of accepting the offer I was made to do a PhD in Psychology but chose instead to return to Medicine and I eventually graduated in 1991.

My year as a houseman wasn’t a happy one and my wife will tell you how low I was during what was also, purely coincidentally you understand, our first year of marriage. She sometimes had to literally feed me breakfast in the morning, and put my shoes on to get me ready to leave for work. So convinced was I that I would not remain a doctor for long, I even temporarily opted out of the NHS pension scheme. But in time things got better again and I somehow survived my first year as a doctor.

GP training was also an initially miserable time, so much so that, before completing my training, I lined up a job in Psychiatry thinking I might follow this as an alternative career path. Six months of that though was enough and so, with my MRCGP now under my belt, I became a GP locum. One practice I spent three months at asked me to apply for the partnership that they were advertising and, having done so, I was fortunate enough to get the post. And so, in January 1997, I began what thus far have been 26 largely happy years at the practice at which I still work. Initially I hated it though. Not only was I genuinely convinced I was useless, I also was totally convinced that everybody regretted taking me on a partner. But then things got better once again proving that, at least on occasions, things can and do improve over time.

That said, I’m not sure that medicine is getting better. On the contrary, I am concerned that the world of medicine has lost it’s way. I’ve been writing about this for well over a decade now but the situation only seems to be getting worse with every passing year. With the medicalisation of normal life and the overemphasis on clinical parameters rather than the individual to whom those parameters refer, modern medicine has diminished what it is to be human and diminished too what it is to be a doctor. What’s more medicine has for too long arrogantly acted as if it had the power to bring about eternal life and never ending happiness. It spends far too long trying to do what it can’t and too many of those charged with that Sisyphean task have killed themselves and made themselves unhappy in the attempt.

And, perhaps as a consequence, whereas once doctors were their patients advocate, it seems that patients now are too often perceived as the enemy, made up of those who have to be managed rather than those who need to be cared for. And as doctors are driven further away from their patients, as they become more remote from them, so I believe they will find themselves caring for patients less – even as their patients care less about them.

It also seems to me that medicine has priced itself out of the market. With all that medicine can potentially do, it is now simply too expensive, not only in terms of the burden it imposes on the tax payer but also in terms of the personal cost paid by those who work in healthcare. The toll is too high and something really does need to be done about it.

I’ve been writing on a regular basis now for a little over four years. I find it helpful – so much so that this website is far too cluttered with posts. In his essay ‘Why I write’, George Orwell gave four reasons, suggesting that, to a greater or lesser extent, each one is present as motivating factors in all those who put pen to paper.

The first reason he gave, was SHEER EGOISM. I don’t deny it. I enjoy writing for writing’s sake but if occasionally someone likes what I write, if perhaps I manage to raise a smile or somebody finds something I’ve written helpful, I find that that brings with it a little extra satisfaction.

Next came AESTHETIC ENTHUSIASM. And once again I put my hand up to that one. I enjoy writing because I enjoy writing, even when no one else enjoys reading what I write! I like playing with words, finding an arrangement of sounds that rolls off the tongue and which is pleasing to at least my ear.

Thirdly on Orwell’s list, was HISTORICAL IMPULSE – the simple desire to write about how things are, to record for others what the truth is. Again mea culpa! I feel it’s important to write about the state of the world, or at least the medical world that I inhabit. And writing helps me think about what is going on around me, it helps me understand the realm in which I operate.

And the last reason Orwell gave for why writers write was POLITICAL PURPOSE, by which he meant a desire to influence others, to move others to think in ways that the writer thinks themself. And I suppose that’s true of me too, at least to some extent. Indeed I suspect it would be a bit odd if it were not the case.

But there is, I think a fifth reason for why I write, one which is at least slightly different to those given by Orwell. And it’s this. The NEED TO BE HEARD.

There are some things that are so important to us, that we need them to be important to others. And for that to happen our concerns have to be heard, and felt, by others.

In an indifferent world it’s important that we listen to those we care about, to make a real effort to hear what they are saying. We may not be able to do much about what is spoken about, not in any practical sense at least, but caring enough to recognise it matters to the one who is saying it, is, at least, a start. Because to share a little in the experience of others, perhaps even shedding a tear ourselves as others express their sadness, draws us a little closer to the one who suffers, and makes a connection with the one who grieves, a connection that, too often in this frequently contactless world, we fail to make.

And so I write about the things that matter to me most.

I write about cricket – is there anything more important than the domestic cricket season and the violence being done to it by the introduction of franchise cricket? I doubt it, but even so, now is not the time for me to get on that particular soap box again.

I write about medicine – of how the NHS is broken and breaking the people who work within it. I write of how it bothers me immensely that patients aren’t getting the treatment they need, not, at least, in a timely fashion. And I write about how it bothers me immensely that people who I care about, people with whom I work, are too often close to tears because of what the job now demands of them.

And I write about other, more general, concerns that trouble me because it’s not only in relation to the world of medicine that people suffer. And irrespective of the reasons for that suffering, and especially when, rather than getting better things seem to be getting progressively worse, I find it helpful to express in what I write some of the sadness I am sometimes prone to feel.

And I also write about my faith – because if it’s everlasting life and infinite joy we want, I believe we will need to look for it somewhere other than medicine. Without the faith which sustains me in difficult times, without the sure and certain hope of a better tomorrow, I really don’t know how I’d be able to cope with all that life sometimes entails. Like the psalmist I believe that, though weeping may tarry for the nighttime, joy comes with the morning – and I hold this to be true irrespective of how long and dark the night may be, or how far off the day still seems.

So as working in the NHS becomes evermore difficult, will my recurrent thoughts of wanting to leave medicine finally be realised? Will I retire a year or two earlier than 59 which is, I believe, the average age that GPs now hang up their stethoscopes? I don’t know. But if I do it won’t be for the reason that I have considered giving up so many times in the past. Back then my thoughts of quitting were largely linked to my feelings of inadequacy, of not being good enough as a doctor. Now, however, though still inadequate to meet the needs of all that is demanded of me, I have become resigned to my inadequacy. In his 2014 Reith Lectures, American surgeon Atul Gawande spoke of our ‘necessary fallibility’ – that now we all inevitably make mistakes because it is simply not possible for us to know all that there is to know or be able to do all that we are asked to do.

So then, if I do leave early, the reason will be, not just because there is something else I’d rather do, but also because of what medicine has become, an often arrogant and frequently cruel taskmaster, one that I have lost faith in. I don’t want to work in an environment which forces employees to be more concerned for their own welfare than the welfare of others. There’s a lot of talk these days about how we need to be kind, generally accompanied with the caveat that our kindness should extend to ourselves. There is undoubtedly much truth in such talk but it remains the case that if we’re to be kind to those we interact with, it is inevitably going to mean that sometimes we will need to be unkind to ourselves, to sometimes make sacrifices for the sake of others. But here’s the thing – when we do, I believe that, rather than suffering, we are enriched by our actions. Sometimes real success comes as a result of our losing everything. There is, I believe, historical precedent for such a view.

Some years ago, on my day off, a parent phoned the practice regarding their 8 year old son who had been experiencing diarrhoea and vomiting. He was given wholly appropriate advice for home management and advised to call again in the event of any deterioration. The next day the father did indeed call back but proceeded to inform me that all his son’s symptoms were improving. But there was something about the fathers tone of voice that unsettled me and so, at around 6.30 that evening, I called him back and learnt how the child had subsequently significantly deteriorated. Though I was not on call, I offered to do a home visit, an offer that was gladly accepted. When I eventually arrived, the lad had the most obvious meningism I have ever encountered and I duly gave him a stat dose of iv benzyl penicillin and called for an ambulance which, as they did in those days, duly arrived and whisked him off to hospital in good time.

Now as it happened, that evening I had been invited to a party of a friend who was celebrating her 80th birthday. Inevitably I was very late. When I arrived, several guests expressed their concern for me, imagining, given my tardiness, that I must have had a bad day. I hadn’t. Though entailing an interruption to my plans, being where I was genuinely needed was hugely rewarding, it was a joy to have been able to help that evening. And today the lad is a young man, one who is still my patient, and always thanks me every time he sees me, foolishly imagining that it was me who saved his life rather than the clever souls at the hospital who did all the hard work.

I’m not sure though that modern general practice is conducive to that sort of doctor-patient relationship anymore. Not only is this a great shame, it also makes losers of us all, both doctors and patients alike. Sadly the way General Practice used to be is over and those who work in primary care can no longer be expected to work in the way they once did. For whilst there is much that is rewarding about going the extra mile for patients, constantly being required to give more than you have to give is simply unsustainable. And whilst I would like to think we could abandon medicine by rote and return to a simpler and more thoughtful way of working, I fear that now there is no going back. The horse has bolted and the stable door has been left flapping in the wind.

And so at 56, assuming the colorectal screening that I’ve just had the dubious pleasure of undertaking doesn’t result in a spanner being thrown in the works, I am of an age when I may yet be able to give 10 years to something else. As such I am open to moving on in a way that I’ve never been before. I would of course miss my patients but I already find the job makes me less connected to them than I once was. And I would of course miss my colleagues who really are some of my very best friends.

Even so, whilst recognising that I am nothing special and that in times past I could easily have been replaced, the fact is that recruiting GPs is currently almost impossible. As such, were I to retire prematurely, I would struggle if my leaving destabilised the practice which has been such a large part of my life, the practice that provides care for the many patients of whom I have become so very fond, and the practice which, as I’ve already said, is made up of colleagues who are also my friends.

So what am I saying? How long do I think I’ll remain a GP.? Well if there were half a dozen excellent doctor’s hammering on the doors of the practice, each one of them desperate to join the partnership, I think that, in the event of some alternative opportunity being presented to me, I would almost certainly consider moving on. But as thing’s stand, I really don’t know. Just now though it’d be hard to leave.

Time will tell if things will one day get better again. I for one am sure they will, in ways better than we can possibly imagine, when every tear will have been wiped away, death will be no more and doctors simply won’t be required.

And then we can all retire. Personally I can’t wait!

‘For all our days that tear the heart
Leading us somewhere
Somewhere else to start’

Before an option to read a whole load more words, for those who would rather hear them sung beautifully instead, here is a link to the title track of Jessie Buckley and Bernard Butler recently released album. My advice though is to listen to the whole album – it really is superb.

Related blogs:

To read ‘An Audience for Grief’, click here

To read ‘On Not Remotely Caring’, click here

To read ‘Contactless’, click here

To read ‘Vaccinating to remain susceptible’, click here

To read ‘On Approaching One’s Sell By Date’, click here

To read ‘Eleanor Rigby is not at all fine’, click here

To read ‘The Abolition of General Practice’, click here

To read ‘General Practice – still a sweet sorrow’, click here

To read ‘On being overwhelmed’, click here

To read ‘General Practice – is time running out?’, click here

To read ‘Blaming it on the Boogie’, click here

To read ‘Health – it’ll be the death of us. Is there institutional arrogance in the NHS?’, click here

And now three blogs which, in my mind at least, make up a trilogy on the subject of burnout:

To read ‘Somewhere over the Rainbow’, click here

To read ‘When the Jokes on You’, click here

To read ‘With great power…’, click here

And one blog on the dangers of perfectionism:

To read ‘Professor Ian Aird’ – A Time to Die?’, click here

Some unlikely GP tales:

To read ‘Mr Benn – the GP’, click here

To read ‘A GP called Paddington’, click here

To read ‘Scooby Doo and the Deserted Medical Centre’, click here

To read ‘Paddington and the Ailing Elderly Relative’ click here

To read Dr Jonathan Harker and the post evening surgery home visit’ click here

To read ‘Bagpuss and the NHS’, click here

To read ‘the day LITTLE RED RIDING HOOD got sick’, click here

To read ‘A Dream of an Antiques Roadshow’, click here

To read ‘The NHS Emporium’, click here

To read ‘Jeepy Leepy and the NHS’, click here

To read ‘The Three Little GPs and the Big Bad Secretary of State for Health’, click here

To read ‘The Happy Practice – A Cautionary Tale’, click here

To read ‘The State of Disrepair Shop’, click here

A selection of cricket related posts:

To read ‘Scooby Doo and the Mystery of the Deseted Cricket Ground’, click here

To read ‘Brian and Stumpy visit The Repair Shop’, click here

To read ‘A Tale of Two Tons’, click here

And finally, on an explicitly Christian theme:

To read ‘Hope comes from believing the promises of God’, click here

To read ‘T.S, Eliot, Jesus and the Paradox of the Christian Life’, click here

To read ‘Luther and the Global Pandemic – on becoming a theologian of the cross’, click here

To read ‘Why do bad things happen t9 good people? – a tentative suggestion’, click here

To read ‘Suffering – a personal view’, click here

THE ABOLITION OF GENERAL PRACTICE

Aristotle had it right when he wrote in his ‘Metaphysics’ that ‘Those who wish to succeed must ask the right preliminary question’. More than 2000 years later, doctors would do well to listen to his advice.

Before adopting each and every new advance that claims to be good for our patients, we should ask what we are hoping to achieve by following such recommendations. And we ought to consider whether the answer we come up with tallies with what I would propose might, in Aristotle’s eyes, be a good preliminary question to ask.

What do good doctors do?’

In ‘The Abolition of Man’, C.S. Lewis had some interesting things to say about how the focus of what science seeks to do has changed over time. Whereas once ‘wise men of old’ sought knowledge in order to understand how humankind conformed to reality, Lewis suggested that for science the problem had become ‘how to subdue reality to the wishes of men’.

But, for Lewis, there were dangers inherent in such an ambition. He realised that it would be those with power who would impose their wishes on the weak and maintained that any attempt to subdue reality to the wishes of the powerful, would require nature to be conquered in order that it conformed to their desires.

And that, he said, would require a reducing of all of nature to nothing but its component parts, denying anything beyond the merely physical and quantifying everything only in terms of what we can measure. Lewis believed that, since humanity is itself a part of nature, this diminishing of the whole would. ultimately, diminish humanity and bring about what he called the ‘abolition of man’.

So what of medicine today? Does it also seek to go beyond trying to help patients face what nature throws at them and seek to conform nature to what is deemed desirable for its’ patients? And if so, is the result a diminishing of what it means to be human – are people reduced to being defined merely in terms of their medical parameters? Is medicine undermining what it is to be alive?

If the answers to any of these questions is ‘Yes’, the route cause may be that we doctors have lost sight of what our purpose really is. We have forgotten to ask ourselves the right preliminary question.

The NHS came into existence in 1948 based on William Beveridge’s 1942 report urging universal access to health care. This was accompanied by a belief that the state should provide social security ‘from the cradle to the grave’. Inherent then, at the inception of the NHS, was a belief that, though every effort should be made to fight disease and promote health, the grave awaited us all and death was an inevitable reality. In the early days of the NHS therefore, alongside social reformers who developed polices to reduce the risk of disease, the wise doctors of old practised medicine for a population of people with disease whilst never forgetting that death remained a reality that could not be ignored.

That was what wise doctors did. But having forgotten this we have moved beyond this worthy endeavour and foolishly sought to employ medicine to subdue reality to mankind’s wishes. A moment’s thought will bring to mind a number of ways in which medicine has tried to do this – and it will be all too apparent that this has often required the reducing of humans to nothing more than their component parts.

Take for example, perhaps man greatest desire, the wish to live happily forever after. Even though for medicine to deliver this is the stuff of fairy tales, medicine has, nonetheless, attempted to subdue the reality of death and unhappiness.

No longer content to busy ourselves caring for the sick, we now, in the name of promoting immortality, label the healthy ill. Those we consult with may never have felt so well but we insist on telling them, often remotely, that they have borderline hypertension, that their cholesterol is too high and to top it all that they have pre diabetes.

No wonder we have the worried well when we tell the well to worry!

Defining them in terms of unfavourable health indices, we then exhort them to take our medications with all their side effects and demand that they behave in ways they would not otherwise choose.

And if they fail to be happy, if they become anxious or sad, we try to convince them that their feelings are not really their own – that rather than experiencing a genuine emotion, they have instead had just a conditioned response to the levels of serotonin floating around their biological system.

And for that, they are told, there is a pill as well.

Slowly but surely, people become patients who, rather than being enabled to live well, are reduced to little more than automaton whose only concern is nothing more than to avoid death and feel pleasure. They are made to worry over what is normal and become dependent on medicine to solve the problems that they do not have. Their lives are diminished by the pursuit of what we have told them they should desire most.

Lewis, I believe, was right. But it’s not just our patients who are at risk. If we in primary care forget what it is we do and capitulate to those in power who seek to impose their ideas on how we practise medicine, if we buy in to their vision and are reduced to only being interested in what can be measured, and if we spend our time frantically generating the data they demand, then we will no longer be the doctors we once were, the doctors we always wanted to be.

‘What do good doctors do?’ It’s a question we must urgently ask ourselves lest the answer becomes that we silently watch over the abolition of general practice.

To read ‘The Abolition of County Cricket’, click here

Related blogs regarding the difficulties with the NHS:

To read ‘General Practice – is time running out?’, click here

To read ‘On being overwhelmed’, click here

To read ‘I’ll miss this when we’re gone’, click here

To read ‘General Practice – still a sweet sorrow’, click here

To read ‘Mr Benn – the GP’, click here

To read ‘A GP called Paddington’, click here

To read ‘Scooby Doo and the Deserted Medical Centre’, click here

To read ‘Paddington and the Ailing Elderly Relative’ click here

To read Dr Jonathan Harker and the post evening surgery home visit’ click here

To read ‘Bagpuss and the NHS’, click here

To read ‘the day LITTLE RED RIDING HOOD got sick’, click here

To read ‘A Dream of an Antiques Roadshow’, click here

To read ‘The NHS Emporium’, click here

To read ‘Jeepy Leepy and the NHS’, click here

To read ‘The Three Little GPs and the Big Bad Secretary of State for Health’, click here

To read ‘The Happy Practice – A Cautionary Tale’, click here

To read ‘The State of Disrepair Shop’, click here

WHEN THERE’S NO NHS

To the tune of ‘With God on our side’ by Bob Dylan.

For twenty six years now
A GP I’ve been
And many’s the number
Of patients I’ve seen
They’ve come with their sickness
In times of distress
But where will they go when
There’s no NHS?

Way back when I started
I always did know
To those who required one
An ambulance would go
But now it’s uncertain
And its anyone’s guess
How the sick they will fare when
There’s no NHS

And those who are ailing
Two things they should dread
For hospital treatment
Will there be a bed?
And those caring for them
Will they cope with the stress?
Of not enough nurses
In the NHS

In primary care too
The future looks dire
Cos there’s not the doctors
That we now require
And so I must tell you
I sadly confess
That I fear for the future
Of the NHS

At A&E centres
The waits they’re so long
That patients are dying
Which has to be wrong
And now as the talk turns
To deaths in excess
I wonder how long ‘till
There’s no NHS.

Now some say the future’s
In private healthcare
Though few can afford it
As you’ll be aware
And those without money
They’ll never the less
Still pay a high price when
There’s no NHS.

With apologies to Bob Dylan.

For those who wish to, you can hear his 1964 recording of ‘With God on our side’, by following the link below.

For other medically themed songs for which I take full responsibility, follow the links below. Audio versions are available for those marked with an asterisk.