YESTERYEAR

Yesteryear

I consulted with my patients near

Now they seldom in my room appear

Oh I believe in yesteryear

.

Suddenly

It’s not half the job it used to be

With a plastic apron wrapped round me

Oh yesteryear went suddenly

.

Why it had to go

I well know, it’s all too clear

Something went so wrong,

Now I long for yesteryear

.

Yesteryear

Life could simply be so full of cheer

Now so many folk just live in fear

Oh I believe in yesteryear

.

Why it had to go

I well know, it’s all too clear

Something went so wrong

Now I long for yesteryear

.

Yesteryear

Work was something that I once held dear

Now I sometimes find I shed a tear

Oh I believe in yesteryear

Mm mm mm mm mm mm

.

After John Lennon and Paul McCartney


Related Posts:

To read ‘Baggy White Coats’, click here

To read, ‘What a wonderful job this can be’, click here

To read ‘Summertime’, click here

To read ‘Spare me a doctor’, click here

To read ‘I knew a Man’, click here

To read ‘If’, click here

To read ‘Room Enough’, click here

To read ‘Old Hands’, click here

To read ‘A Hard Year For us All’, click here

To read ‘I am the very model of a General Practitioner’, click here

To read ‘I’ve got a little list’, click here

On Managing Disappointment

‘Some people think football is a matter of life and death. I assure you, it’s much more serious than that.’

So quipped Bill Shankly, the former manager of Liverpool F.C. Even so, a week on from England’s defeat in the Euro 2021 final, most of us, if we ever cared at all, will have got over our disappointment that, once again, football wasn’t coming home after all. Despite Shankly’s assertion, we will have come to realise that, whilst an enjoyable distraction, whether England won or lost wasn’t really all that important at all. It is perhaps only those whose lives have nothing of greater value to worry about who will still be struggling with the heartbreak of yet another penalty shootout defeat and only those who are so insecure in who they are themselves that will feel the need to vilify those they see as responsible for the disappointment that they continue to feel.

Even so, we all know what it is to feel disappointment when things that we have looked forward to don’t materialise in the way we had hoped they would. Many of us, if we haven’t holidayed already, will be anticipating times away from work and all the more so given how pressurised General Practice has been of late. Though it will be good to have that much needed break, it won’t be just a few of us who will experience some disappointment related to our holidays this year. For some of us it will be because our week or two away won’t turn out to be as enjoyable as we had hoped, others of us won’t quite be able to avoid taking with us some of the sadness that we would have liked to have left at home, and for others of us our disappointment will come simply because, however great our vacation experiences turn out to be, they will inevitably eventually come to an end and we will be forced to return to a normality that, for some of us at least, is far from how we would like it to be.

But if we can experience disappointment because our two weeks in the south of France is ruined by the lack of a decent local boulangerie, how much more must the disappointment be for many of our patients who don’t have the luxury of being able to look forward to any time away from the difficulties that they face. For some of them it is not merely disappointing individual incidents that they struggle with but rather an overall, all encompassing, disappointment with how their lives have turned out, be that on account of the social deprivation that they have to encounter daily, the poor physical health with which they suffer or the deep personal sadnesses from which there is never any prospect of any even temporary escape. And then there are those who are facing the prospect of death which, after even the most satisfying of lives, is still unwelcome and a cause for disappointment that the good times are now forever over.

So how are we to help those with whom we consult who come to us with such a sense of disappointment that it is hard for them to carry on. And how are we to cope with our own disappointments when they inevitably materialise in our own lives. Because unlike a lost game of football, not all disappointments can be dismissed by a realisation that the thing that brings us sorrow never mattered at all in the first place.

Whilst it is true that we are all sometimes more disappointed about things than we need be, to sing along in nihilistic agreement to the closing lines of Bohemian Rhapsody that ‘nothing really matters, nothing really matters to me’, makes fools of us all. Because some things really do matter. Our disappointment is a measure of how far things are from how we want them to be. Though unpleasant, it is not an unhelpful feeling, given how it speaks to us, not only of the difficulties that we are currently experiencing but also the better circumstances that we all so long for, testifying perhaps that things can and indeed should be better.

This last week I was sat on Whitesands Beach not far from St David’s in Pembrokeshire watching people enjoying themselves playing in the sea. For some reason, despite wanting to, I didn’t feel able to join them irrespective of how awesome I would undoubtedly have looked with my wetsuit on and ‘Atom’ emblazoned across my chest like some modern day comic strip superhero! My feelings were similar to those I almost always experience at discos, if indeed discos are what they are still called. On such occasions you will always find me on the edge of the dance floor, too self conscious to show off my highly original and frankly alarming dance moves and resorting instead to clutching a pint and simply wishing I could enjoy myself by joining in with those who are dancing and clearly having such fun in the process. I wonder if this somewhat melancholic experience is one that others of us sometimes have, one in which we are all too aware that genuine happiness really is to be found out there somewhere but that it somehow always remains elusively just out of reach.

It was C,S. Lewis that wrote ‘Most people, if they had really learned to look into their own hearts, would know that they do want, and want acutely, something that cannot be had in this world. There are all sorts of things in this world that offer to give it to you, but they never quite keep their promise…If I find in myself a desire which no experience in this world can satisfy, the most probable explanation is that I was made for another world.’

As I say then, our disappointment has real meaning, speaking to us of a better tomorrow that really is out there for us to enjoy. And, welcome though it would be, I am not referring here to an England victory in next year’s World Cup! On the contrary, regarding our desire for something better, Lewis continues that ‘Probably earthly pleasures were never meant to satisfy it, but only to arouse it, to suggest the real thing. If that is so, I must take care, on the one hand, never to despise, or be unthankful for, these earthly blessings, and on the other, never to mistake them for the something else of which they are only a kind of copy, or echo, or mirage. I must keep alive in myself the desire for my true country, which I shall not find till after death; I must never let it get snowed under or turned aside; I must make it the main object of life to press on to that other country and to help others to do the same.’

If Lewis is right then medicine needs to stop imagining that it can bring about a utopia of perfect health, still less that which not even a fortnight on the Côte d’Azur can bring about, a world characterised by perfect happiness that never ends. That is something that medicine simply cannot deliver, not with a pill, not with a procedure, not even with a course of therapy. On the contrary, even the happiest of lives come to an end and when death does eventually inevitably draw near, medicine has no answer save to ease an individuals passing. This is not to say that palliative medicine isn’t hugely important, only that we make a mistake if we believe that there is ever such a thing as a truly good death. Because there isn’t, not at least for those who believe that our lives matter and that death, however less bad it can be made, is never truly good given the loss it entails and the end of what might otherwise have been.

Rather then than imagining itself to be the answer to everyone’s problems and in so doing only serving to disappoint those who do come to rely on it too heavily, medicine needs instead to play its part in helping others to press on to that other country of which Lewis speaks.

And so, whilst not being it’s main role, I believe medicine needs to make room for other philosophies and, acknowledging it’s limitations, be honest enough to at least suggest to patients that the answers to their greatest needs may be better found somewhere other than in the treatments we sometimes all too readily offer, in something bigger and better than all that even medicine has to offer. And, for me at least, that will, on occasions, involve me encouraging my patients to consider God, in whose presence, ancient wisdom tells us, can be found both fullness of joy and pleasures for evermore. [Psalm 16:11].

Recognise this and perhaps both we and our patients will be better able to cope when the bad times come, regardless of whether the associated disappointment is caused by circumstances, others, or ourselves. Furthermore we may be better able to enjoy more fully the good times when they come without our requiring them to be more than they actually are, without our requiring them to be perfect. Instead we can enjoy them, recognising them to be the echoes of those endless yet better times to come which so many of us continue to look forward to. And when that hope is finally fully realised, as I believe it one day will be, when every tear is wiped away and death is no more [Revelation 21:4], we will discover that it will more than amply compensate, not only for those missed opportunities to go wild on the dance floor, the absence of fresh croissants on our holiday breakfast tables and the consequences following a missed penalty kick, but also for all the genuinely heartbreaking disappointments in our lives, even that of death itself.

For then it will not be football that’s coming home – it will be we ourselves who are homeward bound. And having arrived there and found that we are home for good, I for one can’t imagine ever being disappointed again!


Postscript:

Later in the week I finally overcome my former reticence and adopted my altered ego of ‘Atom Man’ and so braved the waves of Newgale. It was good to forget myself and to feel, not lost or insignificant, but still wonderfully small, happily caught up and enveloped in something immensely bigger and vastly more impressive than I will ever be.

But by golly it was cold!


Related blogs:

To read, ‘Because sometimes not even chocolate is good enough’, click here

To read, ‘Covid-19. Does it suggest we really did have the experience but miss the meaning’, click here

To read, ‘Something to reflect on – are we too narcissistic?’, click here

To read, ‘Towards a more compassionate resilience’, click here

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

To read, ‘Waiting patiently for the Lord’, click here

To read, ‘The Lord is my Portion’, click here

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

ON APPROACHING ONE’S SELL BY DATE

The thing is, I don’t play golf.

Apart from that incident involving a lemon, a stained glass window and the irate members of the parochial church council, I haven’t picked up a golf club in anger for many years. Whilst it is true that I was soundly beaten over 18 holes last summer by my octogenarian father-in-law, it should be remembered that that was just a friendly encounter without any competitive element whatsoever. At least that’s my story and I’m sticking to it. And no you don’t want to know the score. In my defence, though he was 81 at the time, he was, and indeed remains, remarkably good for his age! And what he didn’t tell me, when I agreed to the match, was that, not only had the cataract in his one good eye been dealt with but also the artificial limb fitting he’d been waiting months for had been brought forward and he was now able to stand upright without the support of a walking aid.

Unbelievable!

But the reason why my lack of proficiency at golf has been on my mind lately is that, like my dog, who though formerly always eager for his early morning walk now looks at me as if I am mad if I so much as even hint that we might start the day with more than a single circuit of our local field, I too am getting older. As for Barney, we were thinking of sending him to ‘The Repair Shop’, that wonderful place where things of great personal value are restored to their former glory. Our hope was that ‘The Bear Ladies’ would be able to work their magic and thereby be able to blacken his nose, re-fur his balding back leg and tail, and freshen up his breath. But sadly of course, none of that is possible. The fact that he is ageing has to be accepted and so, just as Emily loved a saggy old cloth cat, one who was a bit loose at the seams, so we too love a dog who has long been dear to us and will always remain so despite even his sometimes pungent aroma.

I’m not sure if it was ever really a thing, but the idea of a GP finding time for a round of golf between morning and evening surgeries has long gone, these days we’re lucky if we’re able to squeeze in a cup of tea and a trip to the tiniest room in the practice building. But though playing golf seems to be something that a good number of retired folk enjoy spending their latter years doing, I can’t see myself following their example.

The other reason that retirement has recently been on my mind is that a few weekends ago I went to a reunion of the eight partners who worked in the practice when I joined it almost 25 years ago. Only two of us are still working and in five months time that will be reduced to one when I become the longest serving doctor in the practice.

As we dodged the showers in the garden where we gathered, it was good to reminisce about the good times we had shared together and to be reminded also of how fortunate I was all those years ago to land myself a partnership with such a lovely bunch of people. And to realise too how my good fortune has continued as, with each successive retirement, a replacement partner has been found who has been just as much a joy to work with as those who have left. It seems odd to think that the partner we are now seeking is likely to be the last who will join the practice before the search begins for someone to replace me.

And when that time comes, as it surely will, a replacement will most certainly be found. Because for every Andy Murray whose best years are in the past, there is an Emma Raducanu starting out with a bright future laid out before them. This is not to imply that my racket skills are any better than my prowess with a driving iron, only that, like a certain dour Scotsman, I too have passed my best before date.

Which got me thinking as to how I might approach my next appraisal. Rather than striving to set targets by which I might pretend to seek to ever improve, perhaps now is the time to get real and instead identify goals by which I might manage my inevitable decline.

This is not to suggest that we cease being useful once we retire, on the contrary, there is of course much that we can contribute as we get older but it is nonetheless true that what we can offer others does, in time, inevitably reduce. But before anyone thinks this is simply me being all maudlin and questioning what worth we have as our capacity to be useful begins to diminish, let me tell you about somebody I once met who was also past his best. Visiting the nursing home which had been his home for some 15 years, I was ushered into a room to see a frail elderly man, not quite yet 90 years of age. Not being my patient I’d not met him before but as I looked at him sitting uncomfortably and uncommunicatively in his chair, his mouth hanging open and his eyes tightly shut, it was clear that his life was drawing to a close. It was tempting to dismiss him as a demented old man whose apparent imminent death would surely be of little significance.

My attention was then drawn to a TEP form which seemed to be out of date suggesting as it did that hospital admission should be considered. And so I spoke to those who knew him best. Firstly to the senior nurse manager who had been acquainted with him throughout his time at the home and who cared enough about him to express that she would be sad if he were to die in hospital. And then to his only relative, a younger brother who, after saying that he felt sure that hospital was best avoided, added words which I will not easily forget. Barely able to control his voice, I could just about make out what he said: ‘He is my hero. As a boy, he looked after me when there was no one else to’.

I found the words intensely moving. Not ‘He WAS my hero’, but rather ‘He IS my hero’. Four words that whispered something that needs to be heard loud and clear.

The fact that a ‘demented old man’ remains somebody else’s hero is worth pondering. Or at least it is for me. Because it is all too easy for me to sometimes self importantly, mistakenly imagine that I am more significant than others and foolishly dismiss as of no value those I casually deem to have no practical use. Furthermore we all need to recognise that we too will all one day pass our best before date. Even as we do though, our worth will remain, just so long as someone, somewhere cares enough to remember who we are, who we once were and who, despite our palpable defeat, we might yet one day become.

The truth is that, even as we mentally and physically decline, when we don’t know one end of a golf club from the other and are unable to walk five metres in a day let alone in the four seconds required if we are not be considered frail, our worth nonetheless remains.

Because even though our best before day might have long since passed, our value extends well beyond our sell by date.

Even if we do then perhaps smell a little off!


Related blogs

To read ‘Vaccinating to remain susceptible’, click here

To read ‘Shot of Love’, click here

To read ‘The Repair Shop’, click here

To read ‘Three Times a Patient’, click here

To read ‘A Not So Shaggy Dog Story’, click here

To read ‘Book Review – The Book About Getting Older’, click here

To read ‘Old Hands’, click here

To read ‘Room Enough’, click here

To read ‘I knew a man’, click here

What a wonderful job this can be…

Don’t know much about anatomy

Don’t know much physiology

Don’t know much about the CCG

Don’t know why we have the CQC

But I do know as a GP

Because of those who work along with me

What a wonderful job this can be.

.

Don’t know much about nephrology

What the ‘C” is for in CRP

Don’t know how to read an EEG

Why no Zantac’s in the pharmacy

But I do know that I can see

Because of those who still consult with me

What a wonderful job this can be.

.

Don’t know much about anion gaps

Don’t know how to do those pleural taps

Don’t know much about such a lot

Don’t know quite what’s in my pension pot

But I do know that it’s OK

And even if I help just one today

What a wonderful job this can be.


Related Posts:

To read ‘Spare me a doctor’, click here

To read ‘I knew a Man’, click here

To read ‘If’, click here

To read ‘Room Enough’, click here

To read ‘Old Hands’, click here

To read ‘A Hard Year For us All’, click here

To read ‘I am the very model of a General Practitioner’, click here

To read ‘I’ve got a little list’, click here

ON BEING CRAZY BUSY – A TICKLISH PROBLEM

For me, the last few weeks have been crazy busy and, I suspect, they will have been no less so for you. Nevertheless I have had some fun moments. A highlight for me was meeting one of the Mister Men. Patient confidentiality prevents me from mentioning his name but it will I think suffice to say that, not only was his skin not as vibrant as I’d expected, but neither were his arms as long as I’d been led to believe they would be.

And then there was the patient who, noticing that she had a lump ‘down below’, thought she might have a uterovaginal prolapse.

Being a lady of a certain age she was initially a little reticent at exposing that most intimate part of her body to me on account of my being a chap but, eventually, she rationalised her decision to allow me to have a look with her assertion that I’d no doubt seen more of the anatomical structure in question than she’d had hot dinners.

So we did a calculation.

Hazarding a guess that the days on which she had eaten nothing but cold food would be no more than 20% of the total number that had made up her life, we came up with a conservative estimate that the number of cooked meals she’d eaten during her almost 95 years was 27,695.

At which point I assured her that I’d not seen anywhere near the number she imagined I had of the aforementioned body part.

It made us both laugh – and that seemed to matter.

But even so, the last month ot so has been busy – dangerously busy. And oftentimes it has been hard. The phrase ‘unprecedented demand’ has considerable precedence when used in the context of GP workload but these last few weeks certainly have seemed to have been busier than I can remember it ever having been before. General Practice has felt like it has been under siege with every day seeing us called upon to deal with far more patients than anyone could possibly conceive that we could ever manage properly. As such the work, as well as being less enjoyable and satisfying, has, for me at least, felt less worthwhile too.

The reasons for the surge in demand are many and varied but amongst them would be that some patients are now feeling brave enough to come forward with problems that previously they had felt too anxious to bring to our attention, that long hospital waiting times have resulted in patients repeatedly having to turn to their GP for the care that they might otherwise have received from specialist teams and, of course, that the uncertainty and fear generated as a result of the pandemic has seen a huge increase in the number of mental health problems being presented to primary care.

There will be undoubtedly be many other reasons for why demand has increased but over and above these understandable and appropriate reasons for patients wanting to consult with us, I wonder if there is another, more existential, cause.

With increasing numbers of people no longer believing that there is a better world to come, be that in this life or the next, and fewer of us experiencing any hope for a brighter tomorrow, too many of us are insisting on our best life now. We are increasingly unwilling to wait for what the media tells us we should expect our lives to be characterised by, namely an absence of pain and inconvenience and an abundance of happiness and fun.

But real life is not like that. Though we may be able to airbrush our social media profiles, we cannot airbrush out those aspects of our life that are not to our liking. And, despite the best efforts of health care professionals, neither can medicine.

Even so, the expectation remains and the attempt to do so goes on. When medicine is portrayed as possessing a god like omniscience, is it any wonder that so many people bring their problems to us, promised as they have been that we can provide for them the solutions they desire.

The truth though is that medicine does not posses the resources or ability to deliver the answers it does not have.

If things are ever going to get better, we, our patients, and the policy makers who continue to demand of us what we cannot deliver, are all going to have to recognise both our limitations and the limitations of the profession that we are a part.

Because good health begins, not with good medical care, but with having something worth being healthy for. And that’s something that increasing numbers of people are finding that they do not have, some, for the first time perhaps, as a result of the wider consequences of the coronavirus pandemic.

And for as long as a packet of fags, a bottle of scotch and a Happy Meal are the highlights of our lives, so we will continue to seek, and fail, to find our happiness in such things.

In his book ‘Walden’, Henry David Thoreau wrote that ‘the mass of men lead lives of quiet desperation’. That may have been true once but now that same desperation is becoming ever louder such that now it is a deafening roar. Even so, still the desperation remains and many are still set to ‘go to the grave with the song still in them’

As more and more people experience what Leonard Cohen once said we sooner or later all come to know, that is the ‘defeat of our lives’, the question becomes will they continue to expect medicine to provide a way back? Or will they instead be encouraged to look elsewhere for the help that so many of them so desperately need?

And that, of course, includes us.

Many of us are increasing feeling overwhelmed and threatened by the demands put upon us. Under siege we continue to try to fend off all attacks yet succeed only in finding ourselves imprisoned behind the barricades we have erected in our forlorn attempts to stave off defeat. Perhaps it is time instead to at last appreciate that since medicine does not equip us for the battle in which we are engaged, ours is a fight that we can not ultimately hope to ever emerge as victors. Recognise this and we may find ourselves free from always having to win, free from always having to be the ‘NHS Heroes’, that, inundated as we are now, it is all to clear none of us were ever cut out to be.

And then who knows, we might just find that we are able to find some satisfaction, some enjoyment, even some fun, in our work once more.

We might even meet Mr Happy!


Related Blog:

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

desolation row

she’s taking photos of the future

she’s painting the background black

the walls they’re closing in on her and

she’s not pushing back

and the minutes pass like hours

the weeks they pass like years

as eyes keep filling up until

there’s no room for her tears

and she’s stuck inside of silence

not knowing where to go

so she’s resigned to living on

Desolation Row.

.

now there’s no hope for tomorrow,

as there’s no dream for today

her thoughts they’re going nowhere,

and those thoughts won’t go away

and her only true companion

is her cold contactless phone

it’s never very far from her

it keeps her on her own

but the only calls she’ll ever make

in the life that she’ll forgo

are the calls she’ll make whilst dying on

Desolation Row

.

After Bob Dylan


Related posts:

To read ‘together in line’, click here

To read ‘the wrong patient’, click here

To read ‘beaten’, click here

To read ‘Resting in Pieces’, click here

To read ‘Crushed’, click here

To read ‘Masked’, click here

To read ‘She’s The Patient You Don’t Know You Have’, click here

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

To read ‘Contactless’, click here

My Back Pages

‘Ah, but I was so much older then, I’m younger than that now.’

As a boy, I spent my early years playing. I did not endeavour to please anyone as I did so, though my parents no doubt were happy to see me having the fun that all children ought. I did not seek to play better than those I played with – what would be the point? I simply played, and was glad to do so.

Then came school and, though I did not seek to impress, I was, from time to time, rewarded. Stars for pleasing the teacher. And I saw that the number of stars I received was compared with those that were bestowed on others. I was, I realised, in competition with my peers.

School continued and the tasks set me became more complex – the rewards more contingent on my reaching a certain standard. ‘Work hard’, they said, ‘and you might do well – you might progress’. Which I did. But there was always a next stage, never a point beyond which one could simply stop and rest.

And so I continued on to university – where those who strived hardest secured the best jobs. Then, inevitably, came work. And the rewards dried up, replaced now by the threat of sanctions. Instead of rewards for achieving, now there were punishments – even for those who were simply standing still. Good enough was no longer good enough. ‘You must improve’, they said, ‘You must be better, you must do more’.

And then, finally, came criticism. Initially implied, then explicit. It was not merely that I was not good enough, rather it was that I was to blame.

So harder and harder I worked until, finally, I stopped – exhausted – defeated.

And I realised I had grown old. And not only in years

Oh for a lesser load, and a little rest, for a yoke that was easy and a burden that was light. Oh to be treated gently, by someone strong enough to cope with my weakness, someone who, rather than treating me harshly and constantly demanding of me ever increasing levels of perfection, was lowly of heart. Oh to be cared for by someone accepting, someone forgiving, someone who could, and would, provide for me the long desired perfection I had long been striving for and thereby offer me rest for my soul.

And so I remembered my days as a boy. And I sought to become like a child again, someone who was wiser than the foolish adult I had become, someone who accepted his need of help. And as I did so I looked to simply enjoy doing what it was that I was meant to do.

Because the world can be a cruel taskmaster and competing in a misguided attempt to prove our perfection makes losers of us all.

Perhaps though there is someone out there who, even now, is glad to see me imperfectly endeavouring to do what is right, someone who cares for me, someone who isn’t only out to criticise and condemn. Perhaps there is someone out there who loves me that much.

I happen to believe there is.

If I’m right, what a relief that would be!

[‘My Back Pages’, is the title of a song by Bob Dylan from which the line ‘Ah, but I was so much older then, I’m younger than that now.’, is taken. It appears on the 1964 album, ‘Another Side of Bob Dylan’. This blog is an updated version of one originally written in 2018. It expresses, of course, more of an aspiration of where I would like to be rather than where I actually am. As with much in life, we journey on to become what we already really are.]


Related blogs:

To read ‘Rest Assured’, click here

To read ‘“The Medical Condition” of “Hannah Arendt is Completely Fine”’, click here

To read ‘Somewhere over the Rainbow’, click here

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

To read ‘Expressive Individualism and the Drive for Perfection’, click here

To read ‘Nicky Alexander’, Dr Perfect?’, click here

To read ‘Don’t forget to be ordinary if you want to be happy’, click here

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

Getting in touch with your inner Womble.

Sometimes, being a GP feels like something akin to being a Womble – that’s right, sometimes it seems that we are dealing with rubbish all day long!

But that’s not the only reason I feel an affinity to those inhabitants of Wimbledon Common that scurry around, diligently clearing up after others. Nor is it simply because one of those fury little creatures takes his name from the town in which I live. And no, I do not live in Tomsk and, though I may be a little on the short side (5’4” thank you for asking), neither am I particularly hirsute. My Wombleness is much more layered than that.

‘People don’t notice us, they never see.

Under their noses a GP might be

We GP by night and we GP by day

Looking for ways to take problems away.’

Furthermore we all sometimes find ourselves having to dance. But even though the one on which we are led may seem a merry one, it is a dance that we are accompanied by nothing as delightful as the Minuetto Allegretto. Instead we are encouraged to quick step to the cacophony of sound that emanates from NHS England and the media, and to waltz to the unearthly din generated by the government, QoF and the appraisal process.

‘Oh slave now like your partners

Young GP’s were told

With satisfact’ry colleague feedback

You will work ‘till you’re old’

Unless of course you burnout young.

More positively though, like Wombles, GPs are organised, work as a team. GPs are tidy and’, for the most part at least, ‘GPs are clean’. Furthermore we are ‘so incredibly utterly devious’, that lesser known Womble characteristic that enables us to make good use of the things that we find, irrespective of how limited those resources that we come across actually are. Just as it is with Wombles, so it is with we GPs – our communities would be a lot messier without us. Our work is hugely valuable and, though our efforts may not be valued by some, most of our patients, really do appreciate all that we do.

So…

When the sun doesn’t shine and it’s cloudy and gray

And it’s only the beginning of the GP-ing day

And the CQC inspectors say that they’re on their way

When the phones are going crazy and you just can’t see

How you will even find the time to drink a cup of tea

And every patient says that you must see them urgently

When the newspapers are saying things that just aren’t true

And everyone is laying blame for everything on you

And they’re telling you exactly what it is you’ve got to do…


Remember, remember, remember, remember Remember, remember, remember (member, member, member)

(Altogether now)

Remember you’re a GP (Remember you’re a GP) Remember you’re a GP (Remember you’re a GP) Remember you’re a GP (Remember you’re a GP) Remember you’re a GP (Remember you’re a GP)

Remember, member, member, what a GP, GP, GP, you are.

And remember too just how loveable and cuddly you really are!

And with that, like Orinoco, I’m off to get an extra 40 winks!


To read ‘A Hard Year for Us All’, click here

A Hard Year For Us All

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A HARD YEAR FOR US ALL

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Oh, where have you been, my GP team?

Oh, where have you been, whilst you I’ve not seen?

We’ve worked every day of this dreadful pandemic

We’ve managed all kinds of conditions systemic

We’ve delivered shots at the Covid vaxs clinic

We’ve tended the folk whose hearts are ischaemic

We’ve been close at hand to those emphysemic

And it’s a hard, and it’s a hard, it’s a hard, it’s a hard

It’s been a hard year, for us all

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Oh, what did you see, my GP team?

Oh, what did you see, whilst you I’ve not seen?

We’ve seen patients in person when we’ve needed to

We’ve seen desperation in not just a few

We’ve seen the dyspnoeic as they became blue

We’ve seen those with conditions requiring review

We’ve seen palliative people their dying all through

And it’s a hard, and it’s a hard, it’s a hard, it’s a hard

It’s been a hard year, for us all

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Oh, what did you hear, my GP team?

Oh, what did you hear, whilst you I’ve not seen?

We’ve heard news reports that caused us to bridle

We’ve heard people saying that GPs were idle

We’ve heard some denying the pandemic was viral

We’ve heard people crying as they fought for survival

We’ve heard those describing their thoughts suicidal

And it’s a hard, and it’s a hard, it’s a hard, it’s a hard

It’s been a hard year, for us all

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Oh, who did you meet, my GP team?

Oh, who did you meet, whilst you I’ve not seen?

We’ve met with so many their mood melancholic

We’ve met young and old with a too high systolic

We’ve met those in great pain from their biliary colic

We’ve met breathless people from causes embolic

We’ve met those depressed by hardship economic

And it’s a hard, and it’s a hard, it’s a hard, it’s a hard

It’s been a hard year, for us all

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Oh, what’ll you do now, my GP team?

Oh, what’ll you do now, you who I’ve not seen?

We’ll watch as the problems towards us they throng

And lean on each other to somehow stay strong

And wonder how long all of this may go on

And whether or not we still want to belong

In a job where some things they seem sometimes so wrong

Cos it’s a hard, it’s hard, it’s a hard, and it’s a hard

It’s been a hard year, for us all

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After Bob Dylan’s ‘A Hard Rain’s A-Gonna Fall’ – in the week of his 80th birthday.


Related Posts:

To read ‘If’, click here

To read ‘I knew a man’, click here

To read ‘Reintroducing GPs Anonymous’, click here

To read ‘On not remotely caring’, click here

Reintroducing GPs Anonymous

Today is the Glorious 13th – the day that marks the start of the GP shooting season. Admittedly, this year, many seemed to have jumped the gun but, with headlines a plenty in the national papers, it is clear that the annual tradition of having a bop at your local provider of primary care services is, once more, well and truly underway.

This is not to suggest that the criticisms aren’t entirely appropriate, it’s not as though we’ve been experiencing unprecedented demand of late, or that we have had to struggle to balance the twin concerns of managing patients safely whilst avoiding unnecessary contact in light of a global pandemic. On the contrary, we have all been enjoying more time on the golf course having finally been able to take up that executive club membership as a result of the vast profits we’ve made from administering Covid-19 vaccinations.

In recent years it’s been increasingly accepted that GPs are to blame for most of the problems in the NHS and being a GP is now, quite rightly, seen as something for which we ought to be ashamed. Surely, then, it’s time we considered getting ourselves some help.

Whether it be our delayed diagnoses, our inappropriate admissions or our failure to offer enough appointments, it’s time to face up to the uncomfortable truth, GPs are the problem. Having for years been told this repeatedly it’s finally time we listened. The facts, as they say, speak for themselves – it really is all the fault of we GPs.

We must deny it no longer. We must stop trying to convince ourselves we’re OK and instead acknowledge our failings. After all, if we don’t, how can we expect anything to be done to help us. We will just go on making our own life, and everyone else’s, miserable.

Everyone’s aware of how embarrassing GP behaviour can be. You know the kind of thing, how we love to spoil people’s fun by advising those with a fever and a new continuous cough not to visit their great aunts for tea or how we refuse to allow our waiting rooms to fill up with patients who wish to discuss the sudden loss of their sense of smell. Without a doubt it is selfishness such as this that leads to A&E departments being inundated with such patients who are thus forced to waste precious hours of their time seeking a proper medical opinion.

And then, of course, there is our wilful ignoring of patients whose symptoms clearly suggest that they have cancer but who we deliberately neglect to refer preferring instead to put an unnecessary burden on secondary care services by recklessly admitting patients to hospital just for the fun of it.

So let’s all face up to our problem. I’ll go first by introducing myself:

My name is Peter – and I’m a General Practitioner.

If you’re similarly afflicted, come and join me – I’m setting up ‘GPs Anonymous’ in the hope that together we can support all those who are stricken with the affliction that is ‘being a GP’.

But perhaps you’re still not convinced that you have a problem. If so, can I urge you to ask yourselves these four screening questions? Answer two in the affirmative and you may have a problem – answer ‘Yes’ to all four and you’re in real trouble.

C – have you ever felt you wanted to cut down how much general practice you do?

A – have you ever been annoyed by criticism of your actions as a GP?

G – have you ever felt guilty for what you have done as a GP?

E – have you ever started doing your ‘GP thing’ early in the morning?

Extra phone lines will be installed should demand for this new service prove overwhelming.

But why do people fall into the destructive behaviour patterns that are characteristic of general practitioners? Some have suggested that in some cases there may be a genetic component – seeing your parents behaving as GPs seems to predispose some to follow a similar path. Mercifully, however, this is becoming less common. Others experience a little bit of general practice early on in their medical career and naively imagine that it’s a good thing – something that they can control. After all, just one attempt at a ten minute consultation can’t hurt can it? But before long they’re out of control – only in it for the extortionate pay, the long hours of ‘off duty’ and the kicks one gets from the systematic mismanagement of those who thought they were there to help.

It’s a tragic condition but now, with the arrival of ‘GPs Anonymous’, there is at last some real hope for change. So please give generously, together with your help, this year we can rid the country of the blight that GP’s have become.

And then won’t everyone be happy?

[This is a reworking of something I wrote previously. Apologies to those who may have seen it before but sadly it continues to seem ever more relevant today.]