THE VERY MODEL OF A GENERAL PRACTITIONER?

I am a type of doctor one who majors in the general,

I have a working knowledge of those matters anatomical,

I deal with illness physical, and problems psychological,

And try to make suggestions that aren’t only pharmaceutical.

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Each day at work I undertake, a range of consultat-i-ons,

And lately have become one skilled, in giving vaccinat-i-ons,

I’m always on the look out for, hern-i-al strangulat-i-ons,

Whilst still exploring all ideas, concerns, and expectat-i-ons.

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I’m competent if called upon, to tackle venesect-i-ons,

And know just what I am to do with urinary infect-i-ons,

I know the interval between all those B12 inject-i-ons,

And for appraisal purposes, I note down all re-flect-i-ons.

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I know that those who vomit blood will contact me annoyedly,

And so I give a PPI with all drugs non-steroidal-y,

And those who come to me who have been bleeding haemorrhoidally,

I duly send them for a scope, exploring them sigmoidally.

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I love to sit with patients both the shy and the loq-ua-ci-ous,

And listen to their stories which, are sometimes quite sal-a-ci-ous,

But nothing brings me greater joy than when I’m effi-ca-ci-ous,

At, with a little xylocaine, removing cysts seba-ce-ous.

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In truth those houseman days of old, were like a fire baptis-i-mal,

But now my days in medicine are not so very dis-i-mal,

There are of course those things at which I’d truly be abys-i-mal,

E.g. repairing pulsatile aortas aneurys-i-mal.

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After W.S. Gilbert and Arthur’s Sullivan


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

Book Review: ‘The Book about Getting Older’, by Dr Lucy Pollock

Having read this week ‘The Book About Getting Older (for those who don’t want to talk about it)’, I have a few problems with its author, Consultant Geriatrician, Dr Lucy Pollock. The first is that, since she is of a similar age to me, should I be fortunate enough to make it to a ripe old age, it is extremely unlikely that she will still be working when I have need of someone to oversee my medical care. However, with luck, whoever it is who will one day have the misfortune of being called upon to advise me in my dotage will have read her book and taken on board all that she has written there, for it sums up what good medicine is, for me, all about. And so the second problem I have with Dr Pollock is that she is liable to cause me to run out of the superlatives necessary for describing what she has said.

For this is a book that, along with considerable humour, oozes wisdom, overflows with compassion and is chock-full with sensible counsel which really does make it a must read for hospital consultants, general practitioners and anybody who cares for an elderly person. And that, of course, includes anybody who is themselves elderly or one day hopes to be so. No wonder she is so highly regarded by those I work with who refer into the hospital where she works and who, on occasions have had the very great pleasure of hearing her speak.

Much of the book is written like a novel with exquisitely drawn descriptions of patients, written by somebody who clearly cares deeply about those she is writing about and who draws the reader into their stories, making us care for them too. Here then is somebody who cares enough to notice the little details of an individual’s character, somebody who listens attentively to what it is they are saying, spoken or otherwise, and somebody who makes every effort to understand those who come to her for help, surely the foundation upon which all good care must rest. Here too are elderly folk, described as they truly are, not as burdensome individuals who drain the healthcare system with their multiple problems, but people who have lived and loved and have much to offer despite the level of their current need for support.

The book takes an honest look at the problems that increasingly longevity brings with it. As more and more of us are living longer, with those added years inevitably being at the end of our lives, greater numbers of us are consequently spending our final years increasingly dependent on others. The book urges a thoughtful consideration of how medicine can be best applied to those individuals for whom yet another medical intervention will not always be in their best interests. But Dr Pollock never suggests that old people are not worthy of being treated. On the contrary, as she helpfully puts it, some treatments are simply not good enough to be used on some elderly folk. It is the treatments, not the patients, that aren’t worthy.

Rather than thoughtless adherence to medical protocols and treatment algorithms, it is for Dr Pollock an understanding of her patients and what it is that is important to them as individuals that should drive the decisions that are made by the clinician, the patient and their families, as to what should and should not be done. Just because something can be done doesn’t mean it should be. The book is full of cases of how this principle is not one that is held merely theoretically. Her sadness and frustration at the case of the elderly patient who, over the course of a previous three month hospital stay, suffered 77 blood tests, undertaken for reasons that were no doubt well meant but were nonetheless almost entirely unnecessary, is a case in point. Rather than yet another investigation being ordered, a discussion of what was important to the patient leads to the individual going back home to enjoy watching football on the TV with his son whilst taking a few sips of cider. That really is good practice, medicine that, rather than vainly seeking to add years to life, aims to add life to the limited time those who of an advanced age inevitably have.

The book also has a useful discussion about advance care plans, a realistic look at the success or otherwise of attempts at cardiopulmonary resuscitation and the challenges of dementia. There are also some practical chapters on assessing capacity, powers of attorney and considerations around driving.

It really is a superb book in which the author clearly cares about the reader every bit as much as she does her patient as evidenced both by the gentle way she softens the delivery of less palatable truths and by the slightly larger font that has no doubt deliberately been employed whilst mindful of the deteriorating eyesight of some of her readers. Please do read it, and then recommended it to your family and friends and, for those of you working in healthcare, recommend it to your patients. It really does deserve a very wide readership.

Which brings me to my final problem with Lucy Pollock. In the unlikely event that I am ever cast away on a desert island, I am now going to have an even more difficult task choosing what book I might like to take with me alongside the Bible and the complete works of Shakespeare. For this is a book, full of delightful characters, that is in turns both moving and inspiring, one that makes me want to live better and practice better. It is also one that, marooned on a desert island far from any medical attention, might just reassure me that perhaps we don’t always need quite as much medicine as we sometimes foolishly think we do. Even so, all alone on an island I would undoubtedly miss doctors like the writer of this excellent book and the wonderful patients I, like her, have had the joy or caring for.

But never mind this review, read the brilliant Lucy Pollock’s, brilliant book. Easily worth six stars.


To read, ‘Vaccinating to remain susceptible’, click here

To read, ‘Shot of Love’, click here

To read, ‘On not remotely caring’, click here

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

To read, ‘The Repair Shop’, click here

I’ve got a little list…

I’VE GOT A LITTLE LIST – Take One

As some day it may happen that a victim must be found

I’ve got a little list — I’ve got a little list

Of medical offenders who might well be underground

And who never would be missed — who never would be missed!

There’s the patient who believes that he has suffered every ill

And even those he hasn’t yet he knows someday he will

The CQC inspector who insists the rules are kept

And pouring urine samples down the sink he won’t accept

The turmeric advisor – yes that dreadful herbalist –

I don’t think he’d be missed – I’m sure he’d not be missed.

.

He’s got them on the list — he’s got them on the list;

And they’ll none of them be missed — they’ll none of them be missed

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There’s those who deal with teeth and gums who aren’t there to prescribe

The elusive dentist – I’ve got him on my list

And patients who have symptoms that they simply won’t describe

They just do not assist – they never would be missed

The chap who takes his jacket off and hangs it on the door

The halitotic sufferer whose breath you can’t ignore

The ones who by their actions make it clear that they’re acopic

The bloke who needs a blood test but who says he’s needle phobic

The one advised to see you by their crystal therapist –

I don’t think she’d be missed — I’m sure she’d not be missed!

.

He’s got them on the list — he’s got them on the list;

And they’ll none of them be missed — they’ll none of them be missed

.

The fellow feigning sickness who requires of you a note

That symptom fantasist – I’ve got him on my list

The ones, cos you were running late, complaining to you wrote

I wish they would desist – they never would be missed

The folk you ask what pills they take who haven’t got a clue

They only know that some are red and others they are blue

The ones who think they’re dying since they did that Google search

Who know that they’ve got cancer cos their little finger hurts

The medicines advisor who on certain drugs insists

I’d like to slap his wrist – I’m sure he’d not be missed.

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He’s got them on the list — he’s got them on the list;

And they’ll none of them be missed — they’ll none of them be missed

.

And then there are the patients who have issues that are legion

They’ve got a long long list, I’ve got them on my list

Who seem to have a problem with their every bodily region

Their think perhaps a cyst, they never would be missed

Those moaners at prescription costs despite their untold wealth

And those who want a call from you who say they’ve ‘mental ‘elf’

And those who say it’s urgent though they’ve had their problem years

The chaps who come with issues with their gentlemanly spheres

Who really would be handled best by a vasectomist

He’d give them both a twist, I’m sure they’d not be missed.

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He’s got them on the list — he’s got them on the list;

And they’ll none of them be missed — they’ll none of them be missed.

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Those saying the pandemic was by Bill Gates orchestrated

The conspiracy theorist – I’ve got him on my list

And all those antivaxers who unfounded fears created

They never would be missed, they never would be missed

The one who says that Covid caused his cough in ‘92

And won’t accept a single thing you ever say is true

The people who in parliament who only cause us hassle

The government advisor that once went to Barnard Castle

Who should instead have gone to see, a skilled Optometrist

I don’t think he’d be missed – I’m sure he’d not be missed.

.

He’s got theem on the list — he’s got them em on the list;

And they’ll none of them be missed — they’ll none of them be missed

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After W.S Gilbert and Arthur Sullivan

For those unfamiliar with the song, the original appears in the comic opera, ‘The Mikado’, first performed at London’s Savoy Theatre in 1885. Sung by The Lord High Executioner, modern productions include topically updated versions of the song with tongue in cheek suggestions of those people whose loss, were he to be called upon to act professionally, would be a distinct gain to society. If you’d like to hear an example of a fairly recent version, a link to one follows.

https://youtu.be/-MDyurTABdU

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I’VE GOT A LITTLE LIST – Take Two

Because, in reality, having always enjoyed good relationships with both patients and colleagues alike, and that includes dentists and medicine management advisors, there are many I’ll miss when my time comes to retire from General Practice. Please be assured that the truth is that I am really very fond of everyone that my job brings me into contact with and no more mean to suggest real criticism in the above than, presumably, Gilbert and Sullivan did when, in their original song, they identified children who had an impressive knowledge of historical dates and those with irritating laughs as those deserving of the attention of the Lord High Executioner.

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As one day I’ll retire when my working days are done

I’ve got a little list, I’ve got a little list

Of people I will want to thank, who’ve made my job such fun

They’ll all of them be missed, they’ll all of them be missed

There’s the patients who forgave me for mistakes that were my fault

The folk who every Christmas gave me smokey single malt

And those who every morning, at half ten knocked on my door

And brought me cups of coffee and those biscuits I adore

They’re none of them draconic, those kind receptionists

They’ll all of them be missed – they’ll all of them be missed.

.

I’ve got ’em on the list — I’ve got ’em on the list;

And they’ll all of ’em be missed — they’ll all of ’em be missed.

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And then there are the nurses who were always sympathetic

I’ve got them on my list, I’ve got them on my list

When I got into a pickle managing a diabetic

They’ll all of them be missed, they’ll all of them be missed

The HCAs who helpfully squeezed in those ECGs

And never made me beg for one whilst down upon my knees

The times when I had issued drugs whilst just a tad distracted

And someone pointed out the way they may have interacted

Indeed I am so grateful to our helpful pharmacists

I know that they’ll be missed – I’m sure that they’ll be missed.

.

I’ve got ’em on the list — I’ve got ’em on the list;

And they’ll all of ’em be missed — they’ll all of ’em be missed.

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The team up there in admin, those who type what I dictate

I’ve got them on my list, I’ve got them on my list

Who hear the words I mumble that they’ll first have to translate

Though I sent them round the twist, they’ll all of them be missed

The practice manager who I have driven up the wall

By not reading my emails and by changing my on call

My partners who I have been glad to have close by my side

Who’ve been there as I’ve laughed a lot, who’ve been there as I’ve cried

Well I am very sure now that you all have got the gist

They’ll all of them be missed, they’ll all of them be missed.

.

I’ve got ’em on the list — I’ve got ’em on the list;

And they’ll all of ’em be missed — they’ll all of ’em be missed.


To read ‘A Very Model of a General Practitioner?’, click here

The Repair Shop

‘Everything is broken’

Bob Dylan

‘There’s a crack, a crack in everything – that’s how the light gets in’

Leonard Cohen

This week I watched another episode of The Repair Shop. It’s an excellent programme in which items of great personal worth that have fallen into a state of disrepair, either as a result of neglect, misuse or simply the passage of time, are brought to a team of expert craftsmen and craftswomen for repair. We then watch as they apply all of their skill and experience to the task of restoring the inner workings and external appearance of the precious items. Slowly they are given back their former glory before being returned to their owners, all of whom are invariably delighted with what has been achieved in making what was once broken whole again.

Despite my utter incompetence in all things practical, why anyone would ever allow me to perform minor surgery on them I’ll never know, I found myself feeling envious of those I was watching, wishing I too worked in The Repair Shop. Until, that is, I realised how similar our job is to theirs.

Those who come to us are also of great value but have become broken, likewise due to having been either neglected, treated badly or as a result of simply becoming old. And it is our job to use all our skill and experience to bring about some kind of repair.

The artisans in the programme clearly derive a huge amount of satisfaction from their job and it left me wondering why it is that, if our jobs are alike in so many ways, we do not always experience the same sense of satisfaction that they do.

As I watched this weeks episode I was struck firstly by how all those who work in The Repair Shop seem to really care about the item they are working on, both in terms of appreciating its intrinsic worth as well as recognising its value to the one who brought it. And then there is the obvious love that they have for what they do, the enjoyment they get from the challenge of applying all of their expertise to the task in hand as they work out how best to effect a repair. And finally there is the the very apparent pleasure they experience when they see the joy their efforts bring about in those for whom they have worked.

All of which might give us some clues as to why we sometimes struggle to find the same degree of joy that those in the Repair Shop seem to experience and, more importantly perhaps, thus offer some pointers as to how we might go about deriving greater job satisfaction ourselves.

But before we do, it needs to be acknowledged the differences that exist between our world and that of those who appear on the TV programme. To watch ‘The Repair Shop’ is to spend an hour in a wonderfully reassuring place where everything can be fixed, where everything can be put right. The hectic reality of our daily working lives is, however, very different to the serenity of the world within The Repair Shop where only things of genuine value are brought and where those who work have all the time, space and equipment required to do their job properly. We, in contrast, with our limited resources, sometimes struggle to find the time to do properly those things that are of value, bombarded as we are by the constant demand to also attend to the seemingly relatively trivial. Furthermore, whereas those working in The Repair Shop are always hugely appreciated, we not infrequently feel like we are sometimes being taken for granted. And unlike those in the programme who invariably achieve all that they set out to do, we know all too well that we can’t fix everything. Inevitably we are not always as successful as we would like to be and, as a result, often have to face the fear of being criticised by those who cannot accept that we are unable to bring about the impossible.

Even so we would do well to value those who come to us for help. They really are of immense value. People have huge intrinsic worth and their health is something that is of the utmost importance to them. In the busyness of our working day this is something that is frequently lost as we all too easily end up seeing patients, not as individuals with genuine needs but as merely nuisances instead, ones who seem set on spoiling our day with their difficulties. In reality however, the majority of the problems that are presented are genuine, even if some are more significant and more appropriately brought to a doctor than others. Furthermore, people really are amazing creatures, intricately knitted together, a beautiful and complex amalgamation of the physical, emotional and spiritual, too complex indeed for any of us to fully understand. Perhaps then, if we are to recover some job satisfaction, we need to try to rediscover that sense of wonder that our increasingly frantic working lives have succeeded in squeezing out of us. And perhaps we also need to gain a greater appreciation of what a privilege it is to be involved in the important work of seeking to restore such a precious thing as a fellow human being who finds themselves in need of repair.

That said, it is of course not only our patients who are broken. We, some more than others, are broken too, physically, emotionally and spiritually, both inherently and as a result of circumstances be they our neglecting ourselves, our being treated badly by others, or simply as a consequence of long years in a job that has taken its toll. We all sometimes need the help of others if we are going to make it through – it’s no shame to ask for it. Because we too would sometimes benefit from being taken aside by a master craftsman, to place ourselves in the hands of one who genuinely values us, understands our inner workings and has all the skill, patience and kindness required to complete the good work he begins in putting us back together.

Perhaps then we too need to visit The Repair Shop. If we do we may find ourselves reassured that everything really can be fixed, that everything really can be put right. Furthermore, having spent a little time there, someone, somewhere might just experience the joy of having us back, a little less broken than we were before.


To read ‘Rest Assured’, click here

AN UNCOMFORTABLE TRUTH

‘I’ll go along with the charade until I can think my way out’

Bob Dylan

Recently a patient presented at the practice where I work having been sent to us by a doctor from the local minor injuries unit. She had been advised to request an urgent blood test to determine her blood levels for a certain heavy metal after an ECG she’d had had shown some minor abnormalities. It subsequently turned out however that the automated report had attributed these abnormalities not, as had been believed, to lead poisoning but merely to lead positioning!

An embarrassing mistake to have been made by somebody who had clearly not been thinking properly. But before we laugh too loudly, I wonder how many times we too have stopped thinking for ourselves, failed to see what was there to be seen and addressed only our own ideas, concerns and expectations rather than those of our patients.

As time pressured clinicians it is all too easy for us to stop thinking for ourselves and fall into stereotypical patterns of behaviour based on the assumptions we make and which, though they may speed our decision making, too often serve our purposes more than they do our patients causing us as they do to draw conclusions which steer us down those familiar paths along which we find it more comfortable to travel.

Might it be that we too have stopped thinking properly, failed to see what was in plain sight and thereby absolved ourselves from any responsibility to help as we have passed blindly by on the other side? I don’t doubt that I have, on occasions, done just that and am left asking myself why that might be.

Of course the easy answer to that question would be to say that it’s because I’m either too lazy, too incompetent or too busy to address the problems that are presented to me properly. I suspect that, if I am honest, each of those explanations have almost certainly sometimes been true, but another explanation might be that, rather than face the distress of a problem that cannot be solved, it has sometimes been easier for me to not notice what medicine cannot fix.

In his book, ‘How to think’, Alan Jacobs writes of how, once established, the consensus is hard to challenge because there is great comfort in sharing the commonly held position. He quotes Marilynne Robinson who suggests we have a ‘collective eagerness to disparage without knowledge or information’ alternative or unpopular views ‘when the reward is the pleasure of sharing an attitude one knows is socially approved.’

If this is true, as doctors we are, in the medical setting, predisposed, without thinking, to endorse the view that medicine can solve all our problems because we know that, given they have presented to us, those we are talking to are likely to share this view, and will approve of us for so doing. This is, perhaps, particularly true on account of how so many of us in medina do so want to be liked.

We are, in the moment of the consultation, invested in not thinking because, it would feel too uncomfortable to disagree because, as Robinson puts it, ‘unauthorised views are in effect punished by incomprehension…as a consequence of a “hypertrophic instinct for consensus”.’

Jacobs asserts that if we want to think, then we ‘are going to have to shrink that “hypertrophic instinct for consensus.” But, he says, ‘given the power of the instinct, it is extremely unlikely that [we will be] willing to go to that trouble”

Jacobs believes that the ‘instinct for consensus is magnified and intensified in our era because we deal daily with a wild torrent of what claims to be information but is often nonsense’. That is certainly true in the medical world where nonsensical demands are too often unjustifiably imposed upon us. Jacobs quotes T.S. Eliot who, almost a century ago, wrote, ‘When there is so much to be known, when there are so many fields of knowledge in which the same words are used with different meanings, when everyone knows a little about a great many things, it becomes increasingly difficult for anyone to know whether he knows what he is talking about or not.’ And in such circumstances, ‘when we do not know, or when we do not know enough, we tend always to substitute emotions for thoughts.’

That is, confused about what to believe, we will default to what feels comfortable and agree with the consensus, the perceived wisdom. Could it be then that when we are presented with a problem we cannot fix, a problem for which medicine is not the answer, the cognitive dissonance we therefore experience serves to make it less likely that we will see that problem at all and and end up seeing only those with which we feel we can deal.

Jacobs believes that ‘anyone who claims not to be shaped by such forces is almost certainly self-deceived.’ We are social beings who need to feel accepted and, since agreeing feels good, we are prone to toe the line. ‘For most of us’, Jacobs suggests, ‘the question is whether we have even the slightest reluctance to drift along with the flow. The person who genuinely wants to think will have to develop strategies for recognising the subtlest of social pressures…The person who wants to think will have to practice patience and master fear.’

So could we as General Practitioners do that? Could we practise patience and master fear and thus resist the ‘hypertrophic instinct’ which insists that medicine is the answer to all our problems.

I’d like to think we could but it will be uncomfortable, as speaking the truth often. It’ll mean giving up the charade that as doctors we have all the answers and accepting instead that there are times when we can do no more than simply notice the distress our patients are experiencing, acknowledge it for what it is and, perhaps, try to ease it a little by being human enough to sit alongside them and share in it with them for a while.

Which will be a whole lot more use than another unnecessary blood test.

On not remotely caring

‘Those who feel the breath of sadness, sit down next to me

Those who feel they’re touched by madness, sit down next to me

Those who find themselves ridiculous, sit down next to me’

James

Back in the 1960’s, in the days before research required ethical approval, American social psychologist Stanley Milgram carried out a series of experiments designed to investigate the extent to which subjects would submit to the demands of those in authority. Individuals, believing that they were assisting research into how punishment influenced somebody’s ability to learn, were, on the instruction of an ‘experimenter’, asked to act as ‘teachers’ and administer electric shocks to ‘learners’ every time they failed to answer a question correctly. With each wrong answer the ‘learner’ gave, the strength of the administered electric shock increased. Unbeknownst to the ‘teachers’ however, it was they and not the ‘learners’ who were the real subjects of the experiment. In reality, no electric shocks were being given and the ‘learners’ were merely actors who were simulating the effects of the shocks that they were supposedly receiving. The study revealed an alarming willingness on the part of subjects to act against their conscience when told to do so by authority figures with some, on the say so of another, even prepared to give potentially lethal electric shocks to vulnerable individuals with supposed heart conditions.

But what, to me at least, is more interesting still, is how the subjects of the study were prepared to give significantly higher shocks, when those supposedly receiving them were at a greater degree of separation from they who were administering them. That is, as the strength of the shocks got increasingly more dangerous, subjects were more inclined to refuse to administer them when they were able to see the one supposedly being shocked than when they could only hear their apparent cries of anguish. And they were more willing to administer the most dangerous shocks to those from whom they more separated, those who they were kept from both seeing and hearing.

It would seem therefore that the less contact people have with others the less they are concerned about their welfare and the more they are prepared to act against conscience in order to just get the job done.

I wonder if this has something to say us who, over the last year in particular, have been encouraged to remain remote from our patients. Leaving aside the dangers of missing important diagnoses and the withholding of human contact from those who really would profit simply from sometimes seeing us, could it be that working remotely has adverse effects on us too? Might it be that the less contact we have with those for whom we are supposed to care leaves us less concerned about their welfare than we might otherwise have been and result in our being more likely to simply going through the motions as we too just seek to get the job done? Furthermore, as a result of less time with us, might our patients also end up caring less about us?

A year ago we heard a lot about the so called ‘new normal’ but make no mistake, there has been nothing normal about the virtual world we have been living and working in this last year. We are all diminished by such a virtual existence. As tentative steps now begin to be made towards a life without restrictions I hope we won’t seek to hold on to our remote methods of consulting, or, at least, not too tightly. For though some problems may genuinely benefit from such an approach, many do not. And even though some conditions can be managed perfectly safely over the phone, that doesn’t mean that they aren’t better dealt with face to face. I know for sure that this week I have made at least one better, more humane, decision as a result of seeing a patient I might otherwise have even tempted to manage from a distance.

Since, as Milgram’s experiments seem to suggest, remote care runs the risk of us not remotely caring, avoiding patient contact is detrimental for both patients and doctors alike. Furthermore, by working at arms length from our patients, we have allowed much of the satisfaction that the job once held to slip though our fingers. As restrictions begin to lift, rather than holding onto the remote consulting that some see as more efficient, I believe we would do well to once again make face to face consultations with patients our normal working practice. By doing so, not only will we providing better care, we will begin to grab back some of the job satisfaction that has been lost in the last year.

Two years ago I wrote of my unease about how medicine was being encouraged to adopt more remote ways of delivering healthcare. That article can be read here. I never imagined then that I would be practicing the way I have been forced to this past last year, encouraged as I have been to avoid patient contact wherever possible. For me it has not been a happy transition and it has not been one I have found terribly easy. Nor is it something that I have done terribly well, for which I am not sure I’m sorry. Even so, as we now move slowly out of lockdown, such a remote existence must not be allowed to become the norm, not for medicine, nor, indeed, for any other area of our day to day lives. Because it’s simply not healthy.

Humans are social creatures, to fully live we need to have contact with one another, we need to touch. When lovers kiss, it’s more than just a sign of their love, it is an act of love too. And that’s important because more than simply knowing we’re loved, we need to feel it too.

We need to be present in each other’s lives. As in the words of the song, ‘It’s hard to carry on when you feel all alone’. Sometimes, when it seems there is nothing one can do, to simply be there is of genuine value. 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.’

Perhaps that is also the type of GP who cares. If Milgram’s experiments have anything at all to teach us, perhaps it is this: that it is not simply that those who care will draw close to those in difficulty but rather it is those who draw close to those in difficulty who will find themselves caring for others in ways that they wouldn’t otherwise have been able.

We have all had to endure it for nearly a year now, but over the coming months let’s look to leave social distancing behind – in all its forms. And let’s look to sit down with, and care for, each other once more.

Because living a contactless life isn’t a remotely good idea. It would be shocking to think otherwise.


To read ‘Contactless’, the article mentioned in the above post that was written two years ago, click here

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

To read ‘Hannah Arendt is completely fine, click here

To listen to the song ‘Sit Down’ by James, click here. You can even sing along – you know you want to!

Spare me a doctor…

Spare me a doctor, who makes the mistake
Of telling me how, I must stop eating cake
Who hasn’t a hint of the apologetic
When he tells me at 90 I’m pre-diabetic
One who in truth is a silly old fool
Who’s not learnt a thing since at medical school
One who insists he must always keep trying
And solemnly swears that he’ll keep me from dying.

After W.H. Auden


And Auden’s original.

Give me a doctor partridge-plump
Short in the leg and broad in the rump
An endomorph with gentle hands
Who’ll never make absurd demands
That I abandon all my vices
Nor pull a long face in a crisis,
But with a twinkle in his eye
Will tell me that I have to die.


Picture is from Van Gogh’s Portrait of Dr. Gachet



To read, ‘A Pregnant Pause, click here

To read, ‘If’, click here

To read, ‘The Very Model of a General Practitioner’, click here

Old Hands

After long months apart,

For a few short minutes

They sit at arms length,

And hold each other’s hand.

.

A touching scene,

that came too late

A tear filled struggle, to discern,

Just who the other is.

.

She, his bride whom he a lifetime loved,

He, a stranger in a mask,

Who remembers she’s forgotten,

Who discovers that she’s lost.


To read ‘I knew a Man’, click here

To read ‘Room Enough’, click here

To read ‘Beaten’, click here

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

To read ‘Resting in Pieces’, click here

To read ‘Crushed’, click here

To read ‘Masked’, click here

To read ‘Patient’, click here

To read ‘Yesterday and Today’, click here

WWJD – What Would Jack Do?

‘I have found that attending to one’s own faults is seldom as entertaining as attending to those of others. But it is generally more profitable.’

Jack Leach is a man I admire greatly, both for what I see of him on the cricket field and for what I read about him off it. Writing after England’s win over India in the first test at the MA Chidambaram Stadium in Chennai, the former England captain, Michael Vaughan, wrote this about the England and Somerset slow left arm bowler:

‘Sometimes there is one character who defines a team. For England it is Jack Leach. Yes Stokes, Anderson, Root and Archer are world class. But Leach stands out for me as someone who epitomises what this England team is about. He has got immense character and spirit. He has a lot of self-doubt but he keeps going. He bounced back from that pummelling by Rishabh Pant and the way he bats down the order with such courage proves his inner fight. It tells you the team are together. Every team needs a Leach…alongside world-class players. They are not necessarily the most talented players but they have the biggest strength of all, which is wanting to fight for the team’.

This weeks second test was not so enjoyable for England supporters with India comprehensively winning a one sided game. Leach still took half a dozen wickets but he was unable to recreate his batting heroics of a couple of years ago when his one not out proved vital in England’s win over Australia at Headingley in 2019. This week though, as England vainly attempted to save the match, Leach was out for a first ball duck.

Even so it’s still the case that, ‘every team needs a Leech’. And not just cricket teams. Primary Health Care Teams need one too.

Though, perhaps, it would be fun to be a GP version of a Ben Stokes or Joe Root, a world class doctor capable of great acts of medical heroism, the plain truth is that I’m not. The reality is that I’m not the greatest doctor in the world, nor am I the greatest doctor in my practice. And sometimes, I’m not even sure I’m the greatest doctor in the consulting room when the only people there are me and my patient. Like Jack Leach, I know what it is to experience self doubt and to sometimes fall short. Perhaps you do too. But even so, we who are not the most talented still remain important members of the teams we are a part, both inside and outside of work. Because ‘every team needs a Leach’.

The problem for many of us though is that we tend to compare ourselves with the most magnificent and often end up feeling, therefore, a poor second best. Perhaps then we would do well to stop imagining we could ever perform at the levels of those exceptional, seemingly superhuman, individuals we sometimes read about. Perhaps we need to accept a more modest, but no less important role. Perhaps, instead of wondering how we can magic up a degree of awesomeness that is beyond us, we would do well to sometimes simply ask ourselves ‘WWJD – What Would Jack Do?

If we do we may come up with a helpful answer, one which encourages us to keep going despite our weakness and failures, one which spurs us on to keep fighting for the team.

I don’t know about you but I sometimes find myself wanting nothing more from the working week than to get through it unscathed. But taking such an attitude never leaves me with any sense of satisfaction. I want and need to be part of a bigger cause than that, one that has me looking for more than to merely leave work promptly at the close of play, one that will stretch me beyond my abilities and which will mean that I therefore sometimes fail. Because to settle for a life in which all I want is for my reputation to remain intact and to have enough free time to make full use of my Netflix subscription will see me having settled for something that I will not find fulfilling.

So sometimes it’s good for me to be out of my depth, even if on occasions it means I start to drown, for it is then that I most feel my need of others, it is then I most feel my need of rescue.

Like England’s test players, even the best teams have bad days. But it’s important that we maintain the fighting spirit of a Jack Leach and seek to display something of his character and courage in order that we may continue to play our part, even on those bad days which are due to our own weaknesses. Though it will sometimes be painful we still need to bear that pain, alongside team mates who hopefully will be there for us just as we are there for them when they too inevitably make their mistakes. But it’ll be worth it because, regardless of how little credit we ourselves may receive, much that is achieved by the teams we are a part is genuinely worthwhile, whether that be Team GP, other working teams or the teams made up by the members of our own family. And it is frequently all on account of the seemingly small things.

Because, sometimes, even a modest ‘1 – not out’ makes all the difference.

Even so, there will be occasions, like it was for Jack Leach this week, when even the small things will be beyond us. The sad truth is that sometimes we simply will not possess the strength of character that we aspire to, our courage will leave us and we will let ourselves and others down. At such times, however long we spend asking ourselves ‘What would Jack do?’, we will nonetheless find ourselves unable to perform the way we would like. Because, let’s face it, we’re none of us as great as Jack Leach is portrayed in Micheal Vaughan description of him above. I doubt that even Jack Leach himself is always that perfect in his weakness. If, then, we hope to ease our burden by simply lowering our expectations, by contenting ourselves with being a Jack Leach rather than a Ben Stokes, we will find that we will not actually have eased our burden at all. Because however hard we try, and however modest our ambition, we simply won’t always be up to the task.

It won’t only be others then, that we disappoint, it will be we ourselves as well. So when we feel that weak, that powerless, when we find that all we have is nothing and it is no further use to keep on asking what it is that we should do, what then?

When unsure of what to do, there are some who walk in similar circles to me who ask themselves what another ‘J’ would do and seek then to act as he would. But whilst it is not wrong to do so, it is foolish to imagine that we will ever fully succeed since, if we can’t attain to the standards of a Jack Leach, how will we ever attain to the standards of one who really was perfect. For me then, whilst appreciating that on occasions it may be helpful to ask what that particular ‘J’ would do, realising full well that the answer might be to suffer and die for those who don’t deserve it, when I am conscious of having messed up, when I am at the end of myself and am finding life a struggle, I find it helpful to ask a different question. Rather than asking ‘WWJD’ I ask myself ‘WHJD – what has Jesus done?’ And what did he achieve as he hung there?. For it’s the answer to that particular question that gets me through the night when I am particularly conscious of my weakness and failure.

Because when my best is not good enough, it’s good to know that somebody else’s is.


To read ‘For when we can’t see why’, click here

beaten

without understanding

the rules

to the game

in which she never wanted to compete,

she only knows that

she’s lost

.

defeated

by a system

too strong for her,

its victory, one

for which she herself

has unwittingly

worked

.

beaten,

she no longer wants

to play

.

[The title picture is of a sculpture by Grace Erskine Crum entitled ‘Hopelessness]


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

To read ‘Resting in Pieces’, click here

To read ‘Crushed’, click here

To read ‘Masked’, click here

To read ‘Patient’, click here