Time out

I’ve had a bit of time off this week, in no small measure down to the current pandemic (still feels weird writing that). This was supposed to be the week I went diving in Egypt to see Hammerheads and all manner of other sea creatures. Instead of sunny weather and unlimited food served on a luxury boat, I have made do with overcast skies and ready meals from M&S. 

Not one to waste the time given though, I decided to dedicate the week to getting some music done. My goal is (and has been for some time) to get an album written. Since wrapping up my band a few years ago, I have wanted to get a collection of purely self indulgent songs written to cleanse the palate. Needless to say life gets in the way somewhat, particularly when this process often involves extended periods of time to work. It isn’t the sort of process one can just jump in and out of. (Not for me anyway).

It’s been quite a cathartic week as it happens. While I am no where near finishing, I now have a bit of momentum and I’ve had great fun exploring all the cool instruments I buy and then never get the chance to use. With no time pressure, the more creative I can be. That may not be the case for some but it certainly is with me. 

Meanwhile, my hair grows ever longer. I will admit I popped out to get it  cut for the first time in a few months yesterday. Just a minor trim though – I’m fully dedicated to growing this stuff out. Twice before I have tried and failed. I am determined the third effort will be a success.

Anyway, purely for documentation purposes, I left a camera rolling for much of it the songwriting activity so, if you’re interested, I’ve mashed some of it up to some music and here’s what it looked like. 

Black Lives Matter

To avoid letting all of that unfocused anger simmer into a lifetime of disquiet and more division, the movement needs a leader.

It’s been a few weeks now since the Black Lives Matter movement hit the headlines with a surge of media coverage. As we all know, it was triggered by one particularly heinous incident in the US but there have been countless other instances along the same lines throughout history. Why then all the furore now? Perhaps the shocking footage being circulated across social media, perhaps the need to lash out following weeks of being confined to homes. Whatever the reason, it all seems to be fading again. What has it achieved? Call me a pessimist, but perhaps not much. It is even possible things have been made worse.


While mostly peaceful, some of the protests have been marred by violence (far eclipsed by the far right counter demonstrations). More to the point, it has also highlighted, from my perspective, a vague sort of righteousness from many corners that in many ways feels a little disingenuous; as if one must speak out on this as more of a procedural duty rather than from any meaningful understanding. While many campaign, I wonder whether some really get it. ( I should say that most – the BAME campaigners, many of whom will have experienced some form of racism – will almost certainly ‘get it’ in one way or another.) Arguably however, the campaigning that does take place is not necessarily useful.

I understand from some points of view the need for democratic decision in a civilised society when it comes to removing a statue. The debates regarding the statue in Oxford are probably more in keeping with this rather than the unceremonious toppling we saw in Bristol. Having said that, if the democratic process is demonstrably failing to acknowledge the issues, I can’t be too critical of those involved. When you see young girls burning the union jack on the cenotaph however, it is clear to me that the emotions (justifiably strong) of some are misguided.


My fear is that this movement, as well meaning as it is, is merely deepening the divide. There will be a significant proportion of people in the UK I am sure who will see these protests in a negative light and this will galvanise inherent racism all across the country. (Particularly as they fell in the midst of a pandemic which many will have been diligently isolating from – don’t forget, those out protesting and not observing the lockdown may not become unwell themselves but will potentially spread coronavirus and be responsible for deaths of others that could have been avoided. Raheem Stirling said that there was only one virus. I’m afraid he is wrong.)


However, more worryingly, I can’t help but wonder if other more moderate individuals will begin to feel a little intimidated by the ease with which BAME individuals label anything that happens to them as ‘racist’. For example, I mentioned to someone the other day that a friend of mine was playing a character with a Caribbean accent and they replied asking if that’s ok to do? It got me thinking. Why shouldn’t it be? From my point of view, being able to impersonate and Australian accent or an American one but not a traditionally BAME accent deepens the divide rather than heals it. Many celebrities have come out recently apologising for using ‘black face’. This is a little more contentious perhaps but nevertheless open to interpretation in the same way. I would argue that, as long as done without malice or under a genuine misguided sense of superiority, it is not offensive. Of course, things are not often so simple and there is a spectrum but we must all use a bit of common sense from time to time rather than cry fowl at every opportunity.


In many instances, this oversensitivity is counter productive and could be seen as ‘political correctness gone mad’ by many. BAME individuals will inevitably be treated differently under this scenario, with many people tip-toeing around issues or even avoiding altogether in order to avoid making some unintended faux pas.


Of course, I do have sympathy to the reactions of many considering the unimaginable injustice that has occurred historically and unfortunately that still does today. My point is that, while racism must be tackled, tackling it in the wrong way makes it somewhat of a self fulfilling prophecy. All the while, the more damaging and malignant stuff carries on underneath. In order to wipe out this sort of discrimination, it needs two things: time and focus.


Generally speaking, racist leanings are learned behaviours from parents or peers. Once learnt, they are very difficult to wipe. The call for education and inclusion in curriculums of things like slavery therefore is one of the positives of the Black Lives Matter movement. As the older generations fade, time will hopefully bring more enlightened younger ones. Hence time but also focus. Arguably the focus element is most important here. To avoid letting all of that unfocused anger simmer into a lifetime of disquiet and more division, the movement needs a leader.

It needs someone who is measured and accessible to people of all races. Someone who can guide the anger of those who have been wronged and help them to heal the divides and encourage others to heal their own prejudices. Someone who is able to build influence enough to discourage people from self destructive behaviours such as the protests during the pandemic (not all self destructive I should say because it has of course got everyone talking about it) but instead encouraging people to channel their emotions into more sensible and tactically more beneficial endeavours; ones that are not going to alienate the huge swathes of society that are probably the ones they need to win over the most.

While there are higher proportions of BAME people living in poverty, this is a result of historic disadvantage and current division and cannot be changed overnight. Poverty, from an economic point of view must be tackled as one issue, not divided up into white and BAME poverty or else the divides will continue through the generations. From a social point of view however, BAME poverty can be changed only by a focus on changing attitudes.


To find someone who can guide us all through such a change is challenging. Whether someone suitable will step up to the plate is hard to say. If no one steps up – or indeed if the wrong person does – and perpetuates the divisions further, then I fear this brief surge in popularity will have little impact in the long run.

W

Thoughts of the Week

It’s been however many weeks now in lockdown and, although easing a little, much of the entertainment (or at least unpleasant distraction) is watching our government muddle their way through things in farcical fashion.


Covid aside for a second, there was furore about the $26,000 (actually pounds but my keyboard doesn’t let me do a pounds symbol) or so salary limit on foreign workers, with critics accusing the government of not valuing the work of those on lower salaries. My gut reaction was to agree with the dissent until I heard another side to the argument – that workers below this salary cap can be more easily and more cheaply trained; not that the people and the jobs being done were at all not valued. I don’t like our government, don’t get me wrong, but it was a moment I had to check myself and remind myself that there is bias on both sides of the spectrum and there are always two sides to the story. This is something that we must all be wary of. Even when there is no attempt to deliberately mislead (and there are plenty of examples of that), the sheer strength of opinion almost took me to one side of an argument that, when one looks closer and puts aside bias, is not quite as simple as it seems.


I tried to remain measured when it came to Cummings. I really did. ‘If it was just a trip up to the house in Durham to isolate there’ I said, ‘then well I suppose I can understand that’. Of course, everyone now knows it wasn’t just that and to defend it is indefensible in itself. If you disagree you are hopelessly deluded or there’s something in it for you.
It is this sort of blatant disregard for accountability and flagrant shamelessness that we have come to know and love in politics in recent times, to the extent that even those who have practised it in the past have called Cummings and the PM out for it.


Our leaders are a bit like that naughty child at school. The one who constantly pushes his luck and plays up, each time emboldened when the consequences are far less severe than anticipated, the bluff of punishment having been well and truly called.


Not many succeed at this better than Donald Trump but, to me at least, it is obvious in our government too. Frankly I wouldn’t even trust Boris or anyone of his cronies to take a picture of me lest they run of with the camera. What surprises me is that some people are surprised. There are those who are now saying that this blatant refusal to be held to account in a position of power is a slippery slope. Of course this is true but what many don’t realise is that we’re half way down that slope already.


Enough of that. In other news, I’ve been reminiscing on my childhood Wednesday evening tv viewings (the slot just after the Neighbours/Simpsons power combo of my teenage years). Star Trek is not my favourite of the “Star” franchises. Despite the tangled and ill thought out mess of the recent Star Wars films, I favour the original trilogy above all else. Having said that, I did enjoy Patrick Stewart in the Next Generation, if not just for the outstanding potential for quotes. (“engage”, “make it so” etc). The new Picard series was something I was a bit sceptical of as reviews had, for some reason, been a bit cold. I have no idea why because quite honestly it’s brilliant. Clever, action packed, stylish, nostalgic and quite poignant so far, I am absolutely loving it. I genuinely don’t want it to end (although I will definitely finish the series, unlike my refusal to watch the last season of Lost, thereby somehow making it last forever in my head). Anyway, watch Picard, it’s awesome.


One final note, this week on cyclists. This lanky and lycra-clad species are a perpetual menace to me at the best of times. Let me be straight, I am never aggressive and am always safe when I drive but deep within me, I boil over with rage whenever I see one on the road. They are particularly irritating when strong in numbers, sitting lazily in packs across an entire lane and quite literally stealing 10 minutes of my life away from me. The rage is intensified all the more as they sail straight through a red light, presumably safe in the knowledge that they’ll just phase through any oncoming traffic without so much as a hair out of place (although is it just me, or are a lot of them not just tall and lanky but also quite prone to balding as well?). Either way, I don’t know if it’s the lockdown, the weather or both but there’s bloody loads of them out at the moment. They need to stop it. In the interests of balance, I will mention the one cyclist who waved me past him as the traffic light went green the other day. I was so shocked that he’d even obeyed the law enough to stop at the red light, let alone reveal some semblance of a conscience, so perhaps I didn’t thank him as much as I should have done. Regardless, he is in the minority. Get rid of them.


Ps. As a doctor, quite apart from the environmental benefits, I would say cycling is an excellent form of aerobic exercise, especially if you want to take the load off your knees and it should be unfalteringly encouraged.
W

Thoughts of the Week

What a bizarre few weeks under lockdown this has been. While much of my life has been fairly similar in terms of structure (ie normal working days etc) the content of those days has been very different. I am one of the lucky ones in this respect. Fortunately, what my life has lacked in terms of pubs and cafes and shops, it has made up for in other ways.
The excellently amateur online pub quiz has been a particular highlight on a Thursday and Saturday night. It is genuinely something I look forward to and is something the whole family gets involved in. I have also been playing on the PlayStation a lot (Divinity: Original Sin 2 for those who are interested – an extremely nerdy but very involved dungeons and dragons type game which is not my normal choice but which I am finding awesome fun). Coupled with that – and I really have been getting my geek on – I have started playing a real life dungeons and dragons story with a group of friends via Zoom. I’ve never tried it before and I have to say, it’s cracking fun. Great change to catch up with friends from around the country (and the world) apart from anything else.


That has reminded me of a Harvard study I read about once in which levels of happiness were measured and quantified. The outcome I remember was quite poignant – those who were the happiest weren’t the richest or the most successful necessarily but were the ones who had maintained close friendship groups for long periods through their lives. Something that is particularly relevant at the moment I think. With so many people separated and levels of mental health issues rising, we should all be seeking to solidify friendships above all else.


In the same vein, a recent YouGov poll found that 8 out of 10 people would prefer the government to prioritise health and wellbeing over economic growth and GDP during the coronavirus. 6 in 10 wanted this to continue beyond. In some ways, slightly meaningless because one might argue economic growth is intertwined with wellbeing. Just as above though, this may not always be the case. I do wonder sometimes whether we are hurtling forwards inexorably in the interests of progress and expansion at the expense of so many things, not least the world around us. To halt this chain reaction is far from simple of course but there may be no better time than now to reassess things.


With the muddle the government have got themselves in this week over the new lockdown rules, I am not holding my breath. While I have actually been defending their overall plan (something that I never thought I would be doing) the evasive way it has been presented and the obvious and unsavoury motivation behind it (that of political damage control and self congratulation) has been pretty farcical. Looks like the lockdown is not as stringent as it was but it is not lifted. And we are to “stay alert”. To come up with that sort of nonsense slogan really is a symptom that comes from a lack of cohesion and leadership. Spin on care home deaths, overall cases and misuse of the R number (see my latest medical article) are just a few of their misdemeanours. There is no doubt that the government’s overall mismanagement of this crisis (and I repeat, I actually think their current measures are appropriate and require people to just use a bit of common sense and stop being so precious) has been nothing short of rubbish. That this is in any way surprising to people is the biggest surprise of all from my perspective!
Keir Starmer looks to me to be the future (and had done for a long time). Such a furore and a to do for so long before someone sensible like him comes along is the biggest tragedy. It’s just a shame we will have to wait a long time for him to get hold of the reigns.


Talking of length (apologies for the tenuous segue), my hair has not been cut for a couple of months now. Most obvious are the sides of my head which are expanding outwards at a fair rate. I look like Nicholas Cage. Beanie hats now make me look legitimately like a surfer dude (at least in my own head). My beard is another matter altogether. It is wild even despite my own feeble attempts at trimming it. I am one of those vain types that normally gets my hair cut every 3 weeks or so, so I have taken this as a sign and an opportunity to grow my hair out. I have tried it twice before in my life. Both times were pretty bad and I didn’t get past the mid length stage. (In fact my first attempt coincided with my “digestives and nutella” phase at uni and so, with the extra weight I was carrying at the time, I don’t think I have ever looked more physically repulsive. I am determined for things to be different this time – with the barbers closed, I really have no choice. So far I have resisted offers from several people who fancy themselves as stylists and so will have to just let things take their natural course. I think this is the right decision.

My Take on Music

“I see music as a catalyst for thought and emotion.”

 

“Music can change the world because it can change people” according to Bono. To be honest with you, I’m not really sure what he means by that. Indeed, I am not even sure whether the cheesy Irishman really knows what he means either. When it comes to music and what it represents, there are quotes galore from musicians and all sorts of other people on the subject of music and their interpretation of what it means to them. Lots of them refer to it being “life” and part of their “soul” and stuff like that.


Whatever anyone says, it is clear music is important. The recorded music industry was estimated to be worth $19.1 billion in 2018. That it is so popular is no coincidence. There is a difference between playing music and listening to it of course. Listening to it or playing it to yourself is enjoyable for reasons I will go on to explain. Performing it to an audience is altogether different, like opening up your mind and sharing an experience with other people. For those who are shy or lonely, this collectivism can be quite a release and encourage others to understand them a little. It is a way to gain recognition and to evoke a feeling of belonging to the performer. Very often, those listening will experience the same feeling and this may transcend the actual music itself. After all, most things are more enjoyable if experienced together.


It is the versatility of music – the ability to be both solitary and communal and to appeal to all types of human being – that is its main strength.


Despite all of this, I find myself listening to music less and less. A large part of it is related to how music is delivered in this day and age compared to when I was growing up. I used to love the excitement of getting a physical CD and listening to an album; fresh, organised and planned. I am of the cohort who insists on reading actual books rather than surrendering to kindles. Electronic versions whether it be music or books lose something in my opinion. Having the actual copy in your hands feels like the complete project rather than just a knock off version. There is also the draw of building a palpable collection that one can put on display and pick from at leisure rather than hiding away in a dusty hard drive somewhere.


Quite apart from the above, although streaming does still give one the option of listening to an album, it tends to be more a case of listening to individual songs these days. I have compiled some Spotify playlists to which I will add a song on occasion but find that playing these playlists over and over again gets a bit tired. New music is ever harder to come by and I find that relying on the algorithms Spotify uses is not quite the same as my discovery methods used in my youth. I can’t put my finger on why it doesn’t seem as good though.
Part of the problem, I suspect, is the sheer volume of music available now. On the face of it, one might see this as a good thing but when you factor in the quality on show, it becomes more clear.


Music as an entity is incredibly broad, so much so that it could be considered several different entities altogether rather than a single thing. I tend to think of it as similar to the concept of life – one form of music can be as different to another just as a single bacteria is to a blue whale. With a hugely varied spectrum of quality and an ever increasing ratio of good vs bad, the general pool of music available has been severely diluted.


Using the current ‘hear a good song and wack it onto a playlist when you hear it’ method of collecting music nowadays – by no means my favoured primary way to engage with music but all I am left with – the dilution of quality serves as a huge hindrance to this process.
We favour a song if it has the ability to enhance our current emotion, almost like a drug used to accompany everyday life. This could be joy, sadness, hopefulness, introspection, wonder, a feeling of courage and self-assuredness or any one of a multitude of other feelings. This is what composers are going for when they write (for the most part). Leo Tolstoy said that “music is the shorthand of emotion” and I would tend to agree. Imagine a scene from a film without music – far less intriguing or gripping for the most part. To that end, I see music as a catalyst for thought and emotion.


My thoughts on what makes a good song therefore starts with the above definition. Beyond this, things begin to get highly subjective and quite hard to put into words. For my part, a good song may fall into any genre and can be simple or complex. It will most likely have a unique and interesting and evocative melody alongside an intelligent rhythm. I also like a progression; a sense of building although, particularly for pop music, symmetry and appropriate resolution is a positive. Clever and well thought out use of time signature and pushed beats are features that draw me to a piece. I enjoy aggression and extravagance in my rock music and intricate and technically impressive instrumentation in jazz and pop. Orchestral music appeals to me if it is epic and bold rather than understated; think the Riders of Rohan theme from The Lord of the Rings as an example. Use of the right instrument is of interest to me as well but this will be dependent on the song; I don’t have a favourite instrument to listen to per se. Finally, nostalgia has a big part to play too – much like a smell, a song has the ability to activate memories in just the same way.


For me, lyrics are not that important. I do write music and I do take care to write lyrics of good quality that relate to a piece’s message but, ultimately, the music is far more important to me. I will rarely listen to the words of a song and I’m unsure of the lyrics to even some of my favourite songs.


Changing tack for a moment, there are certain things that will mark out poor quality music in my eyes. What does nothing for me is a song that lacks in detail. Much the same way as a childrens’ cartoon or a plastic toy will employ broad and simple colours and few points of real detail, so too will a generic song peddling the basics and nothing more. Unfortunately, there are a lot of these around, often relying upon a generic template; a cheap knock off of a once original idea – one known to sell. The fact that there are many of these around is likely due to several reasons. For a start, the market for children is a big one and so it follows that music appealing to teenagers and even younger exists and that it is fairly basic and uninspiring. Beyond that, there is a tendency now for the emphasis in music commercially to be more on style and image of the artist rather than the music itself. Many a song has been released by an artist well known for their influencing more than the quality of their music. It is likely that people will truly believe they like the music even if they wouldn’t think twice about it if released by a jobless drifter. There is a psychological premise behind this, the same one that leads people to rate the taste of whisky served in a crystal glass higher than the same one served in a plastic cup.


Unfortunately, for those interested in just the songs, this is not helpful and results in artists releasing material they would normally leave on the cutting room floor as they know it will sell anyway.


Thirdly, there is a category of people – and sometimes I feel this category is quite large – whose draw to music is so superficial, that they are drawn in by the trick of a catchy riff or a gimmicky chorus. They don’t have the ability to appreciate anything deeper. Before you say I am being a snob, let me explain. Some people really don’t have that ability. In the same way I can’t comprehend how someone can paint something from scratch, nor can others comprehend the sounds we hear and process them as such. Michael Jackson once said that “everything living has rhythm.” Clearly he never saw my Dad dance. Nor does everything have melody for that matter. My flat mate at university could not hold a note let alone a tune. Music is very much in the mind.


As such, there are a lot of people out there that are content with a broader collection of music, whether they like it or not , as they don’t necessarily comprehend how one can appreciate in any greater depth. Popularity drives industry and music is very much a capitalist endeavour. The onus is on selling music rather than producing something of quality and clearly it works.


Of note, there is another cohort at play here. The ‘music for quality’s sake not commercial potential’ crew, of which it would appear I am part of based on the above. That may be true but there is colossal potential amongst this group for pretension and can result in just as much dross; music to make a statement rather than actually being any good.
The sweet spot for a good song is, in my opinion, not commonly hit upon and is often not consistently hit upon by one person (hence the occasional but increasingly rare greats).


The upshot is, I find myself searching endlessly for good songs and this can be both time consuming and frustrating. When I do stumble across a decent one, it tends to be in isolation – there is no cohesion to the quality stuff, scattered as it is across genres and artists. What matters I suppose is that, as long as the mass of music out there (including the bargain bin dross) has an audience and evokes a strong emotion in people, it could be said to be valuable. My fear is that a lot of it is at least partially popular for the wrong reasons and moreover is detrimental to the production and showcasing of higher quality material.


For me, writing this has been quite cathartic and will no doubt redouble my efforts to find more music. There are phenomenal amounts out there. Just being out there in this day and age is not enough though. Finding a way to organise and collect my music to replicate the excitement and novelty experienced before the streaming age is the key. Whether that be vinyl or just being a bit more organised with my Spotify, I’m open to suggestions. If you have any tips or indeed any good new music, just drop me a message!

 

Thoughts on our Healthcare

“It is forecast that by 2030, the global consumption of antibiotics will rise by more than 30% (200% if it continues at current growth levels). By 2050, the annual death rate will have risen from 700,000 to 10 million with no action.”

 

It is a humbling situation when one realises how fragile we are in the face of nature and how little we really know in the battle to protect ourselves.

My generation have the unique honour of having grown up at a zenith of medical know-how. As a child, I often reassured myself that, if I or anyone I knew ever became unwell, everything would be fine. I always comforted myself that, should it be needed, there would be the medical expertise somewhere to cure anything. I was confident that the medical care and consensus behind every treatment was solid and complete; its efficiency spotless. Now I realise that this was simply a form of therapeutic self-delusion.

The truth is that, although our capabilities far exceed the wildest dreams of Hippocrates and Aristotle, we are far from perfect. What we don’t know far outweighs what we do. Treatments remain speculative, their quality reliant upon where we fall at any one time on the curves of demand and supply. Despite officious regulation, treatment remains highly subjective according to who treats you (bearing in mind this may be an exhausted doctor or nurse running on empty), and could still be based on faulty or unreliable evidence. We can’t guarantee a cure for your cancer and we can’t always tell for sure why you’re feeling so tired and achy, so sometimes we have to guess a bit.

Our exaggerated opinion of our own ability as a species extends beyond just medicine of course. While that can be catastrophic in other fields, it does at least provide some benefit in a healthcare setting. Confidence in physicians can be a therapy in itself. Despite what I have said, this trust is important and well placed. Though not perfect, we are better than nothing! And yet, when something like the Covid-19 pandemic hits – something so undeniably out of our control – it highlights those cracks that we’ve otherwise consciously chosen to ignore. 

What has struck me most about the Covid-19 pandemic is our reaction to it. While in some places it has highlighted tremendous courageous and community spirit, in others it has merely brought out human attributes that are the polar opposites of the aforementioned. For me, it has emphasised the prospect (and quite possibly the need) for fundamental change in how we utilise the medical expertise and the knowledge we have accumulated.

The meaning of ‘our NHS’ has become a bit warped in recent times. When someone has been treated with kindness and care, it is the NHS that gets the thanks. In reality, it is the people that work for the NHS who should be thanked as well as the organisation as a whole; a distinction that I feel too often gets overlooked. Obviously this is semantics and very often that is what people will mean when they praise the NHS. But in merging the two, a powerful message is being lost.

The people that work in healthcare, whether it be within or without an NHS, deserve all the praise they are getting. Likewise, the idea of a National Health Service that provides universal, comprehensive and free healthcare should also be praised. The problem is, at its inception in 1948, the idea of comprehensive healthcare is very different from what it is now.

In 1948, paracetamol was yet to become readily available, open heart surgery was 4 years old, statins had not yet been invented and antibiotics were in their infancy. Fast forward to the present day and we are seeing around 200 heart transplants a year in the UK, an entire pharmacy of medications available to us at our beck and call, lifesaving emergency services 24/7 and access to state of the art intensive monitoring equipment. Around half of the UK population takes at least one regular prescription medication. If your hips or knees go, you are entitled to have metal replacements inserted for no extra charge. If you have a rash, you can have it seen to or if you want your ingrowing toenail sorted, you can have it clipped or lopped off. If your ears are blocked, someone will clear that for you too.

With our population increasing and growing older, it is little wonder that the whole thing is beginning to creak. The outcome…? You have to wait a long time for your hip replacement, you might be denied the chance to have your bunions sorted out because it is a low funding priority. Your GP is running late by 20 minutes or even a bit longer. That may seem a bit insensitive or flippant (or both) but believe me, I’m not happy about it, certainly if it means people are waiting for treatments in agony. While some have a rational grip on such situations, others will not. Those are the ones that abuse the staff who are only trying their best in impossible circumstances.

Demand has far outstripped supply already. At current levels of funding, the promise of delivering a comprehensive service is no longer accurate. But that is only if we all agree on what counts as comprehensive.

We have been rather spoilt with the NHS, rather like a child who is given one sweet and then pleads for several more, never content with what they are given. The level at which our baselines have shifted (there is an actual concept know as shifting baselines syndrome that one could probably apply to much that is wrong with the world) is significant. Consider 100 years ago, antibiotics were non-existent, surgery was more dangerous than beneficial and not long before that there wasn’t even the luxury of an anaesthetic. Just read the 1810 diary account of Fanny Burney, the English novelist, who developed Breast cancer and underwent a mastectomy without anaesthetic to see what I mean.

Antibiotics and our use of them serve as a perfect microcosm to demonstrate my point. For all they have given us, they have also contributed to levels of antibiotic resistant infections that kill 700,000 people a year globally. Don’t get me wrong, antibiotics are great; a lifesaver in fact. Prior to their widespread utilisation, a cut or scratch could become infected to life threatening degrees and as such they have arguably become the single most important tool in our therapeutic arsenal (vaccination is arguably more important). And yet they have suffered a severe case of mission creep. They lend a hand in all sorts of unexpected ways. Caesarean-sections and routine hip replacements would be rather more hit and miss in terms of survival without them. Not content with saving lives, in fact they have become somewhat of a luxury, whether it be to shorten a cough or a bout of diarrhoea or to fatten up our animals so their meat is better.

In the UK, at least 20% of antibiotics prescribed in primary care are inappropriate (I would probably argue that figure is higher depending on your definition of inappropriate). At any one time, a third of patients in hospital are on an antibiotic. 

Resistant organisms transfer at will from one person to another, or to food and animals. As they do, we edge ever closer to a circumstance in which we are unable to treat them at all. There are already strains of TB and gonorrhoea that cannot be treated even by the antibiotics reserved as last resort.

The WHO cites antibiotic resistance as the biggest threat from global pandemic. Considering what is going on at the moment that should prick some ears.  Just as there are warnings about antibiotics, so there were for coronavirus. A pandemic such as the one we find ourselves in isn’t exactly a surprise and yet to a large extent, we have all been caught napping.  I liken it to sitting on a beach with a bag of popcorn, admiring the spectacle of a tsunami rolling in. Suffice to say, a tsunami of antibiotic resistance is far less palatable than the comparative swell of coronavirus we are seeing now.

It may therefore be time for some realism and some hard choices. This includes both those at the very highest levels but also, I’m afraid, for us all. Who knows in what shape we’ll emerge from the current saga.

In an ideal world, the government would pledge a suitable amount of money for the NHS to cater perfectly for everything from the largest and most severe of our medical needs down to the smallest and most trivial. Failing that, management of the entire system must get realistic and we must allow it to do so. No one wants to see a privatised NHS, (including the government if what they say is to be believed). Clarity of mission alongside acknowledgement of the problems– not spin – is what we need. Without this, whispers and rumours of privatisation will continue. If measures are to be painful, in my opinion telling people that is far better than trying to sneak it under their noses. Better still, a cross party approach in order to depoliticise proceedings is preferable so election success no longer rides on it. What we don’t want to see are more layers of management. Time and time again, we experience instructions from those at the top, far removed from the realities and often the progress we make is in spite of these targets instead of because of them. In any situation, the more layers you add, the more complex it becomes and the easier it is to trip over yourself. A bit like the game Tetris – a certain amount of blocks at the right speed will build something solid but as soon as the rate and number of bricks increases, it all runs away from you.

Just as importantly, perhaps even more so, is our individual role in all of this. As we clap our health workers every Thursday evening while in lockdown, perhaps take a moment to consider what we ask of them under normal circumstances. A large proportion of GP consultations are unnecessary and could be dealt with either by a pharmacist, or by the patient themselves. The NHS website has the information available if people were only to access it.

Between February and March, there has been a 22% fall in A&E attendances, many of would have been unnecessary anyway and would have taken up valuable resources and time.  General practice and outpatient secondary care has also seen a sharp drop in demand for routine enquiries. Many issues will have gone away on their own, or have been dealt with using online advice. Still more infections will have settled without antibiotics. We must harness this new way of using the health service.

This current situation may therefore serve as a not so gentle reminder of what are reasonable expectations in terms of our healthcare. That said, between early and late March, there has been a fall of 150 patients per day presenting with symptoms of heart attack. Now, it is unlikely that the Covid-19 pandemic has somehow cured heart disease altogether and though many people with chest pain turn out to be fine, there will be some within that cohort of 150 who have had real heart attacks; heart attacks that are currently going untreated.

Lack of presentation for this sort of thing, or indeed other worrying symptoms of things like cancer (loss of weight and appetite or a change in bowel habit to name just three), means the health impact of this pandemic will not be just related to Covid-19. For anyone with worrying symptoms like this, you absolutely must not ignore them just because of the outbreak.

We need to use the NHS sensibly. Not too much, but not too little. We have swung from one extreme to the other in the last few months. Once we emerge from this, we must all consider how best to use it going forwards, and focus on the bigger issues at hand, no doubt at a time of great change. Self-care is a big part of that, not just in how we deal with an acute medical situation but also in how we look after ourselves in general. Smoking alcohol, diet and exercise are the key areas that cost nothing to improve.

As a nation, our perspective in terms of the scope of our healthcare has run away from us. Some expect miracles – you don’t need to go to your GP if you have a cold. Nor do you need to go to A&E with a broken fingernail or a year old rash. Meanwhile, the threshold for others is far too high and there is a proportion of people that will hold off in coming to a doctor when they actually need to be seen.

As doctors we want to ensure that everyone who needs to be seen, and who we can help, presents to us appropriately. At the same time, we would request that others, who might reasonably be able to manage their own minor issues, do so. It is a fine balance and even writing this makes me uneasy that some may stay away for fear of overusing the service. The level of disparity in comprehension of how best to use the NHS is, in my experience, remarkable.

Nevertheless, I think we all could perhaps do with shifting our baselines back a hundred years or so. As doctors, we need to look at how we are using our resources and considering whether far more significant changes are necessary. Antibiotics use is just one example. Fundamental change at the top is needed to streamline the provision of healthcare and cut out the obfuscating bureaucracy. Difficult lines must be drawn. Leaders must consider taking more than half a glance at the deeper issues facing us – after-all from our current position, an antimicrobial resistant pandemic suddenly doesn’t sound as far-fetched as it did a few months ago. If that change is severe then so be it. Sometimes you have to go backwards to go forwards. In that case, we all have a responsibility to understand it and adapt, though politicians must realise that we cannot be expected to do that if left in the dark.

Urgent care must remain a priority for the service as a whole, but how we look after an ageing population effectively is just as vital. Prevention of health problems is key. One of the best ways to help therefore is to look after yourselves properly (we can only do so much in that respect) but also to seek help when appropriate in order to avert bigger health issues down the line. Staying away isn’t always the answer (particularly at the moment) although granted, there is a fine balance. That balance has always been upset one way or another and we all need to contribute in order to redress it. Now might be the time to set it straight.

 

 

 

 

 

 

How to Use the NHS

Some now expect miracles – there is no benefit and therefore no point in going to your GP if you have a cold. Nor do you need to go to A&E with a broken fingernail or a year old rash (these are real examples).

It may be a bit of an understatement to mention that a lot has changed recently. No more so than for those working in the health service and, while many are unwell with Covid-19 and while those that need it most struggle to get the PPE they need, the everyday aspects of their jobs have somewhat fallen by the wayside. Figures for February and March show a 22% fall in A&E attendances. General practice and outpatient secondary care have also seen a drop in demand for routine enquiries.

While this has freed up resources for the issue at hand, some may notice that many of the issues for which they might normally have sought help and advice have gone away on their own. Others have been able to find the answer to their questions online. The sore throat that you had might have cleared up on its own without antibiotics. That painful ankle might have cleared up with measures you followed from the NHS website.

This unusual set of circumstances has highlighted an area that perhaps we can all learn from as we emerge from this crisis (though there is a long way to go yet). As a nation, we have become somewhat spoilt by the free healthcare we can expect; our perspectives have shifted over time as more becomes possible. Some now expect miracles – there is no benefit and therefore no point in going to your GP if you have a cold. Nor do you need to go to A&E with a broken fingernail or a year old rash (these are real examples).

In 1948, at the inception of the NHS, paracetamol was yet to become readily available, open heart surgery was 4 years old, statins had not yet been invented and antibiotics were in their infancy. Fast forward to the present day and we are seeing around 200 heart transplants a year in the UK, an entire pharmacy of medications available to us at our beck and call, lifesaving emergency services 24/7 and access to state of the art intensive monitoring equipment. Around half of the UK population takes at least one regular prescription medication. If your hips or knees go, you are entitled to have metal replacements inserted for no extra charge. If you have a rash, you can have it seen to or if you want your ingrowing toenail sorted, you can have it clipped or lopped off. If your ears are blocked, someone will clear that for you too.

With our population increasing and growing older, it is little wonder that the whole thing is beginning to creak. The outcome…? You have to wait a long time for your hip replacement, you might be denied the chance to have your bunions sorted out because it is a low funding priority. Your GP is running late by 20 minutes or even a bit longer. That may seem a bit insensitive or flippant (or both) but, believe me, I’m not happy about it, certainly not if it means people are waiting in agony for treatments. While most people have a rational grip on such situations, a few do not. Those are the ones that sometimes abuse staff who are only trying their best in impossible circumstances.

This current situation may therefore serve as a not so gentle reminder of what are reasonable expectations in terms of our healthcare. That said, between early and late March, there has been a fall of 150 patients per day presenting with symptoms of heart attack. Now, it is unlikely that the Covid-19 pandemic has somehow cured heart disease altogether and, though many people with chest pain turn out to be fine, there will be some within that cohort of 150 who have had real heart attacks; heart attacks that are currently going untreated.

Lack of presentation for this sort of thing, or indeed other worrying symptoms of things like cancer (loss of weight and appetite or a change in bowel habit to name just three), means the health impact of this pandemic will not be just related to Covid-19. For anyone with worrying symptoms like this, you absolutely must not ignore them just because of the outbreak.

There have been some cases of people cancelling urgent cancer referrals due to concerns over the virus. While one can understand the anxiety surrounding this, these referrals are there for a reason. Do not delay them.

We need to use the NHS sensibly. Not too much, but not too little. We have swung from one extreme to the other in the last few weeks. Once we emerge from this, we must all consider how best to use it going forwards, and focus on the bigger issues at hand, no doubt at a time of great change. Self-care is an enormous part of that, not just in how we deal with an acute medical situation but also in how we look after ourselves in general. Smoking, alcohol, diet and exercise are the key areas that cost nothing to improve.

As doctors we want to ensure that everyone who needs to be seen, and whom we can help, presents to us appropriately. At the same time, we would request that others, who might reasonably be able to manage their own minor issues, do so. It is a fine balance and even writing this makes me uneasy that some may stay away for fear of overusing the service. The level of disparity in people’s views of how best to use the NHS is, in my experience, remarkable.

In summary then, urgent care must remain a priority for the service as a whole, but how we look after an ageing population effectively is also vital. Prevention of health problems is key. We should look after ourselves properly as far as is practicable but also seek help when appropriate in order to avert bigger health issues down the line. Staying away isn’t always the answer (particularly at the moment) but there is a balance to be achieved. Now might be a good time to redress that balance.

Healthcare After Covid-19

“Just as important as the government’s role in the NHS as it emerges from Covid-19 is the responsibility all of us have. We must shift our baselines back a hundred years – maybe more”


As a civilisation, humanity knows so much. To have in our arsenal an understanding of physics that includes relativity and all of its applications alongside our almost infinite artistic creativity is testament to our intelligence. These examples only scratch the surface of what we can do. So it is hugely humbling when we experience something like the Cvoid-19 pandemic.


As powerful as we are, we are still painfully fragile in the wider context – something we have a tendency to forget. It was not so long ago that we had to undergo operations without the luxury of anaesthetic and before antibiotics, we were faced with the rather uncivilised prospect of fighting infections using just our own immune systems.


Indeed, so uncivilised has the idea of being even slightly unwell become, that people now will seek medical help for a few days of cough and sore throat. The expectation for these worried well is that it is their right to expect an immediate cure. “Surely if we can do all of these marvellous things with technology, there is no disease we cannot sort out if we put our minds to it,” these people think. But these people are living in a different world, one of their own imagination. Others more prudent, sensible or experienced will realise that what we can do falls far short of this idealistic expectation.


We as a species go further. We harm ourselves willingly and then expect our medical professionals to pick up the pieces – even become angry when they can’t. Smoking, lack of exercise, poor diets – take your pick. That these things are bad for us there can be no question.


Of course one cannot wholly blame individuals for this. Capitalistic society is to blame here as much as anything. Profit and competition introduce temptation at the expense of welfare. I am not preaching socialism here – far from it. I simply point out that the drive for business to gain custom at any cost is a huge flaw in the system and in our health.


Whichever way one looks at it, we have become spoilt. Our perspectives on what we might expect from our healthcare have been shifted gradually but significantly over the last century. Only now are we being brought down to earth with a more humbling realisation; the thin facade of our supposedly advanced age has been withdrawn. There is even a name for this sort of thing – shifting baselines syndrome. It could be applied to many things. We have come to accept the nonsense and bile that comes from Donald Trump’s horrible little mouth as just the way it is these days. The baseline has shifted.


Just in the same way, many have been spoilt by the healthcare provision that they expect as a given. What we expect as a free benefit from our NHS nowadays (toe nail surgery, access to a GP to tell them about your cough, state of the art surgical procedures, cures for cancer and lifesaving emergency response within minutes) would have been the stuff of dreams for our ancestors. That the ever-expanding achievements of the last 50 years of medicine has caused the entire system to creek under its own weight is not surprising.


When I was younger, I reassured myself that if I or anyone I knew ever became unwell, it would be fine because there would always be someone somewhere that could cure whatever ailment had befallen them. My impression of medicine was that it was water-tight and so much more precise than the reality. A reality that slowly dawned on me during medical school. Much of it is guess work. Barely any treatment is 100% effective. What we don’t know far outweighs what we do know. The assumption is that there will always be a medicine to solve all problems. In a profession that revolves around trust in the doctor or nurse (a reassurance that can be therapeutic in itself) it is difficult sometimes for us to admit that we don’t have all the answers and can only do so much. Perhaps it is time we were more open with its limitations or else we make a rod for our own backs.
One might argue that what we now provide under its umbrella has gone far beyond the boundaries of what is sensible. To argue that we can effectively achieve 100% of what we aspire to medically is not possible. The issue is, the more superfluous and luxurious perks we add in, it edges out or at best blunts the core services that are most important.


At a time in which we are faced with something as dangerous and universal as Covid-19, we must heed a wake up call. The work the NHS is doing at the moment is what it is there for. Add to that health prevention, basic surgical treatments, mental health support, serious disease detection and treatment (including cancer), dignified end of life care, and social care.


Beyond the essentials, it is time for government to look at what the NHS really stands for and what it can really achieve. (Or preferably a cross party response to side step the political distractions). In an ideal world it would do everything to maximum efficiency. If a government wants to invest enough to make this possible, then great. The reality though means that the healthier a population is, the older it gets. Add to that the ever increasing scope of potential therapeutic options and one may argue that we could reach a point where a line must be drawn in how far we go in prolonging life. Should we become reliant of a system of health to such an extent (and perhaps we have already reached that point), the consequences of that system and it’s resources failing do not bear thinking about.


Governments need to look at this, decide where the line is drawn in what the NHS does and is expected to do. More importantly, they must be open about this. To back the NHS in a blind head long rush into the future, pledging vague sums of money that don’t make any sense to those in the know – none of this is helpful in any other way than to win elections. To acknowledge the need to be sensible about what is achievable and what is not seems difficult for politicians. Hence back room deals, rumours of privatisation etc. No one wants to see a privatised NHS. If the politicians are to be believed then they are included in this group, so why the cloak and daggers? The public deserve transparency and straight forward answers. Most understand that there is no definite right answer to a problem, even more so if it is explained to them. Without this, conspiracy and disquiet will breed.


Just as important as the government’s role in the NHS as it emerges from Covid-19 is the responsibility all of us have. We must shift our baselines back a hundred years – maybe more. This is urgent. Everyone must consider how we use our health service. That cough or rash that you might normally have seen your GP about – seems to have gone now doesn’t it?! That lack of exercise, my poor diet, that smoking habit – I can do something about that myself. No one else can help and we shouldn’t have to hold your hand. (Of course we do this and will continue to do so). Self care has been important during this lockdown. And yet, it shouldn’t be any more so now than any other time.


The problems with the health care system are clear. We all know about them. Covid-19 has affected us all and is scary. But perhaps it is the wakeup call that we all need.

Musings in Quarantine

With such nice weather, I hope you’re all staying inside! Quarantine is a funny old thing and through something like this we get to see both the best and worst of humanity. (It’s just unfortunate that, in a situation such as this, we are only as good as the worst of us). It’s gearing up to be a rocky few weeks with the day job so it’s nice to catch up with this sort of stuff in the downtime. 

So, while the covidiots rush out to their barbecues, the sensible people stay indoors and the Americans head out to buy loads of guns, I thought I’d update on the book. 

A couple of rejections thus far but most agents I have carefully selected have not yet got back. It’s worth saying that, having researched exactly what getting an agent represents to a fairly extensive degree, I have been selective in who I have gone for. It’s a given that I am looking for agents who have interests in books such as mine, but I am also going for those with non-fiction interests as well, not least because I have ambition to write in both arenas. Of course, when someone is recommended to you, that’s even better.

But here’s the thing. I don’t know if anyone else does the same (and even if they don’t admit it, I suspect they do) but I have been placing a significant emphasis on selecting those with whom I think I would work best based on how they look in their photographs. Where I can find interviews with them, even better. Call me superficial but I feel like I am a fairly good judge of character and so can usually gain a good idea of whether I would click with someone based on their appearance alone. 

They say don’t judge a book by it’s cover, but I’ve never heard anyone say that about agents so I’m going with it. I only hope they will adopt a similar approach when assessing my material. The whole process feels a bit like online dating and if history has taught me anything, it’s that I’m not very good at online dating. Time will tell. 

 

 

 

 

The birth of a new viral lexicon

All of this inevitably got me thinking about other words that, quite frankly, we should all be trying to create as a result of this crisis – or corisis

By now we are accustomed to hearing new words and phrases hitherto unheard of even a short while before. Of course the youth have almost an entire language to themselves. (This is quite a painful admission as I consider myself to be youthful still).

But in the age of Brexit, we as a species have begun to tinker with the English language in ever more ingenius ways. At present, there are 171,476 words in the Oxford Enlgish dictionary. There are many more unofficial ones in circulation, should you be streetwise enough to be using them. 

In 2019 there were 650 new words added to that number including whatevs, chillax, Jedi (which I think is cool and I’m surprsied it took this long) and sumfin (which is think is kind of mental).

Flashforward to now and we are in the midst of a global pandemic. It is bad and is only going to get worse so I wanted to focus on something positive. To that end, the fact that ‘covidiot‘ is now trending on twitter has brought a refreshing twist on humanity’s inherent stupidity. 

The word refers to those special individuals who rush out to panic buy toilet roll and pasta or those who think social distancing just isn’t for them. 

It’s not the only new word I’ve heard. Caremongering, the act of caring for those most vulnerable and encouraging others to do so, seems to be taking hold across the pond. It seems to have emerged from Canada which makes sense because – well, Canada. 

Presenteesim is the word for NHS workers who will lean towards going to work even if they are unwell which, in the current situation is not good. Under normal circumstances, I too have experienced this phenomenon, having crawled into work more than once feeling like the inside of John Mccririck’s underpants, only to be met by a smiling patient telling me they have had a cough for a few days. 

One of my favourites is the word for the cohort of babies born as a result of everyone being cooped up in isolation over the next few months. Coronials.

All of this inevitably got me thinking about other words that, quite frankly, we should all be trying to create as a result of this crisis – or corisis. Here are some of the best ones so far…

Quaranteens – The teenagers who are now home for the forseeable future since the schools closed, for which their parents are – I’m sure – ecstatic. 

Coronference call – As more and more of us begin to work from home, these are the ideal way to observe the social distancing measures while maintaining business efficiency. 

Whatsapp Thumb –  With friendship groups torn apart by the isolation, Whatsapp groups have gone wild. The chat within previously dormant groups has been going through the roof. Make sure you take precautions and limit your use lest you experience this painful condition. 

Covexit – The much sought after and mythical end to this epidemic. Who knows when we can reach it?

Recovid – My personal favourite here. With many people having already recovid from the disease, here’s hoping that many more will do the same. 

So there you have it. I’m sure there are plenty more of these so your suggestions are most welcome. Perhaps, by the time the next pandemic comes around (my money is on peronivirus) we may have a completely new set of vocabularly at the ready. 

WJ