Category Archives: Arts

Heroes: general practice and Karpman’s triangle

David Misselbrook

David Misselbrook

David Misselbrook was a South London GP for 30 years. He was involved with GP training, CPD development and medical ethics. He now teaches Family Medicine and ethics for RCSI Bahrain.
David Misselbrook

Living in a different culture is exciting and fascinating. But living in Bahrain we do miss “culture” in its other sense. There is a magnificent National Theatre, usually empty, putting on just a few touring shows a year. The nearest opera house is 500 miles away. But for a small nation it sure has lots of cinemas.

So this evening we went to see Sully, a film by Clint Eastwood. It stars Tom Hanks as the eponymous pilot, Chesley ‘Sully’ Sullenberger, who heroically landed a passenger jet with 155 people on board on the Hudson River in New York following the loss of both engines after bird strike. I wondered how you could make a whole film about this one incident, assuming there would be lots of flashback time to Sully’s youth as a military pilot and his long flying career. But the main theme of the film is how, having pulled off a near miraculous landing on water saving each of the 155 people on board, the incident investigators then treated Sully and his younger co-pilot, Jeff Skiles. It is based on Sullenberger’s own account from his book, Highest Duty.

Within a minute of the investigators’ initial interview with Sully and Skiles starting it was obvious that the assumption was “you must have messed up – our job is to show how”. In moments Sully went from hero to suspect, who risked his passengers’ lives by choosing a reckless water landing rather than other options which “must” have been available. And anyway no twin engine jet had ever lost both engines through bird strike, so the pilots must have been mistaken.

The film follows Sully’s self-doubt, his being overwhelmed by media frenzy whilst trying to process a traumatic event, his imagined “flashbacks” to less happy endings. His wife and family alone at the end of a phone whilst he has to attend the inevitable investigation. Mostly though the film depicts the incredible imbalance of power between one man, doggedly seeking to hold a corner he knows from long experience to be right, against the investigative power of a large well-resourced organization with its absolute confidence that Sully must be wrong. And its annoyance that he makes it hard for them to prove this foregone conclusion.

Perhaps it is time for a confession. One of the many reasons why I left the UK after 35 years as an NHS doctor, was the sense that every year I worked, I and my family gained less from staying. But every year I worked I risked more and more from the career-ending multiple jeopardy and shame to which we are now exposed. The lines crossed several years ago, it just took me a while to work it out. I only once received one of the GMC’s notorious “we haven’t got you this time but we’ll keep an eye on you” letters. And this was for a complaint that a five year old child would have dismissed after the briefest perusal of the facts. Of course, had I been a locum the GMC would have, de facto, already smeared my name to all my places of work – don’t tell me that such letters are a “neutral act”. A close friend took early retirement as he feared the GMC brown envelope every day, for no reason other than the ever increasing background risk. And I also got out before I had the pleasure of a CQC visit.

Attribution: Steven B. Karpman, M.D.

Attribution: Steven B. Karpman, M.D.

When I was a trainee I was taught about Karpman’s victim/rescuer/persecutor triangle. The heroic rescuer saves the victim. But this attracts the attention of the persecutor, or often the victim becomes a persecutor. Now the rescuer is the victim. And so the drama unfolds. Rescuing can be dangerous to your health. Have we as a profession become imprisoned by Karpman’s triangle?

But back to the film. If you haven’t yet seen it then look away now. Sully has to demonstrate the failure of simulation to model reality. If a pilot had turned back to the airport at the very moment of bird strike then they might just have made it within the three minutes remaining. But it required 17 simulation attempts to pull it off. However it took 35 seconds to assess the situation and make that decision. And if Sully had followed all prescribed procedures, rather than relying on his experience and judgement, it would have taken longer. But his rapid decision and his consummate skill in landing a passenger jet on water (plus a big dollop of luck) let to everyone on board surviving.

Well, being a film, the investigators grudgingly accept he was a hero. They don’t apologise for their persistent accusations to a man trying to come to terms with a traumatic event – but hey, that would be a fantasy. Similarly you and I have to just live with the knowledge that we did a good job. A better job than we are ever contracted for, because we see ourselves as professionals. It’s enough, but for how long?

Anyway, we’ve just arranged to fly to Muscat to see an opera. But I don’t reckon I’ll be seeing Sully as an inflight movie any time soon. Still, at least I’m safe.

The importance of self care for GPs: tackling burnout through comedy

doctor in the house photo 2smallAhmed Z Kazmi is a doctor and stand-up comedian. If you would like to see his show ‘Doctor in the House’ he will be performing at Brighton Fringe 20-24th May 2016, Hollywood Fringe 19th-26th June 2016 and Edinburgh Fringe Festival 4-14th August 2016. For lots more information and to purchase tickets please go to www.doctorahmed.net

At my medical school interview I was asked what I did to relax, I remember thinking that was an odd question. My GP training curriculum included lectures entitled ‘How to avoid burn out’ and I remember sighing and rolling my eyes. It was not until I was in the role of qualified GP for some time that I started to feel a drain on my wellbeing. Then in 2015 my father died from cancer and I really struggled to remain the empathetic and attentive doctor I had prided myself on being. The presence of grief and mourning added an additional ball to the juggling act of clinical duties, professional development tasks, administrative tasks, family and friend obligations and the banal tasks of daily living, and I found myself struggling. I suddenly saw the relevance of the question asked of me at my medical school interview and the rationale for the lecture on burn.

I think it is fair to say general practice is a high intensity occupation. The high volume of patient contacts per day plus the short consultation duration coupled with often unrealistic patient expectations create a sense of panic and unrest during the working day. The relatively frequent rearrangement of service structure and health policy combined with a constant media flurry around the NHS and general practice can produce for many GPs a gloomy atmosphere within which to work. This environment was sadly a contributing factor in my decision to move from the UK in 2014 and practice in Australia.

As mentioned earlier, it was not until last year that the importance of non-academic outlets and self care became evident to me. I used to consider exams or diplomas or courses a leisurely parallel to my role as a GP. I loved to learn, enjoyed keeping up to date and saw an update course as a luxury activity. With social media being inundated constantly with healthcare politics I found myself almost totally unable to switch off from the job, even in my personal time,  and for the first time decided to temporarily reduce my working hours and take up a hobby unrelated to my vocation. But alas the apple never falls far from the tree. I decided to try my hand at stand up comedy (not after an unsuccessful attempts at becoming a pole dancer and instagrammer respectively) and quickly had to embrace that my work as a GP was in fact my largest source humour. I decided to make a stand up show about the funny side of being a doctor. I wished to create something that would be playful and entertaining whilst remaining respectful to patients and the profession. I took a few months to write and rehearse the cabaret comedy show ‘Doctor in the House; What your doctor really thinks’ and made my comedy debut at the Perth Fringe Festival in February 2016. All my shows sold out and I received positive reviews from critics, colleagues and spectators. I managed to raise over $5000 AUS for a local cancer charity from ticket sales and donations. In addition to this I used the show as a vehicle for some more serious subtexts including patient responsibility, cancer awareness and bereavement. Above all the experience did renew my empathy and interest in my vocation.

The experience taught me that even in this current climate we can create opportunities for fun and laughter around our work. It is all too easy to become stationary in a vehicle stuck in mud where the wheels are turning but the car is not moving forward. Several of my friends had hobbies during medical school: music, art, fitness but sadly these were made redundant as general practice and family pressures grew. I would encourage the reader to gently reflect on the following questions:

  1. Do you feel content at work?
  2. Do you feel you are nearing burn out?
  3. If you are content, well done, how can you ensure that continues? If not how might you address it?
  4. Think of one or two hobbies/interests/activities (big or small!) you would like to do more of or have never tried and would like to sample.
  5. Lastly think about how you might actually start to undertake the activity and create room for it in your life.

I am not suggesting everyone take a four month sabbatical and go on a world fringe festival tour of their solo stand-up comedy show… But I think now more than ever it is imperative for GPs to become good at self-care. Yoga? Swimming? Mindfulness meditations? Reduction in sessions? Cookery class? Or, yes, even stand-up comedy. What would you say to your patient in a similar position, need I say more!

Desperately seeking Plato

David Misselbrook

David Misselbrook

David Misselbrook was a South London GP for 30 years. He was involved with GP training, CPD development and medical ethics. He now teaches Family Medicine and ethics for RCSI Bahrain.
David Misselbrook

file0001075296394We were in Athens with a couple of hours to kill. Acropolised out, too early for Ouzo. We had seen Socrates’ jail cell (almost certainly apocryphal).  We had seen the remains of Aristotle’s Lyceum, lovingly excavated. We had felt the weight of Pericles and the genius of Phidias. So we had a chance to check out an old rumour that the site of Plato’s academy was now marked only by a Texaco garage. (We had just found a Lidl on the site of the battle of Marathon, so who knows?) There it was on the map, “Plato’s Academy Archeological Park”, just a few miles out from the centre of Athens.

According to Alfred North Whitehead all philosophy is a series of footnotes to Plato. When my out of hours driver had been mind blown by the illusory world of “The Matrix”. I explained that this came from a two thousand year old thought experiment that we call Plato’s Cave. Suddenly my driver was interested in philosophy. Plato tackled the problems of perception and how we can (or cannot) know reality long before Descartes or Kant. He and a few mates created western thinking.

So we asked a taxi driver, gnarled as an ancient olive tree, to take us to Plato’s Academy. He looked confused. “But there’s nothing there.” We say that’s OK, we would just like to see the site and take some pictures. “Well, I haven’t been there for years” he said. We offer him our map, which he declines. We leave the tourist trail, driving through run down streets, the never ending layers of graffiti resembling Jackson Pollock’s stream of consciousness. A corner shop displays its stock of “Essex” washing powder, the finest goods on offer.

Unfortunately we have chosen a taxi driver straight from My Big Fat Greek Wedding. He explained all of Greek history with a running commentary on language and civilization, demonstrating exactly What The Greeks Did For Us, which by a remarkable coincidence turned out to be absolutely everything. Triangulating with what I already knew I reckoned about a third was approximately true, albeit exaggerated. We decided not to mention Lord Elgin.

We reached the area on the map. There was a post apocalyptic park of sorts. A couple of adjacent areas of worn and scrappy grass with a few dejected trees were surrounded by railings within what looked like a condemned South London Council Estate. We drove around randomly looking for something the driver recognized. There were no signs, no indication of an archeological site (surely the only square mile in Athens so deprived). The driver stopped to exchange enquiries with puzzled locals, none of who had ever heard of Plato and all of whom clearly wondered if we needed strong psychotropics.

We settled for jumping out of the taxi and taking random photos of the grass, concentrating on the occasional stone wall, which may or may not have been more than fifty years old. The driver became excited by some stone columns in a lock up yard, but on close inspection they were recent architectural salvage. However we found some overgrown stone ruins behind yet another fence, inaccessible and unlabeled. We declared these to be the ruins of Plato’s Academy, and duly photographed the hell out of them.

Driving off through the dystopian labyrinth we found a structure resembling a grey shipping container with the sign “Plato’s Academy Digital Museum”. It was locked. We walked round and found two elderly Greeks. “Come back tomorrow” they advised. A good suggestion except that by then we would be in France.

We drove back. So many shabby streets. We had not even found the Texaco garage. We heard more dodgy political theory than the whole of Plato’s Republic. How was it that this city, so full of ruins (and so full of itself) could not remember its greatest philosopher? We could find no trace of Plato. Not even a cave.

We sped back towards our hotel. Time for Ouzo and another view of the Acropolis.

Visit bjgp.org to find and read David’s series ‘An A-Z of medical philosophy’. 

RCGP Conference 2015: Stephen Bergman on good patient care

UnknownStephen Bergman is a doctor, novelist and playwright. He is currently a Clinical Professor of Medicine in Medical Humanities and Ethics at New York University Medical School. His book, The House of God, published in 1978, is firmly established in medical culture and deservedly has wider ‘cult classic’ status.

In 1971, I wrote this piece, and recently have looked back at it. In a sense it has all the things I’ve learned since, and that every good General Practitioner learns. I give a little current comment on what in fact I have learned, at the end.

THE PATIENT IS THE WORLD

Samuel Shem 

Medical students in their course on diagnosis are taught: “When you hear hoof beats outside the window don’t assume it’s a zebra.” This means that you should think of common diseases first, not exotic ones. Decades ago when I was a medical student in Boston at one of man’s greatest hospitals, I was assigned a woman with “difficulty breathing.” She was 56 years old, a mother of three whose husband had died two years before. In good health all her life, she worked in a flower shop. She had never before had trouble breathing. Her husband’s death had been a shock, but with the support of friends and family she had gotten through it pretty well. The resident—my boss—came in and took his history, in a rat-a-tat technique of asking a probing question which had to be answered yes or no, and as soon as there was a response, cutting her off and moving on to the next—I knew he was filling in his grid, a decision tree that would provide the diagnosis. No new information came up. Physical exam showed nothing but her panting. Lab work revealed increased eosinophilia, the blood cell that increases when the body is allergic to something. The resident went back and grilled her on allergies. Nothing.

Her workup proceeded in classic academic fashion, with increasingly refined blood tests and X-rays. The latter showed a diffuse pattern of lung irritation, but no lesions or tumors. Experts were called in, and each diagnosed something in their area of expertise, from the psychiatrist diagnosing “melancholia” at her husband’s death, to the surgeons wanting to cut. She kept getting worse, the oxygen levels in her blood falling lower and lower, blueing her lips, paling her face. A look of doom seemed to cloud her eyes. The surgeons did a lung biopsy which showed only that her lung was reacting to some antigen, as the blood test had shown.

She continued to decline. Palliative treatment was begun. The resident and staff doctors seemed reluctant to enter her room. I felt scared for her and sorry, and spent more and more time sitting with her, just talking—a medical student has time for this arcane procedure. One day I asked where she lived. She said that after her husband died she’d taken in boarders to survive. I asked about them. “One of them’s…a real trip,” she gasped. “A magician.” I smiled and asked more about him. Part of his act involved trained pigeons, which he kept in cages in the basement. “The cages are right above my washer drier.” My ears perked up. It turned out that whenever she ran the drier, the pigeon droppings were aerosolized and she breathed them in—for the past two years. I rushed to the medical library—in those days we still used books—and found “Pigeon Breeder’s Lung Disease.” Treatment: get rid of the pigeons; and a course of steroids. Prognosis: excellent. The magician suffered. She got well.

Looking back now, what did I learn?

That the science of medicine is astonishing and useful, but it can keep us from practicing the human art of listening and responding, face to face, heart to heart, without a decision tree in mind or a computer on our laps so we stare into the screen instead of look into the eyes, all to “save time”. That the for-profit insurance industry dictates that we doctors don’t have time to listen to our patients if we want to get paid. That if we rely on technology and tests and neglect “being with” the patient, we may well miss the vital human facts that will solve the mystery and bring the cure. And that the patient is never only the patient, the patient is the spouse (alive or dead), the family, the house and who lives in it, the friends, the community, the toxins, the climate, where the water comes from and where the garbage goes. The patient is the world.

And finally that the “hoof beats” outside the window can be zebras—or, if you listen carefully, just the light steps of a common bird.

What I’ve learned since

I’ve learned that the delivery of good medical care is based on understanding, and communicating with the patient, the risk of isolation, and the healing power of good connection. Doctors now are into their screens, and the best ones are those who can type without looking at the keyboard. The real issue in caring for the patient based on two things:

Connection comes first: if you are in good connection, you can talk about anything; if you’re not in good connection, you can’t talk about anything (this, of course applies to life outside medicine—thnk of your spouse or partner).

It’s never only what you do or say, it’s what you do or say next. No one ever gets connection right all the time, we are always getting it wrong, mostly in little ways. The ones who are great with patients—and with spouses,  partners etc—are those who, when there’s a disconnect, note it, hold it with the other person, and then do something next to turn it into a better connection.

Good relationship, good connection, is the key to good patient care.  And GPs are lucky—you get to actually be with patients in this way.

BJGP Book Review: Out of Chaos Comes a Dancing Star

F1.large-2Out of Chaos Comes a Dancing Star: Notes on Professional Burnout by Chris Ellis. OpenBooks Press, 2014, PB, 95pp, £18, http://www.lastoutpost.info

This book review was written by Ami Sweetman and was in the April 2015 issue of the BJGP.

The author of this book has a fellowship and doctorate in family medicine, and from 2005 to 209 was an associate professor of family medicine at the University of the United Arab Emirates. He is now back home, semi-retired, and doing family practice in Pietermaritzburg, South Africa.

The opening quote from the philosopher Friedrich Nietzsche sets the tone, ‘Out of chaos comes a dancing star’, which in its fuller context reads: ‘One must have chaos in oneself to give birth to a dancing star.’

The text derives from his collection of notes taken from experience, workshops, and courses on the management of stress and burnout in medical doctors, and those involved in the healing professions, although he says it applies to all professionals whether in law, business, or driving the school bus. Stress is a common theme risking progression to burnout. His work shows that understanding another person’s trials and tribulations can be a source of inspiration. Although the text has a serious undertone it sparkles with wit throughout.

Insights into some of the struggles experienced by healthcare professionals are revealed, creating an awareness of the similarity of concepts and conditions encountered by all doctors. The book offers advice and motivation to see past the common despairs of working life and provides comfort in the knowledge that you are not alone when times can get tough.

Topics included are: how we see patients, attitudes to medicine and the practice thereof, the organisation of our work, and conflicts. There are quotes from attendees at the workshops, and excerpts from ‘iconic texts’ scattered throughout the book for contemplation.

Even the list of contents is intriguing. For example; the wounded healer; long hours and no sleep; the character of the doctor; management of acute burnout; guilt and loneliness; the Mr God complex; the angry doctor; the doctor–doctor relationship; credentials needed for burnout; know thyself; and finally, the Phoenix Phenomenon.

Fundamentally the problems are of time, or rather the lack of time, overwhelming obligations, anxieties over making errors in diagnosis, the increasingly informed, uninformed, and misinformed patient, and, of course, the burgeoning administrative and management problems. There are numerous splendid quotes and example situations placed throughout the text.

I would encourage you to dive into this treasure trove of medical wisdom and take away those insights that mean the most to you personally. Although many of the concerns are the products of extreme circumstances, it’s fascinating to see how the messages relate to the NHS or similar systems all around the world, no matter how sophisticated we may think our version of health care to be. We all, save a few of us, appear to suffer stress in trying to fulfil our role.

Review: A Fortunate Man

BJGP JonesProfessor Roger Jones is editor of the British Journal of General Practice.

A Fortunate Man: the story of a country doctor. John Berger and Jean Mohr. Canongate, London, 2015

First published in 1967, this is one of those must-read general practice books, essential for every trainer, trainee and practice library, and one, I suspect, which has been more frequently recommended than read. It has been re-issued this year in a new edition with an introduction by Dr Gavin Francis.

Anyone coming fresh to A Fortunate Man, expecting a paean to idyllic country general practice, will be disappointed, because the romanticised hero of John Berger’s extended essay is a deeply troubled individual to whom the epithet “fortunate” can be applied, at best, with irony.

Berger, now 88, is a distinguished critic and Booker Prize winner. He met the central character of the book, Dr John Eskell, as a patient in St Briavel’s, in the Forest of Dean, Gloucestershire, and became close friends with him. Eskell had been a Royal Naval surgeon during the war in the Mediterranean, and was now in single-handed practice following the death of his GP partner. Some time after Berger had left England for Geneva, Eskell, who becomes Dr John Sassall in the book, invited him and the photographer Jean Mohr to spend six weeks with his family and to shadow him round-the-clock in  his surgeries, on his many house calls and, presumably, in his domestic life, although this is not mentioned once In the book. Sassall was clearly a revelation to Berger, and the degree of connection, empathy, and acceptance that he showed to his patients, and the lengths that he went to, literally, to care for them are clearly regarded by Berger as both astonishing and exemplary. In describing Sassall’s actions and thoughts, and it is more often than not very difficult to know whether Sassall or Berger is doing the thinking, many of the core qualities and responsibilities of a general practitioner working in an isolated rural setting are perfectly captured.

However, Sassall’s hyper-commitment to his practice and his patients was, at least in part, a function of his manic-depression. Berger rather coolly describes Sassall’s lows, but doesn’t seem to quite understand the highs. Sassall’s wife, who ran his practice, died in 1981 and Sassall shot himself the following year. His professional life was troubled and he practised with little professional or, indeed, social contact. Whilst being admirably reflective and sensitive, he appeared to lack, or at least managed to avoid, any real recognition of his wider role as a general practitioner as an advocate for his practice population’s health or as a medical scientist. I can’t help making comparisons with Julian Tudor Hart, working wonders in Glyncorrwg, and John Fry laying the foundations of general practice research from his little practice in Beckenham.

I started reading this book 30-odd years ago and was put off by Berger’s often convoluted, freewheeling writing and Jean Mohr’s dreary photographs. I grew up in the Forest of Dean and, while recognising its comparative social isolation, bridled at Berger’s patronising depiction of Forest folk as uncultured half-wits, and still do. However, re-reading it at one sitting very recently, I recognised the limpid beauty of some of Berger’s prose, the subtlety of his descriptions of nature and of human interactions,  and his insights into the needs of ordinary people faced with illness, anguish and loss. His – or is it Sassall’s? – understanding of the role of the general practitioner as a witness and a “clerk of record”, needs to be widely understood, and never more so in these days of therapeutic miracles and performance indicators, when the unmeasurable essence of patient care can so easily be overlooked.

Robodoc will see you now…

DSC_6556Elinor Gunning is an academic GP and UCL Clinical Teaching Fellow (@EJGun)

“So, in the future, can we just replace GPs with a diagnostic robot?”

Is it just me, or do other GPs hear this question a lot? Often it’s more commonly phrased ‘who needs a GP when you’ve got Google’, but the replacement of doctors with computer programs seems to be a recurring theme when discussing the technological future of medicine.

[bctt tweet=”BJGP Blog: Who needs a GP when you’ve got Google?”]

Most recently I heard this question posed during a Q&A session for ‘The Day Before Tomorrow’, a documentary exploring the impact of technological developments on health care. Part of the documentary addresses what is referred to as ‘quantified self’, a new movement which proposes that self-tracking our personal health data can improve our health. As a society we are suddenly generating an awful lot of health related data – industries have realised that consumers enjoy self- monitoring, and this has led to an explosion of devices and apps which record information such as heart rate, activity, weight and even mood. Perhaps these devices will become so advanced, it was argued, that one day they would interpret the data and diagnose us too – so who needs primary care?

This economic convergence of healthcare and technology is certainly generating a lot of money, but is it just a fad or can it benefit patients? As I sat in the audience, surrounded by representatives of private healthcare providers with dollar signs in their eyes, I wondered whether simply measuring these indicators can actually make us healthier? Where is the evidence that if I record my mood, activity and heart rate I will become happier, fitter and live longer? If an app told me each day that I wasn’t walking far enough, would this ultimately motivate me to change, or would I just turn my phone off? Can novel digital feedback ever be as effective as a consultation with a doctor who can ask me why I am less active and perhaps discover that I am depressed?

I have no doubt that with more research this vast amount of monitoring data will lead to improved diagnostics, chronic disease management and preventative medicine. But medicine needs the ‘art’ as well as the ‘science’, and that means human involvement. Robots may be cheaper, but we need doctors too, doctors who can empathise with our lives, listen to our worries, and, most crucially, don’t have an off-switch when they tell us what we want to ignore.

Review: The Possibilities are Endless

IMG-low resEuan Lawson (@euan_lawson) is the Deputy Editor, BJGP.

In 2005, Edywn Collins had a brain haemorrhage. There’s no gentle intro to this film; it is immersive as we are plunged into a fragmentary sequence of memories, images and sounds. There’s footage of Helmsdale, the hills and the beaches where Edwyn and his family spend their time, and childhood memories collide with adulthood. Edwyn offers broken commentary, his voice hesistant, frequently stuck and unintelligible. Grace, his wife, speaks to Edwyn, and we can feel her at the bedside comforting him. It’s claustrophobic, frightening and frustrating. It’s also mesmerising and quietly horrific as we eavesdrop on an inner life where your brain is unanchored, adrift.

How do you reconstruct your life after a brain injury that leaves you with a hemiplegia and practically aphasic? His only words: Yes. No. Grace Maxwell. The possibilities are endless. He has to learn to read again. Edwyn draws the same rough portrait of a man again. And again. He struggles to remember how many days there are in a year. It took me a while to place Edwyn and it wasn’t until they showed a clip of his biggest chart hit, A Girl Like You, that I had him. A handsome, tall, prodigiously talented musician with a self-assured melodious Scottish accent. Grace and Edwyn just kept going, tiny amounts upwards and onwards. As Grace says, sometimes you just have to “suck it up”. The words of his songs start to come back to him and he sings again.

There is often a whiff of the condescending when relating life-affirming stories of the apparently afflicted. There’s no room in this story for any plastic admiration; nothing in this film plays on victimhood. It’s just Edwyn’s and Grace’s story with no smear of self-pity to blur the vision. This is not a motivational movie with the life story burnished so we may weep at the indomitable human spirit. It’s not making promises that by watching you will be a better person. Yet there is a quiet satisfaction here and an insight into brain injury that embraces the medium of cinema.

Spoiler: You will be disappointed if you are hanging out for a magical moment of recovery with all his memories and skills flooding back in an exultant moment of slow-mo triumph. Ultimately, we come to Edwyn as he his now: ribbing his wife; laughing with his son. He’s not where he was before 2005, perhaps not where he might have expected to be: but then who is? Edwyn is laconic: Possibly before my stroke I was a bit too focussed. He goes on in his staccato style: The next stage of my career. No, no, I was nice. Don’t get me wrong. But arrogant in a way. I’m over that phase.

[bctt tweet=”BJGP Blog: The Possibilities are Endless. A remarkable film with @EdwynCollins. #braininjury”]

Visit the website: www.thepossibilities.co.uk. The Possibilities are Endless is showing in selected cinemas in February and March, or you can buy and download it via the website in hard copy or digitally via the iTunes Store. Twitter: @EdwynFilm