Category Archives: Random

Why Slazenger’s cat explains global warming

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

707I admit that Slazenger’s cat is a red herring, but my wife was in a rail carriage a while ago, close to a small group of friends in earnest discussion. One was trying to refer to the paradox of Schrödinger’s cat, but couldn’t quite remember the name, so it came out as Slazenger’s cat, which has remained within our family folklore hereafter. But the cat that explains global warming is owned by a friend, a mathematician rather than a quantum physicist. They were faced with the perennial question – what to do with the cat when they go on holiday?

Our friend here in Bahrain flees home to Canada for the summer (well, Canada does not reach 48°C in August). Mr Tibbles never goes out of their flat. So a fairly routine problem of care you would think? They have an additional problem. Should one just leave the air conditioning on continuously for 6 weeks, risking it breaking down when they are not there, thus killing the cat through heat exhaustion? Their Arab helper (whom they employ to wash their cars) will care for the cat. He is competent, although illiterate. So they give the helper a key. At the helper’s request they lock all the internal doors except for the room with the cat. The helper turns on the air con every morning when the cat gets fed, and turns it off every night, when the outdoor temperature will go down to the low 30°C. All should be well.

Except of course it isn’t. The air con in the cat’s room breaks down just as they are leaving for the airport. Fine, put the cat in another room and let the helper know. But the helper has no phone (and is still illiterate). So my friend’s children rapidly draw diagrams and maps of the layout of the flat with large arrows on walls leading a path to the cat’s new abode, a room with functioning air con. And of course my friend spends the summer in the same state of suspended belief as Slazenger, Schrödinger, whoever.

But this rather shaggy tale explains why this part of the world is not going to cut back on its carbon emissions any time soon. I am sitting writing this with the air con on. It’s a few degrees cooler today, only 43°C. We turn the air con off when we are out, to give it a rest, img_3956but there’s no way we could live by day or sleep by night without it. But, hey, energy from oil powered power stations is so cheap out here. We don’t get an electricity bill – it’s not worth it, it’s just bundled up into the rent because it’s as cheap as chips. (Well, considerably cheaper than chips to be accurate.) And our lush green apartment gardens would be dry and dead in days without the unending power hungry efforts of the local desalination plant – well it rains four days a year and there are no rivers in Bahrain – where do you think the water comes from? Oh, and I haven’t mentioned our apartment’s two 500,000 litre swimming pools. Desalinating water for both of them would take about 28 car petrol tanks of fuel, enough to drive from the UK to New Zealand (although I wouldn’t advise trying it).

As I look out of my window over the blue waters of the Gulf and the squat square rooves of my neighbours I can see plenty of jet skis and high end cars but no solar panels. (I didn’t even know they made a five-litre Jaguar until I came out here.) So the Middle East won’t be giving up its reliance on fossil fuels any time soon. And what of the rest of the world? Despite what I have seen of refugee camps in this region and slums in African townships, poverty in most parts of the emerging world is reducing overall. And to what does the emerging world aspire? To a low impact organic recycled utopia, or to air con, MacDonalds and five litre Jaguars? I’ll leave you to guess.

p1000465I love a line our daughter wrote on her website: “when we throw something away, where do we think away is?” We make rather feeble attempts to live a low-impact life that is actually impossible as an ex-pat in the Middle East (and in any case is trumped by our air miles travelling home a few times a year.) And the west is still obsessed with “growth”. Actually the west is all grown up and just a bit too big. Should we not be obsessed with stabilizing our planet? It’s our way of life that needs to become more resilient, not our GPs. Grown-ups putting on weight is not healthy and it’s time we attended to our planet’s BMI.

By the way, the air con worked fine – Mr Tibbles lives.

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’. 

The onesie: a red flag sign for GPs

DSC02665Adam Staten is a GP trainee in Surrey and is on Twitter @adamstaten.

Cold reading is the art of obtaining information about a person by making a rapid assessment of their body language, manner, age, dress and behaviour. It is commonly used by psychics, mediums and illusionists. General practitioners do it too, whether it’s noticing the subtle nail changes in an undiagnosed psoriatic, or clocking the smell of stale alcohol on the problem drinker.

We find clues about patients all over them and all around them. In exams the signs are usually obvious, it may be the inhaler and BM monitor carelessly left by the bedside or a medic alert necklace turned face down on the chest. In practice signs may be less obvious, less tangible, but equally revealing. Your recognition of these signs may not be conscious but they form part of your assessment none the less; the fifteen year soft neck collar of the somatising patient, the midwinter tinted glasses of generalised oddness, or the teddy bear sign of pseudoseizures are a few examples.

Dress, in particular, is one of the key components of the mental state exam but judging it can be tricky. One man’s chic is another man’s psychotic. However there is one item of clothing that requires no interpretation. There is one item of clothing that is a clear cry for help. You may have found yourself in the consultation room struggling to listen to a middle aged woman’s account of her sore throat or aching knees because you can’t stop wondering why this grown woman is wearing a Babygro®.

[bctt tweet=”BJGP Blog: Struggling to listen because a grown woman is wearing a Babygro®?” via=”no”]

Rather than resisting this thought process you should embrace it. This is the era of holistic medicine and all patients are supposed to be seen as part of their bio-psycho-social milieu. The onesie is a gift to the busy, time pressured, general practitioner because it is the psycho-social snapshot par excellence.

This is an item of clothing that declares to the world that a patient lacks the gumption and will power to struggle into a second garment. It is an item of clothing that declares to the world that an adult’s self-worth has sunk so low that he does not mind being seen in public dressed as a baby. The wearing in public of a onesie by anyone over the age of two years should be considered a clinical sign, Staten’s sign if you will, of extreme psycho-social distress and should prompt an urgent mental state assessment.

The evidence supporting this new clinical sign lies somewhere just below grade 5 and thus it is an area requiring further research. Yet it seems likely an extra question will be added to the PHQ-9, ‘on how many days in the last two weeks have you worn a onesie in public?’. Be vigilant, if your patient is onesie positive, then they are in need.

Introducing GPs Anonymous

photoPeter Aird is a GP in Bridgwater, Somerset.

Is it just me or is being a GP increasingly being portrayed as something for which one ought to be ashamed? If so, then perhaps we should consider if we need some help.

With the latest suggestion that patients will be able to bypass their GP and refer themselves for cancer investigations, perhaps it’s time to face up to an uncomfortable truth. We’ve been told enough times by enough people – perhaps the implication is true: we’re not up to the job. It’s all the fault of we GPs.

We mustn’t  go on denying it any longer – convincing ourselves we’re OK – after all, until we acknowledge our problem how can we expect anything to be done to help us. We will just go on making everyone’s life a misery.

We all know how embarrassing GP behaviour can be – you know the kind of thing, spoiling everything for everybody on Christmas Day by turning up at a family gathering rather than opening our surgeries as normal – and thereby compelling people to waste hours in A&E departments with their sore throats and itchy toes. And then, of course, there is the wilful ignoring of our patients who clearly have cancer whilst, at the same time, putting an unnecessary burden on secondary care services by admitting patients to hospital just for the fun of it.

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

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

There that wasn’t so bad -to be honest it’s a relief to have it out in the open – I hope you can find it in your heart to accept someone as shameful as me – after all the hurt I’ve caused. If you’re similarly afflicted, come and join me – I’m setting up ‘GPs Anonymous’ in the hope that together we can support all of us who are stricken with the affliction that is ‘being a GP’.

But perhaps you’re still unconvinced you have a problem. Can I urge you then to ask yourselves these four screening questions? Answer two in the affirmative and you may have a problem – answer ‘Yes’ to all four and you’re in real trouble.

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

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

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

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

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

[bctt tweet=”BJGP Blog: Peter Aird is joining GPs Anonymous. Try the CAGE questionnaire.”]

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

It’s a tragic condition but, with the arrival of ‘GPs Anonymous’ at last there is some real hope for change. Perhaps together we can rid the country of the blight that GP’s have become.

And then won’t everyone be happy?