Knowing your doctor well keeps you well as well

Look at this from Private Eye‘s wonderful ‘MD’ (aka Dr Phil Hammond) (15-28 October 2021 p 8)

The model of general practice – trying to manage multiple complex risks and needs in very brief encounters – has long been unsafe and unsustainable. You have 10 minutes to help an 80-year-old woman who is arthritic, breathless, recently bereaved and on 12 tablets. It takes three of those minutes to walk her from waiting room to consulting room.She wants to talk about her late husband; you want to ensure her breathlessness was not a red flag for a life-threatening condition or a side effect of the pills you have prescribed.

It takes another three minutes to undress her and get her up on the couch to be examined. And yet her main reason for coming was loneliness.

….

A study of Norwegian health records, published in the British Journal of General Practice, found that — compared with a one-year patient-GP relationship — those who had had the same doctor for between two and three years were about 13 percent less likely to need out-of-hours care, 12 percent less likely to be admitted to hospital, and 8 percent less likely to die that year. After 15 years, the figures were 30 percent, 28 percent and 25 percent.

Healthcare depends crucially on relationships, and staff knowing and understanding you.

Imagine a GP being resourced enough to combine a vocation as a doctor with the time and stability to develop relationships with patients. Vocation and relationships … just like in a book I recently wrote, which I may have occasionally mentioned in this blog. And which is still ‘forthcoming’…

Covid and the rawness of life

The skin gets scraped off

Interesting to see how Covid is scratching the surface off us and revealing the rawness underneath. I read a lovely article in the Grauniad which I wanted to share in case you hadn’t seen it.

Rachel Clarke (journalist turned physician, apparently, and drafted into intensive care) wrote eloquently and superbly about the stress, the exhaustion, the despair, the abuse on Twitter and elsewhere. She incidentally writes about how ‘Sometimes, in the darkness, a patient pleads to die. They cannot take the claustrophobic roar of their CPAP mask any longer.’ (I recognize that emotion, though I didn’t want to die, just not fight any more, when I was attached to a CPAP in 2013.)

But then this:

All across the hospital, you see it. In the tiny crocheted crimson hearts, made by locals for patients and delivered in their scores so that no one feels alone. In the piles of donated pizzas, devoured at night by ravenous staff. In the homemade scrubs, whipped up by an unstoppable army of self-isolating grandmothers whose choice in fabrics is fearlessly floral. In the nurses and carers and porters and cleaners who keep on, despite everything, smiling. I may be tired and angry and sometimes mad with grief, but every single day at work, I see more kindness, more sweetness, more compassion, more courage, more resilience, more steel, more diamond-plated love than you could ever, ever imagine. And this means more and lasts more than anything else, and it cannot be stolen by Covid.

Breathtaking: Inside the NHS in a Time of Pandemic by Dr Rachel Clarke is published by Little, Brown

Why having a convoluted ancestry is quite OK

In which we explore myths and endless genealogies, but in a good way.

Even if your mum is a virgin

moviedo at Pixabay

I have been spending more time than is good for me reading atheist websites. They like to throw stones at the Bible. So far it’s been dispiriting stuff, and not because of the quality of the arguments.

I could offer atheists an algorithm before sounding off about ‘Moab being my washpot’, or Cain and Abel, or Noah. Here’s the algorithm:

  1. Consider whether or not people who take the Bible seriously may not also have noticed what you have noticed.
  2. Consider whether they may or may not have explored the problem at a depth you do not seem to have appreciated.
  3. Have you explored the literature?
  4. Do you agree that first figuring out what the authors and compilers were trying to say to their original audiences is fairly important when handling ancient texts? The Bible is not a Penguin Modern Classic, tha’ knows.
  5. Stop sounding like a Flat-Earther or a Biblical Creationist already, plucking random things from flawed popular reading and confecting an argument.

The genealogies in Matthew and Luke are an easy target. Even a rushed reading will conclude:

  1. They contradict each other
  2. They end with Joseph, who wasn’t even Jesus’ biological dad.

While this is an easy Aunt Sally for the atheist projectile, it’s also fruitful to apply our algorithm and think more deeply. Here are two thunks.

  1. The best thing I’ve read on genealogy and ancestry is Adam Rutherford’s book A brief history of everyone who ever lived. (Dr) Adam Rutherford is a smart, fair-minded BBC producer and presenter, whom I have occasionally heard defending his atheism on the radio, though in a kindly, almost Anglican way, not with the stridency or rudeness of some. Dr Rutherford was more concerned with genetics than genealogy in his book but it explained beautifully some of the fun stuff around the topic. Of course we all have grandparents, great-grandparents and great-great-grandparents in exponentially increasing numbers. But, there were fewer of them back then, not more. Which obviously means that everyone can trace several paths from Ancestor (A) (say, for example Charlemagne or Ghengis Khan) to Descendant (B), yourself. So, interestingly, even if there were nothing else going on in the New Testament genealogies, it would be right if they traced different paths from Abraham to Jesus. And the denizens of the ancient world obviously knew that.
  2. The only two gospels that talk about the Virgin Birth are the same two gospels that give a genealogy of Jesus. Perhaps they are trying to tell us something. An Arab friend of mine who was a convert to Christ from Islam was stopped at the border of her Arab country as she tried to get home. It was a slightly tense moment. The customs person looked at her passport and her name. ‘Very good family’, he said, and welcomed her in. Which perhaps is the point. Of course Joseph was Christ’s stepdad. So, as the genealogies tell us, Christ had been adopted into a very good family. The two gospels that describe Christ’s nature (born of a virgin) also are at pains to point out his nurture (adopted into a regal family). I think.

While we are talking myths and endless genealogies, it might be worth mentioning another book:

I understand this book to be a thought-experiment about how a literal Adam and Eve, born several millienia ago, could have been common ancestors to all living humans. (Adam and Eve would not have been the only humans around at the time, and nor would they have been named ‘Adam’ or ‘Eve’.) This book has been praised by many for its scientific rigour and gentle spirit. It’s a bit of a surprise for those of us who have become comfortable with a non-literal Adam and Eve. I haven’t read this book yet but I have heard a presentation by the author, and it’s a fresh contribution to what arguably is a stale set of arguments.

Slow meat-eating

The vegans are definitely 1-0 up over the carnivores and it’s well into the second half of the match, so I’m going to have to quote the Guardian at them.

Veganism is rightly touted as a response to industrial farming and butchery. It produces less CO2 as well, at least on its way into the stomach. (I’ve not seen research on what happens within the vegan stomach and beyond but prejudice suggests plenty of CO2 and CH4 emerges from human digesters.)

I did see, however, a contrary article that at least constitutes a brief rude noise in the sonorous vegan sermon. To quote:

Rather than being seduced by exhortations to eat more products made from industrially grown soya, maize and grains, we should be encouraging sustainable forms of meat and dairy production based on traditional rotational systems, permanent pasture and conservation grazing. We should, at the very least, question the ethics of driving up demand for crops that require high inputs of fertiliser, fungicides, pesticides and herbicides, while demonising sustainable forms of livestock farming that can restore soils and biodiversity, and sequester carbon.

This is appealingly slow. The writer, who re-wilded her traditional dairy and arable farm, adds:

So there’s a huge responsibility here: unless you’re sourcing your vegan products specifically from organic, “no-dig” systems, you are actively participating in the destruction of soil biota, promoting a system that deprives other species, including small mammals, birds and reptiles, of the conditions for life, and significantly contributing to climate change.

Our ecology evolved with large herbivores – with free-roaming herds of aurochs (the ancestral cow), tarpan (the original horse), elk, bear, bison, red deer, roe deer, wild boar and millions of beavers. They are species whose interactions with the environment sustain and promote life. Using herbivores as part of the farming cycle can go a long way towards making agriculture sustainable.

There’s no question we should all be eating far less meat, and calls for an end to high-carbon, polluting, unethical, intensive forms of grain-fed meat production are commendable. But if your concerns as a vegan are the environment, animal welfare and your own health, then it’s no longer possible to pretend that these are all met simply by giving up meat and dairy. Counterintuitive as it may seem, adding the occasional organic, pasture-fed steak to your diet could be the right way to square the circle.

Isabella Tree. (Yes, she really is called that.) Here’s her book, which I have not read.

The slow pushback on the autocrats

Underneath the headlines, autocrats keep being foiled

Just read the annual letter by the head of the American-based Human Rights Watch, Kenneth Roth.

He talks about the slow pushback on the autocrats. Messy, partial, grassroots, ragged and often not making the headlines, it makes the tyrants lives harder and more complicated and at times, impossible. Poor them.

In some ways this is a dark time for human rights. Yet while the autocrats and rights abusers may capture the headlines, the defenders of human rights, democracy, and the rule of law are also gaining strength. The same populists who are spreading hatred and intolerance are spawning a resistance that keeps winning its share of battles. Victory in any given case is never assured, but it has occurred often enough in the past year to suggest that the excesses of autocratic rule are fueling a powerful counterattack.

Kenneth Roth, Human Rights Watch, 2019 Keynote

He adds

… new alliances of rights-respecting governments, often prompted and joined by civic groups and the public, have mounted an increasingly effective resistance. Political leaders decide to violate human rights because they see advantages, whether maintaining their grip on power, padding their bank accounts, or rewarding their cronies. This growing resistance has repeatedly raised the price of those abusive decisions. Because even abusive governments weigh costs and benefits, increasing the cost of abuse is the surest way to change their calculus of repression. Such pressure may not succeed immediately, but it has a proven record over the long term.

He then offers an impressive survey of current human rights abuses and how in many cases unorthodox groupings have added to the headaches for the autocrats.

I like this. It’s a very ‘slow mission’ way of opposing evil.

A little while, and the wicked will be no more;
    though you look for them, they will not be found.
11 But the meek will inherit the land
    and enjoy peace and prosperity.

Psalm 37:10-11 NIVUK

Mission as being where Jesus is

This (from Rowan Williams, Being Disciples) is one of the most attractive reasons for the mission enterprise that I have read.

Being where Jesus is means being in the company of the people whose company Jesus seeks and keeps. Jesus chooses the company of the excluded, the disreputable, the wretched, the self-hating, the poor, the diseased; so that is where you are going to find yourself …

That is why so many disciples of Jesus across the history of the Christian Church –and indeed now — find themselves in the company of people they would never have imagined being with, had they not been seeking to be where Jesus is: those who have gone to the ends of the earth for the sake of the gospel; those who have found themsevles in the midst of strangers wondering, ‘How did I get here?’ People like Thomas French, a great missionary figure of the nineteenth century who spent much of his [p12] ministry as bishop in the Persian Gulf at a time when the number of Christians in the area was in single figures, and who died alone of fever on a beach in Muscat. What took him there? What else except the desire to be where Jesus was, the sense of Jesus waiting to come to birth, to come to visibility, in those souls whose lives he touched — even though, in the long years he worked in the Middle East he seems to have made no converts. He wasn’t there first to make converts, he was there first because he wanted to be in the company of Jesus Christ — Jesus reaching out to, seeking to be born in, those he worked with and loved so intensely. It’s the apparent failure, and that drama of that failure, so like the ‘failure’ of Jesus abandoned on the cross, that draws me to his story, because it demonstrates what a discipleship looks like that is concerned with being where Jesus is, regardless of the consequences.

Rowan Williams Being Disciples (pp 11-12)

The hidden plague

loneliness

lonely

Fascinating article in about a great source of un-wellness in our society1: loneliness. 

‘In Britain 7.7m people live alone … Seventeen million adults in Britain are unattached. More than 1m older people feel lonely all or most of the time, and most of them do not feel able to admit their loneliness to family and friends. Loneliness is one of the chief reasons people contact the Samaritans, though often callers find it hard to admit it. “People who call us sometimes feel that loneliness is not a good enough reason for calling,” says Nick, a long-term Samaritans volunteer. “They feel ashamed or embarrassed, as though feeling lonely isn’t something serious.” Three out of four GPs say they see between one and five lonely people a day; only 13% feel equipped to help them, even though loneliness has a detrimental effect on health equivalent to smoking 15 cigarettes a day. Only 22% of us have never felt lonely.’

‘In the autumn last year, the body of 68-year-old Marie Conlon was found in her flat at Larkspur Rise in Belfast. She had been dead for nearly three years. In a statement, her family said they were “shocked and heartbroken” at the death of the “beloved sister”. Call be cruel, but how beloved could she have been if they hadn’t seen or spoken to her since the beginning of 2015? I popped into my local funeral directors to learn how often they were presented with bodies which had lain along in flats until they began to decompose. The lady in charge that day was wary of my questions, and made me promise not to give her name. But yes, she said, this happens quite regularly–bodies lie undiscovered until neighbours complain of a smell.’

Justin Welby’s ‘Reimagining Britain’

The Brexit referendum was the moment the ceiling fell in; but the dripping had been a problem for some time. Justin Welby’s book ‘Reimagining Britain’ is what happens when an Archbishop joins a crowd of workers leaning on shovels, looking at our nation, sucking their teeth and saying that this is going to take some fixing.

I like our Archbishops a lot. Archbishop Sentamu actually does stuff, like fasting, actually going hungry, which is a step up from most members of the order Primate, who usually only do stuff metaphorically (like ‘wrestling’ with a Bible text).

In Justin Welby, meanwhile, it is so refreshing to have an archbishop who doesn’t look like he’s just stumbled out of a library and can’t find his way back.

My liking for the Archbishops may make me too kindly disposed to this book; but even if it has flaws, it’s a really enlightening read.

Archbishop Welby is striving to ‘reimagine Britain’ after the loss of a Christian backdrop, the rise of pluralism, and above all, after the divisions brought to light by the Brexit referendum.

It’s a good fight and it needs someone, just as the nation needed an Archbishop Temple when Britain was being previously reimagined at the end of WWII. Welby believes Christians can lead this reimagining; in fact they must.  

Government-issue British values

The government’s response to the retreat of Christendom seems to have been to ask some poor civil service intern to write up a set of  ‘British Values’ on half a sheet of A4.1 This is to replace what grew through the toils of scholars, monarchs and martyrs in the last millennium and a half. They are:

  • democracy
  • the rule of law
  • individual liberty
  • mutual respect for and tolerance of those with different faiths and beliefs and for those without faith.

Welby rightly rejects these as too flimsy and attempts to replace them.

‘When faith is increasingly privatized, it leaves a vaccuum which relativism in belief or a great plurality of incommensurable beliefs is unable to fill … There is a need for a generous and hospitable metanarrative within which competing truths can be held.’

He goes on  ‘It will be a suggestion of this book that Christian faith, centred on love-in-action, trusting in the sovereignty of God rather than political power, provides the potential for such hospitable and generous holding.’ (p 17)

 

So he first suggests a set of values, then attempts to reimagine aspects of British life with reference to them. 

Justin’s values

The Archbishop’s suggested values for reimagining Britain are ‘community’, ‘courage,’ and ‘stability’. If those sound too wishy-washy, suspend disbelief for a moment.

Community is about the way we all belong to each other, a note distinctly lacking in political discourse at the moment. After the referendum, the leavers didn’t say ‘let’s be magnanimous, let’s move forward together’. Instead we had, ‘You lost, get over it.’

Courage means giving room for animal spirits of competition, innovation and creativity.

Stability is basically a commitment to compromise, combined with a caution that gives room for bad stuff to happen without causing everything to collapse. Compromise! Forethought! Caution! Imagine!

So it’s good stuff. These are good directions to urge our society to head.

The best bit

The best part of the book for me was the reminder that Christians can rest on two truths: God is good, and God is King. In depressing days like these, I like the freedom to hope.  

The pain-reducing effects of dancing together

The joy of team

VIMOS’s last embrace

Researchers at Oxford University did an experiment with communal dancing.

They gathered a group of strangers and taught them different dance moves. Then they put four of these strangers together and gave each person headphones. So any given foursome could have:

  • Same dance moves, different music
  • Same music, different dance moves
  • Same music, same dance moves.

After the dance floor experience, they tested their pain threshold by tightening a blood-pressure cuff on each of them.

It turned out that the synchronized dancers (hearing the same music and doing the same moves), had a much higher pain threshold than the others. 1

Why is this? Perhaps we have become wired to be rewarded when we work alongside other people toward a greater end. There’s a health-giving benefit to being a harmonious part of a team effort. Most of us have felt this at one time or another, the sense of wellness from a team of people achieving something together by each doing our bit.