Death In All Its Many Forms

I see dead people: lots of them. Primarily in my job as a doctor in a geriatric ward, I have issued dozens of death certificates. For the vast majority of these patients death came after "a good innings", and for a lot of these people death came as a blessed relief from pain, or other distressing symptoms. For most folk, death is something they rarely come across, and it remains very much a taboo subject for much of the UK population, even in the 21st Century. For me, and the doctors and nurses I work with, death is very much part of life. Some might see this response (or lack of it) to death as a form of desensitisation, and I certainly think my response to my father's death was influenced, and probably blunted, by my medical experience.

Today I'm on call for the Police. At 17.00, when I was thinking of going for a curry, I was asked to go and examine a 25 year old man who had put the barrel of a rifle in his mouth and pulled the trigger. He had left a suicide note. I can still see his face.

If that sort of death ever stops touching me I should probably "hang up my spurs".

You Know It Makes Sense

As you know, I don't often find the time to blog these days but the debate about health care reform that rages in the US and simmers in the UK has finally overcome my natural lethargy. This brilliant little animated video spells out in terms that are difficult to argue with why the United States should provide universal health care that is funded by taxation and not by greedy, self-serving insurance companies. When you stand at the top of the Empire State Building in NYC some of the most lavish buildings you can see are owned by insurance companies, which should be telling us something!

These companies and their right-wing supporters have a lot to lose if Obama is successful: hence the vitriol and scare-mongering that is coming forth just now. America makes a big thing of its Christian values, but many US citizens apparently don't see that failing to provide large chunks of the population with health care is inconsistent with this.

On this side of the Atlantic, I am pleased to see that the debate is showing up major fault lines in Cameron's façade of the new "caring, sharing" Conservative Party. The Tories' commitment to the British NHS has been shown to be a total sham, but I don't know if this will be enough, in itself, to lose them the next election, unfortunately! Labour's increasing attempts to part-privatise the NHS in recent years have been shameful, and a genuine commitment to a publicly funded system, free of the need to pander to the demands of shareholders in private companies, might allow voters in the next election to chose a party that appreciates the true values upon which the NHS is based.

Texting the Obvious?

I was not previously a fan of sending text messages. My old Nokia phone had predictive text, but I could never get the hang of it. As a result, I needed to perform multiple key presses, making sending even the simplest of messages a slow and painful chore. Wosog is quite a dab hand at predictive texting, as are my children. I believe my daughter's friend can even text at amazing speed using predictive text on her phone without looking at it! How the Hell does that work? Anyway, I've now got a BlackBerry Curve smartphone with a separate key for each letter, so texting is a dawdle.

I've heard of text messages being used for a few medical purposes: reminding patients about their clinic/ surgery appointments; reminding asthmatic children to monitor their peak flow measurements etc. This article on the BBC website describes a trial of the use of text messages to warn patients with seasonal affective disorder of impending overcast weather. To quote the article:

"Under the pilot project, alerts are sent to participants before gloomy days warning them to spend 20 minutes in front of their light box, and to read the accompanying advice that day.

This should help them to prepare for the dark weather and know what to expect when they draw the curtains."

Maybe I'm being stupid here, but unless these folk have very thick curtains (which would not seem a good idea in someone who craves light exposure) can't they get a pretty good idea what the light level outside is by examining the light coming through the curtains?

Down in the Mouth

I must admit I have never fancied being a dentist. When I was a medical student we shared pre-clinical classes with dental students, and I could never understand why it was felt that dentists, who are solely concerned with affairs above the neck, required a training as long as that of a doctor. Most medical students are driven to at least a small degree by a spirit of altruism, but as far as I could see most dental students were motivated by a heart-felt desire to make as much money as possible and retire as early as possible. I may be doing them a disservice here, but somehow I doubt it!

Even though I have always felt that most of the dentists I knew were financially better off than I, I really didn't envy them. Several decades of poking around in mouths afflicted by halitosis does not appeal to me, and I don't think I would find the work very varied. I hadn't, however, thought of the degree to which these guys were exposed to litigation as well.

In the usual way that trends tend to flow across the Atlantic from the USA, litigation has been increasing in medical practice in the UK. So far, general medical practice has not been affected too badly, although my Defence Union subscriptions have increased a fair bit over the years. According to this article, however, legal claims against dentists have increased dramatically in recent years. Much of this seems to relate to increasing amounts of private dental work.

I wonder if the people making these claims care about the fact that their successful litigation will inevitably lead to escalating costs for them and everyone else in the future? I suspect not.