Silent as light

The Antiquary: “is preoccupied on every level by the relation between past and present.”

Mary Midgley: “These doctrines are often bizarrely over-confident and over-simple”

George Orwell in Why I Write: “… one can write nothing readable unless one constantly struggles to efface one’s own personality”

Raymond Tallis in Summers of Discontent “There are several things to be noted about emotions. The first is they fill the world with meaning”

Kenneth Calman in Makars and Mediciners:  “It is perhaps here that the role of literature and the arts generally can have an advantage, by the author exposing poor health choices and behaviour patterns, in ways which are more powerful and effective than that of the medical teacher or professor. The writer’s imagination and expression can change things. The word can be powerful.”

Nathan Filer in The Shock of the Fall: “I think that’s what I am doing now. I am writing myself into my own story and I am telling it from within”

Andrew Greig: “He knows fankle from bourach.”

Raymond Tallis in Defence of Wonder “When we are in love we see the ordinary things about another person for what they are: not in the slightest bit ordinary.”

Gilbert K. Chesterton: “The world will never starve for want of wonders; but only for want of wonder

“She makes sunlight dim” (Sian)

Thomas Tranströmer to his lifelong friend Robert Bly: “In this climate it`s all or nothing. Anybody not 100% for is “self-evidently” 100% against. Have I given you a little picture of the climate? All you can do is Follow your own crooked conscience, wait for the moment of truth and hope you won’t need to be ashamed one day of how you lived through these years.”

Raymond Tallis: [Philosophy is a return] into that nearest, which we invariably rush past, which surprises us anew each time we get sight of it”

Tomas Tranströmer: “Balansnummer is ‘balancing act.’ The poem is partly a protest-poem against the prevailing mood in Swedish intellectual life. What I say is that finding the truth, being honest etc. is a difficult individualistic act of balance, you have to put off the rhetoric, all slogans and moustaches and prejudices and . . .”

Stephen Bann, MIDWAY: Letters from Ian Hamilton Finlay: “I recall saying once to Finlay that the special feature of the letter as a literary genre was that one never went back on the first draft to produce a fair copy.”

Nathan Filer in The shock of the Fall: “I have approximately 7.4 x 1027 atoms in my body”

Ian Hamilton Finlay: “Sometimes my wee best seems just not good enough”

Richard Holloway in Leaving Alexandria: “The toughest lesson life teaches is the difference between who you wanted to be and who you actually are. And it can take a whole life to teach it”

Robert Louis Stevenson: “Letter to a young gentleman who proposes to embrace the career of Art”

A. S. Byatt in Possession: “He put little slips of paper in the entries that made up his fragile narrative or non-narrative”

Adam Nicolson in Sea Room: “I’m wedded to this plunging-off form of thought, and to the acceptance of muddle which it implies”

Mukul Kesavan in Looking Through Glass: “Like all chroniclers of the relatively recent past, history ran out against the present”

Julian Barnes in The Noise of Time: “He bought a large scrapbook and pasted ‘Muddle Instead of Music’ onto the first page.”

Ronald Ross: “Science is the differential calculus of the mind, Art is the integral calculus; they may be beautiful apart, but are great only when combined.”

Walter Scott in The Antiquary (in Oldbuck’s room) “Amid this medley, it was no easier to find one’s way”

Margaret McCartney in The Patient Paradox: “The conclusion that variability is bad is distant from the much simpler observation that patients are all different.”

Robert Crawford in Young Eliot: “Leafiness suited him”

Alexander McCall Smith in Chance Developments: “His one and only book, ‘The Future Lies in the Past’, eventually published”

Patrick Deeley in The Hurley Maker’s Son: “I sensed the sun, beaming from a place that was higher than the world”

Penelope Fitzgerald in The Bookshop: “The sky brightened from one horizon to the other”

Hanya Yanagihara in A Little Life: “You made art because it was the only thing you’d ever been good at, the only thing, really, you thought about between shorter bursts of thinking about the things everyone thought about.”

John Berger in Here is where we meet: “To find any sense in life it was pointless to search in the places where people were instructed to look.”

Edmund De Waal in The White Road: “He writes a letter about how things are made, but it is actually about compassion.”

Alice Hoffman in Faithful: “No one could count all the stars. There are far too many.”

Madeleine Thien in Do Not Say We Have Nothing: “So familiar to me, like an entire language, a world, I had forgotten”

John Steinbeck in Of Mice and Men: “Both men glanced up, for the rectangle of sunshine in the doorway was cut off”

“Just a word”

In an official Medical Society Blog the following words were recently used in response to thoughts that I had submitted on a medical subject.  These singular words were put in inverted commas by a most senior healthcare professional who does not know me.

The Medical Society involved has since removed the post:

I share the view of Barrack Obama that we should all try and engage in debate with those who may have different views.

I would suggest that such “one word” approach [with words used to stain] may not encourage helpful debate.

Improvement science: engineering 42 – ethics 0

In my last post I considered a “thought paper” entitled “The habits of an improver” and welcomed that critical thinking was considered a necessary habit.

The word “engineer” or “engineering” is to be found on 42 separate occasions in this Health Foundation thought paper.

The word “ethics” does not appear at all. Despite the fact that the introduction begins with this quote:

That ethics do not seem to be considered amongst the “habits” necessary for “improvement science” is concerning.

The last time I looked, I found this result using the Healthcare Improvement Scotland search facility:

The former Chief Executive for the Mental Welfare Commission for Scotland used to introduce me as “Bayesian Peter”. Bayesian is the name given to interpretations of probability and returns to Reverend Thomas Bayes original considerations of complexity.

Healthcare, like life, is complex. We are human and live in an ever changing world.

This is not all so simply “engineered”.

Ethics is integral to science.  I do not deserve the epithet “Bayesian Peter” – for whilst I am interested in ethics this does not mean that I am more ethical than you the reader.

However, I want to say as clearly as I can, and yes with passion, that without ethical considerations “improvement science” should linger in quotes.

“The Law of the Few”

Malcolm Gladwell in his book ‘The Tipping Point’ describes what he terms “The Law of the Few”: namely that the influence of a few people can result in change in behaviour across a wider population.

This Hole Ousia post is about the education of psychiatrists and takes all its material from publically available sources. This post hopes to demonstrate the considerable reach (to the many) of a handful of educators.

This post follows on from the evidence that was gathered for my petition to the Scottish Parliament to consider introducing a Sunshine Act for Scotland. That petition closed 16 months ago following a consultation with the Scottish public who, in majority, asked that payments made to healthcare workers and academics be declared on a mandatory basis. I have argued the reasons why I am of the view that such mandatory declarations should be registered on a single, open, central, searchable, independent database.

Evidence has demonstrated that when a doctor has a financial “conflict of interest”, this can affect the treatment decisions they make, or recommend. There is longstanding evidence that exposure to industry promotional activity can lead to doctors recommending worse treatments for patients.

The post has come about following my invitations in the last month to Continuing Medical Education (CME) provided in my place of employment (NHS Scotland). I do not knowingly  attend sponsored medical education and so declined these two talks. The first was by Dr Peter Haddad (sponsored by Lundbeck) and the next one, just two weeks later, was by Professor McAllister Williams (sponsored by Lundbeck).

I am an ordinary psychiatrist working in a provincial NHS general hospital and to find such prominent individuals visiting our wee corner of Scotland left me to reflect upon the wide influence of a few key individuals.


The British Association for Psychopharmacology (BAP) describes itself as “a learned society and registered charity. It promotes research and education in Psychopharmacology and related areas, and brings together people in academia, health services, and industry.”

Professor Hamish McAllister-Williams is an Ex-Officio Member of BAP and is currently the BAP Director of Education.  Dr Peter Haddad, former Honorary General Secretary of BAP, has been involved over a number of years with BAP education providing articles and masterclasses.

Over the course of my career as a psychiatrist I have frequently heard colleagues say that BAP “is the place to go” for CME.  It is now a requirement for General Medical Council Appraisal and Revalidation to demonstrate with our College that we have participated in CME. Once this has been demonstrated the Royal College of Psychiatrists will issue a Certificate of “Good medical standing”.

As BAP Director of Education, Professor McAllister Williams recently shared this offer to trainee psychiatrists. Following the dissemination of this I took the opportunity to look more closely at the current BAP calendar for Continuing Medical Education. This again demonstrates the wide influence of a small number of individuals, some of whom would appear (within the limits of the current voluntary disclosure regime) to have potential financial conflicts of interest.

In the remaining part of this post I have included a few examples

As BAP Director of Education, Professor McAllister Williams chaired this BAP 2015 Summer Meeting: “Expert Seminar in Psychopharmacology”. The key-note speaker was Professor Stephen Stahl who many consider as one of the most influential key opinion leaders in world psychiatry.

In the USA, pharmaceutical and medical device companies are required by law to release details of their payments to doctors and teaching hospitals for promotional talks, research and consulting. This was the return for Professor Stahl at the time of his contribution to BAP as an educator of UK psychiatrists:

In the UK disclosure of payments is on a voluntary basis.

Professor David Nutt, former BAP President, has declared financial interests on the voluntary ABPI Register. Over the ABPI “disclosure period”, Professor Nutt has declared just short of £46,000 that he has received from Janssen-Cilag Ltd and Lundbeck Ltd.

There are strong links between BAP and the Royal College of Psychiatrists. The President Elect for BAP is Professor Allan Young.  Professor Allan Young is Chair of the Psychopharmacology Committee of the Royal College of Psychiatrists. Dr McAllister Williams, the BAP Director of Education is an appointed member of this Committee. Some years ago I wrote this post about the Royal College of Psychiatrists Psychopharmacology Committee.

Some years ago I put together this Hole Ousia post on Professor Allan Young and also this post. It is clear that Professor Allan Young remains a very active educator and opinion leader in the UK and beyond:

Professor Guy Goodwin was President of BAP between 2004 and 2005. In April 2014 he featured prominently on  BBC Panorama:

On the 40th anniversary of BAP, Professor Peter J Cowen was given the Lifetime Achievement award:

Professor Philip J Cowen featured in this post of Hole Ousia of some years back: All in the past? Well no. Definitely not.

Conclusion:
The recently retired CEO of the Royal College of Psychiatrists, Vanessa Cameron, who had been with the College for 36 years was interviewed for the Psychiatric Bulletin in December 2016. This was the view that she expressed:

Each time I reconsider this subject I do not find evidence to support this view. My worry is that the Royal College of Psychiatrists is being complacent in facilitating the education of the many by such a small group of individuals. The Law of the Few.

Footnote:

If you click on each invite below you will access what is available 
in the public domain regarding the educational activities of the 
recent speakers. I apologise if this is in any way an incomplete 
record.

 

Stifling distortions












<a

‘It was odd being dead’

This is a fictional film. It is about a teddy bear, Dr Hale Bopp and a day of two halves. In the morning Dr Hale Bopp goes exploring in the Scottish Borders and he comes across the ruin of the Monteath mausoleum on Gersit Law. The oak door of the mausoleum has been breached and one can get inside and be with Monteath and the two angels that guard this forgotten statesman. Above him the dome has beautiful window stars to the universe beyond.

Dr Hale Bopp is a well-travelled bear and is constantly exploring, enjoying and reflecting upon the world in which he lives. The guid doctor has come to the view that life is complex, diverse and sometimes “messy”. He leaves the Monteath mausoleum with paws that were muddy and heads for a different afternoon. An afternoon of Appraisal to ensure that as a fictional bear and doctor that he is providing Good Medical Practice.

So that was the day of two halves. This film is about that.

Dr Hale Bopp is getting on a bit now and is at the end of his fictional medical career. One day soon he will retire from being a doctor but meantime he is of the view that his wanderings, philosophical and creative between the arts and sciences, has been nothing but to the benefit of the patients that he cares for.

Important note:
None of the words used in this film are those of the filmmaker. They are “borrowed” from C.P. Snow’s “Corridors of Power”; Evelyn Waugh’s “Decline and Fall”; and Jessie Burton’s novel “The Muse”.

‘It was odd being dead’ from omphalos on Vimeo.

Source material:
(1) Physicians of the future: Renaissance of Polymaths? By B F Piko and W E Stempsey. Published in The Journal of the Royal Society for the Promotion of Health. December 2002, 122(4), pp. 233-237
(2) Time to rethink on appraisal and revalidation for older doctors. By Dr Jonathan D Sleath. Letter published in the BMJ, 30 December 2016, BMJ2016;355:i6749
(3) Career Focus: Appraising Appraisal. Published in the BMJ 21st November 1988, BMJ1988;317:S2-7170
(4) Revalidation: What you need to know. Summary advice for Regulators. General medical Council.
(5) The Good Medical Practice Framework for Appraisal and Revalidation. General medical Council.
(6) Taking Revalidation Forward: Sir Keith Pearson’s Review of Medical Revalidation. January 2017.
(7) GMC response to Sir Keith Pearson’s report on Taking Revalidation Forward.

Music credits (under common license, thank you Dexter Britain):

(1) Perfect I am not – by Dexter Britain
(2) Telling stories – by Dexter Britain


Decline and Fall



Ursine physiology – may not be mainstream physiology

Filmed on a family picnic to the ruined castle of Arnhall on Sunday 26th March 2017








200 years of news

The 200th anniversary of the Scotsman newspaper 
took place on the 25th January 2017.



What follows are a few of the adverts from the very first edition 
of the Scotsman: