This letter written by Peter and Sian has just been published in the BMJ
(dated 20 September 2017):
We want to gain the public’s trust, but are we listening to them?
Reply
Category Archives: Two cultures
Memory hold-the-door
This film is an artistic representation of a visit to the house that John Buchan was born in. Peter and Sian visited 20 York Place, Perth on Saturday 16th September 2017.
Memory hold-the-door from omphalos
Music credit: Scott Walker Revisited and the BBC Proms
What is “realistic” in terms of public expectation?
On the 12th August 2017 I sent the following letter to Shona Robison, the Dear Cabinet Secretary for Health and Sport for the Scottish Government:
Dear Cabinet Secretary for Health and Sport,
PE01493 on a Sunshine Act for Scotland. Are the Scottish public being listened to?
PE1493, A Sunshine Act for Scotland was closed by the Scottish Parliament in March 2016.
The Scottish Health Council published its public engagement exercise the same month.
The Scottish Government’s last public statement about this matter was in your letter dated 22 March 2016. In this letter you confirmed that “a majority of participants felt that publication of financial payments to healthcare professionals should be mandatory. In terms of next steps, the Scottish Government will discuss the contents of this report with the appropriate regulators and scope out options of how mandatory publication of payments to healthcare professionals from industry could be delivered.”
As far as I am aware there has been no further update to the Scottish public in the 17 months that have since passed. My view is that this is a failure of governance and would seem to demonstrate a lack of respect for democracy.
On becoming First Minister, Nicola Sturgeon stated: “I intend that we will be an open and accessible Government”.
I am writing to ask if the Scottish Government intends to update the Scottish public on this matter and when. The public would rightly hope that your reply will have meaningful content. I would be grateful if you could reply to this letter in writing.
Yours sincerely
Dr Peter J Gordon
I have organised a peaceful protest to be held on Monday 21st August 2017 for anybody who has had difficulty communicating with high public office in Scotland.
I have now received this reply from the Scottish Government, dated 15th September 2017:
I am disappointed in this response for a number of reasons:
- there seems to be a missed opportunity to consider this issue as part of the Chief Medical Officer’s Realistic Medicine initiative
- the public view on this issue has been established yet, after all this time, my hope of an update to the public seems unrealistic
A novelty in interviews
The maverick sociologist, Patrick Geddes, was of the view that in terms of education there needed to be a synthesis of all new knowledge and that such knowledge needed to be based on experience as much as theory.
In this short film the conversation is taken from a BBC Radio Scotland broadcast, 13th September 2017.
A novelty in interviews from omphalos
The music tack is “The Fresh Monday” by Dexter Britain (which is under common license)
A maverick in the social sciences
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”
Frailty – nothing about us without us
In September 2016, Professor Martin Vernon, National Clinical Director for Older People and Integrated Care at NHS England stated why diagnosing frailty is important:
In the same month Professor David Oliver had this Acute Perspective published in the British Medical Journal. It attracted over twenty responses many of which, but not all, were supportive.
I submitted this response as I was not convinced that “frailty” was inherently any less likely to stigmatise our older generation:
A year later, Dr Steve Parry, the Vice President of the British Geriatrics Society (BGS) had this perspective published on the British Geriatrics Society Blog , asking “when does a well-meaning medical fashion become a potentially destructive fad?” This perspective also attracted over twenty responses.
A week later, the former President of the British Geriatrics Society, Professor David Oliver argued why he was “fine with Frailty”:
Dr Shibley Rahman, an Academic in Frailty and Dementia and has outlined why he is of the view that such a model, based on deficits only, if applied to our older generation could cause harm. This article also attracted many responses.
In a recent Acute Perspective Professor Oliver outlined his concern that the British public may not have realistic expectations when it comes to frailty and “progressive dwindling”:
My understanding is that the term “progressive dwindling” was first used by George J. Romanes in this 1893 book:
This is the context in which the term is used:
The dictionary definition of “inutility” is: uselessness or a useless thing or person.
Healthcare Improvement Scotland has been concentrating on frailty as one of its National Improvement initiatives. This first started in April 2012 and so has developed significantly in the five years that have followed. NHS Scotland staff have been reminded to “THINK FRAILTY”. Up until now the focus has been on deficits and how to “screen” for these with “toolkits”.
In a BBC Radio Scotland “Thought for the Day”, the broadcaster and writer Anna Magnusson recently considered the language that we use in relation to our older generation. I made this short film using her words and voice. I have shared it with Anna Magnusson and she wrote a kind personal response to me:
We are far more than our labels from omphalos
These words from an Edwin Morgan poem resonated with me as a description of the complexity of ageing:
The people best placed to assist in understanding the complexities of ageing and the language best used to describe it are surely the older generation themselves.
Delirium screening (some years later)
Over three years ago I wrote this summary of my concerns about mandatory delirium screening. The consequences for me in writing this were life changing: the reality of having the courage to care in NHS Scotland.
Time has moved on and we should consider recent statements on this subject:
6th June 2017: Dr Claire Copeland:
“Two heavyweights of the delirium world: Wes Daly takes on Professor Alasdair Maclullich: to screen or not to screen. Let the battle commence”
5th August 2017: Dr Sharon Inoyue:
“Very important. Studies show dramatic increase in antipsychotic treatment with mandatory delirium screening”
31st August 2017: Dr Dan Thomas:
“In the UK I would be very surprised if many with delirium in hospital left on antipsychotics (which is good!)”. This is a speculative response to an article in the Journal of the American Geriatrics Society which had found that “most patients with delirium discharged on a new antipsychotic had no instructions for discontinuation”
Footnote: Whilst evidence cannot ever be complete there has been consideration of antipsychotic use for delirium:
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 habits of an improver
I have recently read this most interesting “thought paper” entitled “The habits of an improver” which was published by the Health Foundation in October 2015.
Several months before this was published, the Executive Clinical Director for Healthcare Improvement Scotland wrote to my employers stating that “[this individual] clearly does not understand the improvement science approach”. This defamatory letter almost ended my unblemished career as an NHS doctor. I subsequently felt that I had no option but to resign from NHS Forth Valley after 13 years as a Consultant working in Clackmannanshire. The glowing and unsolicited feedback that I received on my resignation can be read here.
‘The habits of an improver’ would seem to confirm that it was in fact the Executive Clinical Director for Healthcare Improvement Scotland who lacked understanding of the “improvement science approach”. Two of the key ‘habits’ include (1) a willingness to consider conflicting points of view and (2) a requirement of critical thinking.
I have asked for an apology from Healthcare Improvement Scotland but it has been confirmed from the Chair, Dame Denise Coia, that this will not be forthcoming.
In a follow up post I will share evidence that appears to substantiate the concerns that I raised about mandatory screening for delirium.
