It was ever thus!

As the New Year awaits us, I feel the need to pen a few words regarding the present. As leap years go, 2012 has not been without incident. It has not witnessed the political change of 1968 but has nevertheless achieved more than I expected. Against all odds, France now sports a socialist President and America has once more plumped for Obama. Back home, we are mid term and brave would be the man who chose to predict the outcome of the general election of 2015 based on the headlines of today. We live through interesting times with a Coalition Government not unlike a marriage of twenty years whose love has long been lost but whose public persona remains committed to the common cause. Doubtless, the coalition will see things out to the bitter end before the real recriminations begin. Politics aside though, the country remains in a perilous position irrespective of the politics of those who run it. High streets up and down the land are witnessing a progressive erosion of their credentials with business after business conceding to the greater resources of the large national retailers. Jobs have seldom seemed so scarce and happiness so palpably lacking. The Olympic Games brought brief moments of joy and pride but reality resumed quietly and without fuss. I read that lessons are slow to be learned with the majority having turned to personal loans and credit cards to finance the celebration of the birth of Christ. Unfortunately, one day passes quickly to the next and Christmas with its excesses and fripperies is soon forgotten while its price is paid over the ensuing weeks and months. As Greg Lake penned in his rather unfashionable protest song about the commercialism of Christmas, "The Christmas we get we deserve".  I was saddened beyond words to learn of the brutal murder of the Sheffield man on his way to church to play the organ for midnight Mass. The Church stands on foundations of matchsticks as it is so stories like this one are a great blow. Over the years I have referred often to the predictions of Nietszche and regret enormously the accuracy of his words. Syria continues to engage in open warfare with man killing his fellow man while the rest of the world stands by. Quite how their President sleeps at night is beyond my comprehension. As ever, tensions between Israel and her neighbours simmer quietly while the world around them crosses its fingers.

Unlike 1976, the weather of 2012 has been largely forgettable so it is reasonable to assume that 2013 can scarcely offer worse. Good weather for ducks it may have been but good riddance to to a soggy year on the weather front.

In spite of his historic win in one of the majors, Andy Murray remains Scottish in the eyes of the many. This reflects on the rising tide on nationalism which prevails throughout the members of the Union. United we stand but divided we fall goes the saying. Time will sadly bear this out. One of his fellow countrymen continues to divide opinion in his role as manager of Manchester United. Football has become the symbol of our time displaying the worst excesses of greed and avarice. It is now far more a business than a sport - a trend which seems certain to continue at least for the time being. While it continues to expand in to new realms of obscenity, most of our towns and cities now have food banks borne not out of want but out of need. The haves and have-nots have grown even further apart.

Based on the findings of the last census, white English now constitute an ethnic minority within the confines of our capital city. This is not an indictment. It is merely an observation of the extent to which our country has changed. Perhaps this picture will be reflected in our towns and villages in the years to come. If this creates a more cohesive society, I am all for it. The internet pervades our society more and more but not always for the better. However, I can see why it is here to stay. As it gains strength, the postal service recedes further into the background. The increased levy on postal stamps seems now to have been a misguided decision at best and a politically motivated one at worst. The extent to which we communicate on a personal level has sadly diminished more and more.

This year I face my final written exams of my medical degree. To even write those words fills me with dread. The higher you go, the further you have to fall. So too it is with a medical degree. I shall give it my best as I have always sought to do and pray this will suffice.

The Public Sector continues to rail against inroads being made against its erstwhile impregnable fortresses of power and the Unions squawk and complain against the affronts being made upon those who finance them. The world seems a harder place to be than at any time in my life and rather more in tune with the world described so eloquently by Dickens and Collins in the nineteenth century. Perhaps the this is the beginning of the road which re-introduces us to our neighbour. I hope so and pray for the world around me.

The next year heralds the Chinese year of the Snake. Powerful and ambitious, the snakes are known to be the great thinkers. I suggest we have seldom needed their wisdom more than now. They are noted for their materialism so I hope this is seen to be lacking this year. 

The forthcoming year is what we all make of it. I look forward tp playing my part and wish one and all a New Year of spiritual happiness, fulfillment and good health.

Happy New Year        

Heroes and Villains

The death of Tony Greig was announced today. That he died in Australia was perhaps fitting for this sporting chameleon. Born in South Africa and thus denied the chance to play for his native country, he went through the necessary qualification for England and indeed went on to be captain. It is worth reflecting that even if South Africa had not been consigned to the international wilderness, it is doubtful whether Greig would have even made the team such was the embarrassment of riches available to them at that time. England though were in a precarious state of affairs being captained by the ageing Ray Illingworth with only Geoff Boycott as his serious alternative.

Like his predecessor Ray Illingworth, Greig was a better captain than player. While he was an effective batsman, neither was he a class batsman and would not have been picked solely for his batting. Indeed, it is seldom that men of his extreme height become world class batsmen. History shows the best batsmen typically to be between five foot four inches and five foot eleven inches. Certainly, this is the height range occupied by Bradman, Hammond, Richards, Compton, Harvey, Cowdrey, Weekes et al. As a bowler, he was, like Gary Sobers, equally at home bowling seam or spin. Unlike Sobers though, he was inadequate at both. There is one match though which serves to question these assertions and it would be difficult to overstate the importance of that performance.

Following the demise of Illingworth during the Oval Test against the West Indies in 1973, Mike Denness of Kent was chosen to captain the side to tour the West Indies for the winter. It was a disastrous choice from a variety of viewpoints. It upset Geoff Boycott who felt very let down at having been passed over for the captaincy himself. Denness was hardly a proven man manager and his sole claim to the captaincy was his luck at having such a bevy of international stars at his disposal at Kent. With players of the calibre of Cowdrey, Knott, Underwood, Luckhurst and Asif Iqbal to turn to, he could hardly fail. The tour started badly and was on the brink of defeat at Port of Spain in Trinidad. A draw or loss would have seen the West Indies retain the Wisden Trophy. Enter the two players who had the least reason to put in a performance for Denness.  Boycott scored 99 in the first innings and was unbeaten on 112 in the second. Greig made the questionable decision to switch from bowling seamers to spin with dramatic effect. With eight wickets for 86 in the first innings and a further five wickets in the second, Greig had delivered a truly match winning performance which kept Denness in the job long enough for Boycott to suffer a collapse in form and confidence against some innocuous Indian seam bowling. The way was paved for Greig to succeed Denness and the course of English cricket for the 1970s had been decided.

Greig was a shrewd operator and it was a surprise to few people when he resigned the captaincy in favour of the Australian dollars of Kerry Packer. Greig's legacy will thus be as the man who accelerated the predominance of one day cricket at the expense of the five day game which will always remain the definitive challenge of any serious international side. It is sad that he had died at just 66 years of age but sadder still that he attained a captaincy which history shows he did not really value. Nearly forty years later, we have since tried a few more of his fellow countrymen including Strauss and Peterson with varying degrees of success. Perhaps one day we will try to secure the services of an Englishman to take the helm of the national side. Greig will be remembered as a cricketing mercenary but it is important to make the point that in common with many of his fellow countrymen, South Africa's exclusion left him few alternatives. Mike Proctor, Barry Richards and Clive Rice all plied their cricket where a good wage was waiting. Farewell then Tony and thanks for the memories.     

Accountability

In their seminal 1967 song, Creeque Alley, the Mamas and the Papas sang the line "trying to get a fish on the line". Andrew Mitchell must be able to identify with this lyric because the fish in his waters are wriggling furiously at present. It is unpleasant to see grown men wriggle. Their dignity and honour would be better served by confronting their mistakes and taking responsibility for them. With regard to the whole sorry mess concerning Andrew Mitchell, the Chairman of the Police Federation of England and Wales yesterday asserted that the organisation had taken a clear line but that he could not account for all 43 local federations. If he is the Chairman, who exactly is accountable for all 43 local federations. If not him, he is evidently surplus to requirements. While I remain in reasonably good humour, I shall refrain from seeking the particulars of his present renumeration. His already low stock plunged yet further yesterday when he refused to comment on members wearing t-shirts emblazoned with PC Pleb. He prefered to wait for the outcome of the investigation currently being conducted by thirty police officers all of whom will be members of the Police Federation. Aside from the fact that he takes us all for complete morons, it is the arrogance that angers me. Lord Baker last night warned against the Police becoming political in its view. He is absolutely right. We can't stop someone from thinking in a political way and nor should we, but we can ask that they keep such thoughts to themselves and get on with the job they are paid to do. Political views are fertile in all walks of life but not to the extent that they interfere with jobs. Doctors have to treat their patients irrespective of political belief and as another public body, the police are no different. They clearly believe they are different and this needs to be addressed. A succession of governments have pussy footed around the police and it needs to stop. Given the current state of play in the Mitchell affair, now would be the right time to sort this out properly.

The police have misgivings about anyone from outside coming in to oversee their organisation and yet such practice is now the norm in public life all around them. Of course, the real issue here revolves around money. They don't want their pensions, pay, promotions or early retirement tampered with. I'm all right Jack - pull the ladder up! Well, sorry boys, but we really are all in this together. There are millions unemployed who would be more than happy to come in and do this or any other job right now. Money is hard for everyone. Its time to be grateful for what we have and to put up or shut up. The arguments inevitably come back around what a challenging job the police have. This is not in dispute! We all appreciate the challenges they face and this is reflected in their salaries, pensions and early retirement. Last night, one of their defenders argued that officers were being denied their right to promotions. Come in boat number six! Nobody has a right to a promotion. Promotion is earned if it is even available. I've known scores of brilliant people who never had the promotion they deserved but just got on with it anyway. Life unfortunately does not always go the way we would wish.

To his great credit, Andrew Mitchell resigned not because he was guilty of the allegations leveled against him, but because he was so utterly fed up with the constant baying for his blood by the Police Federation and the left wing press. It is a shame that certain individuals connected to the Police don't have a fraction of his honour and follow suit. This refusing to go in the face of overwhelming evidence has been gradually making its way into our public life over the last fifteen years or so. When Gordon Brown was caught on microphone refering to "that bigoted woman", he did not go. When John Prescott was found to be conducting an extra-marital affair during work hours at tax payers expense, he did not go. When, Peter Mandelson was found guilty of dodgy financial transactions he did go only to be reinststed a few months later when the dust had settled. Of course, I could go on and on but the point is made. Hypocrisy is sadly alive and kicking in British Public Life and it seems there is little we can do to change things. As a point of interest, I haven't yet heard a squeak from the Labour front benches regarding the Mitchell affair. We couldn't shut them up a fortnight ago..."You're not singing anymore" as they sing on the football terraces! For the record, if it hadn't been for the profligate spending of the previous Labour administration when the times were good and if it hadn't been for Gordon Brown giving away the national gold reserve, perhaps we wouldn't be in this mess today and the precious pensions, pay, promotions and early retirements of the police would just carry on unchallenged. Every cloud as they say.        

Remembering Dixon of Dock Green

Although they were probably just repeats, I am old enough to remember watching Dixon of Dock Green on television. Of course, that was when we had real choice - BBC1 or ITV. If it was shown today, Dixon of Dock Green would invoke widespread mirth. A policeman walking on pavements and questioning people? How silly and dated would come the refrain.

I raise this issue on the day the modern day police service has been shown to be a mere shadow of its more boring predecessor. Today, the High Court found the South Yorkshire police force to be guilty of hiding the truth and failing in their duty on the day of the Hillsborough tragedy in 1989. I was living in the Anfield area of Liverpool on that fateful day and will never forget the deathly atmosphere which engulfed the entire city for the ensuing days and weeks. The now infamous headline printed in the Rupert Murdoch Sun in the immediate aftermath will linger long in the memory like a bad taste in the mouth. This publication remains an object of scorn and derision in Liverpool to this day and rightly so. Publish and be damned it is said. How Mr Murdoch must regret not paying heed to this very old adage.

It also transpired today that a serving police officer in the London Metropolitan police force sent an e mail purporting to be present when the Andrew Mitchell was alleged to have labelled duty policemen as plebs while trying to exit Downing Street on his bicycle. He has since admitted that this was not the case. He lied and for that he has been suspended from his duties on full pay.

I am not writing to label all police as lying, untrustworthy people because I am certain this is not the case and nor would it be reasonable to think so. However, I do wish to make a few general points. These are public servants from whom we can expect honesty and integrity as a bare minimum. Granted we none of us are perfect, but honesty and integrity in public life go with the territory. Above all else, I can't see who they are accountable to. If a doctor gives the wrong drug which results in death, he is absolutely accountable and will be struck off. If a mechanic fixes your brakes and gets it wrong, he is accountable for the consequences.

The High Court judge presiding over the Hillsborough affair today advised that criminal action will be taken against individuals found guilty of hiding or fabricating the truth. I hope this is true and that the families of the dead are able to see a semblance of justice being done. The unforgivable crime is that it will have taken nearly a quarter of a century to achieve this. The governments of Thatcher, Major, Blair and Brown will all have failed to deliver. Shame on them all but praise to Andy Burnham the Labour MP who has been instrumental in putting this whole sordid business to bed. I hope those found guilty have enjoyed their liberty these last twenty-three years and can only marvel at their utter lack of conscience and remorse.

I am absolutely certain that we have not heard the last of the Andrew Mitchell story and it is difficult not to suspect another shameful cover up by the boys in blue. For the good name of all those policemen and women who can hold their heads up high, I hope this does not transpire.

This is 2012 in the UK and put bluntly we deserve far better. It takes years to acquire reputations but five minutes to lose them. The police force have a mountain to climb before they can hope to be mentioned in the same breath as Dixon of Dock Green.

Yesterday, today and tomorrow

It is often asserted that the only constant is change. This is borne out by the conclusions of the latest census and should surprise nobody. The UK now boasts 4.1 million fewer Christians than in 2001. There remain 33.2 million Christians who profess their faith and they now constitute 59% of the population. If I compare these figures to the picture I have observed at my own church during this time, I can only express a degree of shock that the numbers have remained so respectable. Of greater worry to me is the revelation that the 7.7 million who professed no faith in 2001 have nearly doubled in size to 14.1 million. Indeed, one person in eight in the UK today was born outside of it. There is nothing wrong with this - on the contrary, it is to our credit that we have embraced such a rich variety of cultures into our society. Statistics though, can be as clear as mud. Also revealed in the latest census is that 71% are employed and 7.5% unemployed. Whither the 21.5%? The ageing retired population perhaps?

Closer to home, the number of Welsh speakers continues its seemingly inevitable decline. The 576,000 who admitted to be able to speak Welsh 10 years ago have shrunk to 562,000. In all but two of the counties, the numbers are falling, most notably in the traditional heartlands of Anglesey and Gwynedd. Few can be surprised by this. Language thrives in a social setting. The fact that Welsh is being promoted at Primary School is missing the point. What happens to these children when they grow up and raise their own families. With increasing frequency, they seek and find their employment over the border due to the lack of opportunity in their own country. Like its Gaelic cousin Scotland, Wales is suffering the hangover of an over-inflated Public Sector. Employment outside this bloated behemoth is painfully thin on the ground and is only likely to get a lot worse before the Private Sector can once more have its day. It is this which will be the saviour of the Welsh Language if there is to be one. The Public Sector is quite rightly being cut left, right and centre with the machete of the coalition.

It was Nietszche who predicted the rise of nihilism in the middle of the nineteenth century. How right he was. With 14.4 million people now professing no faith and the hunger for instant fame and celebrity as insatiable as ever, perhaps the churches will, in due course, be the arenas for local X-factor competitions. But no, wait. They will serve a much more worthy purpose. The rate of unemployment continues its inexorable rise and the poor need to eat. Even Dickens realised this in The Christmas Carol. Perhaps this is part of its enduring appeal at this time of year. Food banks are opening ubiquitously nationwide as I write. They are borne out of need rather than opportunity and are becoming the difference between life and death for many people. Doubtless, many of these in need have no faith. Be that as it may, it is the role of the church to provide be it Christian or otherwise.

When I attend my church, I am the youth because I see little coming behind me. I am 44. Until the church seeks to welcome our young and introduce them to moral values which will serve them well throughout their challenging lives, it will perish. The elderly dominate my church but they would because they have always gone to church and know no different. When I went to Primary School in North Wales, I attended a Welsh speaking school from the age of 8 and attended church every Sunday. I came from English stock unlike my welsh speaking classmates. They all attended chapel which was far more a social event than a religious one from what I ever observed. This has now eroded with the television superceding the church and the chapel.

The only constant is change. Dylan Thomas wrote, "Rage, rage against the dying of the light". It is not too late for those with faith to rage against the dying of the light. It is our duty to do so. In his song "I believe in Father Christmas", Greg Lake writes "The Christmas we get, we deserve". He wrote it as a protest against the commercialisation of Christmas. He wrote it in 1975 so was clearly well ahead of his time. In truth, it is not just the Christmas we get which we deserve. I would argue that the society we get, we deserve.

This is not a God-bothering diatribe against atheism and multiculturalism. I do lament though the erosion of moral value and the spoils of capitalism. Employment is a hope rather than a given and we move closer and closer to the society of Dickens at our own peril. I hope and pray that out of hard times come bright lights. As things stand, it seems as though the predictions of Nietszche were right and religion and morality really has given way to the aspirations of wealth, fame and commercialism. Well, we've had a good blast of commercialism now since the war and perhaps the time has come to cast an eye over our shoulders and evaluate where we are now.      

Elitism, empathy and excellence: Mutually exclusive or natural bedfellows?

When, at the age of 40, I embarked on my studies as a medical student, I approached this new dominion with no preconceptions. Certainly, I was aware that medical students tended to be the cream of the crop academically speaking. Broadly speaking though, there are three sub-types of student who embark on a medical degree. The first and by far the most common is the student who arrives at medical school straight from school having achieved impressive grades in their A levels a few months previously. The next subtype consists of students who have completed a degree in another, often scientific, subject prior to applying for medical school. The latter often narrowly failed to achieve the requisite grades at A level and sought their entry to medical school by a less direct route. Finally, and by far the least common, are those students who have lived a bit of life often working in a completely unrelated field before having a change of heart at any age from their late 20s to their 40s. Clearly, these three subtypes all have to be committed to their studies and yet they have all arrived from very different routes. By definition, they all have to achieve a baseline of academic excellence in order to gain entry. All well and good so far.
However, it is at this stage that the waters start to become rather more murky. The fact is that excellence of this standard emanates from a wide variety of academic backgrounds. Put bluntly, some students are the product of privilege having had thousands invested in their education. Others have had to do it the hard way with little or no support with many lying somewhere between the two. From the viewpoint of the medical school, all these subtypes constitute the elite who are deemed worthy of a place and the opportunity to study medicine. However, this is merely the viewpoint of the medical school. How these subtypes view one another is rather more interesting. Let me be quite clear about one fact before I proceed any further. Medical school is very competitive. Really competitive. For some students, reaching the top of their cohort constitutes their raison d'etre and all but defines them. The source of this aspiration is not always immediately obvious but can often be a combination of personal and parental expectation. Other students are quite content to just pass their exams and thus be eligible to proceed to their next year of study. It is consequently a rather confusing academic environment within which to study given the massive variance in competition.
To further stir up the already murky waters, the empathy inherent within each student is highly variable. This is not a criticism - this is merely an observation. It does not make one student more acceptable than another. However, if empathy really is an important attribute for somebody embarking on a career in the health service, then my final observation suddenly assumes much greater importance. The problem with empathy though, is that it can't really be taught. You can hardly teach somebody how they ought to feel for a patient in a given situation. By defintion, this has to be an individual choice. However, recent studies strongly suggest that there is a minimum level of empathy which is expected by patients. If this is true, it is difficult to see how empathy can be gauged. Doubtless, somebody has already formulated a psychometric test to try and measure it. The problem with such tests though is that people can practice them and become more adept at them. It is a matter of considerable conjecture to decide if academic excellence and empathy are mutually exclusive but there is a worrying assumption going on here. It is assumed that only students of high academic ability can become a good doctor. I would hope that others would join me in questioning this assumption. While a medical career ultimately culminates in making potentially life saving decisions, it is surely of equal importance that the decision maker has a degree of empathy to augment their decisions.
On a clinical rotation last year, a retiring consultant suggested to me that a high proportion of the surgeons she had met, displayed the characteristic diagnostic criteria for autism. I have nothing against autism and know several such people in my social circle. However, given that one of the hallmarks of autism is poor social skills, I would consider it a trifle worrying to consider a patient being thus dealt with. I'm sure the medical knowledge of such people is excellent and many would argue this is the most important thing. They would argue that the end result of treatment supercedes all else. I would argue that a little understanding is essential in the pratitioner-patient relationship. People on the autistic spectrum are known to lack a Theory of Mind. As such they struggle to acknowledge that others have beliefs, desires and intentions different from their own. Surely, Theory of Mind is essential in being able to understand the person sitting in front of view. Only armed with this could you presume to treat them. Indifference to pain and suffering has been well documented. Some psychopaths are able to mimic caring without actually feeling it and to take the extreme, narcissistic personality disorder have a lack of empathy and seek to maintain a secure emotional distance. Clearly, the psychopaths and narcissists are thankfully low in number but for all that they do exist. To my knowledge, the medical school interview could not accurately pick up such a person. Assuming they would want to, what tools exist to enable them to do so? It is also important to make the distinction between empathy and compassion. Carl Rogers established that a person must have a certain amount of empathy for another person before compassion can be felt. Hence, we can't feel compassion without first having a minimum level of empathy. For this reason, empathy is therefore hugely important in any patient relationship. Research now shows that empathy is attained in humans from the age of two with the rudiments becoming apparent at age one. Rogers also impresses upon us the need to differentiate between cognitive and affective empathy. He argues that those on the autistic spectrum are less able to gauge the feelings of others but have a greater response to stress that they experience others experiencing than so called neurotypical people.
I recognise fully the need to recruit academically able students to pursue a career in medicine, but also argue that steps are needed not to instill empathy in to students as currently occurs but rather to seek those who have a baseline of empathy in the first place. Failure to achieve this will make true one of the oldest cliches in sales management - if you do what you've always done, you'll get what you've always got. If this provokes a debate, great. If it doesn't, I'll just try harder. That is my prerogative.