Wonders of getting out and about
‘It has been salutary to discover that they do things differently’
In recent weeks, I have been working in a different practice from the one in which I worked for 30 years, and it has been salutary to discover that they do things differently there. Two unfamiliar experiences have been particularly striking. One is attending, at eight o’clock in the morning, breakfast discussions of current clinical and scientific topics. My earnest and formidably erudite younger colleagues seem impressively well informed about subjects as diverse as early childhood development and hormone replacement therapy.
The second is that I have been assigned to spend one afternoon a week reviewing the elderly and housebound in their own homes. It has been a great pleasure to cycle around the practice territory in the mild late summer and early autumn weather, visiting patients with dementia and chronic mental illness, diabetes and chronic obstructive pulmonary disease.
They are mostly medically stable and personally content, and a visit provides an opportunity to discuss, among other things, whether they would like the appropriate services to be notified that they do not wish, in extremis, to have the full rigours of cardio-pulmonary resuscitation inflicted upon them. This encounter with the full range of contemporary medical practice put me in mind of that ill-fated pioneer of scientific medicine in the English Midlands in the 1830s, the character of Dr Tertius Lydgate in George Eliot’s Middlemarch. Literary critic Janice Mclarren Caldwell observes that Eliot “shows the general practitioner at the intersection not only of interpersonal and scientific medicine, but also of patientcentred and doctor-centred medicine”. Nearly two centuries later, GPS are still working at the same intersections.
Dr Lydgate embraces the tension between medicine as science and medicine as pastoral care. He says: “I should never have been happy in any profession that did not call forth the highest intellectual strain, and yet keep me in good contact with my neighbours.” As he concludes: “There is nothing like the medical profession for that: one can have the exclusive scientific life that touches the distance and befriend the old fogeys in the parish, too.”
Focus on the flu jab
It is shocking to learn that, despite a vigorous campaign to make flu vaccines readily available to NHS staff, nearly one third of healthcare workers refuse to get vaccinated.
It is true that the public health authorities’ handling of the 2005-06 swine flu pandemic did not inspire confidence. The flu vaccine then in use was relatively ineffective and recommended drugs more or less useless. But the current flu vaccine provides good protection, particularly to vulnerable patients, and carries a low risk of adverse effects.
The refusal of so many health workers to get the flu vaccine shows a deplorable lack of concern for patient safety. In the United States, hospitals have sacked workers who have refused the flu vaccine and British authorities are already threatening to redeploy health workers in contact with high-risk patients.
It would be good if those campaigns proclaiming the altruism of NHS workers could show their commitment to patient welfare by persuading their supporters to get a flu jab.
Battle is brewing
The world of public health has become as fractious as Parliament in the grip of Brexit controversies. In the latest outbreak of hostilities, the Alcohol Health Alliance, sponsored by Public Health England, has fallen out with Drinkaware, a charity seen by some as a front for the alcohol industry. The official campaign favours penalising poor drinkers by raising the minimum price of alcohol, while the drink trade is promoting “alcohol-free days” as a way of reducing the harms of excessive consumption.
Similar spats have erupted over e-cigarettes, so-called junk foods and statins. All sides, of course, claim that their cause is conclusively justified by scientific evidence. The alcohol wars are reminiscent of the 19th-century conflict between the temperance crusade and brewing and distilling interests. A more recent parallel might be found in the disputes among the factions of Monty Python’s People’s Front of Judea.