On a recent walk, Wendy and I spotted a buzzard. Or rather, we were walking along deep in conversation when somebody came over and said, “excuse me, have you noticed that buzzard over there?”

We hadn’t, and frankly, I wouldn’t have recognised it even if it came and perched on my arm.

This struck me more than it would usually have done, as I’d only recently read a blog post by Richard Smith in which he called himself uneducated:

Recently a group of us walked through the Yorkshire Wolds. One friend knew the name of every bird, and he recognised their songs from just a few notes. He could see them when I couldn’t. He knows the names of flowers and trees. I can tell an oak tree from a beech tree—but not even that with confidence. I marvel at flowers but know the names of few.

My ignorance began to weigh heavily on me as we walked. What is the point of knowing the difference between a mean, median, and mode if I don’t know the names of stars, flowers, trees, and fish? If abandoned on an island like Robinson Crusoe—or even in my own garden after a pandemic had killed everybody else—could I grow anything to eat? I fear not.

I agree with Richard that we need to live as part of nature, but my complete lack of knowledge of stars, flowers, trees, and birds doesn’t weigh heavily on me: I’m perfectly content to simply enjoy them.

This occurred to me on another occasion recently, as Wendy and I were walking under some trees, and she wondered aloud what species they were. Neither of us had a clue. On almost any other topic, I’d have later found myself searching the web, my curiosity driving me to learn a little about it. I don’t have that compulsion at all when it comes to the natural world around us: it’s completely absent.

And I think that’s okay. I think it’s legitimate and healthy to have areas of life that don’t drive me in that way. I think it’s good for my mental health to have things that I see and wondrously appreciate, rather than analysing. It’s nice to have the freedom to appreciate the shade of a tree without being nagged by an awareness that I’ve no idea whether it’s an oak or a beech tree.

Sometimes, being at peace with my ignorance is preferable to forcing self-development.

Wendy took the picture of the buzzard at the top of this post.

Ordinarily, I’m a voracious reader. I typically have two books on the go at any one time. I usually get through about a hundred per year.

But occasionally, I have spells where I don’t read much at all. It’s as though I fall out of the habit, and just can’t bring myself to pick up a book. I find myself wondering how I ever found the time to read as much as I did.

These spells typically last about six weeks, and I’m about five weeks into one at the moment. I know it is starting to lift because, in the last few days, I have been reading again–albeit less frequently and for less long than usual.

I don’t understand why this happens. I haven’t spotted any great pattern to it. And it’s not something that really concerns me. But given how much I bang on in this blog about reading, and the books I’ve read, it seems reasonable to mention that it’s not always like that. Occasionally, my drive to read inexplicably evaporates.

It always comes back.

The picture at the top of this post is an AI-generated image created by OpenAI’s DALL-E 2.

Ten years ago today (eleven by the time this is published), I learned that I had passed my medical school finals and became a doctor. It doesn’t feel like it was a decade ago.

At work, I recently happened to have a meeting with someone I worked with as an F1 doctor but haven’t seen since. It felt like we worked together a month ago rather than a decade. I still occasionally say “hi” in the street to the porter who used to comment on my “Bird’s Custard” colour tie as an F1. And yes, somehow my F1 year was long enough ago that ties weren’t yet banned in hospitals.

I think the Simon of ten years ago would be amazed to find that I’m now working in public health. I didn’t enjoy the occasional public health bits at medical school, and I wasn’t even really aware that it was it’s own specialty until I came to pick a career path. Public health always struck me as worthy, dull, and far removed from anything that actually had any measurable impact on patients.

It was only after a serendipitous run of F1 hospital rotations that I started to see the point. My first job was in upper gastrointestinal surgery, a subspecialty involving seriously brutal surgical interventions to treat cancers with very poor prognoses. My second job was in stroke medicine. My third was in gastrointestinal medicine, a speciality in which a large proportion of the patients had end-stage liver disease as a result of alcoholism.

I think it’s impossible to go through that sequence and not feel slightly despairing: hospital medicine comes too late for most of these patients. Their lives very often cannot be pieced back together: as one particularly insensitive consultant used to regularly say, for those patients “the party’s over”.

The most effective treatment for these patients would be to rewind time and tackle their problems before they were ill. This initially pushed me towards General Practice, until I realised (late) that this was the point of Public Health. My realisation of this came so late that I didn’t really know what public health doctors did all day, but stuck in an application to the specialty anyway… as well as general practice.

After long essay-style application forms, written exams and half-day intensive interviews known as “selection centres”, it somehow came to pass that I was offered places on both the GP and public health training schemes. I had 48 hours to decide between a familiar career path and one which sounded fascinating but that I barely understood. In truth, I hedged: I went with public health because general practice always under-recruits, and I was pretty confident that a re-application to GP would be successful in 12 month’s time if public health turned out to be awful.

I was also put off by the obsession with portfolios in General Practice. My experience of clinical portfolios was that doctors were judged too much on their ability to write and present evidence rather than on their practice of medicine. I was, even if I say so myself, great at presenting portfolios of glowing assessments as a Foundation Doctor, but this felt a bit flat. It seemed to me that people in public health were known by results and reputation, and I liked that idea. I’m not so sure that was an accurate assessment of either speciality, but it certainly played a part in my decision-making at the time.

Leaping into public health felt brave at the time, even if it seems like hedging in retrospect: no end of people were telling me that I’d be “wasted” in public health and that my skills with patients meant that I’d be a fantastic GP. Some of this was subfusc whispers in my ear, some was formal written feedback, some was mildly paternalistic advice. Only a minority were enthusiastic. Luckily, once I set my mind on something, I’m pretty strong-willed.

Public health wasn’t awful. I mean, it had its moments: within weeks of me accepting a place, the coalition Government announced an intention to move public health outside of the NHS. This may have been the right decision, but it was terrifying for me as an NHS doctor to know that my NHS career path had been cut off just as it was beginning.

As I progressed through my training, I came to really enjoy health protection, the part of public health which deals with outbreaks and other biological, chemical and radiological threats to the population. I liked the combination of clinical-style short-term pressure, thoughtful balancing of risks, and the close association with clinical colleagues (and occasionally patients). I wrangled the system to spend almost half of my training in health protection placements, and since 2016 I’ve been a consultant in health protection. It is—by far—the most enjoyable and rewarding job I’ve ever done, in which I’m surrounded by a brilliant team who never give anything less than their best.

So, in career terms, I could not be further from where I thought I’d be ten years ago. But I also couldn’t be happier with the choices I’ve made. I don’t really know that there’s a lesson in that.

Someone once told me that the most important thing in career planning is to do what you enjoy and collect certificates along the way. Delayed gratification is rarely worth it in career terms: the gratification might never come. But its hard to ever regret doing something you enjoy, and collecting certificates provides tools to make a “leap” to something else when the first thing stops being fun.

I don’t know whether that’s good advice or not, but it roughly correlates with my experience over the last ten years. Let’s hope that I’m still enjoying things as much ten years hence – whatever I’m doing then!

The picture at the top is obviously my own. It was from my graduation which was, of course, a little later than the day I found out I’d passed.

I wanted to reflect my nine years of blogging in today’s photo-a-day, so had the idea of nine fairy cakes assembled in the shape of a 9… I’m not entirely sure I pulled it off to the extent that you’d realise it was a 9 without being told…

I wrote a bit more about my nine years of blogging earlier today, if you’re interested!

Today marks nine years since I started blogging. Nine years. Increasingly, people are becoming concerned about the permanence of stuff posted the internet. Rick Santorum’s presidential campaign was hampered by the web, and the fact that for almost everything he said, he’d previously given an equal and opposite quote to some other source at some point in the past. And, of course, there’s many other less prominent examples of people’s online history coming back to haunt them.

Anyone with a blog, like me, can essentially make a choice. I could delete a load of old stuff. It wouldn’t make it completely unavailable online, as content from this site is cached all over the place; I guess it might make it slightly more difficult to find. But I’ve chosen not to do that. I’ve chosen to keep the complete sjhoward.co.uk blog intact. And I’m sure many people wonder why.

Firstly, let me say that it’s not because I think everything on here is great. It’s not. There’s some terrible stuff. There’s stuff that’s just plain dross. I’ve written things that I’m a ashamed of, like using “gay” almost as a punchline, or referring to the entire French population as “crazy frogs”. There’s positions I’ve asserted that, at best, are altogether blunter than I’d ever express now, like saying “I’m very anti-smoking”. And that’s before we even open the can of worms labelled “unnecessarily base humour”.

So why, you might ask, do I keep this stuff online, with my name written at the top of the page in a massive font size?

This is something I’ve thought a lot about. In the end, my reasoning was fairly simple. What I wrote in 2003 might have been unprofessional, but I wasn’t a professional then. It might have been immature, but so was I. The date is clearly and prominently shown on all the posts I’ve written. Of course I don’t hold all the same opinions I did when I was 18 – does anybody? We grow, we develop, our viewpoints and opinions change.

One of the more remarkable things about this little site is that you can how it happened. You can see the softening of my opinion on Tony Blair, from barely concealed hatred, to grudging admiration, to actual respect. My changing interests are reflected, from the 2005 election, during which I published daily “swing updates” based on a complex formula weighting different polls, to the 2012 local elections which were only mentioned in passing beneath a pretty picture of a bus stop.

All of this history, and all of these changing opinions, set out the path to where my politics and opinions lie today. And, of course, both will continue to shift over time.

In the end, I guess I came to the conclusion that if someone chooses to judge me on a personal opinion I held a decade ago, then so be it. Though I’d suggest that a far more interesting and intelligent approach is to ask questions: “You once said you thought x: do you still believe that?” or “Your position used to be y, now it’s z. What changed your mind?”

I don’t know exactly when the meaning of the term “flip-flopping” in political discourse changed from being about presenting different views to suit different audiences to being about actually changing your mind on a given issue, but I don’t think it’s a helpful change. I’m vaguely suspicious of people who claim to have “always believed” something – it has a slight whiff of valuing dogma above thoughtful and reiterative consideration of the issues. I can only speculate that the increasingly tribal nature of politics has led to increasing institutional derision of free thought: we must all toe the party line.

If you ask me, the sooner we lose the vogue notion that a change of opinion or reconsideration of position represents a weakness, the better off we all will be.

I’ve finally completed my Mencap Spellathon challenge, which was to learn to spell 2,500 words. It’s taken me quite a few weeks, but I’ve made it, and want to thank everyone who has sponsored me over the last little while. At the time of writing, I’ve raised £50, which is beyond both my own expectations and Mencap’s target.

But let’s raise even more! Mencap is a great cause, supporting 1.5 million people in the UK with learning disabilities. If you gave me a penny for every ten words – that’s just £2.50 – Mencap could make that go a long way. So get over to the JustGiving page Mencap have created for me, and give them some cash.

Thank you.

I’ve decided to give the site’s masthead a bit of a makeover, as the old one was starting to feel more than a little dated. The new one still has elements of the old: the same background image, the guillemet, and a bit of bold-italic verdana being the most obvious examples. But I hope the overall effect is a bit more modern, and a bit more typographically interesting.

The old one (see here) had remained basically the same since 2005 (see here), albeit with various different tag-lines, a couple of different size variations, and a short-lived change of background image. I can’t think of another website that’s had the same basic masthead for seven years – and the last masthead itself was an updated version of the original 2003 logo (see here).

Anyway, I hope you like it. I’m sure I’ll tweak it over the next few days and weeks – the curse of perfectionism, I’m afraid – but it’ll settle eventually!

As you can see, I’m now 1000 words into my 2500-word Mencap spellathon challenge. I think I underestimated how many words make 2500 – it turns out that 2500 is quite a lot. So keep sponsoring me, and keep me spelling!

Mencap is a great cause, supporting the 1.5 million people in the UK with learning disabilities. If you gave me a penny for ever ten words – that’s just £2.50 – Mencap could make that go a long way. So get over to the JustGiving page Mencap have created for me, and give them some cash.

Thanks for your support!

Those readers who view my posts directly on this site can’t have failed to have noticed a few design tweaks over the last couple of days. I’ve been attempting to improve the readability of the text, and make it easier to delve into the archive. There are a few graphical changes too, to make things look a bit more modern.

A lot of the changes are really tiny – text sizes, contrast and line spacing, for example – but some of the more obvious ones are the improved handling of archive pages (which now show full posts rather than lists of titles), the ability to flick through the blog chronologically, and the vastly clarified “calls to action” under posts on single post pages.

The latter includes one-click access to similarly tagged archive posts. Unfortunately, few of my posts actually have tags, as they’ve never had any practical function from the front-end until now, but I am determinedly ploughing through the archive tagging away.

I hope the changes are to your liking – as ever, I’d be delighted to hear your feedback.

I’ve been using Tumblr for a few months now, mainly because of ease of access on the move. However, having become frustrated with the limitations of a third-party service, I’ve leapt back to WordPress sjhoward.co.uk from today.

I’ve duplicated almost all of the posts from Tumblr – there weren’t all that many, and I don’t anticipate this transition shaking the Earth to the core. I tended to post more varied content on Tumblr that I historically did on here, and my posts were almost all shorter than typical posts here, and I plan to continue that style back on here. I’ll be doing my photo-a-day project via here, for example.

There’s bits of housekeeping to be done to tidy things up on here, which will no doubt get done in time. Feel free to comment on this post if you spot any glaring errors for me to pay some attention to.

Thanks for your support over the eight or so years that I’ve been blogging – I hope you’ll continue to enjoy reading!