A few things I’ve been thinking about this week. The third post of a trio, which may or may not become a regular thing, inspired by Jonathan Rothwell.

Thanks to a leisurely trip on the Caledonian Sleeper this week, I’ve showered on a moving train for the first time. Reflecting on the experience, I think a quick late evening trip up to Scotland to catch the sleeper is probably preferable to those pre-pandemic early mornings when I occasionally had to catch the 0526 to London for a 0900 meeting (and still often arrive late as it only gets into King’s Cross at 0839).

One of the many thankless duties of the most junior of junior hospital doctors is to write a summary of a patient’s hospital admission to be faxed to their GP at discharge. At least it was a decade or so ago, when I was in that position.

On one occasion, I summarised that a patient had been admitted with “dehydration secondary to a diarrhoea illness.” I was surprised a couple of days later to find the GP on the phone to remonstrate with me.

The GP wanted the note to be amended to clarify that they had sent the patient into hospital because of the diarrhoea, not because of dehydration. The dehydration had only been detected on blood tests that I had done as part of the patient’s clerking on arrival at hospital.

My fellow junior doctors and I found this hilariously pedantic: after all, people with diarrhoea don’t necessarily need to be in hospital; people who are unwell with diarrhoea, perhaps because they are dehydrated, may need to be in hospital. It was a distinction without a difference.

In retrospect, the GP was correct about what had precipitated the admission, and was entitled to make their view known given that they had arranged it and knew what information they had at the time.

This experience has been swirling around my head this week because of the media discussion of admissions to hospital ‘for COVID’ and ‘with COVID’, as though the two are completely distinct entities. For most patients, this is patently untrue.

Suppose a patient has been admitted in a diabetic crisis after being thrown off their routine. Suppose a patient has been febrile, a little confused, and has broken their hip in a fall. Suppose a patient’s mental health reached crisis point after months of social isolation. None of these patient needs admission ‘for COVID’—they don’t need antivirals or monoclonal antibodies or respiratory support—but all of their admissions are, at least in part, because of COVID, rather than merely ‘with COVID’.

Many patients in hospital ‘with COVID’ rather than ‘for COVID’ wouldn’t be there ‘without COVID’.

Medicine is rarely black and white.

Wendy and I are both really lucky to live within walking distance of where we work, and also to have a lifestyle that allows us to walk. We’ve both walked for years, and in fact have changed home and work locations and carried on regardless. There’s nothing that clears my mind as completely or reliably as a decent walk.

A few things I’ve been thinking about this week. The second post of a pair, which may or may not become a series, inspired by Jonathan Rothwell.

There’s a bit in Paul Beatty’s book The Sellout which says

That’s the problem with history, we like to think it’s a book—that we can turn the page and move the fuck on. But history isn’t the paper it’s printed on. It’s memory, and memory is time, emotions, and song. History is the things that stay with you.

I don’t think we’ll ever again speak of that first COVID-19 lockdown in the UK without mentioning illegal parties at Downing Street. They made no difference to any of us at the time—we didn’t know they were happening—but we all feel the gut-punch now.

Parties pale into insignificance compared to the unfathomable loss of life, a blow we have not yet collectively absorbed. Perhaps we can’t absorb it while continuing to grieve more COVID-19 deaths in the UK each day than terrorism has caused in the century to date; a Lockerbie of life lost each day.

But that insignificant image has such emotional weight that it will stay with us, and—I suspect—become a prominent dark thread in the tapestry of the history of the pandemic in the UK.

Wendy and I enjoyed dinner at Hibou Blanc for the first time this week. Neither of us could remember the word hibou from French lessons, which is not at all unusual. Neither of us looked it up out of curiosity before we went, which is very unusual.

Over the last couple of years, I’ve come to think that public health agencies, and probably healthcare providers, should disengage from (e.g.) Twitter. We have ample evidence that most social media is harmful to the public’s mental health. As agencies charged with improving health, we shouldn’t be driving people to engage with something we know to be harmful for many.

This week, I changed my mind. I would have always said that it is crucial that public health messages reach people; it’s self-evident that social media allows us to do just that. It’s a weak argument to suggest that people stick around on social media for the public health messages, so engagement with these sites isn’t really promotion. The risks of the small degree of acceptability conferred by the appearance of trusted organisations are almost certainly outweighed by the benefits of reaching people who would otherwise not see relevant messages.

I’m not sure what made me ponder these issues this week, but it’s an issue on which I’ve entirely changed my view, almost overnight, based on no new evidence.

Inspired by Jonathan Rothwell, here are a few things I’ve been thinking about this week. This may turn out to be one of those things that never appears again, or may turn out to be a regular thing.

The Waste Electrical and Electronic Equipment (WEEE) regulations mean, in broad terms, that anyone selling electronic goods has to pay for environmentally friendly disposal at the end of the product’s life. My top tip is to take any electrical recycling to Currys, as they accept all of it without question and without purchase, and it’s generally less hassle than trying to get to a council recycling site.

The practical implementation of WEEE regulations isn’t perfect, and a lot of equipment still ends up in landfill. However, it is a reasonable baseline standard of the sort of environmental responsibility we should expect: you produce it, you fund safe disposal of it.

It seems strange to me that we don’t have similar regulations for product packaging. Why, for example, can food manufacturers get away with selling products in non-recyclable single-portion packing and not have to fund safe disposal? How is it societally acceptable to sell stuff with the expectation that it will be used for a few days, then buried underground for thousands of years?

As a public health doctor, I’m as much an advocate for the value of vaccination as anyone. Yet, it’s hard not to think that we’ve lost any sense of subtlety and nuance in discussion of anything COVID-19 vaccine-related.

Asking sports stars to publicly disclose their medical history to compete in a tournament is uncomfortable. There is reasonable uncertainty about whether an unvaccinated doctor is better or worse than no doctor. Mandating vaccination inevitably hands a megaphone to those choosing to resist, with predictable negative consequences.

The balance between personal choice and public protection will always be delicate and ethically complex, even moreso in countries with tax-funded healthcare. Balancing those risks is basically my professional role, every day, across myriad health threats (though I’ve no real say on COVID-19 measures).

None of this is black and white; except the fact that almost everyone will benefit from a course of COVID-19 vaccination.

My car insurance was due for renewal just after Christmas, and I moved to a new provider who promised to beat my renewal quote and to provide an Amazon voucher on top. I automatically assumed that the voucher was a workaround to the new Financial Conduct Authority (FCA) rules which prevent people who are renewing policies being charged more than existing customers.

I expected that January would see a slew of voucher offers for people switching providers. When this didn’t happen, I investigated further. It turns out that I am entirely wrong: the FCA rules require insurers to include incentives for new customers in their calculations.