Benedict Evans wrote an interesting blog post recently. It discussed why, when new regulations are passed, the tech industry’s first response is always negative. He made a wider point:

Whenever anyone proposes new rules or regulations, the people affected always have reasons why this is a terrible idea that will cause huge damage. This applies to bankers, doctors, farmers, lawyers, academics… and indeed software engineers. They always say ‘no’ and policy-makers can’t take that at face value: they discount it by some percentage, as a form of bargaining. But when people say ‘no’, they might actually mean one of three different things, and it’s important to understand the difference.

The three meanings are: that they just don’t like the change; that the change will have grave negative consequences that haven’t been understood; and that the change is misconceived and impossible to implement.

I think this is more generally applicable to the process of change, and that doctors are probably more likely to say “no” to change than other groups. Because it was a tech article, it made me think of times when tech changes had been imposed on my medical work.

I can think of two notable tech changes over my consultant career to date which I thought fell into the third category, but—when they were introduced anyway—turned out to fall into the first category.

I can also think of two which I thought fell into the third category, and where I turned out to be correct, and rollout was abandoned at the very last minute. In one case, this was even after staff members had been trained to use the new system. In the other, which was cancelled after it was supposed to have rolled out, I was vaguely threatened by someone saying “I’m not asking you to use this system, I’m instructing you to”—as though that made any difference to the fact that I could not have access to their system.

And this makes me reflect that perhaps, like so many things in life, the problem boils down to failures of communication. If the concerns I raised weren’t genuinely showstoppers, then I would have felt better about the rollout if someone had helped me to understand the flaw in my thinking. For the two which were showstoppers, perhaps a conversation along similar lines would have revealed that I wasn’t talking nonsense.

And, of course, that assumes that those performing the rollout have the time and resources available to have those conversations.

The image at the top of this post was generated by Midjourney.

I was tickled this week when I noticed that Donald Trump’s supporters were selling merchandise with his mugshot on it, with the text “never surrender”. The juxtaposition of a photograph of someone taken as part of the process of surrendering with an exhortation never to do so was simply too much.

But then I came to understand that the Trump campaign itself was selling this merchandise… and it became a lot less amusing.

I sometimes have reflective moments when I wonder whether I’m too critical of politicians: after all, I wouldn’t want to be one, so it seems a bit petulant to be critical of those who do step forward.

It’s in that spirit that I’m choosing to assume that Grant Shapps is genuinely the best person in the country to have held no fewer than five Cabinet positions in the last twelve months:

• Secretary of State for Transport
• Home Secretary
• Secretary of State for Business, Energy and Industrial Strategy
• Secretary of State for Energy Security and Net Zero
• Secretary of State for Defence

There may be those who say he is the ‘Minister for the Today Programme’, a useful mouthpiece who will repeat whatever lines he is given while in front of a microphone. He is, they say, being promoted in a ‘jobs for friends’ culture of rewarding loyalty.

I’m choosing not to believe that. I’m choosing to believe that he is a multi-talented superstar politician able to turn his hand to anything from boats to power stations to aircraft carriers as the moment demands.

Our nation is lucky to have him.

The Times front page had a headline yesterday morning proclaiming that “most people die while on NHS waiting list”. The opening paragraph:

More than half of all people who died in England last year were on an NHS waiting list, research indicates.

I didn’t get a chance to read beyond that point, but as I walked to work, it played on my mind. I thought a lot about how it was a sad inditement of modern medicine. How depressing, I thought, that so many people are dying in limbo, expecting some kind of treatment for something, rather than being supported to achieve a good death. People who are at the end of their life should not be worrying about clinic appointments and waiting lists.

On the other hand, I thought that perhaps this news was perversely positive: it was good, I thought, to see realistic medicine enter the national conversation as never before.

And then I read the full article. And The Guardian’s coverage.

And ho-hum, I’d got it very wrong. It turns out that I was supposed to be thinking:

Record numbers of people are spending their final months in agony, waiting for treatment that never arrives. The basic promise of the NHS — that it will be there for us when we need it — has been broken.

And that the statistics represent a:

terrible indictment of this government’s mismanagement of our health services.

And:

These figures are a stark reminder about the potential repercussions of long waits for care. They are heartbreaking for the families who will have lost loved ones and are deeply dismaying for NHS leaders who continue to do all they can in extremely difficult circumstances.

I suppose my reaction differed from that of the various spokespeople because they assumed that most patients were dying while on waiting lists for treatment for the thing that killed them.

That seems so unlikely that it simply never occurred to me, and there’s nothing in the cited data to challenge my view. It’s not uncommon for someone to languish on a waiting list because they are being treated for something else: people don’t get hip replacements while they’re going through chemotherapy, for example. Certainly, some people are referred for treatment for a condition, deteriorate unexpectedly quickly, and die while waiting, but those events strike me as quite exceptional, quite far from the norm, not least because lists are generally arranged by clinical urgency.

But really, this statistic is intriguing for being an interesting combination of meaningless and significant. It’s meaningless because it is extrapolated from a small data set, we have no evidence of any causal link, and it’s not immediately obvious that improving it would improve patient care. Yet, it is significant because it helps to give some emotional context to bland waiting list statistics and reminds us that people’s lives continue while they wait.

The image at the top of this post was generated by Midjourney.

In Psyche, Janet Geipel and Boaz Keysar describe research that concluded that people are more prone to think intuitively when they listen to a problem, and more prone to think analytically when they read about a problem.

In my area of work, one of the major changes of recent years has been that group discussions of complex issues that would once have happened by email have now become meetings on Microsoft Teams. I’m often found complaining about the time inefficiency of this, and some of my colleagues complain about the relative lack of engagement and high probability of distraction.

But I hadn’t previously considered that the decisions taken might also be less analytical, which could be problematic in some circumstances. It’s one to ponder.

The Holy Jesus Hospital in Newcastle is a Grade II* listed building, which started life as an Augustinian Friary in 1291. The hospital bit was built in 1682. These days, it’s a load of offices, so don’t go thinking you can have a poke round.

For my part, despite having lived in the North East for two decades, I’d never passed the building on foot until today. I’ve never made a special effort to see it, and it is well tucked away.

The tucking is due to the disastrous 1960s town planning decisions taken in Newcastle, which almost saw this historic building demolished. It was ultimately ‘saved’—but now has the Central Motorway thundering past it just a few metres away, and is cut off from the city by the multi-lane Swan House Roundabout. It can only be accessed by a series of underpasses. It became a local history museum shortly after being ‘saved’, but this closed in 1995.

It’s not somewhere it’s easy to just happen across… although I managed to do just that when wandering the area.

I loved Eliza Clark’s first novel, Boy Parts, which was dark, violent, and very subversively funny. I really looked forward to getting stuck into this second novel, though I slightly feared that it might be a ‘difficult’ second novel. There was a danger that Clark might just try to repeat the singular tone, style, and content of her first novel, and not quite pull it off.

I needn’t have worried: Clark is clearly a much better writer than that.

Penance is a parody of a true-crime book. It is ostensibly written by Alec Carelli, a thoroughly unlikeable journalist whose obsequiousness drops from every page. He is manipulative and judgemental, and Clark relentless skewers him.

The crime in the book is the violent murder of a 16-year-old girl, committed by three of her school friends on the night of the Brexit referendum. Clark inhabits no end of different styles for this book, perfectly parodying true crime podcasters, commenters on internet forums, and discourse on Tumblr. She even writes a pitch-perfect Guardian interview as a postscript.

Granta recently named Clark as one of the best novelists under 40. I think she’s one of the best novelists, full stop, and this book only goes to prove that.

Some quotations:

Vance Diamond, for the uninitiated, was a nightclub owner, radio and television presenter and a philanthropist. He was also a serial sex offender – possibly one of the worst in British history if one could quantify sex offences on a scorecard the way we might ‘score’ a serial killer.

The Cherry Creek massacre was a pretty obscure case—it still kind of is outside of true-crime circles, honestly. Another American school shooting—it feels like there’s one every five minutes so it’s like who cares, big deal, even the most obsessed people can barely keep up with them.

Violet liked battered things. Nothing was so delicate and precious as that which had already begun to fall to pieces. She wanted to preserve its last gasp of colour and beauty.

I would put up a big front online, but I spent a lot of time alone in my room, feeling really shitty about myself.

Not so long ago, I watched the 1950 film version of Sunset Boulevard for the first time. The plot includes Norma Desmond writing the script for a new film about Salome, the biblical character who requested the beheading of John the Baptist. This became the subject of Oscar Wilde’s 1891 play.

I know nothing about Salome, but I do know something about throwing myself into things, so I decided to stream Yaël Farber’s 2017 play based on her story. Farber took the Wilde play and added some ancient Arabic and Hebraic and came up with… Salomé.

This is a one-act play lasting about an hour and a half. It felt like the whole thing was shouted, except for the occasional bit which was screamed. I think this might be an attempt at ‘urgency’ or high emotion, but it is exhausting. I also had no clue what was going on. It would be traditional in a post like this to summarise the plot, but the experience of seeing the show hasn’t adequately equipped me to do that.

It was, however, far from a complete disaster. The lighting and staging were incredible. Tuning out the unintelligible script, this was an absolute treat for the eyes, a bare-bones stage utterly transformed from moment to moment. There were numerous curtains, cascading sand, splashy-watery bits, a giant ladder, and gorgeously atmospheric lighting.

There were revolves which rarely stood still, even when their revolutions seemed to do more to distract than enhance. There are some stunningly camp bits of self-conscious tableau: they re-create Da Vinci’s Last Supper repeatedly, and even revolve that—I mean, who hasn’t wanted to see a representation of the last supper on a lazy Susan? It’s among the most exuberant staging I’ve ever seen, especially for only having a handful of bits of set.

There’s also a brilliantly sung soundtrack accompanying the whole thing.

I suspect there is a lot to like in this, and that—to be honest —most of it sailed above my head. If you’ve more idea of the background, you’ll probably get far more out of this than I did.

Salomé is available to stream on National Theatre at Home until at least December.

I can’t recall having previously read Colm Tóibín’s 2019 moving account of his testicular cancer. You can also listen to him reading the piece at that link.

The whole essay is quite wonderful, and it feels a bit wrong to pick out specific bits, but on my most recent reading, I was particularly struck by this passage:

In the end I phoned the hospital. The nurse could not have been kinder, but since there was no pain, no precise problem, she did not seem to know what to say. Feeling bad was part of chemo, so the fact that I felt bad was not news. Eventually, I found that I couldn’t explain what I felt and we ended the conversation. A few minutes later, she called back and said I should come over to the hospital and pack some things with a view to staying for a few days.

It made me think firstly about the difficulty of articulation. As humans, how many times have we all thought “there’s just something not quite right”—but been unable to describe, even to ourselves, exactly what is wrong?

And secondly, it took me right to the mind of the nurse. As a doctor, it transported me to all those times when my gut feeling has said something’s wrong, and after a bit of soul-searching, I’ve made a bold decision in response.

In 2012, I blogged about Benwell Roman Temple.

This is the world’s only temple to Antenociticus (also called Anociticus for short), which must mean he’s a local Geordie god, I suppose, alongside the likes of Kevin Keegan and Alan Shearer.

Antenociticus’s head—or, at least, the head of his statue—was found here in 1862, and is now in the Great North Museum. Apparently, his hair style suggests either a connection to the Greek gods or a Celtic deer god.

Eleven years is a long time to wait for a pay-off, but please meet Antenociticus:

I’m not sure his hair is all that different to how mine looks if I let it grow out, and—weirdly—no-one has ever mistaken me for a Greek god. Nor a deer, for that matter.

For the avoidance of doubt, Shaun the Sheep did not feature in Roman Britain, but is here as part of a disastrous charity art trail. Perhaps upstaging the local god unleashed a curse.

In the years since I wrote the original post, another carved head of Antenociticus has been found down the road at Bishop Auckland, probably from a statue in a bath house. Oh, and he’s been recreated in Lego.

I’ve also realised that Antenociticus previously lived at the (now demolished) Newcastle University Museum of Antiquities, which I visited a few times between lectures as a medical student. I recently very much enjoyed reading this account of the museum’s outreach work, written by Lindsay Allason-Jones just as the museum closed its doors.