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31 things I learned in January 2020

1: Alan Bennett had open-heart surgery in Spring 2019 and the news completely passed me by.


2: A paucity of Papal patience provides problematic publicity for a Pontiff preaching peaceful pacifism to pious pilgrims.


3: Norovirus probably causes about two-thirds of care home outbreaks of gastrointestinal disease.


4: Fewer than 20% of schools in Texas teach children about safe sex. Texas is among the States with the highest teen pregnancy rate. Any connection is disputed by conservatives.


5: I’m reading Matt Haig’s Reasons to Stay Alive at the moment, and there’s a line advocating for greater ‘mood literacy’ which I found a rather lovely turn of phrase. It reminded me of this blog post advocating examination of one’s own response to the outside world to better understand one’s mood. Both taught me something about self-examination.


6: One of the room booking systems at work requires me to “invite” a given room to attend a meeting. I’ve now learned through bitter experience that rooms can decline invitations… which felt a little humiliating, even if it does open up a whole new seam of entertaining insults (e.g. “that meeting sounds so pointless that even the room declined the invitation”).


7: Populist ‘knee-jerk’ reactions in politics are commonly discussed and clearly dangerous. I’ve been reminded today by an article on the lack of legislation around in vitro fertilisation research in the USA that the opposite—a complete failure to react because issues are complex and divisive—can be just as dangerous.


8: Merely possessing a placebo analgesic, without even opening it, has been shown to reduce pain intensity.


9: The average age of a BBC One viewer is 61. If one considers that a problem, as the BBC seemigly does, then I suppose one might conclude that removing children’s programmes from the channel was not the right approach.


10: The Royal Botanic Garden Edinburgh is only a short walk from the city centre and is a great place for a winter stroll. The uphill walk back to the city centre is a touch more tiring.


11: Over the past decade, the proportion of the UK’s electricity generated from wind and solar power has increased from 2.4% to 20.5%. The proportion from coal has fallen from 31% to 2.9%. (As reported in Positive News, though the specific article isn’t online.)


12: Aspiring comedians often go on ‘introduction to stand up’ courses. I’d never thought about these sorts of courses existing, but of course they do.


13: More than half of Luxembourgers speak four languages. The best-selling newspapers in Luxembourg have articles in two languages. This makes me feel inadequate.


14: In the 1990s, John Major mooted renaming Heathrow airport after Churchill, while Lindsay Hoyle and William Hague fancied naming it after Diana.


15: I have long known the North East is an outlier for antibiotic prescribing in primary care, but hadn’t fully realised until a meeting today that the North East isn’t an outlier for antibiotic prescribing in secondary care.


16: I was surprised to read that a survey suggested that only one in three people on the UK knows the standard VAT rate is 20%, and one in ten knows the basic rate of national insurance is 12%. But then, on reflection, my own surprise surprised me, because I don’t really know how or why I know those figures myself. I’m sure there are plenty of similar figures on which I’d have no idea myself!


17: Since last September, Monday to Friday, the City of London Magistrates’ Court has been filled by Extinction Rebellion defendants from around the country.


18: The developers of Morecambe’s Central Retail Park have “put an extraordinary amount of effort into stylising the car park” including quirky themed artworks, sculpted steel waves and effigies of seabirds diving for fish.


19: In the US, a broadly similar amount is spent on treatment for back pain ($88bn) and treatment for cancer ($115bn).


20: Office for National Statistics Travel to Work Areas are an interesting way of dividing up the country.


21: Civil servants in China cannot ordinarily be dismissed. One wonders what Dominic Cummings makes of that.


22: Over 70% of 12- to 14-year-olds in China are short-sighted. The Communist Party has set targets for reducing that, leading to some slightly strange practices in schools, including compulsory twice-daily eye massages and dressings-down for those whose sight worsens over time.


23: It’s not a public health emergency of international concern.


24: Blinded trials are not always best. I remember having to write an essay or answer an exam question on this topic at some point in the past, but haven’t really thought critically about it in years.


25: The attendance fee for the 2020 World Economic Forum in Davos is 27,000CHF (£21,400). I will never complain about medical conference registration fees again!


26: Luxury branded homes—as in, “I live in a Bulgari residence” or “I’m in the Porsche apartments”—are now a thing. Is it possible that this is a global conspiracy to see how far the definition of “gauche” can be pushed?


27: “We fill our days with doing laundry, replacing our brake pads at the auto shop, or making a teeth-cleaning appointment with the dentist, in the expectation that everything will be fine. But it won’t. There will be a day that kills you or someone you love.”


28: “To err is manatee. A manatee might mistake a swimmer’s long hair for shoal grass and start munching away, oblivious to the attached figure. To err is baby elephant, tripping over her trunk. To err is egg-eater and moonrat and turnstone and spaghetti eel, and whales, who eat sweatpants.


29: Pulmonary tuberculosis can be detected in babies by doing PCR tests on faecal specimens. Sensitivity of the test varies according to the exact methods used, and this is an active area of research.


30: It’s a public health emergency of international concern.


31: The TV series Love Island has an unexpectedly innovative business model which involves selling items seen on the show via the app which viewers download to vote for contestants.

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Interesting… isch.

The Bay of Naples

I’m currently reading My Brilliant Friend, which is the first of Elena Ferrante’s Neapolitan novels. I’m not particularly enjoying it… but it does remind me of the lovely couple of weeks Wendy and I spent in Naples back in 2014. While Naples is not a universally loved tourist destination, Wendy and I had a wonderful time, and it ranks among our favourite holidays together.

There is frequent mention in My Brilliant Friend of Ischia, the distinctive volcanic island on the edge of the Bay of Naples, famous for its thermal spas. Wendy and I didn’t go there.

The source of the name ‘Ischia’ is much disputed. But seeing it written down so many times (and with so little distraction from meaningful plot) I started to wonder about two medical words which bear a striking resemblance: ischaemia, where a part of the body receives an inadequate blood supply, and ischium, which is part of the pelvic bone and the hip joint.

Two different views of the ischium

I didn’t imagine that either of these were connected to Ischia, which is just as well, as they are not. But I did think that there much surely be an etymological connection between ischaemia and ischium – but couldn’t for the life of me work out what might connect the two. I even asked Wendy, and she also couldn’t think of a plausible connection, and she’s far cleverer about this sort of thing than me.

Neither the Collins, Penguin nor the Oxford Compact dictionaries on my shelf offered any etymological notes, but nevertheless increased my sense of intrigue by listing no other words which start with an isch- prefix. So surely they must be related!

And so to the OED online – this confirms that both words are derived from Greek, and that the isch- prefix comes from the Greek ‘to hold’. In the case of ischaemia, to ‘hold blood’, and in the case of ischium, to ‘hold’ the hip.

The OED also lists a few other lovely medical isch- words that have long since fallen out of use: ischuria, for urinary retention, is my favourite of these. Health protection rarely calls for reference to urinary retention, but “I’m sure it’s ischuria” could become a favourite refrain should I ever return to hospital medicine!


The photo at the top of this post is my own. It doens’t show Ischia, but it does bring back happy memories. The anatomical image is a composite of two images deposited in WikiMedia Commons from Bodyparts3D, both of which are used here under their Creative Commons licences: an anterior and lateral view of the ischium

This 2,465th post was filed under: Health, Posts delayed by 12 months, , , , .

Reflecting on my first ten years as a doctor

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.

This 2,450th post was filed under: Health, Posts delayed by 12 months, , , , .




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