Why Lawyers?

Today the Times newspaper reported that lawyers are being encouraged to take 'time out' in The Priory, usually well known for their high profile clients. A book entitled 'Why Lawyers Should Surf' co-authored by myself and barrister Tim Kevan is a self-help book aimed especially at lawyers, after several studies have cited that lawyers suffer from an above average rate of low mood. An extract from the book is given below:

"In the early 1990s a John Hopkins University study compared the rates of depression among one hundred and four occupations and found that lawyers were nearly four times above the average rate of depression. This then begs the question ‘why do lawyers have such a high level of depression’? There are several hypotheses for this, well beyond the explanation that law is a stressful and busy job.

Professor Martin Seligman argues that the key thing about lawyers is that they tend to have pessimistic personality types. When lawyers are asked the famous question: ‘Is the cup half empty or half full?’ most respond by saying 'half empty'. This somewhat pessimistic response may be a distinguishing advantage within the legal profession, because viewing troubles as pervasive and continuing, is at the very heart of being a prudent lawyer. The inherent and honed ‘scepticism skills’, enable the lawyer to see every conceivable hiccup or catastrophe that might occur in legal transactions. Therefore, the ability to anticipate any pending or possible snare or disaster gives a positive legal outcome, as the lawyer can then help clients defend against potential negative eventualities. Hence, ‘pervasive pessimism’ and possibly ‘catastrophizing’ can be seen as a powerful legal tool, helping to anticipate disaster, and encouraging lawyers to think the worst before it has happened. However, on the flip side of the same coin, is that if you take that same pessimistic mindset home with you from the office, it may form part of the answer as to why lawyers are more likely to suffer with low moods.

Another hypothesis is that lawyers tend to express ‘high-dominance’ as a key feature of their personality; again something which aids successful legal careers. Key features of a ‘high-dominance’ personality include people who: interrupt others, talk longer, take charge of conversations, decide when to change topic, state strong preferences and opinions, have an unyielding manner and tend to enjoy giving instructions and advice. ‘High dominance’ personalities also tend to believe in statements, such as, ‘winning is more important than playing the game’. This may be an integral part of being a successful lawyer who never looses a battle, however, when this is mindset extended outside the workplace it fits less well with the challenges of daily life. When things have not gone the way high dominance personalities have planned, it can be a time when they struggle to manage or cope on a psychological level.

A further hypothesis is based on the accumulating psychological evidence that much work stress arises from interacting with people rather than things. In fact, ‘emotional labour’ is more mentally taxing than the old fashion labour jobs that were more physically taxing. It has been shown that the more your job requires you to fake emotions, the more emotionally detached you become from those around you. Hiding or faking emotions, can lead to ‘clinical burnout’. Since lawyers keep a professional detachment from their cases and cannot get too emotionally involved, this could potentially lead to the burnout state of mind. Burnout can result in symptoms of emotional exhaustion, fatigue, detached attitude towards others, low sense of effectiveness, helplessness and also low mood.

The risk of the inherent pessimism means that lawyers should be especially careful not to extend the negative mindset perspective into other areas of their lives. This book will hopefully assist the reader in finding perspective, so that even during the most difficult times in life a context can be found, which can also provide something to learn and grow from. As Shakespeare said, “There is nothing either good or bad, but thinking makes it so”.

The book can be pre-ordered on amazon here

Thought of the Week - Has This Also Happened in your Area?

This week the 'Dr Crippen diaries' questioned psychiatry health provision. This blog post is dedicated to looking back at some of the local provision of psychiatry services. Although, I am not aware of this local story ever breaking into the national papers; I suspect similar cuts to mental health provision are mirrored in other areas. For reasons that will be obvious from the text, I am not going to comment on these issues, but merely offer the links and some of the text, as reported in the local rag (Cambridge Evening News):

Only last week the latest report highlighted the scale of the mental health crisis in Cambridgeshire, “when the figures showed that the county's specialist trust has lost almost one in five dedicated hospital beds in just two years.” Local MP Andrew Lansley said: "These figures demonstrate in the clearest terms the pressure that we know mental health services in our NHS are under…While the number of people sectioned has hit its highest level in history, the NHS financial crisis is forcing the closure of mental health beds throughout the country.”

Looking at older reports, “Health Secretary Patricia Hewitt chose to back £3 million cuts” to the local mental health services, despite “a House of Commons debate… in an attempt to stop the cuts” and despite “hundreds of protesters” who “marched through Cambridge to oppose savage cuts to mental health and other NHS services.” Reports went onto say “Patricia Hewitt has ignored the opinions of every organisation concerned with the provision of health care by the City of Cambridge and South Cambridgeshire Primary Care Trusts” including the saddest fact of all, that “patients will be let down by savage reductions in mental health services.”

And let's not forget the report when MP David Howarth "launched a furious attack on mental health chiefs who have tried to "gag" staff." After a "letter" had "been sent to all employees of the Cambridgeshire and Peterborough Mental Health Partnership NHS Trust demanding that they do not contact the media.” This followed on from a letter signed by “27 consultant psychiatrists" who wrote "about the plans to strip £3 million from the local mental health budget”.

10 years on from "24 hours to save the NHS"

There is one very big anniversary coming up – this Monday is 10 years since Tony Blair said those unforgettable words “24 hours to save the NHS”. Never has there been a time when those words rang so true. The BBC cover the medical crisis here.

The story about changing medical careers has been a catalogue of errors, which is fast developing into an urgent patient safety issue. The BMA chairman James Johnson has written to Tony Blair warning doctors' anger will grow if the government does not address the problems with MTAS "with the level of urgency they deserve." As Andrew Lansley has said, Patricia Hewitt is in "denial", so it's down to Tony Blair to urgently answer the questions:

Are there doctors to staff the wards on the 1st August?

Which doctors will have a job and where?

Why are the next generation of consultants having an estimated two thirds of their training time cut?

How did the errors in the MTAS system occur?

How did personal details of applicants leak all over the internet?

Why has the government not listened?

And if he doesn't feel comfortable answering medical questions, there are plenty of legal questions to answer as well. His very own 24 hour clock is ticking.

And Finally...

Just when you thought it couldn’t get any worse… Channel 4 news reported that if you want the name, address, personal details, telephone number, race, religion, police records and even sexual orientation of any MMC doctor applicant... their details were all exposed via the on-line recruitment system. For the rest of the story read here.

Watching Patricia Move

In a brief review of some of the highlights from the Hansard Report:

Shadow Health Secretary Andrew Lansley started by stating his reasons for the debate "First, we want to secure some answers; secondly,... we want to make clear the necessary steps that the Government should accept to regain the confidence and support of the medical profession; and thirdly and not least, we want to demonstrate to the many junior doctors who have come to Westminster today to tell their Members of Parliament of their personal experiences, their disillusionment and, in many cases, their anger at what has happened to them…” He went on to quote from a junior doctor, who I know to be an excellent doctor, and described his experiences: “I have a first-class degree in medicine/neuroscience, medical degrees with distinction, two research doctorates . . . in behavioural neuroscience, nearly 30 scientific publications including text books and commercialized research software, research prizes, three years’ experience as a lecturer in neuroscience at the University of Cambridge, and two years’ experience as a medical SHO at teaching hospitals . . . whilst I was short-listed for an ST2 medical position I failed to be shortlisted for ST1 psychiatry, which requires no previous psychiatry experience." He continued with “The consultants at Addenbrookes in my constituency sent me the results of a consultant survey that they had recently undertaken, and three quarters of those consultants said that they would refuse to take part in further interviews. Ninety-seven per cent. of them wanted to see the previous system of appointments restored for this year. I do not necessarily agree with that. However, there is something that we can and must do between now and August. It is not good enough to wait for Sir John Tooke’s review in order to produce a report in September.”

Henry Bellingham MP highlighted that “doctors are worried that they will not receive sufficient training under MMC. For example, orthopaedic surgeons received 22,000 hours of training under the old system, but they will receive only 6,000 hours of training under MMC.” Norman Lamb MP poignantly stated “What will happen on 1 August?” and continued by calling modernising medical careers “a straitjacket.” He highlighted that warnings “went unheeded. The Royal College of Physicians warned but was ignored. The British Medical Association said that it tried to get the Government to listen, but it was ignored.”

Then it was over to Mrs Nadine Dorries MP to lighten the mood and recount the words of Dr. Sonia Heyer: “As a junior doctor who may be unemployed this summer as a result of the present recruitment fiasco, I was delighted to learn that we may be required to seek employment with voluntary services overseas. I would go, provided I could secure the company of the present Secretary of State for Health, in which case I would gladly accept a mapless mission to the Amazon jungle.”

Finally, perhaps it's also worth mentioning that watching from the gallery, Patricia Hewitt was observed to shuffle once in her seat, and it was to these words from Andrew Lansely "The review still has serious problems and it will be subject to legal challenge."

More from the Lobby

The below clip is a very short piece from the lobby today, with the junior doctors' RemedyUK representative. He explains how the government have changed training into a tick box exercise rather than being concerned about patient care:

The Lobby

Today was the mass medical lobby at Parliament. It started with a rally outside the House of Commons with cross party speakers (Conservative Andrew Lansley, Lib Dem Norman Lamb and Labour Ian Gibson), the RemedyUK organisers and hundreds of doctors from every grade.

After that it was time to lobby my local MP (David Howarth) along with Dr Rupert Beale and Dr Zoe Fritz. David Howarth MP, was very supportive of both junior doctors' concerns and the concerns regarding patient safety. In the short term, patient safety may be compromised when job changes come into effect on 1st August, and in the long term patient safety may be compromised if consultant doctors have not been given enough time to train within their chosen specialty (training time to become an orthopaedic consultant surgeon has been cut from 22,000 hours to a mere 6,000 under the propsed MMC).

Previously this blog has written about the thoughts from three eminent consultants, and today there was a debate in the House about these impending changes. Andrew Lansley suggested that Patricia Hewitt was in "denial" about the scale of the disaster created by MMC and her "chronic mismanagement". He went onto highlighted that she has scheduled the 'second MMC review' to report in September. However, as 1st August is the key date when doctors start new jobs, such a review date is too little, too late.

A Guest Blog - Dr Rupert Beale

The following post has been written by a medical Senior House Officer - he is a doctor twice over (qualified as a medical doctor and has a PhD). He is one of the doctors caught in the middle of the changes to medical careers. He is an experienced and excellent clinician, is married and has three (very lovely) children:

"Many thanks to Michelle for inviting me to contribute. I'm one of roughly 30,000 doctors caught up in the Modernising Medical Careers fiasco as I try to complete my training in general medicine. Tomorrow I am going to lobby my MP to do all he can to bring the government to account over this astoundingly incompetent implementation of a very bad idea. I suppose I am generally an optimist, but even someone fully dosed up on the strongest happy pills would struggle to think we are going to be able to entirely reverse the government's policy. Depressingly, we are looking for damage limitation in one form or another.

I'm not going to recite the litany of blunders and half-baked lunacy that has led to the sorry mess we find ourselves in now. What I'd like to do is highlight the various forces at work behind what is happening at the moment. Unless you are immersed in what has been going on, you may not even have heard of some of them. My main point here is that there are so many of them, each with an important role in this process and each claiming to represent some disenfranchised body such as patients, voters, junior doctors, the NHS, medical education, surgeons etc. Since there are so many of them, I propose a simple classification scheme:

Forces of Darkness:
The Department of Health Trying to control doctors to serve political ends
NHS Employers Trying to drive down the cost of doctors by manipulating supply and demand
Patricia Hewitt Trying to save her sorry political neck
MMC (Modernising Medical Careers) It has lost its head (twice). Like many other stupid things, this still runs around the farmyard
MTAS (Medical Transportation to Australia Service) computerised system for selecting doctors on the basis of their creative writing skills
PMETB (Postgraduate Medical Education and Training Board) set up to wrest control of medical training from the Royal Colleges.
Deaneries Cravenly implementing Hewitt's policy because of legal threats

Forces of Light:
RemedyUK Noble organisation, shoestring budget, run full time by junior docs. Oh, sorry – actually run by full time junior docs.
Prof Morris Brown et. al. Actually most of the consultants are against MMC, but until now very few of them have had the courage to say so. See blog post 'Medical Heroes'.

Farces:
BMA Hasn't even bothered to find out the views of its members, let alone actually do anything.
BMA JDC (Junior doctor's Committee) They have been in the review. Then out. Then in. Then used by Patricia Hewitt as evidence that junior doctors support the review findings. Muppets.
Royal Colleges Moribund organisations that will shortly go the way of the once powerful medieval guilds.

You will notice that the Forces of Light are outnumbered and out-gunned, but since it's St George's day and the situation in Scotland, Wales and Northern Ireland isn't as bad...
Cry God for Morris, England and Saint George!"

Doctors Mass Lobby the Government Tomorrow

Tomorrow will make history when thousands of doctors will lobby the Government about propsed plans to reform medical training that will put patient care at risk. Some Cambridge medics have sent me some of the points they will be raising with their MP tomorrow:

"Patient care is set to suffer under current proposed government changes to medical training. The controversial Modernising Medical Careers programme (MMC) is being implemented by the government on August 1st 2007, despite vehement opposition from the majority of doctors and the Royal Colleges. Patricia Hewitt has already “unreservedly apologised” for the shambolic national application scheme (MTAS), which has prompted two independent reviews. She has yet, however, to acknowledge the detrimental impact that the proposed major changes in training will have on patient care.

On Tuesday 24 April, doctors from all over the country will come together to exercise their right to lobby MPs in Parliament. The mass lobby, co-ordinated by Remedy UK (www.remedyuk.org, an independent representative group for medics), aims to raise awareness of the impact MMC will have on patient care. They argue that the changes proposed by MMC can not be allowed to go through if patient safety and the quality of medical training is to be maintained. An immediate, comprehensive and genuinely independent review of changes in training must be undertaken.

Current medical training consists of “preregistration years” followed by several years at Senior House Officer (SHO) level, during which doctors broaden their medical knowledge and take professional exams to become members of the appropriate Royal College. Once these century-old, internationally recognised and respected exams had been passed, doctors apply for Registrar posts in their chosen speciality and continue training for 5-7 years before being able to become consultants.

The reforms being implemented by the government do away with both SHO/Registrar training, and the collegiate exams and replace them with “run-though” training programmes of 4-5 years. This shortens the period of training, removes any flexibility from the system ( for example, the option to gain furrther training abroad, work in a related speciality, or indeed to take time out to have children), and requires doctors to choose a speciality early in their careers, before knowing what might best suit them. In addition, there are insufficient training posts for the number of doctors currently educated in this country.

Changes to training as a consequence of MMC, will result in a reduction in the length of training for doctors in many specialties – at the same time as the average working week is reducing from 56 to 48 hours, in line with the European Working Time Directive. Inevitably, this will result in doctors who do not have the necessary experience to provide safe practice. For example, it is thought that training time for surgeons to become consultants will be effectively be cut from 21,000 hours to just 6,000 hours.

The MMC programme’s requirement to select a specialty at a significantly earlier stage in a doctors’ career, does not equip a doctor with the skills necessary to identify and treat complications or patients with multiple medical problems. Due to the ageing population in Britain, patients with multiple coexisting illnesses are becoming increasingly common ,meaning a broader knowledge base is required, which seems contrary to MMC implementation.

“Modernising Medical Careers will result in poorly trained doctors working in specialities in which they have little interest,” said Dr Jane Graham, a Remedy UK spokesperson for SE England. An overwhelming majority of doctors believe that the new programme will be detrimental to patient care throughout all specialities of hospital medicine. At the national meeting of the Association of British Neurologists in Cambridge on 13 April, 350 physicians voted against the motion ‘MMC is good for patients, trainees and the Practice of Neurology’. Only 4 votes were passed in favour.

The most immediate victims of the government’s ill-thought through “reforms” are those Senior House Officers with with the most clinical experience and knowledge who are loosing out to more junior doctors to ensure that the governments proposed training reforms can be implemented. In a leaked memo on the impending employment crisis for junior doctors from Sian Thomas, director of the NHS Employers Organisation, it stated that of those 10,000 doctors unemployed from August, the Department of Health plans to prioritise finding posts for only the most junior and inexperienced doctors. Those more experienced doctors, who currently provide the back bone of NHS medical care, will effectively be removed from practising, thus putting patients at serious risk.

The health service is already being put under considerable strain as junior doctors currently have to travel to interviews around the country, leaving wards dangerously understaffed. No one can predict the scale of the disruption to service that will follow when the new scheme if introduced this August. The government propose to simultaneously uproot overnight 18,000 doctors, to start work in what for many will be a new hospital, with a new team, in a new speciality. Previously, the transition between junior doctors’ contracts have always been staggered to ensure continuity of patient care and patient safety.

The Royal Colleges have been in charge of medical training since the 16th century, but their grave concerns have been dismissed. There is growing alarm that the quality and level of patient care will suffer both in the short and long term because of the government-driven change. It is of the utmost importance that those in power listen to the concerns raised, and that the public is aware of the dangers, if these serious issues are not addressed immediately."

The Medical Heroes

Three eminent doctors speaking about the proposed changes to doctor training include:
Dr Chris Allen
Professor Morris Brown
And Dr David Clow. You may remember the now iconic video when Dr David Clow spoke during the London doctors' march back on the 17th March.

Here, Dr David Clow returns exclusively to 'The Psychiatrist Blog' to express his views about the changes to medical training:

"Good Things About Reforms
Before I make criticisms of the reforms of the recruitment and post-graduate training of doctors in the UK, let me state some beneficial reasons for reform:

The first is that the cost of job advertisements has spiralled over the years to fill all the posts that become vacant in an organisation the size of the NHS. So, in itself, the use of a workable computer application service for NHS jobs may seem to be a good idea to save costs that could better be used for patient care.

Second, the increased output from medical schools and junior posts has led to multiple applications. For example, I was getting over 200 CVs to short-list and out of those short-listed over 50% would not attend, as they already had a job, or had since been offered something they preferred and this process was a waste of time to all concerned. Furthermore, it led to the degree of rudeness from some trust personnel who on occasions did not even acknowledge those who had not been short-listed.

Why Modernising Medical Careers (MMC) is not the answer
However, despite the need for reform, MMC is fatally flawed because it is being run by self-appointed experts in ‘Medical Education’ and not Consultants at the coal face. The facile mistake is the idea that passing a competence test means that the doctor is competent. Competence tests only measure the ability to pass tests, and not clinical skills.

MMC needs to realise that our "trainees" spend three quarters of their time with no teaching, but are "covering patients” they do not know, because of the way we have chosen to implement the European Working Time directive. Staff are over-tired on their shift patterns that ignore circadian rhythms, and destroy any quality of life. No-one in manufacturing producing 24 hour programmes would use this system.

It’s also important to realise the need to teach ‘the knowledge of the science and art’ of medicine. It is doubtful that one can simply learn "communication skills" second hand. It is best done by learning from experience, teaching and practice in order to improve on your ability. This is the model that we should adopt; see one, do one and then teach one. MMC only looks at the first. MMC must include work and experience for our trainees who have the knowledge but not the experience of working, as they have never followed up their patients and cannot get through the work in the time constraints.

If I can explain from my own experience. As a student I won all the prizes for surgery and felt this should be my career, but when operating under Consultant assistance my manual dexterity was incompetent, and it was clear to me that my patients would be better choosing someone who could operate better. General Practice was attractive, but seeing 60 patients in a surgery and trying to welcome the 61st was impossible . As a middle grade working in paediatrics in a district hospital I found the best form of medicine for my skills and interest. The inflexibility of MMC in making career blind ends at the F2 stage has to change. How can doctors make sensible career choices when they have never worked in their chosen field and thus do not know what to choose?

To restore any faith in the MTAS a public announcement needs to be made that it has been scrapped. I take very seriously the complete disillusion of my fellow marchers at a system that ignores all their previous work, qualifications and experience for selecting a career.
The way of marking, has produced a lottery which only the defendants of the indefensible may argue is completely fair to all candidates.

The Chinese Communist Government allocated positions according to the candidates’ political reliability. Their performance, on such a random method of choosing, resulted in widespread starvation till the system was reformed to allow for choice and competence. If we continue to devalue doctors we risk getting the sort of Health Service, where no one really cares for the patient or their relatives.

This is something I care passionately about. I have devoted my life to the NHS. As I get older it is very likely I will also need to start using it and calling upon the help of these young doctors. Patricia Hewitt needs to change and to show that she really cares about the quality of the NHS by addressing the substance of the objections to the system she has introduced. "

Dr David Clow, Consultant Paediatrician, Greenwich

The One to Watch

Consultant Neurologist Dr Chris Allen speaks exclusively about the reforms to junior doctor training. Dr Allen has been the Dean of Cambridge University medical school, authored books and has published widely, including the Lancet and British Medical Journal. He is a member of the Association of British Neurologists and a Fellow of the Royal College of Physicians. I thank him kindly for his time today to give this interview; it makes compelling viewing:

Coming Up...

Tomorrow there should be a treat for 'The Psychiatrist Blog'... so watch this space for the Friday Coup.

Will the Commons Listen to the Lords?

A YouGov poll just published found that the public do not support proposed laws that would make it easier to detain and treat people with mental health problems against their wishes.

The poll, commissioned by the Royal College of Psychiatrists, showed that:

72% do not think that people with mental health problems should be forced to have ‘treatment’ from which they cannot benefit.
68% do not believe that hospitals should be used to detain people with mental health problems if they cannot benefit from treatment and have committed no crime.

These poll results have been released in advance of this week’s second reading of the Mental Health Bill in the House of Commons. The Government has indicated that it intends to force through amendments to the current Bill. The Royal College of Psychiatrists believes that this would bring far more people who cannot benefit from ‘treatment’ within the scope of mental health legislation and make it more likely people would be detained and treated inappropriately.
Professor Sheila Hollins, President of the Royal College of Psychiatrists said “The House of Lords has made some very sensible amendments to the Bill, which if retained would lead to fair and effective mental health legislation fit for the 21st Century. We call on the Government and all MPs not to overturn these amendments in The Commons.”

New Labour do Things in Pairs

If there was going to be an apology then why not make it two in one day?
New labour united the health and defence of the nation, in the form of a 'sorry'. The first, from Patricia Hewitt who said that "this has been a time of great distress for junior doctors and their families and I apologise unreservedly to them for the anxiety that has been caused." Understanding that she has caused a great deal of distress and anxiety, her plan: to establish "a second independent Review to consider these and other broader issues." It remains to be seen if 'committifying' this issue with yet another review will help; the answer called for by over 2,000 doctors is to stop the MMC process until it is fit for purpose.

The second sorry came from the Defence Secretary Des Browne who accepted responsibility, admitted to making a mistake and said sorry for the shambles of the cash-for-stories affair.

Perhaps a white flag will be the 10 year legacy.

A Brand New Head Scanner

A hand held device called the ‘infrascanner’ is hot off the press; it can detect blood clots using ‘near infra-red’ light with a beam that can penetrate the skull up to three centimetres. As blood clots absorb near infra-red light differently to normal brain tissue this change in the signal can be picked up and bounced back to the scanner.

I’m looking forward to more results about this technology as rapid detection is paramount with head injury patients. It’s currently being trailed in India. For more information about this great piece of technology see the BBC report.

The Count Down

As Tony Blair counts down the days until he leaves office, he told BBC One's Politics Show today that reducing NHS waiting times, building more schools and tackling anti-social behaviour were among his achievements. Despite a Royal College of Nursing report claiming that 22,300 NHS jobs have been lost in the last 18 months, Mr Blair defended his record on health. He said: "When we came to power, people used to die on waiting lists waiting for their heart operations. People don't do that any more." [?]

On the same day as Mr Blair was trying to sell or spin his NHS legacy, Mr Johnson (Chairman of the British Medical Association) said: "It's disgraceful that thousands of our best doctors could have their NHS careers wrecked through no reason other than government mistakes and poor workforce planning." Also in yesterday's Private Eye MD described that "Meanwhile on Planet Patsy the health secretary fails to see a problem. " MD continued "Thanks to the insolvency of NHS pie, many [junior doctors] have had funding for study leave and training courses withdrawn. Curiously, indebted trusts are still managing to cough up millions to hire management consultants such as KPMG and McKinsey, to tell them to save money by, er, cutting all funds for training."

Mr Blair's NHS legacy will have even more coverage on 24th April when a mass Parliamentary Lobby has been organised by RemedyUK, concerned about the future of doctor training and subsequent patient care. The picture above is taken from NHS Blog Doctor and represents "Planet Spin".

Thought of the Week

Thought of the week has to be dedicated to NHS staff, who continue to suffer from the unresolved problems regarding doctor specialist training and the lowest level of morale ever reported since the NHS began. Patricia Hewitt is coming under increasing pressure to U-turn over her decision to ‘full steam ahead’ with modernising medical careers. Perhaps it’s worth remembering that to steer any ship the captain must be an inspirational leader, and has to be able to harness the power of other people. As Antoine de Saint-Exupery said, “If you want to build a ship, don't herd people together to collect wood and don't assign them tasks and work, but rather teach them to long for the endless immensity of the sea.” Doctors of today want to continue to learn the great crafts and science of their specialties.

It should never be forgotten that human capital is the most important element to be respected by any leader, ensuring that everyone is involved in goal setting, development processes and direction of travel. As Grover Cleveland said “The ship of Democracy, which has weathered all storms, may sink through the mutiny of those aboard.”

Dr Frasier Crane

The Dr Frasier Crane radio show records his radio theme tune, which I thought should be on 'The Psychiatrist Blog':

Are you Aware of the Body Hair Correlation?

As the weather gets hotter in the UK, one may think that having excess body hair would be a disadvantage, yet in a study published by psychiatrist Dr Aikarakudy Alias, it was found that men with excessive body hair may be associated with higher intelligence.

Alias's research focused on mecial students in the USA, which showed that 45% of male student doctors were 'very hairy', compared with less than 10% in the general population. Further investigations showed that hairer men got better grades when student academic rankings were compared. Alias went onto study 117 Mensa members (who have an IQ of at least 140) and found that this group tended to have thick body hair. In fact, men with hair on their backs as well as their chests seemed to have the highest IQ's within the Mensa members.

But, non-hairy men should not dispair as apparently Albert Einstein had no body hair, and there is no doubting his intelligence.

Can Fame be Bad for You?

Historically there have been few psychiatric studies into fame, possibly because it's very difficult to recruit celebrities to be part of experiments. In the past it was thought that the kind of personality who pursues and attains fame may be one predisposed to psychological problems, possibly narcissitic personalities exhibiting self-absorption, egocentrism and self-importance. Yet some recent research suggests that it is the effect of becoming famous that is the real psychological hazard, not the personality type. Research by Mark Schaller proposed that famous people may be more self-conscious and self-obsessed as a result of the increased public attention they face. He argues that the heightened self-consciousness and introspection may trigger mental illness.

Most people would feel self-conscious entering a room if everyone turned around to look at them, and famous people experience this all the time. Schaller argues that famous people have difficulty reducing expectations on themselves and try to live up to unrealistic ideals, possibly imposed upon them by celebrity fans and feel increased pressure to live up to perfection.

The bottom line in the research is that excessive attention may not be good for you, especially when young.

Brief 3 Point Doctor Training Update

1) To read more about the legal challenge proposed by RemedyUK read here.
2) Doctors wanting to add their support please sign the petition here.
3) To donate to RemedyUK click here.

Why Do Medical Bloggers Tend to be Anonymous?

Anonymity is derived from the Greek word, meaning 'without a name', and more originally meaning ‘without law’. Overall it’s thought that both anonymity and pseudonymity are concepts that are concerned with hiding a person's legal identity, others believe it’s the tradition of blogging that keeps the writer anonymous.

Some of the American weblog gurus (for example, David Weinberger) tell us that weblogs are all about identity and the contents of the blog is secondary to the self-expression of the individual who writes them. The exception to this rule he offers are bloggers who are “living in countries where they might face repression or political pressure if they posted under their own name.” Obviously it’s up to the individual if they want to put their name to their writing or not, but it’s noteworthy that the majority of UK medical bloggers choose to write under the cover of anonymity. Below is a list of medical bloggers, which is by no means exhaustive, whose blogs I read and enjoy:

NHS Blog Doctor
Dr Grumble
A Forunate Man
Hospital Phoenix
Dr K
Dr Rant, and his team Dr Cardigan, Dr Blue, Dr Brown, Rev Dr Green, Dr Mustard, Mr Orange, Dr Pink, Dr Purple, Mr Salmon, Dr White and Dr Informed
Life in the NHS
NHS Escapee
The Paper Mask

The Ferret Fancier
SHP
Short White Coats
The Angry Medic

I don't have the answer to why medical bloggers tend to be anonymous, but merely highlight it as a matter of interest. Any comments or thoughts welcomed.

HAPPY EASTER

As we celebrate Easter and the beginnings of new life the short clip shows two really cute baby polar bears. Famous blogger Ellee Seymour very kindly gave me a ticket to see Al Gore speak in person about environmental issues, which really is a an inconvenient truth for polar bears.

May I wish you and your families every happiness over the Easter weekend.

Adding Zeros to put Flesh on the Bone

Having previously written about anorexia nervosa, (the biggest psychiatric killer), today there is the welcome news about the government funding a £2,000,000 research project.

Researchers at the Institute of Psychiatry aim to use the money to devise ways of spotting and treating victims before the disease takes hold. Health minister Rosie Winterton said the research would help combat the impact of young girls wanting to be 'size zero' models and continued saying that "[t]he development of 'size zero' as something young girls aspire to is deeply worrying."

Currently it is thought that less than 10% of eating disorder sufferers receive help and that victims are often not aware they are seriously ill. The BBC report report that pressure to conform to a 'size zero' model look is widely blamed by specialists as a key factor in the prevalence of the disorder. The extra funding can only be a good thing.

This comes with a Blood Pressure health warning.

Patricia Hewitt helps Tony Blair launch the Labour Party "channel" on the YouTube website to communicate directly with voters. In touch or out of touch - your vote.

Have Spin Doctors Spun Doctors?

It has been said that doctors are not very politically savvy as professional group. However, when the government announced their ‘Modernising Medical Careers review result’ exactly 24 hours before the long Easter weekend, I heard many doctors asking about 'a good day to bury bad news' and 'the political theory of spin'. After all, the day before a long weekend is inevitably extra busy in any job; and especially so in hospitals, as patients get reviewed prior to a bank holiday. News releases about work have a tendency to loose impetus as people relax with family over the long weekend. However, have spin doctors underestimated the profession? NHS doctors are used to working over national holidays. This has been evident in the response released by RemedyUK, who have posted that they remain “committed to representing UK doctors and will release an up date on the legal challenge later today.” (and yes, today is a UK bank holiday)

Other MMC news includes the resignation letter from Professor Shelley Heard who stated “… somehow we have lost our way. The high principles of MMC - patient safety being at the forefront of all we do; trained doctors delivering most of front-line care; improved supervision and accountability to allow doctors in training to gain in their skills and confidence – have been lost in the detail and acrimony of a recruitment process which should have supported and not driven it.” She continues “I believe that we need to step back and reassess where we are going. The Review Group has not done this strategically or with an eye to the future.”

The review has been published and the battle has begun:

SPIN DOCTORS V JUNIOR DOCTORS.

Webcameron on Junior Doctors

David Cameron answers questions about the junior doctor training scheme:

Watching Cheese and Coffee

It’s always interesting to read about a friend in the newspaper and in the Guardian 03/04/07 there was a piece about “cult banality on the net”, referring to the website that shows a large piece of cheese as it (very slowly) matures, and it's getting thousands of hits per day.

In a review of internet history they mentioned the now cult and classic ‘The Trojan Room Coffee Pot’ which is thought to be the world’s first webcam. In the days before the world wide web, a friend of mine Quentin Stafford-Fraser (picture left) had the idea of training a camera on the university departments coffee machine to help prevent people from making pointless trips to the coffee machine before it was ready. It later became so famous that the coffee pot was auctioned on-line for £3,350.

Although I can see the use of having a live picture of a coffee machine, I’m not going to be tuning into the maturing cheese.

Patricia Hewitt's Logic

Has Patricia Hewitt been taking advice from 'Yes Prime Minister?'

The Review Result

For the latest BBC report about junior doctors training click here. The review group has reported it has not been possible to scrap the online system completely, and can not allow trusts to go back to using the traditional system of selecting interviewees based on CVs. Instead it has recommended all applicants get a chance to pick another first choice, and get a guaranteed interview at that hospital.

Professor Neil Douglas, chair of the review group, said: "I am pleased that the colleges and BMA have agreed a joint way forward which will allow the best applicants to obtain training posts." The mess that this training bombshell has left within the NHS is far from over.

The Hewitt Apology - An Update

It’s been a long time coming, but today Health Secretary Patricia Hewitt has finally apologised to junior doctors over the continuing recruitment crisis. To read the full BBC story details click here. Ms Hewitt has admitted that the scheme has caused "terrible anxiety" for junior doctors which shouldn't have happened. Speaking on BBC Radio 4's Today programme, Ms Hewitt said she regretted the failures in implementation of the Modernising Medical Careers (MMC) reforms.

An apology is a welcome start, but her problems are far from over. Tomorrow in a further review about the MMC process the President of the Royal College of Surgeons (Bernard Ribeiro) has reportedly said: “I will once more outline my grave concerns about the general situation and these recent developments and to assess whether there is any prospect of finding a satisfactory solution. I have to say that I am not optimistic and I assure you that I will dissociate myself from these negotiations if I see no recognition of the gravity of the situation generally, and particularly for surgery.”

The British Medical Association (BMA) have suggested that the Government has underestimated the specialist training posts by over 10,000 and warn that large numbers of doctors will have no training post in August. Dr Jo Hilborne, chairman of the BMA Junior Doctors Committee, said: "Not only has the government failed to design a fair recruitment process, they've also misled everyone on the number of jobs available.

Health, Love and Marriage

Having been to a wedding over the weekend - which was lovely, it only seemed appropriate to blog about 'love and marriage'. As Antoine de Saint-Exupery stated "Love does not consist in gazing at each other, but in looking together in the same direction."

In a recent study by Dr Roni Tower et al from Columbia and Yale Universities, it was found that the style of marriage you are in alters your chances of dying from a variety of medical conditions 'by a factor of up to five.' Previous research had already established that being married as opposed to being single was good for health, with positive effects being significantly greater for husbands when compared to wives. Dr Tower has now added to this knowledge by saying "it's vital to get the choice of partner right if you are going to get the full health benefits from marriage."

In the study Dr Tower asked married couples (out of earshot from each other) who they relied on most for emotional support and the lowest mortality rates were found for those who named their partner as their key source of emotional support and closeness. However, his reasearch also again showed that it's the male gender who benefit more from marriage in health and mortality terms. In fact, women don't appear to receive many health benefits from marriage compared to men... I'm only reporting the research.