Dr Hairy’s Casebook, section 4

Section 4 of Dr Hairy’s Casebook is now available to subscribers, covering the following:

  • Care of people with mental health problems
  • Care of people with intellectual disability
  • Cardiovascular health

Dr Hairy’s Curriculum Casebook is an attempt to bring the RCGP’s GP Curriculum to life, by showing how it relates to the everyday realities of General Practice.

For more information, click here.

2015-01-20

Dr Hairy’s car on fire:
caronfire04Dr Hairy’s care on fire in the car park:

carpark+caronfire04I think I probably need to get rid of the reflections in the  background car windows, to make them into simpler shapes like Dr Hairy’s car; and his car might need a blue shadow underneath; and the treeline needs simplifying so it doesn’t seem to be mimicking the edge of the smoke.

Does a dog await an outcome?

At just after three in the afternoon I walk up a muddy path to a 5-bar gate just off Angley Road, and wait for my daughter Rachel to come out of school and meet me there so we can walk back home together. I take the dog with me, and as soon as we get to the gate he starts sticking his nose through the bars of the gate, waiting for Rachel to come into view.
It suddenly struck me today – this is all wrong, isn’t it? Human beings are meant to spend their lives focussing on achievements and waiting for outcomes. Animals are meant to live ‘in the now’, without worrying themselves about what’s past and what’s to come. As a matter of fact this is an important part of Romantic philosophising about the difference between the human mind and the natural world. Humans can’t see things for what they are because their rational, manipulative way of thinking encourages them to focus on desired outcomes and regard the time they have to spend waiting for those outcomes to arrive as ‘dead’ time. You work all week and wait for pay-day, or wait for the weekend to come so you can enjoy yourself. You save up your money so you can buy yourself a car. When you’re young you can’t wait to be grown up. When you’re an adolescent you can’t wait to start having sex. When you’re grown up you can’t wait to become a success, get your own house, or whatever. In this way you wish your life away. Animals don’t do the same. Their lives are much more immediate. They don’t waste their time wishing for things they haven’t already got: they spend them paying attention to the here-and-now, the world of their immediate sensations.
But if you look at my dog and the way he behaves, it’s immediately obvious that none of this is really true. In the morning I take the dog out for a walk, and when we get back from the walk I have to wash up the dishes from the night before and then make breakfast. He spends the entire time I’m washing the dishes fidgeting up and down the kitchen and whining, because he knows breakfast is coming and he can’t wait for it. When I come upstairs to work, so they tell me, he sits at the bottom of the stairs gazing longingly upwards waiting for me to come back down. When we get to the 5-bar gate, he ignores me and pokes his nose through the gate because he’s waiting for Rachel to arrive. So what if it’s the other way round? What if it’s humans who are sometimes able to free themselves from their own greeds and desires sufficiently to be able to appreciate the here-and-now, whereas animals spend their entire lives wanting and waiting, never satisfied with what they’ve got at the moment because their instincts are telling them to go and get something else?
I think that’s probably overstating the case. The dog looks as if he’s enjoying the here and now when he’s having his chest scratched, or when he stretches himself out in front of the fire, or when he’s on a walk and goes sniffing around in the bushes because he’s smelt something interesting. But it’s a good example of how we like to draw a dividing line between ourselves and the natural world, and project all the virtues that we feel ourselves to be lacking onto the far side of that line. If human beings are goal-obsessed, then animals must be free from that obsession. If we’re haunted by ‘futurity’, as Blake calls it, then they must be capable of living entirely in the present. But it isn’t as simple as that.

Dr Hairy’s Research Summaries, Jan 2015 edition

A bit of a cancer theme this time. For more about the Research Summaries, visit http://www.drhairy.org/concrete5/index.php/research-summaries/ . Here’s a list of the articles summarised:

Pancreatic cancer

BMJ 2014;349:g6385

Mediterranean diet and telomere length

BMJ 2014;349:g6843

Lung cancer

BMJ 2014;349:g6560

Don’t forget the relatives

BMJ 2014;349:g7351

What Atul Gawande teaches us about dying

BMJ 2014;349:g7779

Managing mild, symptomatic pelvic organ prolapse

BMJ 2014;349:g7698

Antenatal and postnatal mental health: summary of updated NICE guidance

BMJ 2014;349:g7394

Physician, don’t heal thyself: the perils of self prescribing

BMJ 2014;349:g7401

Rethinking diagnostic delay in cancer: how difficult is the diagnosis?

BMJ 2014;349:g7400

Serotonin syndrome

BMJ 2014;348:g1626

2015-01-13

I spent yesterday morning visiting my Mum, and yesterday afternoon making marmalade, so I didn’t get much creative work done (unless you count making marmalade as creative work). Perhaps I should post a photograph of the marmalade. However, here are the fruits of this afternoon’s labours: the finished version of the car park –

carpark05

– and Dr Hairy’s car, which is going to appear in the car park in due course –

caronfire

This is all taking much longer than I expected. Everything always does. Very absorbing, however.

2014-12-27

Walking home from work in the dark last night, about half-past seven, I came across a short stumpy individual in a puffy anorak, next to the gateway into the field behind the primary school.  He was holding onto the fence with both hands.

“Can you help me?” he said. “I’m stuck.”

“You’re stuck?”

“Yeah. I came here, and then I got… sort of… stuck.”

“You mean you’re lost?”

“Yeah. Thass it. I came here, and then I got stuck.”

“Well, I’m going across this field to the estate on the other side. You know, Quaker Drive and Quaker Lane. You can follow me along the path if you like.”

“Yeah. Thanks mate. That’d be brilliant. Thanks mate. I really mean that. You’re a life saver. Thanks mate.”

So I set off along the path and he came stumbling along after me, keeping up a constant stream of drunken gratitude. “Thanks mate. I really, really appreciate it. I really mean that. Thanks a lot mate. I mean really thanks a lot. Sorry to go on about it, but really, thanks a lot mate.” At the gateway on the other side of the field he got himself hooked on a bramble – “Fucking hell! Scuse my French, mate,” but then he seemed to know where he was.

“Do you know how to find your way from here?”

“Yeah, course I do. I turn right through here, and then once I’m home, I’m home, aren’t I? Thanks mate. I really appreciate it,” he said, stumbling off the pavement into the main road rather alarmingly, as there was traffic coming, but then stumbling back on again. “Where do you live, mate?”

I was a bit worried, for a moment, that he was going to want to come home with me. “On the Goudhurst Road.”

He was horrified. “On the Goudhurst Road! Fucking hell! Excuse my French, mate.” Then he lurched onto the footpath on our right, and staggered out of view.