Sunday, 3 June 2012

The Importance of that First Line, Baby Squirrels and God Save the Queen

I sometimes think about my mind as being like an unquenchable sponge, rapaciously soaking up words, thoughts images and experiences. Last week, there was plenty to soak up particularly in the words I got to read, and there was a great deal to read last week. On one morning, I got up an hour earlier in order to read and mark some pieces of student work before the day proper began, on another evening I stayed up late trying to get to the end of a 564 page long paper a colleague had sent me to inform a paper I am writing.

So when I have weeks like this the importance of the first line I read can play a critical part in determining the level of engagement I have with whatever it is I am reading. And of course when I write, I also think about this. Perhaps in acknowledging that last week saw much media interest in the quality of care people receive at the end of life (and well done Martin for a great performance on Fridays early morning BBC News) here is a first line I and a couple of colleagues used in a chapter we wrote for Phil Barker last year:

Death sets limits on life. Death serves as a nexus of concerns about what counts as meaningful and about what makes life not just liveable but good.

Warne T., Keeling J., and McAndrew S., Mental Health Law in England and Wales. In P., Barker (Ed) 2011 Mental Health Ethics: The Human Context. And the best first line I read this week came from the provocative but very engaging report Patent’s Preferences Matter (Ali Mully, Chris Trimble, and Glyn Elwyn) published by the Kings Fund last week:

Many doctors aspire to excellence in diagnosing disease, far fewer, unfortunately, aspire to the same standards of excellence in diagnosing what patients want.

This is an evidence based report well worth a quick read (its just 54 pages long), that convincingly provides a cogent argument for the need we have as educationalists, practitioners and policy makers to challenge 5 entrenched but erroneous assumptions underpinning contemporary health care provision:

1 that science alone determines need
2 that variation in care is the problem
3 that patient choice is about time and location
4 that the ‘market’ can sort out health care
5 that commissioners can calculate need

I really enjoyed reading the arguments, much of which drew upon and analysis of the post 1989 NHS reliance on the adoption of the American economist Alain Enthoven ideas around a managed health care market, characterised by a provider – purchaser split. Enthovens central thrust was to improve teh NHS we should subject doctors to market forces – he had much more confidence in Adam Smith’s invisible hand than he did in a restructured organisational chart!

And talking about charts, the first line I misunderstood on first sight this week was from the Nursing Times (online version) who were reporting on a new study. The first line was:

The distress thermometer is a quick screening tool used to measure psychological symptoms in patients with cancer.

Now I read this and immediately thought how cheesed off our psychology colleagues were going to be that someone had invented a ‘slip under the tongue’ device that could measure feelings of distress, anxiety, depression, anger and so on. Clinical psychology practice would never be the same again. But of course the reality was somewhat different. When I actually read the full paper I found it was reporting on a contemporary adaption of the work undertaken by Andrew Roth and colleagues in 1998. that used the metaphor of a thermometer to record patient responses to a series of questions.

Finally, I saw this year’s crop of baby squirrels for the first time yesterday. There are 3 of them, and as delightful as they are, (in comparison to their parents they are about 60% full size), they are literally into everything, exploring every nook and cranny. They have even brought down the bunting erected to celebrate the Queens Diamond Jubilee this weekend! I hope that the rain that has being falling for the past couple of hours stops soon, so that people get to enjoy their street parties and are able to raise a collective toast to her Majesty.