10K Chris

Beacon Medical Practice running teamFollowing on the heels of my determined decision to become fit, slim and healthy a couple of years ago, I’ve been running pretty regularly. Since then, I’ve clocked up roughly 700km of sweaty boring hours, and have even begun to find it less boring, if no less sweaty.

Last year I completed my first Triathlon, and yesterday I managed my first proper 10K road race, running with some of my colleagues from The Beacon Medical Practice. I thought I would share a little about it below…

Location

City Of Lincoln 10K Route MapMy friendly local medical practice, as part of encouraging holistic healthy living, offered to book anyone who wanted to run onto the Lincoln 10K. Nine of us ran it, ranging from an ultramarathon runner to first timers, so the pressure was nice and low.

The City of Lincoln 10K is a very flat course, running two squares around the Cathedral quarter slap-bang in the centre of historic Lincoln. Click the route on the right for a nice big version.

Training

I… didn’t do any. I meant to, but this year has been pretty rough so far. I’ve been ill quite a few times, had a scary exam to prepare for, and suffered from a fair bit of stress/tiredness. Looking back over my fitness log, I’ve been managing around 2-4 shortish runs a month since the new year. Probably enough to maintain fitness, but definitely not improve.

I’d hoped to put in some serious practice, but instead, a week before the race I found myself texting my sports performance specialist friend Jon, asking “How do I knock 5minutes off my personal best for 10K in a week”. I settled on the following plan

Monday 10K at race pace
Tuesday 5K at race pace
Wednesday Rest day
Thursday Long walk
Friday 10K at pace
Saturday Rest day

Regarding nutrition, I ignored this in the days leading up to the race, but on the morning of, I had a quorn and halloumi omelette, plenty of protein and fat, with some carbs in the form of a pack of mints.

I had planned to eat a slice of toast with jam as well, but felt a bit full following the omelette, and felt longer acting carbs vs running whilst overfull was a difficult call. Should have got up earlier, and kicked off with some porridge…

Experience

On the starting line, waiting for kick-off...I had a great time. I slotted myself into the sub 45 minute group at the start line, more to avoid the crush of people slowing me down further back.

It was a great race overall, and my first real experience of the need to pace more carefully.

The first kilometre, I got much too excited by the atmosphere, and the people around me to overtake, and pushed a bit too hard. My earphones fed back to me that I’d managed a 4 minute 11 km, so I made a conscious effort to slow down over the next 2km, picking slightly slower people in the field and keeping pace with them.

I settled into a rhythm, and generally just found 3-5km great. However, I hit the halfway mark, and hit a mental wall, struggling to keep my pace, which was apparent by around 7km, where I’d started to drop from 4:30-4:40s to nearly 5min per kilometre.

Talking myself out of the doldrums, I was able to pick up the pace again at 8km, but then hit more of a physical wall – I’d been pushing pretty hard for 35 minutes by now, and there weren’t any reserves left in my legs. Over the final 2k, I didn’t get my usual burst of energy with the end being in sight, and clocked up my slowest times, at 5:08 and 5:16.

It was a great race overall, and my first real experience of the need to pace more carefully. I think that if I hadn’t had a pacing reminder early on, I’d have carried on pushing a bit too hard, and really crashed later on around 6-7k, almost certainly harming my time overall. As it was, I probably ran it a bit too much as a 5K, with a PB for my 5K time too!

I wonder if fitting in some complex carbs in the morning would have sustained me a little better – difficult to say, I suspect it wouldn’t have made much difference either way.

Results

I was aiming for a sub 50 minute time, solely to beat my brother’s time from his 10K last year. On Monday, 6 days before, I ran a practice run in 55 minutes, which was not terribly encouraging.

What did I manage? Not just one, but two personal bests! New PB for 5K at 22 min 44 seconds and for 10k at 46 minutes 46 seconds. I came 717th out of 4,682 (15th centile).

Even more importantly, we bonded as a team, and I got to eat 2.5 pizzas in the 7 hours following the race. All in all, a total win.Having a well deserved pint to celebrate a combined 90 kilometres of running

Board Games in February!

I love spending time with people, and I love being decimated by them in games of strategy, humour and imagination. Hence why I’m a proud member of…

boardgamesgroupfacebookBoston Board Games Group

Meeting on sporadic nights in and around Boston, we get to try out various exciting new games. All games are fully explained by nerds experienced board gamers, and beginners are welcome.

Go on… join the group on Facebook!

We’ve play games like Settlers of CatanLords of War, 6nimmt!, Carcassone, Coup, 7 Wonders, Dead of Winter, Android: Netrunner, Between Two Cities, and Discworld: Ankh Morpork. In other words: no Monopoly, just fun new table based explosions of co-operation and competition.

Last night…

After missing a month revising for my big scary GP exam final, I was keen to make up for it with an evening of calculated victory…

Pairs

pairsPairs is a great little card game, perfect to pick up in about 2 minutes, and immediately leads to countless moments of groaning, and fraught decisions.

It has a simple premise: avoid getting a pair. The deck is made of numbered cards – there is one card labelled 1, two cards labelled 2, three labelled 3… all the way up to ten cards labelled 10.

You are both dealt one card to start, and then take it in turns next, either deciding to take another card, or wimping out and folding. If you draw a pair, the number of that pair is added to your score. If you fold, your lowest number card is added to your score. First person to a certain number, depending on player numbers, loses.

As an example, let’s watch some Hobbits playing…

Bilbo gets a 3 to start. He takes another card, he now has 3 and 8.

Frodo gets a 10 to start. He takes another card, he now has 6 and 10.

Bilbo feels fairly confident – another 3 isn’t likely to come up, although 8 is fairly common. He takes another card, he now has 3, 7 and 8.

Frodo is a little more concerned, as 6 is moderately common, and 10 is very much so. However, folding would give him a score of 6, so he takes another card. He now has 6, 9 and 10.

Bilbo takes another card, after deliberating whether or not to fold and keep the 3 for his score. He now has 3, 7, 7 and 8. He got a pair of 7s, so the round is over, and his score is now 7.

Frodo is relieved, since he would have probably chosen to fold next turn. As he didn’t fold, his score remains 0, and he is in the lead. The next round begins…

Nick and myself played a few rounds of Pairs whilst we waited for the more temporally retarded members of the group. It became immediately clear that Nick secretly moonlights as a Vegas card shark, since he started counting cards on our very first run through. However, there’s enough luck that you can never be sure of any decision, and it certainly passed 20 minutes quite happily…

Fleet Wharfside

FleetWharfside

Fleet Wharfside is a game of trading seafood, and gaining victory points. Sounds dull, right?

You are a fish trader with two options: visit the wharf (docks) and pick up some fish/crustacean cards, or visit the market and pick up contracts to sell the fish.

Three nice mechanics:

  • You buy new contracts with fish. The cost of those contracts steadily increases, and you can trade down nice fish for cheaper fish, but not the other way.
  • Many of the contracts have bonuses, such as letting you pick up extra fish each turn. This is great, but has the effect that you also don’t want to finish the contract, because then the bonus ends. This is a problem because…
  • there are victory point awards for being the first to finish each size of contract. The quicker you finish, more points you get. You can also win points for having the most King Crabs (think longest road award in Settlers of Catan).
Nick mulling over a particularly tasty looking contract in the market...
Nick mulling over a particularly tasty looking contract in the market…

There are no negative scores for unfinished contracts or fish in your hand – its a simple thing, but it definitely takes the pressure off a bit.

A recent Kickstarter purchase by Craig, it was a nice moderate intensity game to kick off the evening. They played it last week, and felt the King Crabs didn’t add much. However, my royal shellfish earned me around 10 points on their own. When the final scores were tallied up, I won with 55 points, closely followed by Craig at 50, then Nick and Simon trailing somewhat behind. KC For The Win! (tshirts pending…)

Not a game I’ll rush out to buy, and a little light on player interaction, but I’d be happy to play it a few more times, for sure.

Agricola

agricolaPlaying Coup last month was a moment where I finally got my hands on a game I’ve heard loads about but never played. That crown has been thoroughly stolen with the legendary “King of Eurogames“: Agricola.

There’s too much detail to cover here, but I’m going to try to do it in 10 steps:

  1. You are all farmers. Presumably in Europe. Somewhere
  2. You have to develop your farms. To do this, you can plough fields, build up your house, or fence pastures.
  3. Each thing you build can make more stuff. Fields = crops, house = family members, pastures = animals.
  4. You only get to do one action per turn, per family member. So, for most of the game, that’s two actions per turn.
  5. Everyone else is fighting you for the same actions. By the time 4 people have taken half their actions, everything really good on the board will be taken, and you’ll have to wait until the next round.
  6. When harvest comes, you have to feed your family. Food is a challenge, and the more family members you have, the worse that challenge is. Fail to feed your family and suffer a heavy penalty…
  7. As the game progresses, more action cards will be revealed. This allows you to do more exciting actions. Unfortunately, harvest gets more frequent too, so you are constantly trying to rustle up enough food.
  8. Each player has a stack of possible occupations and minor improvements. You can activate these, sometimes for a cost, for specific advantages – say you collect more stone, or you get some fences later in the game.
  9. There is a central pool of major improvements anyone can build. They give you bonus victory points, and allow some more powerful specific actions.
  10. Its simple enough to grasp quickly, and complex enough to be really masterful. None of your plans will quite work, and you will have a half empty farm with no crops, hardly any sheep, and then run out of food and get punished with a begging card. It’s perfectly possible to end a game in negative points.
Craig: fundamentally a bad person.
Craig: fundamentally a bad person. And possibly a secret farmer.

I can see why gamers love this game. Chance plays just enough of a part to keep things fresh, but not enough to hold back great strategy. Interaction isn’t very direct, but when you only have two actions, and the player to your right takes ALL THE WOOD JUST BEFORE YOU WERE ABOUT TO… its fair to say there is a reasonable amount of competition present throughout gameplay.

Who won our game? Obviously Craig did. Craig with his vegetables, and 6 stone houses, and his pigs and his cow and his army of little Craigs somehow feeding themselves despite the sheer impossibility of that task.

really enjoyed Agricola. I spent quite a lot of today thinking about how I’d play differently, if it would be possible just to focus on one task, on having thousands of fences, and hundreds of sheep, or having a huge field brimming over with corn.

So, in conclusion: Craig got more points than everyone else added together, but it probably doesn’t count because he smells faintly of cabbages. Agricola is awesome. Spending time with friends and playing board games is, as ever, brilliant. And that, at nearly midnight, was that.

Feel free to drop a comment below, or check out the posts from November and DecemberDon’t forget to visit the facebook group!

What next? How we save the NHS.

This is a cross post from my Huffington Post column. Feel free to read it there instead…

The Government, and Jeremy Hunt, have said they will impose the new Junior Doctor contract.

In so doing, they continue to demonstrate their disappointing lack of respect for the commitment and intelligence of the 53,000 junior doctors who work for the NHS, not to mention the 377,000 nurses, 97,000 senior doctors and 74% of of the general public who seem to understand that if we lose significant numbers of juniors, the whole system will collapse…

So, what’s next? We could get all angry; but we have a responsibility as doctors. We have a duty to remain professional, to protect patients, and to save the NHS. We want to prevent damaging, poorly thought out reforms, whilst holding strong to the cornerstone of modern medicine: evidence based practice with patient care as a priority.

Action One: Give them some evidence.

There are three simple things we can do to make the Government see the scale of the problem. None of these will cause you trouble with your training, and most importantly, none of them will impact on patient care.

DSC_0642Firstly, go online and apply for a GMC Certificate of Good Standing. This is the form you need for working in another country. It’s simple and free to do, just visit GMC online.

Even if you are not currently planning to leave the country, it gives you faster options if the situation worsens, doesn’t commit you to any action, and demonstrates a potential intent to leave. 200 JDs getting a certificate each week makes headlines (see right). Imagine the news that 98% of junior doctors are considering on leave the country?

Next, my dear colleagues, its time to actually fill in those breach forms. I’m not talking about one annoying F1 kicking up a stink. I’m talking about the 10,000 unpaid hours we logged in 5 days in October. Of course we can’t work to rule – we all feel pressured into working extra hours by our caring attitudes and the low staffing levels: leaving work on time would put patient safety at risk.

However, a BMA coordinated hospital-by-hospital submission of breach forms daily from every ward gives clear evidence of how hard we already work. Put patients first and work late unpaid – most of us regularly do – but let’s let everyone know about it!

Warn them you are thinking about quitting. We need a BMA sanctioned letter for us each to send to our training deaneries, line managers and rota co-ordinators, along the lines of “I am writing to warn you that I am incredibly concerned about the actions of the Government in imposing a new junior doctor contract. We are concerned that the new contract is not evidence based, and comprises a significant risk to the stability of the NHS. In solidarity with many of my colleagues, I wanted to give you the courtesy of telling you that we are considering our options, resignation from our posts being a distinct possibility. We do not feel it would be professional for us to accept a contract that may do so much harm to patient safety and staff morale“.

This gives the Government, and just as importantly, the newspapers, lots of clear evidence that many doctors are talking seriously about leaving, and how much time we are already giving out as goodwill.

They will be more effective if well organised: delivered piecemeal they would lack the impact of an orchestrated BMA campaign. I really call on the BMA to use its management skills to deliver a focused, media savvy approach.

Action Two: Strikes

Junior Doctors StrikePatient safety first. NHS first.

The problem with strikes is they provide a risk for patient safety. So does the new contract, but I know that many of us feel uncomfortable with the fact that withdrawal of emergency care is likely to increase that risk significantly.

How about we take the moral upper ground and plant a massive “Doctors care about the NHS more than we care about money” flag in it?! 

My proposal? We start one week, full strike for all of us – no money – but we still provide emergency care – for free!

That’s right. We say “We can’t afford to let the NHS die, but the NHS can’t run without us”. We have a picket line for awareness – but with just 6 people on it at any time. Everyone else goes to work in A&E. No routine work, but emergency care is filled with professionals in tshirts saying “I’m not getting paid today, I’m working for free because I want to save the NHS”. 

And we co-ordinate this with the senior doctors and nurses and other unions. Because if we let them gut the junior doctor contracts, they will go after the consultants next, the nurses next. The BMA needs to talk to the other unions, promise that if they stand with us, we will stand with them if the Government tries any similar nonsense with them.

Let’s get the hospitals filled with unpaid volunteers who love the NHS. With junior doctors, and nurses and consultants and porters, all volunteering, all saying “This is not about money, its about saving the NHS“.

Action Three. “The Nuclear Option”

And after one week of this emergency care only strike action, if still the Government persists, the BMA co-ordinates a mass resignation from all junior doctors. We sign the forms, give them to our BMA rep, and they deliver 500 at once to every trust in the country at 9am on the same day.

It’s actually fairly low risk for us.

Firstly: the Government can’t let it get that far. Even our enormously foolish health secretary knows that.

Secondly, if they do, your trust will immediately need to hire a locum to fill your job. So, you’ll likely get paid more for a few weeks, and once the dust settles, they’ll have to let everyone back onto their training schemes. It may even be possible to negotiate immediate new locum contracts for all resigning doctors, given that trusts will appreciate that they have no other option…

Thirdly, both Scotland and Wales have made it clear they are keen to have us. Let alone Australia, New Zealand, Canada, South Africa…

So, there you go, a three step plan to saving the NHS.

I desperately feel we need this level of clear, co-ordinated campaign from the BMA. It demonstrates to the Government that we are serious, that we know how to plan and organise, and that we are willing to push very hard in the interests of patients, staff morale and a national health service that still has a heart beat.

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The junior doctors aren’t striking for themselves.

This is a cross post from my Huffington Post column. Feel free to read it there instead…

This week, the junior doctors are going on strike. Again.

Most of the people reading this won’t know why. All these professionals, who claim to be committed to caring for some of the most vulnerable in our society, why would they refuse to turn up to work?

The government has done its best to confuse the issue. Some of the more biased newspapers have followed suit. There are headlines claiming that junior doctors are greedy, that they’ve been offered a 11% pay rise, but they want more. The general theme of the spin has been simple: the junior doctors are looking out for themselves.

I’d like to let you in on a little secret. The junior doctors aren’t striking for themselves. There’s actually lots of things they aren’t striking about:

moneyIt’s not about money. Sure, I think doctors would be right to be upset about the new contract, which – despite government claims of a “pay rise” offer – actually threatens huge cuts in pay. Mr Hunt has offered to increase the “base rate” of pay by 11%, but refuses to say what will happen to the “banding” that the vast majority of trainees also receive.

As a personal example, my pay is made from the base rate plus a 45% banding rate. I may lose my entire banding rate. Even with an 11% increase in base pay, that’s a drop of nearly 25% in my annual salary. How would you feel if your employer announced a non negotiable drop in your salary? Great video asking members of the public the same question here…


It’s not about working long hours.
Doctors are used to working long hours, we know its par for the course. We actually work more hours in our contracts than most professions, 48 hours rather than the more common 37.5 or 40. We understand that – despite the Government’s blindness to the fact – the NHS runs a 24 hour service, and we are all part of providing that.

What scares us is the removal of current safeguards: at the moment, if a hospital breaks the rules and forces juniors to work extra hours, there is a significant financial penalty. This happens fairly often. In the new contract, the hospital may just be asked to enforce the limits, with no penalty. How would you feel if your employer decided to start ignoring the time limits on your contract?

It’s not about weekends. Junior doctor already work weekends. I’m a GP trainee, but I’m still working 2 of the next 3 weekends. Do I get days off either side? Nope. I only have one day off in the next 18. Its going to be hard work!

The government keeps talking about the risk of being in hospital over a weekend. Whilst this has been extrapolated from statistics that prove nothing of the sort, it does mean there is a push to further jeopardise our junior doctors’ already limited opportunity for normal social lives. How would you feel if you were told Saturday is now the same as Monday morning? How would you balance family, friends, childcare…

Money, long hours, weekends. These may seem like totally reasonable causes for a strike. But there are even more important issues at stake…

It’s about safety. Junior doctors are on the front lines. We know how understaffed A&E is; we see how thin on the ground clinical cover is during hospital on calls, and how GP surgeries are fighting against a sinking ship of paperwork, appointments and shrinking finances.

We know that patients are suffering, and, currently, junior doctors are working out of goodwill to hold up the creaking system. Junior doctors logged more than 10,000 hours of unpaid overtime during one 5 day period in October. Push the junior doctors harder? Goodwill gives way to exhaustion. Do you want a tired, unhappy doctor?

It’s about making sure we have enough doctors. The government scares us. They don’t value junior doctors, and they don’t see that junior doctors become senior doctors.

I posted previously about how general practice and psychiatry training schemes are running half empty. Five years ago, over 71% of newly qualified doctors joined training schemes. Last year? 52%. With record numbers of doctors leaving to work overseas, Jeremy Hunt is causing an exodus of professionals we desperately need.

juniordoctorcontractIt’s about saving the NHS. The NHS is at risk of being terminally ill. It needs treatment, or its going to die. Trust us – doctors know about this sort of thing.

I’ll be brutally honest here. If the NHS fails, I’ll be okay.

Sounds cocky, but its probably true. In fact, I’ll probably earn more than I do currently. I’ll be able to afford health insurance premiums for my family, for myself. I’ll be fine.

If the NHS fails, Jeremy Hunt will definitely be okay. More than okay. He will join a private healthcare company board, and earn vast bonuses in a climate of charging people for care they currently receive for free.

If the NHS fails, there’s a big group of people that will not be okay. It’s not doctors. It’s not irritating politicians. It’s the poor. 

There will be hard working people at the bottom choosing between healthcare… and food.
People getting cancer, then losing their homes.
Patients deciding its better to live in depression than in debt.
Children dying because they don’t have parents with enough money to afford treatment.

And that’s not a United Kingdom I’m willing to accept.

Junior doctors aren’t striking for themselves. They are striking for all of us. Support them. #notsafenotfair

Review: Snood

Me in a snood, looking excitedIt’s reached that point in the year where its getting horribly cold. Pretty enough on a Christmas card, much less appetising when its 1 degree outside, and you are heading off to work on the bike at 7am.

This year, I treated myself to a snood. I would recommend it.

It feels like still having the duvet wrapped around you, even as you brave the icy streets. The one I have even has airholes for your mouth, so you can breath through it without feeling like you are suffocating.

I do whole-heartedly advise you to splash out on one, if you do any winter cycling. However, I have a long history of complaining about cycling, so it would be remiss of me not to complain just a little bit…

Problems with a snood:

Reduced peripheral vision

It hardly seems much, but the snood overlaps the edge of my face by around 1cm. It’s amazing how much this affects my view of cars, especially when peering over my shoulder for overtakers.

If possible, try to peel back the edges just parallel with your eyes, since the feeling of being cosy is definitely diminished a bit by being run over by a lorry.

The terrors of snood condensationCondensation

As soon as you stop moving, the warmth of your body and the steam from your breathing rapidly cloud your vision.

Once you set off again, the flow of cold air sorts it out, but I have gone almost completely blind at traffic lights a few times!

Looking like a serial killer.

I have not problem with looking like an idiot – see lycra trousers – but there’s something a little bit bank-robber-esque about covering ones mouth and nose. More than a few people have commented on my sinister appearance.

 

Problems aside, I love my snood, and I wish you all well in your snooding over the rest of this winter!
Have an emotional snood story? Why not share it below…

 

‘Will I Be Able to See You Next Time?’

This is a cross post from my Huffington Post column. Feel free to read it there instead…

Or… “Why patients miss having a regular doctor, and how the new junior doctor contract risks making the situation worse.”

Despite being nearly thirty, married for nearly a decade, with two children, I am a “junior” doctor. Technically, I am a GP Registrar. It’s written on my door, and none of my patients understand what it means. I often get the joke “Does that mean you can marry us after you’ve listened to my chest?”.

2016-01-11-1452522367-1128787-gpregistrar.jpg

I explain that “registrar” means that I am a trainee GP, with one year left before I’m a fully qualified GP.

They always follow this up with the same question: “Does that mean that you are staying here long term…” There’s always a look of hope in their eyes; that I can be a familiar face who knows them; a traditional family GP; a doctor, and a friend.

General practice has changed dramatically over the last 20 years. Practices were commonly run by one or two partners. My training practice has more than 10 partners. Getting an appointment is a scramble of ringing continuously at 8am – hoping to get lucky today – and there’s no guarantee you will see the same doctor each time.

I know that patients are suffering from this lack of continuity: because they complain to me about it. It is no exaggeration to say that 5 patients each day mention how hard it is to get an appointment. Sometimes, on a day when I’m frankly fed up with nodding defeatedly and apologising, I explain why things are changing…

“Why is it so hard for me to get an appointment, doctor?”
You see, Mrs Jones, these days people visit their doctor more often than they used to.

In 1995, on average, a patient would see their GP 3.9 times per year. In 2008, this had risen to 5.5 times. If that trend has continued, in an average practice of 9,000 patients, that would mean a practice will need 22,153 more appointments in 2016 than they did in 1995.

A GP will see around 40 patients a day – although some will see many, many more than this. To meet people’s desire for seeing a GP, every practice would need 3 new GPs. This is the reason nurses have become so vital in GP practices; they help to share the burden of extra appointments.

“Why don’t we just hire more GPs, doctor?”
Unfortunately, Mrs Jones, there aren’t as many GPs as there used to be.

When I applied, 4 years ago, GP training was relatively popular, and there were 30 trainees in my year, locally. This year? We have 7. In London, the problem is less extreme, but it has been devastating across the rest of the country. My colleagues in Chesterfield have just 12 trainees; Lincoln, just 4. And Bassetlaw? Bassetlaw have no new GPs being trained this year. Overall, 30% of General Practice training posts remain unfilled in the UK.

To make the problem worse, GPs are retiring much faster than replacements are being trained. In a recent survey, more than a third of all the GPs in the country plan to retire in the next 5 years – and many others plan to go part time!

Just to keep numbers stable, we would need to graduate 4,000 new GPs a year. This year? Only 2,732 new trainees started GP VTS training, a figure that’s reducing annually. We are heading for an absolute crisis, a shortfall of tens of thousands of GPs across the country.

“Oh dear doctor. What can be done?”
Its a difficult problem Mrs Jones, and no one really has an answer. But there are some simple things that need to be addressed:

We need more medical students. At the moment, there are only 6,800 places in medical schools each year in the UK. In 2007… there were 7,300! Why, oh why, is that number going down? We would need 58% of those students to graduate and become GPs in order to address the crisis that is happening. That would leave the rest of the health service with just 2,800 a year – or just 2.5 new doctors annually for each of our 1069 hospital sites.

We need more encouragement to junior doctors. Jeremy Hunt has tried to unilaterally impose a wildly unpopular new junior doctor contract. There are fears of increased normal work hours, uncertainty about pay cuts and, most worryingly, a very forceful attitude that is leading to a strike tomorrow by junior doctors. Right now, junior doctors need to decide whether to apply for specialty training: primary care is going to see even worse recruitment unless the uncertainty is resolved quickly and positively.

“Is there anything else we can do, doctor?”
Well, Mrs Jones, I’m glad you asked that…

We need to use our brains. The patient before you attended because he had a spot on his nose. Since yesterday. Did he really need to see me? When I work in A&E, I regularly see people who have mild sunburn. I see patients who’ve had a sore throat for 3 days and saw their GP earlier today, but want a second opinion. I’ve seen parents at 9pm because their 2 year old hasn’t gone to sleep yet.

We seem to be afraid to say it, but the NHS needs patients to take some responsibility for minor ailments. Every doctor you will see has a hundred stories about patients attending needlessly. We need a prescription of that very British quality: good old common sense.

If we are going to save the NHS, we need to work together, doctors and nurses, patients and politicians. Its our health service, and its up to us to keep it healthy!

Now, Mrs Jones, let’s get back to you. How can I help you today?
“Well you see doctor, my nose has been running since Monday. I went to the Urgent Care Centre last night, but its not better yet. I thought maybe you could give me some antibiotics…”

Looking back at 2015

I’ve started to write this on December 30th, sitting on a train in Lincolnshire at 7:30am, on my way to work. It’s still completely dark outside, and half the country is still on holiday. I feel slightly jarred, like the alarm clock went off, but no one else has had to get up.

Feeling disjointed is somewhat appropriate – it aids my reflections on the last 12 months.

2015 has been a year of experiences. We’ve lived in three continents; I’ve had an epiphany in healthy living, exercise & weight loss; my medical skills, for the first time, feel formed; and, as a family, we’ve started to have some clarity about how we want to live.

Home

This year has shaken my understanding of home. In many ways, “home” still means “Epping” to me. My parents live there, I grew up there – the streets feel familiar, comfortable and safe.

“Home” is any place that has touched your heart.
Leaving doesn’t stop that.

But in a much more practical way, our lovely house on Woodthorpe Avenue in Boston is home. It’s the place we can best exhale. We can kick off our shoes, settle comfortably onto a high chair on the breakfast bar, and watch the chickens, dogs and children flap around in the garden.

YEditedGroupPhotoet Restore Church, full of our friends, is also home. We seek the heavenly realms together, we drink moderately bad cups of tea together and we laugh about the projector turning everything purple again. This whole year has been a mess of realising that “Home” is any place that has touched your heart. Leaving doesn’t stop that.

If you’ve read Harry Potter, there’s a concept where Voldemort tears apart his soul and stores it into objects that have emotional value to him. That’s not quite how I’m feeling – home is not a horcrux – but there’s no doubt that putting roots down involves investing a part of oneself.

Now I’m coming home
I’m coming home to you again
I hope things haven’t changed
New Found Glory

Many homes

This year, “home” has been Mseleni hospital in South Africa. It’s been Sea Point in Cape Town. Jackson in Missisippi. Alterna community and Koinonia Farm in Georgia. QC Family Tree in North Carolina. Grace & Main in Virginia. The Simple Way and Inner Change in Philadelphia. A little bit of us still lives in the homeless shelters of the Catholic Worker movement in New York City

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Returning to the UK has brought us face to face with the contradiction of “home”: it means a state that is temporary and yet, somehow, extraordinarily enduring.

Our idea of home is shaped by the setting and society we live in. This year it’s meant our children sitting naked, in dusty mud, next to the road. It’s meant seeing giraffes on the drive to the shops. Getting excited about a visit to the town café that pretty much only sells chips. Friends who have never had – and will never have – the life opportunities that I take for granted. Patients who have never slept in a bed, and thus don’t know how to sleep when they are admitted to hospital. Evenings without a TV, without electricity, without water, spent cooking pizza on a wood fire, and laughing. So much laughing.

John M PerkinsAnd it’s meant eating sweet potato wedges with John M Perkins. Jugs and jugs of sweet tea. Contemplative silence in LaGrange, and board games late into the night. Cooking pizza for the entire residency of Koinonia farm. Shaving heads and eating chocolate.

In Charlotte, it meant reincarnation through recycling, through gardening, through relationship, through reimagining an unloved locality. And a little girl doing a poo in a public water fountain. It’s meant permaculture, community gardens, ultra thick milkshakes and sitting on porches in Danville. In Philadelphia it meant pizza (home == pizza), and gunshots, and an understanding that all of us need our home to be sustainable. New York meant $1 pizza slices, enjoying glorious mess surrounded by healing people, and my first ever visit to a board game cafe!

Returning to the UK has brought us face to face with the contradiction of “home”: it means a state that is temporary and yet, somehow, extraordinarily enduring. In common with many others who have crossed cultures, there will always be a discomfort in us, even in situations that have been familiar to us for years.

wp-1451644198031.pngHealth

Alongside learning more about the mental framework we use to fit into the world, I’ve also come to terms with my physical existence here.

For the first time, I can say I genuinely love exercise. I even hate running a bit less!

Sure, 2013 was the year I decided to start losing weight. And 2014 was the year that I realised healthy eating is going to be a life long commitment. But 2015 was the year I started to understand the link between health and happiness.

For the first time, I can say I genuinely love exercise – I even hate running a bit less! I’m more aware than ever how rubbish I feel after an episode of gluttony – Ben & Jerry’s, I’m talking to you here – and I’m starting to have the self control to just not go down that path.

I’ve hammered out a few personal milestones, such as my first Triathlon, my first sub 25 minute 5k, and consistently dropping below 70kg. I’ve also managed sustained periods of exercise, accountablity and weight management – see my blog series: six kilos in six weeks.

Medicine

babychris-800x817Working in South Africa was a privilege – a scary one at points. Having a baby named after me was a highlight, as was being signed off as competent to perform caesarian sections without supervision. It was also the first time I’ve ever worked with a degree of autonomy, and the only time I’ve been at a grass-roots level in the midst of the community I live. Being a doctor… at home.

When I was 17, I made a decision to apply to medical school. I’m now 29.

As I look towards the end of my training, I know that the only way I’m going to be able to sustain the enthusiasm and purpose I need is for my career to have integrity. When I was 17, I made a decision to apply to medical school. I’m now 29. It’s only at the end of this year that I will no longer be on a training scheme. I’ll actually be an adult, able to apply for a job where I get told in advance where I’ll be working, what hours I’ll do and how much I’ll be paid! I’ll be able to raise concerns and suggestions for improvement without putting my entire career at risk! Brill.

In 8 months, I’ll be able to choose my hours, select my workplace and start to explore my sense of vocational calling. Medicine needs to line up with our life goals, my heart and my sense of home. Who knows exactly what shape that will take, but its an exciting prospect.

Next

The bible is full of phrases like this:

“And calling the crowd to him with his disciples, he said to them, “If anyone would come after me, let him deny himself and take up his cross and follow me. For whoever would save his life will lose it, but whoever loses his life for my sake and the gospel’s will save it.”
Mark 8:34-35

When I read a passage like that, I think: “I’m not really doing that”. I’m not saying that I believe God calls us all to martyrdom; but I do believe a luke-warm 50% lifestyle simply doesn’t cut the mustard.

SAM_0952I’ve become certain of one thing this year: we desire to live out the gospel. Really live it. Not half live it, tacking on a bit of grace and love to a plastic Western lifestyle, but LIVE it. Our hope is to explore, sacrifice, pray and practice until “The Kingdom of Heaven is near” starts to resonate with us.

“Home” this year has meant common threads: friends, community, adoption, Jesus, vegetarianism, pizza, board games, fitness, laughter… shared values in others that reflect the hope we have for this life.

One of our mentors, Colin, recently said to us “You need to find your tribe“. As we continue to explore what and where “home” is for us, I think God will make it clear to us who our tribe is. Maybe it’ll be through pulling on some of those common threads, and more importantly, following back to the heart behind them, one that says “My God; my neighbour; our life together.”

Thanks for reading this, and thank you to everyone who has been part of home for us this year. Have a great 2016!

PS. I leave you with a song that is very much on the same page as us…