The Now Show

A topical news show, broadcast on Friday evenings at 1830 UK time.

Worth it for Mitch Benn alone.

And now a podcast!

Give it a rest Tony

For goodness sake.

Its dead.

Leave it alone man.

You won't even be in the country then, you'll be on some lecture tour in the US.

Link to story.

Nursery rhymes

Let me ask you a question: Do you prefer "Baa Baa Black Sheep" or "The Ugly Duckling"?

Those of you who know me will remember (I'm sure) that I am noted for my melodious tones, although generally not the ones emanating from my larynx. I have a repetoire of nursery rhymes inherited from my family which I have sung to my other children to soothe them (with varying success).

Mrs B is 20 weeks now. Bumpy Brown is kicking for England. So I've started talking and singing to it. Rather bizarely, it seems to ignore Baa Baa Black Sheep, Jack and Jill or Half a Pound of Tuppeny Rice, whilst consistently becoming still if I sing The Ugly Duckling or Twinkle Twinkle Little Star, only to get going again once I've stopped (after a suitable pause for reflection and appreciation of its father's performances).

Hopefully, the little mite will recognise my voice after its been born. At 20 weeks gestation, it can already hear things in the womb. My singing will be audible to it, and although the hard consonant noises won't get through the softer vowel sounds and general tone will. Given it already seems to settle with certain songs, I suppose its possible we already have a baby with favorite nursery rhymes.

The alternative is that Bumpy is quivering in the corner or the uterus with it's fingers in it's ears, hoping the caterwauling will stop soon...

Orwell (can hopefully now) RIP

I've spoken about ID cards before.

There were various news articles yesterday (here and here).

The Register's John Lettice reports further today: John Reid, who I have always considered to be a ignorant prat of the highest order (and you know what they say: "Jack of all trades, master of none"), may actually be doing something sensible and kicking this riduclous Big Brother idea into touch (in effect if not officially).

This is most out of character for him. I can only assume he is trying to keep damage to a minimum...

Anyway, labour goons notwithstanding, thank goodness this form of identity management seems to be going away...

Your right foot

This is so funny that it will boggle your mind. And you will keep trying at least 50 more times to see if you can outsmart your foot, but you can't.

1. While sitting at your desk, lift your right foot off the floor
and make clockwise circles.

2. Now, while doing this, draw the number "6" in the air with your right hand.

Your foot will change direction.

And there's nothing you can do about it!

Lack of space

Had a bit of a blog break recently, what with Mrs B being ill and (ahem) other things going on at home, as well as having to go through the trauma of recruiting a replacement for my senior partner at work.

Could do with a holiday to be honest. I hear New Zealand is nice this time of year....

Anyway, to the purpose of this post.

It has become clear to SWMBO* and me that we really can't continue to live in our current domicile once Bump Brown arrives: it is a small Victorian terraced house. Fitting in 3-5 humans (depending on the time of the week) and 2 felines is going to be impossible in the medium term, though we might be just about able to manage for a few months. But where do we put the buggy, or hang the washing?

We've had a traumatic 18 months, what with one thing or another. Our lovely little house has been outgrown. And so we are examining our options: move or stay?

If we stay, we'll have to seriously consider a loft conversion. We are fairly sure that this is unlikely to be possible: the house is just too small. We're also unlikely to get our money back from the investment needed to get the work done.

If we move, we'll have to do it soon. Mrs B is 16 weeks in, so we'll need to be in a new house by the end of October at the latest, or she won't have time to plan the decorating before nappies intervene. But that has its own problems: the windows need refurbishment or replacing, our soffits need repairing, the place could do with a repaint. There are lots of other little and not so little jobs that need doing. Finances will need to be considered carefully as well. We'll probably need a second car (and even if we decide to stick with one, we'll need to replace mine which is too small for a baby carrier/car seat and two booster seats). And of course, where do we move to? Closer to my place of work and family, or stay near where we are, where we've been very happy?

So lots of thinking needed.

Watch this space, it might turn into a moving-house-blog.




*"She Who Must Be Obeyed"

Morning sickness

I've had reason to review my knowledge of morning sickness recently. Most women get this to one degree or other in pregnancy in the early stages of pregnancy. Most don't require treatment and it usually settles around the three month mark.

Some don't settle however. I suspect those women probably don't enjoy being pregnant as much as they were hoping to.

A few unfortunate souls suffer hyperemesis gravidarum. That is more serious and sometimes requires hospital admission, especially if the mother becomes dehydrated. But there are degrees of hyperemesis. Someone close to me has it at the moment (in my completely unbiased and objective opinion). I thought she would require admission last week, but luckily we've avoided that.

The constant nausea and repeated vomiting brought on dehydration and an extreme malaise and lethargy. She is currently not working, which is just as well because I don't think she would be able to anyway. This week, she is coping a bit better. In part this is due to the phenergan she has been using on and off. The only trouble with that is it causes sedation and gives her a headache, which in turn makes her feel nauseated.

See the problem there?

There are other drugs which help some people: prochlorperazine, metoclopramise, cyclizine. None of these drugs are licensed for use in pregnancy related sickness. But numerous studies have been performed which have not shown any adverse effects on the baby. The Prodigy website was one which I have found helpful as a revision, though it hasn't helped Mrs Brown very much. She is trying accupuncture, having already (unsuccessfully) tried the accupressure bands you can buy in any pharmacy. Accupuncture has not been shown to be helpful in 2 randomised controlled trials. But if it helps her, I'm certainly not going to argue.

So in case you've come across my blog because you're suffering from pregnancy related sickness and you've googled it, here is my suggested managment plan:

1. Sip frequently, don't drink large volumes. The quicker you drink a large volume, the more likely you are to throw up. Try using a straw.
2. Drink and eat whatever you feel like. Don't worry about whether the baby is getting enough vitamins because your previosuly healthy diet has been reduced to mashed potato and baked beans. The improtant thing is that you avoid dehydration and manage to get food in to yourself. The baby will take what it needs from you, at your expense.
   
3. If you can't stop vomiting, seek help from the health professional of your choice. Midwives may have some sensible suggestions. GPs certainly will and can prescribe certain drugs (though be aware that many GPs will prefer to avoid them if they can).
4. Try having some sort of bland carbohydrate before you get up (crackers or toast).
5. Don't get hungry: nibble snacks throughout the day and see point 1.
6. Rest. You're not superwoman, and the world won't fall apart because you're knackered. If you have other things that need looking after (like other kids) enlist help from family and friends. Do not try and do it all yourself. You don't have to.
   
7. Despite the fact that most alternative therapies have not been shown to be of benefit, that doesn't mean they won't make you feel better. Any cynical GP (like me) who says anything other than "If you say it helps I won't argue" shouldn't be told (as long as it won't do any harm of course).
8. Ginger in various forms may help. Of course, it makes some people worse.
9. If you're prescribed medication, please use it. We don't prescribe for fun. You never know, it might help.
10. See points 1 and 6 again.
    

And here's Russell's management plan for husband's/boyfriends/whatever:

1. Be sympathetic. Its not nice. Jokes will not go down well and do not make your wife/partner/girlfriend/lover feel any better.
2. Cuddles are good, but don't squeeze. You will regret it.
3. Try and think ahead of yourself. Keep fresh water handy. Try flavoured electrolyte replacement or rehydration salts (such as dioralyte). Buy crackers.
4. If you're worried, seek help. That can be your Mum, her Mum, your doctor, her midwife, anyone you like. If you don't ask, you won't get.
5. Wash up before you go to bed. You won't have time in the morning.
6. Don't feel guilty. Its not (just) your fault. Two people had sex. At the same time however, accept any and all criticism with that stock phrase: "Yes, dear."
7. Don't forget to tell her you love her either. That will help, because the way she is feeling, she is unlikely to love herself at the moment.
8. Just because she isn't eating her broccoli doesn't mean you shouldn't.
9. Beer and whiskey smell. You should be aware that women with pregnancy relates sickness are often made worse by certain odours. Ask first.
   
10. Remember, things will get better. (Probably in about 18 years.)
    

Flea: When Daycare Calls - Part I

Flea: When Daycare Calls - Part I

Flea posted this recently. It seems they have GANFYD's in the States as well.

If you don't know what a GANFYD is, well, hopefully you'll never need one. All they do is create work for people like me.

The number of different notes people ask for never seeks to amaze me: examination board notes, holiday notes, simple "been to the doctor" notes and yes, "safe to return to nursery/school" notes.

Flea is absolutely right: no-one seems to use their common sense anymore. Perhaps more to the point, no-one is happy for anyone else to use their common sense anymore either!

Anyway, I'd better get back to work and stop reading blogs...

Dame Janet slams docs again

Ho hum.

Dame Janet Smith is perturbed by the lack of progress shown by the Government over her recommendations after Harold Shipman's crimes.

Talk about tarring everyone with the same brush...

She made this comment: "There are doctors who still think that everything is fine and that there is no need for change. There are still those who think Shipman was a one-off villain."

Well, wasn't he? Is there any evidence that there are more mega-serial killers in the current medical workforce? No?

Thought not.

I do think that some of the changes she has proposed in one of her many reports are sensible: the proposals about changing death certification and cremation administration; the need for a system to ensure doctors' skills remain up to date; her criticism of the GMC's procedures for monitoring doctors (although that led to the GMC embarking on disciplinary proceedings when perhaps it should not have).

But it seems to me and I suspect many of my colleagues that she would rather have us all shot. That would certainly prevent any more Shipman's.

But there are other things about her rampant anti-doctor attitude that concern me more. I can't help but wonder how many patients have been left in unnecessary pain because doctors have been concerned that adequate pain relief may result in an earlier demise than might otherwise have been the case and that that demise may then be subject to vexatious scrutiny. Certainly I've been aware of a lot more post-operative patients are being discharged by surgeons with simple, less powerful analgesics. Perhaps they don't need anything stronger. Palliative care also feels a lot more defensive in the last few years, or perhaps cautious would be a better word.

Perhaps this caution is for the best. Perhaps doctors do need more monitoring to ensure public safety. But I certainly came in to this career because I wanted to help people through their lives, from beginning to end. I suspect the same is true for most of my colleagues. Dame Janet's viciously negative attitude does nothing to help avoid another Shipman. It just makes doctors feel vulnerable and defensive and that cannot be good for patients.

If I was a rich man....

Apparently, as a GP, I'm very rich. The BBC investigative team have discovered the scandal that some GPs (less than 5%) are earning over £250,000 a year, after expenses.

Well, most aren't. I'm not. Wish I was...

Apparently "Experts have said the contract was ill devised and is partly responsible for current NHS deficits."

Not quite sure who these experts are, of course, that's not stated. And why are us GPs being pilloried for the NHS deficit when the Government negotiated our contract? It was NEGOTIATED!! We're now being paid for things we were already doing. Our pay had fallen behind comparable professions, and its almost caught up, thank you very much.

As far as the guys earning a quarter mill are concerned, good on them. They will be managing businesses (as do I) to the best of their ability, to get maximum bang for buck, and in the process taking a profit. I wonder if there would be so much fuss if it was some private company making a profit from the NHS, perhaps from following an American model of some sort (which Our Glorious Leader seems to want to emulate).

Well, wake up BBC: GPs are private companies. If you think you're not getting value for money, start comparing us to other countries, see how much we spend per head of population on GPs and the services they provide.

Idiots.

Orwell eat your heart out...

Well, when George Orwell wrote 1984, I'm sure he didn't think that we really would end up with a totalitarian regime. And so far, we haven't got one. But that could change.

Our Glorious Leader has done a fair amount to erode our freedoms in this country, usually under the guise of ensuring our safety, protecting us from terrorists and the like.

The main thing is of course Identity Cards. These will apparently "keep us safe". Yeah, right. They really would have stopped the Tube bombings by British subjects, wouldn't they? They'll really stop people getting into the country we don't want, won't they?

A google search of "Identity cards UK" immediately pulls up several websites who are basically against them. they summarise nicely what is wrong with the scheme as is suggested by Tone and cronies. NO2ID are a pressure group whose news letter provides updates on where the legislation is at. After the recent Lords climbdown and "compromise" over the compulsory nature of the scheme (and make no mistake, it is compulsory), we will all over the next 10 or 20 years have to have a card. Then, the police will be able to insist on seeing it on demand. In other words, in a fundamental shift, British citizens will have to answer to the State about their identity.

WHY SHOULD WE?

And now we have more concrete plans for SOCA. This Agency, going "live" very soon, will be a rough equivalent to a combination of the American FBI, DEA, Justice Department and Customs. This one I have less of a problem with.

BUT. What happens if in 20 years we end up with a government led by some sort of megalomaniac, possibly a right wing xenophobe? It could happen, all it would take is a few more terrorist attacks, a whipping up of the populace by the likes of the BNP, an exageration and a playing on of peoples' fears. All of a sudden, we could be in a position of having to carry the cards to prove we are who we say we are when the SOCA officers stop and search you. If we can't, we'd be dragged off to chokey until, well, until who knows when.

The Nazi's insisted on ID cards. Especially for Jews. I don't want to live in that sort of world. I don't want my children growing up in that sort of world. But currently we are being "managed" by a Government more concerned with leaving something for posterity than in the actual well-being of us, the Great British Public. Think about that at the next General Election.

Despair

The latest in demotivational accessories for your company. Just click on the Thread title to go to the web page.

Despair, Inc. are based in the US. They do, however, ship worldwide. With regard to international shipping, their website says the following:


"Despair ships to most international locations. Most orders to most international locations are delivered within 1 week, however- larger-sized orders often can take 4 to 6 weeks (and in a few cases, even longer) to deliver. For faster shipping, we recommend moving to the United States."

The rest of the website, and indeed the whole company ethos, is centred around the principle of demotivation, in juxtaposition to the huge market there is for motivational literature and products.

But I personally recommend the video podcasts, available through the website or iTunes Music Store.

Flame of the week

The Register has published a "how to" for flaming the ultimate flame.

Wonderfully apt, given some of the flamings I've read over the years, and I'm surprised I didn't come across this before.

Mind you, I only really started browsing the Register a few months back, and then fairly intermittently.

So a competition for anyone reading my blog: flame me.

Best flame wins a prize, though I haven't decided what yet.

What kind of coffee are you?

You Are a Frappacino

At your best, you are: fun loving, sweet, and modern At your worst, you are: childish and over indulgent You drink coffee when: you're craving something sweet Your caffeine addiction level: low

What Kind of Coffee Are You?

I am sooooo not a Frappacino...

Flickr sorted

Not sure what they did, but I can now access my account. Received an email telling me how to log in (which was what I was doing) and all seems fine.

Mind you, haven't added any more pictures to it as yet...

Problems with Flickr

Getting lots of problems when I try to log into my Flickr account from work. It keeps telling me that my Yahoo id is already associated with a Flickr account, and I need to merge the acounts.

Fine. So I follow the links and instructions, only to be told that the email address I supply is linked to a Yahoo account and I need to log in there.

Fine. So I log into my Yahoo account and then try to access my Flickr acount, only to be told that I need to merge the accounts.

Guess what happens next?

I've emailed Flickr support, but I guess they'll be on US time, so I will have a bit of a wait.

I've tried to resolve the issue using both Firefox and Internet Explorer, no joy and consequently not many pictures as yet. The funny thing is I can access the account without any problems from home using both safari and Firefox.

It's very fustrating.

Global Warming

Following on from my last post, and by a strange quirk of coincidence, the Sustainable Development Commision, chaired by Jonathon Porrit and reporting directly to Our Glorious Leader, have released a report into whether the UK should invest in nuclear energy.

And the answer is: No!

Surprise, surprise.

A press release is available here.

We all need to reduce, reuse and recycle much more than we are at the moment. That is well known. Developing countries carbon output will inevitably go up over time, so we need to lead by example. If you haven't got a compost bin or water butt, why not? Go and buy one next weekend, or start a wormery. If you need a new boiler (unlikely, granted) get a condensing boiler. Use the car less, walk or cycle more.

Mind you, renewable energy has a long way to go before it can hope to provide us with the energy we need. Wind farms are unpopular, solar water heating is one thing, but photovoltaic solar panels are not as cost effective as they need to be to generate a mass market. It can take many years to recoup your investment.

But, and its a big but, the current Government are only interested in votes, especially those from Middle England. If Colonel Bluster (rtd) from Greater Whinging in Surrey says "No!"*, the politico's wobble and rethink. Sound bites are all. They have to start paying attention to the long term needs of the country. Of course TB says he is. But if that is the case, why is the nuclear option being considered with such alacrity?

Personally, I think the Government should move away from a centralised energy grid towards a more flexible, locally delivered system concentrating both on big power stations and small microgenerating schemes (such as solar energy, small wind turbines on everybody's roof next to the TV aerial/satellite dish). Grants are already available in the UK to help get your roof insulated, even to get solar panels of one sort or another put up. But the Government needs to improve the structure of these mechanisms, making it easier for householders to have the work done, and easier for planning authorities to ensure that developers build in a more sustainable fashion. Why not insist that all the new houses that are being built in the south east of England have either solar water heating, or photovoltaics, or both? Build in water capturing technology to reduce the amount of rain water that goes into the drains, there to the sewers and so to waste. It can't be that hard.

So come on, people. Have a think. And this weekend, do something green.


*Col Bluster is fictional and any relationship to any figure in life or imagination is unintentional and your own problem.

Planet Earth

There's no getting away from it: Sir David Attenborough has done it again!

The first episode was aired last night and already you can see that the show will be a tour de force in the genre.

Stunning landscapes, beautiful animals and state-of-the-art videography and filming have become de rigeur in wildlife filming but, in my humble opinion, there is no organisation who bring it together as well as the BBC.

That it also makes people more aware of the damage we are doing to our home can only be to the good. This post is not the place, however, to go on about global warming. I'll do that at a later date...

Doomed!! We're all doomed!!

It never ceases to amaze me how the media affects people. Bird flu is a case in point.

This morning a patient contacted me to say she had seen a dead duck the day before yesterday. Now she is feeling unwell. She is worried she has contracted bird flu. I take a deep breath, explain that she hasn't got it, and give the usual advice on how to deal with the symptoms of the common cold. But I don't blame her for being worried. How was she to know?

Only recently have the press started being less sensationalist about bird flu and its possible effects on humans. However, somewhat over-egged stories can still be seen in numerous tabloids such as this story in my favorite paper. The BBC has generally been more circumspect, providing a more balanced view of things.

For myself, I am more sanguine: bird flu will inevitably reach the uk. This is not the disaster people think. It is part of the natural order of things. At some point, this virus or another will make the transition to human from whatever it's current host is and we will see another global pandemic.

But there is no need to panic. Admittedly they started slowly, but worldwide, governments are finally starting to take the threat seriously. There have been moves afoot to develop a vaccine for some time, but only recently have governments started to take an interest.

So what can you do to stop yourself getting bird flu? Not much to be honest. But don't worry. At the moment you are significantly more likely to die as a result of an asteroid strike on the Earth.

Normal flu on the other hand is doing the rounds. Advice on flu and managing the symptoms can be found here.

Next patient please...

NHS blog Doctor

I've just discovered this blog.

Very funny, and I commend it to you, one and all.

I only wish I'd got my act together sooner and thought of this first. I could have made a mint from the advertising...