My Birmingham and Solihull GP trainers conference speech 2013 - Virtues and Values

You know that vulnerable feeling you have when you want to tell someone you love them, but you know it could all go horribly wrong and that is the end of that?Alternatively, the love could be reciprocated and you could be the happiest person in the world ( at least for a while)? Well, that is how I felt before delivering my debut speech. It is a "debut" in that I have only been the Area Director for GP Education for Birmingham and Solihull for 6 months now. Many of the trainers and Training Programme Directors do not really know how passionate I am about Med Ed and what drives me. I wanted to tell them and I felt the trainers conference would be the ideal opportunity. I have not really delivered a speech on a topic so close to my heart, especially to a large group of respected GP colleagues (who are renowned for not being backward in challenging ideas they disagree with). 
Thankfully, I have had fantastic feedback verbally, by email and on social media. This has been hugely encouraging and has given me a little more confidence to speak out a bit louder about "my purpose". I delivered the speech at the opening of the conference. I had been up since 1 am ruminating about the themes in my head!

"I saw this slide a few months ago, it really appealed to me. I could not really comprehend why, but I saved it anyway. Walter Benjamin the early 20th century German philosopher once said 'speech commands thought and writing conquers it'. On looking for inspiration for this speech that is what happened. In focussing on the words above it became clear what the vision and the process really were to me.

Let me speak about

The vision (short term and longer term)

Aims of conference

I am hoping you re-engage with why you chose to be a trainer, to revisit the warm glow you get from seeing trainees develop.To enjoy company of colleagues with a similar outlook.

To get away from some of the stresses of running your practices, with constantly moving goalposts.

To learn loads, (I am unapologetic for the noticeable increase in intensity in the content of the conference compared to previous years).

We are so fortunate to have such expertise in our patch.. even a Health Service Journal award winner and docs on the Pulse power 50 GP list! Along one of the founders of "Grassroots GP" .....all will become clear at the end of the conference (clue : social media).

Thank you to all the workshop speakers, in advance! We are most grateful for you putting your head above the parapet and offering workshops.

Long term vision

Well, I could speak about GMCs  "The shape of training" or to their document "The state of Med Ed and practice in The UK 2013" or the revised "HEE mandate".. But, I am going to be selfish and tell you briefly about MY vision. To which you may conclude I require some lithium or something..but here goes. 

I am embarking on a six year part time PhD, not for any pretentious title reasons,or for a particular career pathway, but because I truly believe in the cause, I am essentially self funding. I am studying at Birmingham University School of Education, within the Jubilee Centre which looks at Character Education and Values.

My cause is "Eudaimonia" - state of human flourishing ( as described by Aristotle, 3500 years ago) ..Sarby first heard this and thought it was an STI! 

I believe it is potentially possible to achieve Eudaimonia  if we shift the focus of education to character and values. The focus of my research is practical wisdom (phronesis): being wise, in the broad but very practical sense. Wisdom not just as a cognitive process but as a virtue.

It is inherent to our jobs along with other professions such as Law and Banking. I recommend an inspiring readable holiday book by  Barry Schwartz "Practical Wisdom - The right way to do the right thing". 

I will read you a short extract from the book:

We are happiest when our work is meaningful and gives us the discretion to use our judgement. The discretion allows us to develop the wisdom to exercise the judgement we need to do our job well

I ideologically challenge that tick box curriculums, traffic light management of trainees, in fact the very tenant that medical school is based on - the biomedical model, has the wrong emphasis.

(I came up with this quote during a school run incident!) It conveys the value (consideration) being restricted by the societal acceptance of rules defining behaviours.

When I think about what I remember from my GP training, it wasn't the content of the Wolverhampton training grid, it wasn't the content of summative assessment....it was inspirational people/trainers, their dedication, commitment, kindness and work ethic.

There is an error in this slide, but I love it. These are some of the professional role models in my life. It is not supposed to say "saving" across the top, as that was a process of the "app", but for some reason it does. I think as a result it really illustrates what Professor Billett refers to when he speaks of "Appropriation - setting it (behaviours) apart and using it for my own use".

Prof Billett from Griffiths University, Australia  (guru in learning in practice) closed a Med Ed research conference last week suggesting "appropriate Appropriation trumps Mastery".

I suspect we are getting dis-illusioned and frustrated because tasks are onerous and do not seem to serve their purpose in creating the best doctors, and may even prevent us from being good doctors.

Thus, potential solutions which shift the focus to character and values , such as a current movement for positive education - e.g PERMA (Seligman)........So I am hoping you can see my purpose.

For the cynics and critics amongst you ( and there will be some) the educational endowment foundation looked at a cost/impact analysis of a few educational methods. They found that attending to metacognition ( that is essentially what we are talking about here) has a high impact at low cost. 

The process

"Rely less on processes and more on values and culture"  NHS lay advisor Leon Pollock speaking at a Health Education West Midlands conference last week. I seem to be surrounded by confirmatory bias.

About some recent difficulties along with an apology:

-Administration , still no dedicated administrator for Birmingham & Solihull (BSOL). Flux in the administrators who do support BSOL, thus things slipping through the net. We have a patch was big as Oxford Deanery. I have lobbied, Debra (team leader) has lobbied, Martin has escalated. Still no support...but we ( Debra's team and myself) are doing our best under the circumstances. It obviously boils down to ...cost savings, but in the mean time I am aware of problems with .....just about everything that requires good administration.

I am hoping you are thinking, "How can we help?", well being patient with us in the first instance, (* summer ARCP feedback is on tiny strips of paper, as the thought of emailing 180 trainers was demoralising for me) and secondly ....well, maybe ask Martin what can be done?

-Portfolio frustrations...can we field some of the questions for Ryan and Sian's expertise in the workshop tomorrow as they probably have better answers to hand?

- Tightened education and training budgets in a climate of growing training demands in primary care (déjà vu situation) ..inevitable in the current NHS climate..so some advance apologies if the ramifications affect you.

So, for me the "process" is actually less about the operational aspects of the Deanery (but as patch AD I will still strive to ensure we meet the performance targets, quality standards and curriculum aims), but the PROCESS is more about LEARNING, about INFLUENCE and the BELIEF that things WILL BE better, even GOOD, and WE (me and you) can make and influence that GOOD, even with the constraints and limitations.

So, PROCESS to me, is more about an ATTITUDE.

Thus, if you are open to the concept, I am hoping to unashamedly infect you with the concept of Eudaimonia . We have NOTHING to lose.

So ........after 6 months in my new patch AD role my new mantra:

Just a few final housekeeping things:

We have a twitter wall at this conference so please use the hashtag and tweet learning points, feedback and interesting things!

I am still the Associate Dean for Foundation Training in GP. I have not included any foundation workshops in this conference but I have updated the training guide and it is on the Deanery website as highlighted. 

And finally….

I wanted to say thank you…not just for the explicit things you do as a trainer, but for the tacit things too. I prepared this slide for you - I took the photo in Iceland.

Dr Sabena Jameel

28th Nov 2013

Hinkley Island Hotel

Leicestershire

Back to the Future II - My teenage self aged 17

Okay, so if you have not already read my previous blog then this one won't make sense ( so take a peek at 'Back to the Future'). Yesterday I found some pages of a diary I wrote when I was 17. It's pretty Adrian Mole..ish. I think he is about the same age as me too.
I lived in a Derbyshire town called Glossop. At the time of writing the diary I attended a sixth form college in Hyde (near Manchester). I am a doctors daughter. Dad was a single handed GP in Gamesley.
I could see the 'Snake Pass' from my bedroom. I have wonderful memories of my interaction with the landscapes that surrounded me.

It is an interesting contrast having grown up in a drowsy Derbyshire town to living in eclectic, bohemian Moseley in Birmingham. Birmingham now claims to almost be an ethnic majority city.

So lets get back in Doc's DeLorean and go back in time:

Friday 21st Sept 1990
It was Sarah F's birthday today. As soon as I got to college I gave her the 'Alf'. First lesson was with Doc Edwards, all we did was measure cress roots and shoots. Second lesson was free so Carla took me to Gratis in Hyde, its a lovely store.
We had physics practical which was fine. I got to tell Mr Wright that Rachel thought he was sexy...she wasn't chuffed. We had Doc Neath last and I was so tired.
In the evening I drove all the one way systems to get to Pizza hut, the whole family went, it was fun.
Dad has some post-graduate lectures on the weekend. He reckons that I'll have peace to work when he's gone....which is not nice.
The train ride home was really long. Rob, Ben etc.. were chucking berries at high speed. Samantha was getting annoyed so this lad walked past and she kicked his arse, he turned around and she replied innocently " sorry, my foot slipped". It was so funny!
Until tomorrow, inshallah it will be kind.
10.42pm

Saturday 22nd Sept 1990
Frodo Baggin's birthday. Dad set off to his course early. I went to Shire Hill again. I was on the ladies ward. Things went well, Phyllis even kissed me.
Came home, had lunch, then did a biology essay plan and, oh yes, I filled the dishes with water and played them with chopsticks. After this I did my chemistry homework.
I watched Brookside while waiting for dad. As soon as he came he got a call so I drove him up to Gamesley. Sarah came around and we watched 'Dirty, Rotten Scoundrels' (v funny with Steve Martin and Micheal Caine).
Work for tomorrow - revise chemistry, start essay references for Hampson, sort out Physics, water plants and dust bedroom.
I love my parents a lot. I don't know whether I'll be able to be without them at university.
Dad is so proud of me BUT I wish I wouldn't make him sad and be so selfish. I wish I was worthy of his pride.
10.47pm

Tuesday 25th Sept 1990
What happened Sun/Mon...well I was lazy! It's 10:20, I've just watched a programme on medical negligence. It is so hard for me to see doctors under fire.
Today I did lots of homework; I did a chemistry assessment on anions/cations and I had a driving lesson with Terry from Reeds School. He says I shouldn't need many lessons.
In the afternoon I studied waves with Mr Burridge. I was bunged up and giggly. Mrs Hampson set us an essay for Thursday! Dad told me Matron is leaving from Mansion House.
Yesterday I wore Dad's tweed jacket, it went down well at college. Doc Edwards gave me a video on windsurfing...I need to have a go in Tatton Park.
I got my last ecology biology assessments 9,10 out of 10.
I must tell you about 4am Sunday. Dad got a call off a lady in Gamesley wandering the streets ( same one as Saturday's call). On Monday dad admitted her to Shire Hill, so I'll see her on Saturday.
We might go and see Auntie Marie on the weekend. Mum has her GCSE Maths and English exam tomorrow.
Suzy's thick statement of the day, " Do non-magnetic materials attract everything?"
10.30pm

Wed 26th Sept 1990
I have to admit that the novelty of the diary is wearing off. But it might be fun to read one day.
I had college in the morning. Did the usual...watch bean sprouts germinate.....
I was at the train station at lunch, ready to come home. I was eating an apple and a wasp planted itself on my bitten apple, then another sat on my lip. They tormented me for a while. I flung my apple away and jigged about.  I was alone on the platform. I hate being alone in a crowd.
I came home, did some biology and chemistry homework. I watched 'King Solomons Mines' and 'Doogie Howser MD'. I had a shower then watched more TV.
I am listening to Tchaikovsky very loud on the headphones. Mum did her GCSE Maths and English and has been nattering all day. Dad has gone to a meeting at the Village. Suzy is pestering me about magnetism, which I am ashamed to say I know little about, even doing A level physics. I got a letter from my cousin Nausheen and one from Latha in India.

Friday 28th Sept 1990
Today has been a long and good day. I had a high...one of which I've not had since 5th year! I had Doc Edwards first, we've got him for all 4 lessons now. Next lesson was a free. We tried working, Mandy was in, she usually has Friday mornings off.
Jed was creeping for my Physics work, which I wouldn't give him, so he asked Sam instead, who said my worksheets weren't bad.
I found out Darren made a bet on Carla...so I started writing hate mail to him. Oh, I went to juggling club yesterday, and had Dr Bhattia in the afternoon. Emma wrote a really deep poem about luurve (with Darren).
At lunch time I was being very silly with Alison and Emma, Htwe saw the Oxford photos and mentioned I was "mean"??
In the afternoon I had a physics practical. Simone bitched about Sarah W. Ma and Pa went to Linfood cash and carry and bought 72 cereal bars. In the evening I went to Yachting - good but expensive.
11.15

Sunday 30th Sept 1990
Got up early (9am) and went to Shire Hill. It was a 'Fun Run' today. I showed a lady called Veronica the start of the race. I went to Shire Hill yesterday too. A bloke told me I worked really well as a voluntary helper. There was another voluntary helper too, he was an 'american footballer' in the race. He had a really sweet face. I saw Simone and Ruth, their friend Sarah went as Bill (and Ben). She looked really good.
I served lunch at Shire Hill and came home and had some yummy chicken. In the afternoon we went to Roy Hall, it's very impressive. I saw a lovely woodland picture, but could not get it as the queues were large.
Watched the Clothes show and a lovely programme on the ecology of Arabia. Dr Jonathan Miller had a programme called born talking which was excellent.
I pressed dad's shoulders and neck and pray to be more caring and patient with my parents and sister. Sarah told me her 'N' problems yesterday. She's in deep. I can only advise.
10.52


Tuesday 3rd Oct 1990
Ma is mad at me for not signing my cheque for yachting. Dad got a call saying Mrs Jameel has not signed a cheque....it was me. Oh $*!*. I'm going to the adult centre tomorrow to apologise.
Today I had my interview at Manro chemicals. I was 40 minutes early. I sat on the bus to Stalybridge with Sam's mum. I had a man interview me, he said "If all the people I had interviewed in 27 years were like me he'd really enjoy his job!". I've had an aching grin since.
Dad collected me from the cinema, it was hard to find a phone. I walked into a pub full of dorks. Oh yes, during the interview we talked about sailing. I asked whether he did...he said he isn't a seaman!
Came home, hoovered, watched a few mins of THE OMEN. Sarah told me she is still mates with 'N'. Dad came home late, he had a meeting. He organised a day for me with an SHO doctor.
10.40

Friday 5th Oct 1990
This morning I had a really nice breakfast. Dad brought a doggy bag from 'Woo Sang'. I met Sarah and man on the train. She's moving on Sunday. I'll miss her.
Biology with Doc Edwards involved watching a fishy video. I opened my brolly inside, and got into trouble.
Second lesson me, Carla and Ruth went to get Jemma's pressie. We got £19.50 so decided on a gold chain, cards and badges.
Had Doc Martin for physics practical, he was nice but I embarrassed myself when putting experiment back.
Came home, ironed ready for tomorrow (Worcester), had dinner and got ready for Yachting.
Yachting was about ropes. It was good, Nadine made an excellent chart compass.
Went out to celebrate Jemma's birthday. Saw loads of ex-mates from Glossop School. They've changed. Jemma was really funny. Saw Mr French, Wiz and Priest. Spoz said "Hi", he also said " I was a vision and he had been to the Indian restaurant for his 18th".
12.03

Monday 8th October 1990
Ma's birthday...45! I got up and gave her a present - a nightie, she liked it. Ruth and Alison got their purse nicked on Friday. Did the solid "photoelectric" effect with Mr Ball. Had lunch, ate beansprouts, and ended with Chemistry.
Came home, had some of Ma's birthday cake, watched TV until 6.30pm, had a tiny bit of homework and had an early night.
Worcester was really nice on the weekend. Set off at 7.20am reached at 9.30am. We went shopping in the town. River Island was great. I got a dress and a skirt and top. The Fownes hotel was amazing. We had a buffet lunch. Dad went to his conference while we took mum shopping for clothes. Came back to the hotel and had a shower, flooded the bathroom. Had dinner, wore the new dress with unaided stockings. The doc sitting opposite me was cleaning the wax from his ears with the teaspoon...yuk. There was a dance in the evening, so I boogied until 12.15. I had a major fight with Suzy. On Sunday we got up, had brekkie and visited the Cotswolds. Burton on the Water and Chipping Campden were so pretty. I had a most enjoyable weekend. Dad was so kind.
9.30pm

Saturday 13th Oct 1990
Long time no write. I had a driving lesson. In the evening we went to Yan Sing with Dr Hopkins. It was a wonderful meal, except I drove and it caused stress. On Thursday I wagged school and did homework instead. On Friday I found out Rachel has got an interview for Dentistry at Cardiff. Oh heck, I've not heard. We had a chemistry test which was okay.
Saturday today, went to Shire Hill. P is late. I've been eating too much. I came home from Shire Hill and put hot oil in my hair. Had a lovely lasagna for lunch. Sarah came in the afternoon. I did no homework. Dad gave her loads of furniture. She tried on Ma's saris, she looked nice.
Had a shower then went to see baby Carmella at uncle Samaji's house. We then went to Syma's house to celebrate her 13th.
12.06pm
P.S Jamie said if I read a text book cover to cover I'll get it ?!

So, there you have it - my 17 pages of teenage diary. I have not embellished it or made a 'story' out of it. Sorry there is no 'conclusion' to the stories and characters in the text...I guess I am a living conclusion?
Good luck with your studies. Even if you are not studying, consider writing a diary with your feelings in, at least for a couple of weeks. Reading back on it years on is quite therapeutic, I have enjoyed re-living being 17, especially as the angst is only two dimensional now!

Back to the Future - My teenage self aged 17

I have been meaning to blog for some months now. Forgive me for the long break. I have been busy though. I have read some thought-provoking books for my PhD as well as settling in to my new Associate GP Dean post. If I get chance I will revisit some of the books with you.
The thing that has made me start writing today is something that almost brought a tear to my eye. Whilst filing something away I came across 17 pages of a diary I wrote between 15th Sept and 13th Oct 1990. I was 17 years and 6 months old.

It is the 22nd Sept today, so I thought we could travel back 23 year, almost to the day. I will lay my soul bare. The intention of doing this is not to cause embarrassment to anyone. I am simply hoping that if you are aspiring to do something a little bit out of reach, maybe you are applying to universities? Then gain some strength from my insecurities and teenage reflections ( I clearly had some bad eating habits...not to be emulated). Believe in yourself and do the best you can.

Saturday 15th Sept 1990
Today is a boring day to start a diary. I should have started on my holiday in the Highlands, or when I failed my driving test or something. I wouldn't know where to start. I want this diary to be fairly interesting to read. I want it to be very private and personal but I'd be scared of writing down some of my deepest thoughts as I'd probably be ashamed of them, and if anyone should read anything by accident I would hate for them to get hurt.
I'll have to start being honest about myself, but then I'm scared I'll sound neurotic.
It's 9.05pm, I'm listening to Elgar's cello concerto, in bed. It's really emotional and it reminds me of how much I yearn for peace and refuge in a mountainous, romantic wilderness. I'm not stupid, I know life's not like that, but it's a magical fantasy which casts my mind from " the damping effect on amplitude" and the "reactivity of S block elements".
I really want to be a doctor. I know it will be sooo hard. I hate stress. I become someone else. I hurt people I care for most. Today I am not stressed, but I was frustrated when I couldn't do my physics worksheet. Only Allah knows my destiny.
I went to Shire-Hill hospital this morning. Did the usual, I shaved Harold and some other blokes. I was asked to manicure the ladies too, but I have no scissors.
It was a sunny, warm day. I drove to Tesco in the afternoon. Then I visited Sarah with Raza and company.
I was looking for a suit in a catalogue but got very little inspiration.
Dad asked me , if I had money what would I want. I gave him a few simple answers. All I really want is to be happy, and good to my family. I suppose today's diary is longer than expected.
Don't be surprised if I don't write every day. Don't be surprised if I get the dates wrong.
I'd just like to keep track of me, my feelings etc..
Today Suzy must have been disappointed. She likes Nawad from New York, but she found out he is a different type of muslim, Ahmedy or something.
Anyway, I must leave it for today...with the last word that I would like to lose some weight.
9.25pm

Sunday 16th Sept 1990
Well, what can I say? It's 10:48 pm and I have just driven back from Rizwana's house. We had a good chat, but most of it was about the unfortunate issue of "A levels". She thinks I'm pretty square. I wish to be a happier person.
I spent about three hours doing an essay on cell growth. I don't know what possessed me. It's a form of revision. I think it's a way of rebelling, showing how much I need to work to attempt to do well.
Now for the honest bit: Of course I love my family, but when I am too pressurised by them - going whenever and where-ever they want. I wish they would just go out without me. I hate stopping their fun.
I drove to the cash and carry Roy Hall this morning. The subject of "the test" came up. Why I am so bitter and hurt by it? God, I'm so stubborn. My driving today was affected by my feelings. So dad shouted at me and said I deserved to fail, which I am sure I did. Why can't I enjoy life anymore? It must be growing old. I'll try to be more merciful.
10:56pm

Monday 17th Sept 1990
It's 9.12pm. Words cannot express how I have miserably failed to understand my physics and chemistry homework. I've really got to try and get help. College was tiring but Mr Wright made physics slightly more interesting than usual. I had a "free" first so I did some physics and went in late. I had a carrot at lunchtime and my ryvita at 3.40pm.
In biology I got an 8 in my assessment, which is OK. Doc Edwards was really chatty about windsurfing.
I felt bored in chemistry so I didn't concentrate very hard, therefore I don't understand my homework.
Someone was chucking things in my direction on the train today. God knows why but it HIT numerous times.
Mandy's worried about Andrew who is home tomorrow and Emma won't tell me the secret to her afternoon good moods.
I came home and watched "The Clothes Show" on video, then TV101 (last in series). I tried to do my homework at 6 ( did not succeed).
Uncle Aslam rang at 6.30. We had a small chat. Amir Khan was on "The rough guide", taped "King Solomon's mines". TV was too good today. Work was bad. Life was fine. Alison was ill.
I love my family. I wish I could show them how much.
9.20pm

Tuesday 18th Sept 1990
It's 8.34pm. I am listening to Delibes flower duet. I can't do my physics homework, same as yesterday! Mandy couldn't do my chemistry so the question must be wrong! She said " Never say die", so I reckon that's what keeps her going. I tried saying it when I couldn't do my physics, but as you can tell....I died.
I've got to ask tomorrow.

I rang Reeds driving school and spoke to an answering machine. Dad taped Oprah Winfrey with Tom Cruise which I watched as soon as I got home. At college we had Mrs Hampson, who thinks I am stupid. Doc Neath was alright for a chemistry practical. We also had Mr (I can't cope with him) Burridge.
Rachel was depressed and Mandy was worried.
Dad wants me to go to Newcastle/Lakes this weekend. If I don't go the whole family won't go. I know they want to go, so its almost blackmail.
I know I NEED TO STUDY, but I can't do both. What can I do? Dad says he will not go without me.
I have to get into medicine.
I'd like to do a yachting course at the adult centre on Friday nights. I'm supposed to be doing windsurfing tomorrow but I have made no arrangements. I will have to do something else for complementary studies.

Wednesday 19th Sept 1990
Had chemistry first lesson- I got jip off Mr Haughton. Sarah and Carla had gone to a biology convention at Manchester Poly. At break we had assembly with Mr Ball. It was about UCCA forms. He said the first 15 had been sent off already! I then had physics with Mr Ball. He's a strange man, sometimes you think you know him, other times not.
I had to wait all through lunch for a talk on complementary personal leisure. I went to the Adult centre ( after just catching the train by a breath) and I booked myself on a yachting theory course on Fridays.
I've got an appointment with the expensive Reeds school of driving - (his indicator is on the left).
At 4pm we went to Wigan. We gave Aunty Bunty's anniversary present to her cousin Jean. Her family was lovely. We had dinner at Syma's house. Anam is so cute. We gave Nadia her birthday present.
Overall I had a very lucky day. Mandy is happy Andrew is going to see her. Me and Rachel had a depress sesh. I have to ask about physics C3. Oh yeah, I've got English tomorrow, that will be a change.
11.09pm

Thursday 20th Sept 1990
It is 8.58pm. Yes, pretty early today. I am tired from last night and I have a sore throat. I had a free lesson so I made my salmon ryvitas, did some physics revision ( but not anything worth remembering), I got stuck.
Before I caught the train I withdrew £20 for my Reeds 'rip off' driving lessons. I had biology second class. Mrs H rambled on about chemical mixing in the sea. TRIED to do some physics at lunchtime.
Next week I'll go juggling with Rachel and Carla.
After lunch I had Dr Bhattia for creative writing. I was too creative for Hydra ( I don't want to write for the school magazine). I was sat next to two knobs who laughed all the time.
9.15pm Suzy just brought be some hot blackcurrant drink, she is such a sweetie. I came home at 4pm and was nibbling all the time. Simone surprisingly came over. She wanted to borrow lower 6th chemistry papers.
I was a bit insensitive to my family today. Mum worked hard on homestuff etc... Dad said I was beautiful when I looked like a trog.
I must look after ma and pa.
9.20pm
P.S Try to ask about chemistry and physics.
Must start chemistry revision.


21:30pm 22nd Sept 2013
Get back in the DeLorean folks....I have to put my 3 year old to bed.
I will write some more entries from my diary in the coming weeks....if you want me to?
I sincerely don't want to offend anyone. If you have been mentioned above, and don't like the context, just email me and I will edit. I did not change any names because, whilst typing this I remembered you and recalled the important place you once had in my life...and for some people you still do!

Storytelling

Daughter's lament
"Why did you leave him there for five hours? Admitted straight from diabetic clinic to A&E, unwell. Why not straight to a ward instead of hours waiting 'to be clerked'? The tea lady was nice, simple but caring. Her BMI was no example of 'health'. She looked cuddly though, in her ill fitting uniform. She remained oblivious to time-scales and targets. She dutifully, but kindly, offered us tea every hour or so. No one else acknowledged us. 

He is diabetic y'know. He took his insulin at 5pm and was not given any food - hypo ahead. He cannot hold his neck up in this seated position for much longer, he has cervical spondylosis too. You have made him sit on the A&E trolley for 5 hours.
I can see you are busy. He is in too much pain. I can't watch this.

We weighed up the situation. We decided that being at home is better than this, despite his eGFR (kidney function) being in his boots. We walked out of the department. No one noticed....except for the tea lady. You could see the anguish in her face. She felt powerless to do anything, she tried to tell someone...everyone was too busy. 
She was not powerless...her compassion had power."

This incident broke my heart. It was a defining evening in October 2012. I am blessed that my father is still alive, but the realisation that doctors and nurses are too busy to care drove me to want to be part of a solution...not part of the problem. I work for the NHS, I have to take some responsibility for this event.

"The only thing necessary for the triumph [of evil] is for good men to do nothing." (E Burke)

 I realise I have made a big generalisation, apologies to those who strive to hold on to the values that compelled them to work in the "caring" profession.
Earlier this year we were shocked and saddened by the stories of neglect and poor care described in the Francis report. What is happening? Compassion fatigue?

Compassion costs nothing
On the 25th April I attended an RCGP Midland conference called " Compassion in Healthcare". I heard Prof David Haslam speak of a deterioration due to 'task based care' versus 'person centred care'. He spoke of the barriers to compassionate care e.g. busy-ness, lack of continuity, lack of a sense of personal responsibility. He went on to suggest what we could do about it:

• Value compassion
• Review criteria for medical school recruitment
• Value the role of the Generalist
• Appreciate each other - the way we treat each other matters

Everything he was saying made absolute sense. Interestingly, in a workshop, one doctor said that he has not got time for compassion in the ten minute consultation. I can see where he was coming from as I think he was alluding the the time pressure and being 'busy', but I was not in agreement. Earlier in the week I had an interesting conversation with Kevin Ilsley about the impact one can make in ten minutes. Clinicians are often  not aware that in ten minutes you could change someone's life...by inspiring them, by empowering them, by being kind to them, by offering a solution. On the flip side it takes less than ten minutes to break someone's trust and lose them for life.

Jill Fraser gave a very sincere, high speed talk on the charity Kissing it better. She entertained us with the ridiculous levels of bureaucracy standing in the way of 'greater good'. Admirable and Simple interventions.

The short narrative at the top of this post was written as part of a workshop by Katherine King and Kevin Ilsley. I had never written down the incident before. We were asked to narrate an incidence where compassion was lacking. In writing it down it made me think about how to use words to convey feelings and context. Most of us don't really get the chance to do this kind of thing. 

"For the professionals, storytelling and hearing has some particularly important roles to play in helping us to understand our clients and in helping us to explore our own practice. These stories that we tell and hear, but which, at the same time we are also part of. And we learn early in professional practice, if not early in our life, that there is always more than one version of a story. This, of course can be turned to positive use in trying to understand something through a story. And one of those things that we can learn to understand better is the art of storytelling itself" 

Fish.D 1998 Appreciating Practice in the Caring Professions p154

Stories can be entertaining, shocking, untrue and there is often much to disentangle. De Cossart and Fish - Developing the wise doctor (2011) state that doctors have to make sense of individual accounts of patients or colleagues, in a world of complexity, paradox and ambiguity, above all else, stories:

• Exist in the particular ( they are about individuals)
• Highlight the importance of moral enquiry (they show the importance of seeking in the given case what the most opportune action might be)
• Promote the pursuit of practical reasoning - 'the ability to determine the best action to take in particular circumstances that cannot be distilled into universally applicable solutions'. 

I find the latter point most interesting. De Cossart and Fish cite Montgomery (2006) for the quote. This, to me sounds like Aristotle's concept of Phronesis -  Practical Wisdom.....a subject I am sure to mention again, as it forms the basis of my PhD.

Storytelling need not be in the form we traditionally associate it with. Dr Anne Marie Cunningham (who writes a good blog and is very much engaged in technologies and Medical Education) brought my attention to the potential of digital storytelling and it's ability to help students to reflect. I have to admit that I love watching the RSA Animate videos on YouTube. I had not thought of it as digital storytelling!

One final thing I wanted to mention is Storytelling in Leadership. I am coming across an increasing amount of information referring to the power of the art of storytelling in leadership. There are even courses at top universities e.g "Winning Hearts and Minds - Storytelling for professional managers" - Cranfield Business School. The hyper-links are from Forbes magazine and Harvard Business School, respectively.

I certainly think there is room, for those of us who were pummelled with years of bio-medical and clinical education, to revisit the art of telling, and interpreting tales.

Tell me a fact and I'll learn. Tell me a truth and I'll believe. But tell me a story and it will live in my heart forever. ~ Indian proverb

On Death and Professionalism

The bubble-blower analogy
During our lives we blow content, in the form of experiences, moments of love and sadness and the mundane in between. If we stop to reflect IN life we see the beauty of the translucence, the perfect curve and the reflected rainbows within the bubble. As the content increases so does the fragility of that bubble. Then it bursts, physically evidence less, into the ether.

Empathy the action of understanding, being aware of, being sensitive to, and vicariously experiencing the feelings, thoughts, and experience of another of either the past or present without having the feelings, thoughts, and experience fully communicated in an objectively explicit manner; also : the capacity for this (Merriam-Webster dictionary)

This is an "unscheduled" blog. I only intended on writing one a week. I have been thinking and reflecting all day. Why? Because this lunchtime we had intended to visit a respected relative/friend/GP who has been incredibly resilient in his battle with cancer. We intended to visit him at lunchtime at his home, but instead we attended his funeral.

• He was of my generation
• He has left behind two teenage children and a devoted wife
• He was a Birmingham GP

This, amongst other factors, made this funeral particularly difficult for me. His father spoke in a broken, weak voice. He pleaded that we pray for his son. These words reverberate in my mind. No parent expects to bury their child. A man who bathed his cherished infant was now washing the body of his son, whose body has been consumed by a parasitic cancer. 

Of course Dr F professionally knew death;

" The doctor is the familiar of death. When we call for a doctor, we are asking him to cure us and relieve our suffering, but, if he cannot cure us, we are also asking him to witness our dying. The value of the witness is that he has seen so many others die...He is the intermediary between us and the multitudinous dead. He belongs to us and he has belonged to them. And the hard but real comfort which they offer through him is still that of fraternity"

Berger J and Mohr J. A Fortunate Man. 1967

But he must have had an entirely different experience being a patient. My curiosity led me to do an Internet search on literature on dying doctors. I found an interesting article in the Guardian.

How doctors chose to die

The sentiment resonates with some books I am reading at the moment. Matters of Life and Death by Iona Heath takes a critical look at the state of medicine today,

" Science does not know when to stop"....and I wholly agree with her in this context.

Dr Heath's book should be essential reading for all GPs. She bravely and sensibly presents eloquent examples from the humanities about death...and what a good death might look like. I hope for a good death, when the time comes. I want my patients to have "good deaths" too. John Berger contributed to Dr Heath's book. He wrote A fortunate man, quoted above. This provides a fascinating insight into the life of a country GP in the 60's in Ireland. This conveys a certain professional wisdom and benevolence that I feel needs to be discussed and explored in modern Med Ed programmes. 

Debilitating empathy - has it ever happened that a doctor has had so much empathy for a patient that they lose the ability to think objectively? It would be considered unprofessional I suspect. So as doctors we put up barriers to protect ourselves. Only by reflection can we tell if we get the balance right. 

Tenuous link to the fact that I have had to read the GMC's new guidance on Good Medical Practice, which "goes live" on Monday 22nd April. The reason I have read this is:

• I have to, it is my professional duty to do so
• I am involved in a teaching session on professionalism next week
• It forms the basis of revalidation

Anyway, whilst  reading it something struck me. Statement 16c says:

• Take all possible steps to alleviate pain and distress whether or not a cure may be possible

This perturbed me as I had only just read, and agreed with page 37 of Iona Heath's book:

" You need pain so you are aware you are alive. Everyone says 'do you have any pain' anxiously. It should be the other way round" ( Julia Searle speaking about a good death)

Heath describes that Gadamer felt that biomedical technologies relieving many of the symptoms of dying, deprive patient of the experience of their own dying.

Surely, if we aim to offer truly individualised care we should at least ask the patient how much pain they wish to tolerate?

So, in this late night deliberation I decided to "follow" @gmcuk on twitter, and in only 140 characters describe this conflict. I await their response.

Thank you for taking the time to read this blog. Please interact, I would really love to hear your thoughts on the issues raised and the blog style itself. Forgive my intellectually naivety, for I have words, which I feel are a spectrum racing around in my head. There is a connection, not just linguistically but also in my own personal direction in life.

Life

Death

Humanity

Humanities

Humanitarian

signing off with Lao Tzu's words:
" Just realise where you come from: this is the essence of wisdom"

On mentoring and educating girls

Holiday over. I arrived back in Brum yesterday morning with 3 sleepy kids following a night flight. The tedium of the transatlantic flight was alleviated by watching some movies I have been meaning to watch: The life of Pi and Silver linings playbook. Both films spoke to me, as I am sure they did to most their viewers. I will not bore you with my personal reflections, but one thing I will not forget is the metaphor of the Bengal tiger that Pi most feared kept him alert and saved his life. He missed the Tiger in the end.
After a 60 minute  power nap post entering a freezing cold home, I then went to a local inner city Primary School where I have volunteered to be a mentor on the Mosaic programme.
http://www.mosaicnetwork.co.uk/en_gb/portal/primary-school-mentoring
This is my first experience with such a programme. I wanted to " give something back", to try and inspire a generation of young girls to see the power and value of education. To make the best of themselves and realise their potential. What is great about this programme is that we have sessions with their mothers too. It was a real eye-opener to hear the mothers' stories about their difficulties accessing education. One young Pakistani-origin mum told me that her parents took her out of school when she was 9 having started menstruating, she has not had any formal education since. This was the first day of the mentoring programme, we explored professions and the gender associations with certain jobs. In the run up to today I had attended planning meetings and an interesting educational session on mentoring skills by Michael Mallows, similar to the one in this youtube clip.
http://www.youtube.com/watch?v=TeSadm_GJ7Q
I look forward to developing a relationship with these year 5 girls. One of my aims is to learn from them, and to learn more about myself. I will be sure to update you.
Oh, I must tell you. I am so proud that Malala Yousefzai has enrolled at my daughters school EHS. She is the amazing young lady who continues to be a spokeswoman for womens' right to education. She sustained a Taliban bullet to the head in this pursuit.I wish her all the best in her studies and work. Hey, she even met Angelina Jolie recently!
http://www.youtube.com/watch?v=KFKpcyDKLX4
Finally, whilst I am on the subject. I wanted to highlight a non-profit organisation ( currently awaiting UK charity status) called Symphony. Their mission is to provide women with a means of an education, enabling them to break down socio-economic barriers, and have the freedom to invest in themselves, their communities and beyond.
http://www.oursymphony.org/
This resonates with my blog theme this week, and as you have gathered, a topic close to my heart. I have been liaising with the founder of Symphony about sponsoring the nursing education of a Zambian student. This would be a 3 year sponsorship that would put her through nursing school, enabling her to start out on a life of financial security, while also giving back to her community in a meaningful way. I hope I would not be abusing my position if I were to try and recruit sponsors via this blog (feedback on this issue welcomed). We can then club together and sponsor the medical education of a young woman in a developing nation. A deed I think would be really worthwhile.

"If you are in a country that is progressive, the woman is progressive. If you're in a country that reflects the consciousness toward the importance of education, it's because the woman is aware of the importance of education. But in every backward country you'll find the women are backward, and in every country where education is not stressed its because the women don't have education" Malcolm X. 

Signing off from my study in Moseley
Sheikha M

Coming up:
In my next installment I hope to update you on my new role as a "patch" Associate Dean. I need to get through my 400 email backlog first!

Being taught by my son and my cousin, both 27 years younger than me

Currently on vacation in Florida. My cousin has inspired me to write a blog. She is 13 years old and writes a very entertaining blog. I do not want this act of setting up a blog to be construed as a narcissistic act (did I spell that right? I need to find the spell check). Instead, I have aspirations to reflect on my work as an Associate Dean for GP education and as a GP practicing in inner city Birmingham UK and jotting down any pearls of wisdom from my PhD Studies ( Birmingham University School of Education). So, I guess this first blog's audience is just me! No worries! At least I have learnt many things in setting this up and appreciated the wisdom of the younger generation. I do hope that in time, this blog will be useful, entertaining and informative to others...high hopes, I know!
Oh, just for the record, Sheikha Mozah is the wife of the Emir of Qatar, she is an awesome and most glamorous role model ( hence the blog name). I love her style and she is a great supporter of Med Ed causes. The reason I call myself "Sheikha Moseley" is because I would love to look a good as her when I reach my 50's and I live in Moseley, Birmingham! Technically, I have no rights to call myself a Sheikha but I could call myself a Sultana ( being married to "Sultan"). Shrivelled, brown and wrinkly I don't aspire to though. Signing off from sunny Kissimmee FL.