Competence-Capability-Phronesis: An ancient idea inspiring innovative enhancement to medical education?

Apologies for neglecting this blog site. Good news though, I wrote a blog for the "Good Doctors" website on request by the GMC. I am honoured they are interested in my PhD work on Phronesis ( Practical Wisdom) and its application to Medical Education. Here is the blog, originally published on https://gooddoctors.org.uk on 24/6/16. Enjoy, feedback welcomed:

Wednesday evening, and I am sitting on the side-lines of the dojo watching ‘the Master’ sow seeds of wisdom to my six year old son. The Tae-kwondo teacher is speaking about the belts he has to progress through in order to attain mastery.

“These mark your wisdom” he says, “treat them with respect”.

Fast forward to my other world (GP Education) and I saw a connection; Competence, Capability and Phronesis are like belts. Completing speciality training is not the end of learning journey, in fact it is probably just the beginning.

To me, the ultimate CPD is to seek what it means to be a wise doctor. To do the right thing, at the right time for the right person, whilst keeping societal flourishing in mind and attending to one’s own well-being (Eudaimonia). This concept is described as Phronesis (Practical Wisdom) by Aristotle. Yes, that’s right Aristotle, the son of a physician from 2500 years ago!

Phronesis is an intellectual virtue that adjudicates moral virtues. It has an executive function when moral virtues conflict e.g. honesty versus compassion. It lends itself to situations which are unpredictable and ambiguous. Phronesis seems particularly suited to the work of the General Practitioner, where uncertainty prevails. The dominant positivist approach to the practice of medicine operates on a level of predictive probability guiding the clinician’s knowledge. We know that the rules don’t always fit and the guidelines are often step removed from the real world. General Practice defines itself in terms of relationships, where knowledge is co-constructed and is specific to the circumstances at hand. Alasdair MacIntyre developed these ideas further in his work “After Virtue”, he speaks of Phronesis as a broader concept in holistic professional development.

Phronesis is rooted in Virtue Ethics, an undervalued moral framework in Healthcare education. The moral frameworks that dominate medical education and healthcare are rules-based code ethics (Deontology, Consequentialism and more recently Libertarianism). The code-rules based ethics have no doubt revolutionised medicine (EBM, Quality standards etc.) but I believe it can only get you so far, and we end up with reductionist targets and hidden curriculums as unintended outcomes, sometimes with deleterious consequences.

Phronesis captures not only the essential, well-emphasised cognitive aspects of professional practice, but it highlights the importance of the agent’s affective (character) and reflective abilities. These three elements have been repeatedly emphasised in more general literature on wisdom development and attainment.

“There are three ways in which we learn wisdom, the first is by reflection which is the noblest, the second is by imitation which is the easiest, and the third is by experience which is the bitterest”   Confucius

So, the cynics will now be thinking “character education?”, “Professional virtues?” How is it possible to educate for this with so much moral pluralism in society? Agreed, but we are talking professional virtues and we already have set standards in good medical practice. I think the key here is to nurture a growth mind-set (Dweck) in learners, moving away from the fixed mind-set that plagues competitive courses and careers. We need to talk about professional virtues, benchmarking against each other in supportive environments.

How do we know what a Phronimos looks like? Rodger Neighbour suggests, “We will know it when we see it” (The Inner Physician). Aristotle defines them as attaining the golden mean, which is a path of moderation between two extremes (e.g. Sentimentality…..COMPASSION…..Detachment).

We face huge challenges, but not insurmountable. We know how important it is to be a reflective practitioner, but the wielding axe of legalism comes in, and doctors are scared to reflect candidly in their learning portfolios in fear of being sued. We are time-starved, with stress levels hitting an all-time high for many. To me these are indicators that we need to do something, we need a paradigm shift.

The bottom line is that there are so many unanswered questions, and the only way we will come closer to understanding and maybe even achieving a ‘Phronesis belt in Medical Practice’, is if we take the concept seriously and study it. That is why my PhD aims to look at enacted Phronesis in General Practitioners.

“The best doctor is also a philosopher” Galen.

About Dr Sabena Jameel

Dr Sabena Jameel BMBS, BMedSci, M.MedEd, FRCGP is a General Practitioner in Aston, Birmingham and Associate Dean for GP Education (Health Education England West Midlands). She is also a GP Appraiser for NHS England. She is a third year PhD Candidate at the Jubilee Centre for Character and Virtues, part of Birmingham University School of Education. She is committed to highlighting the importance of the meta-cognitive aspects of learning and developing empirical research that enables professional virtues and values to be developed in Medical Education.

Related links

Online module on Character in Medicine:

http://jubileecentre.ac.uk/1649/character-in-the-professions-medicine

US Undergraduate Phronesis project:

https://news.virginia.edu/content/teaching-wisdom-phronesis-project-brings-practical-wisdom-medical-school

Compassion is a connection

Redeploy your senses

The God of small things

“Health is the soul that animates all enjoyments of life, which fade and are tasteless, if not dead, without it”. 

Sir William Temple. Nectar in a Nutshell 1945.

Some of you may be familiar with Arundhati's Roy's debut Booker prize winning novel "The God of small things" (1997). It is one of my favourite books, for many reasons. I chose her title for my blog because it is a description about how small things in life affect people's behaviour, and their lives.
In this blog I wanted to reflect on the experience of suffering a "minor" illness. In fact, so minor that some doctors would scoff at how such an insignificant diagnosis would violate their already busy day. I am a GP and until recently, I may too, have been lacking in empathy due to poor understanding of the implications, contaminations and ramifications. 
With a retro-specto-scope  I can look back and recall the fear and loss. I can also reflect triumphantly on the lessons learnt. My ailment only lasted 3 weeks and I am back to normal, or am I? I am clinically and physically back to normal...but psychologically I have grown... matured, with a renewed admiration for people with chronic and terminal illness, the tremendous resilience required just to live.

So what do you see? Any medics out there want to diagnose the "minor" illness? The illness that caused pain that seared through my eyes in Christmas week, that rendered me unable to function as a mum, wife and daughter and doctor. That felt like fire burning in my eyelids as I attempted to sleep; no rest when asleep, no peace when awake. A condition that led to blinding intolerance of any light? It required a 30 minute morning ritual of  eyelash exudate dissection. A condition that made me become a patient, submitting powerlessly to the perceived inefficiencies and delays of the NHS. It gave me a couple of panic attacks.......an overwhelming fear I had never experience before. My body was fine, but it was lifeless without vision. A large proportion of my recreational pleasures in life comes from seeing; reading, observing, watching.
The photographs were taken over about 1 week period in Dec 2013. They illustrate a conjunctivitis. Not a normal "common" bacterial conjunctivitis that requires antibiotic eye-drops (and often bizarre nursery policies).
http://johncosgrovegp.blogspot.co.uk/2014/01/conjunctivitis-nurseries.html

This was an Adenoviral Kerato-conjunctivitis.

I bought chloramphenicol antibiotic eye drops over the counter, as initially I thought it was just a bacterial conjunctivitis (from daughter, with love). I didn't improve. I don't like seeing the doctor. As the weekend progressed my appearance and condition deteriorated. I was about two months too late for winning a Halloween costume prize. I missed the surgery Christmas party too. Apart from maternity leave (x3), I had never really had more than a few days off work with illness. I felt I had let my patients down. Checking Deanery emails on my i-pad made me feel normal, at least in my actions..but the reality was I could not tolerate the light from the screen.
For Christmas week I hid in a small dark room, with my three year old son who was also affected. Toddlers are so resilient, they moan, then play!
My family tried to help, but they also feared contracting the illness. My husband even made a roast dinner for 10 people!
I had been to the Midlands Eye Centre A&E about five times over a two week period, mainly because my symptoms were not improving. I was informed of the extreme infectiousness of the virus. I had very good NHS care. The staff listened to me and were kind. I complied with their treatments....and also became one of the 10% of the population who have an allergic reaction to the preservatives in eye drops. Iatrogenic intensification of symptoms?  Oh dear.
Worst of all was the feeling of suffocation I experienced when putting Lacri-lube ointment in my eyes. I felt like I was being buried alive. How disgusting that medication is...I will prescribe with cautious warnings in the future! I spent around £50 on prescription charges, some of the medications became obsolete after one use due to allergy.
I went on to develop a complication from the infection ; pseudo-membranes and corneal precipitates (like cataracts). When the doctor told me the precipitates could last weeks or months I felt devastated. MONTHS????? How can I function if I can't drive for months? Three kids in three different schools, shopping, working in two different places? How? How? Oh no........ I had to submit to this fate. I learnt to be a patient patient. Thankfully the precipitates improved within a week.
It made me realise the importance of the doctor conveying HOPE to patients.

My descriptions may lead you to believe I have a low pain threshold, or I am easily made fretful. Both of these are untrue. This was confirmed by a wise medical educator colleague, a retired GP, who informed me having kerato-conjunctivitis was the most painful thing he has ever had. My yogic breathing thwarted the rising panic....but it made me truly empathise with the patients who come to me with panic disorder. It is an overwhelming wilderness of intense feelings that erupt uncontrollably.

I am certainly not wishing illness on anyone, but I have learnt so many valuable, enduring lessons about life. Not least true self acceptance. I hope this blog will help at least one person with their reflections, with their interactions, with their considerations.

I thought I was just a service provider
My personal NHS Appraisal portfolio entry 10/2/14
I just wanted to reflect on something that has honoured and pleased me. It has also come as a bit of a surprise. Over the Xmas period I was unwell with a serious eye condition. It was the first time I required time off from work for longer than a couple of days (3 weeks). On my return to surgery I have been touched by the genuine kindness and concern from patients about my well being. In fact I have been taken a back, in that it is not just from my regular female patients who are friendly faces, but also from patients I did not even recall - like an elderly Rastafarian gentleman.
I am very honoured to be able to feel their genuine concern. I hope I will always help patients to feel my genuine concern for them. If I ever failed you I am sorry.

Maybe it is just Karma?

I woke up one morning in January and I could open my eyes unassisted. What an amazing experience...to be able to see on waking in the morning. Cherish the small things...as they are in fact the most important things.

Moseley sunrise 12/1/14 - from my bedroom  (smart phone pic, no filter)

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!