Fat But Fit But No

There’s a news story out today – apart from Bad sleep makes you look ‘significantly’ more ugly” – on whether the ‘fat but fit’ myth has been truly busted.

I’m not completely familiar with this ‘health rule’. I think it’s one of those things that they omitted to teach us in medical school (for example, like what toxins were), because, despite their popularity in the general world – they weren’t really a thing.

It’s an impressive story though. Researchers at the University of Birmingham have analysed 3.5 million medical records to see if those who were obese – but with no medical problems, or abnormal blood tests – would avoid illnesses later in life. The answer was no.

What’s impressive about this is the sheer numbers involved. It’s a problem to use a small number of people in a study, because you’re disproportionately likely to be affected by an abnormal result, or ‘outlier’. For example if there is one friend in your friendship group of four who is an idiot, then unfortunately it sounds like 25% of all people are idiots. When you would swear the number is higher. So the smaller the group or ‘sample’ the more it’s bound to be skewed. The bigger the group, the better the representation of what life is genuinely like.

So much of science is just how to get as close to the truth as the possible.

So it’s still not a definitive answer.

For example, the study still needs to be peer-reviewed before it’s published in a paper. This means that other academics will scrutinise it to make sure the scientists are presenting their results in the most honest way, and not just trying to ‘sell’ it. Even then, bad papers will slip through.

Also, it has been noticed that the cut-offs used for blood pressure and cholesterol may be too arbitrary. There’s something in this.

For example, we use the bell curves to work out what is ‘normal’ but inevitably we get people who are normal with abnormal results -they’re the outliers. However, that is a much bigger problem than just this paper, which a lot of medicine is prone to.

So – is it useful?

Yes! I would say so. A big study like this is helpful, as long as we keep the context in mind.

And what does it mean?

Basically we can’t give you the green card to not care if you’re overweight, even if your blood tests are fine. Not yet anyway.

Oh, and apparently not getting enough sleep makes you ugly.

So, no pressure.

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Time to clean your room, UK!

Occasionally I wonder what it must be like for kids in school at the moment.

Adults are wandering around crying it’s the end of days, no matter what’s happening. Rights are getting stripped away from people, and the people who it affects the most are ignored.

It’s a history lesson unfolding in real life.

This is what happens if you do not have a strong opposition in power.

This is what happens if money is allowed to have the final voice.

This is what happens when an incredibly powerful and right wing press gets to run riot over people’s lives.

In one of my favourite sitcoms, The Middle, the oldest teen son finally gets his chance to vote, and his family are shocked by his excitement, considering his total apathy in life otherwise.

“My whole life people have been telling me what to do,” he says. “Sit up straight. That cup’s not a toilet. Clean your room. Well, now I finally have a say. Now I get to tell America to clean its room.”

It’s both beautiful and terrifying in one moment. But that’s democracy.

Sorry, kids, we’ve messed up.

But register to vote (and people will try and stop you!) and you can finally tell us off like we need.

It’s your future after all.

Identity

I wonder if I’ll be the first person to hold an annual blog.

In that I only blog once a year.

It will be like Groundhog day, where people anxiously wait for me to emerge from my hole, tap a couple of times on the keyboard, before fleeing back to safety.

The truth is, starting this blog was meant to be an exercise in knitting together my different identities – doctor, patient – carer. And then my father died. And then I didn’t know what I was.

The phrase would pop up in my head, ‘well, I’m no longer a carer’. But eventually, one day, it jarred.

I’m still his daughter, I thought. I’m still my father’s daughter, that will never change. And those memories, those things I learnt, those experiences as his carer, those painful learning curves have not left. I’m still a carer, though the context is difference. I’m still a carer, though the identity, the experience is part of a wider pool than it once was.

It did help.

Strike #2

So I got a call on Tuesday from a gentleman I previously had spoken to at The Guardian, asking me about the strike.

‘Are you striking?’

‘No, well, I’m not working at the moment, so I can’t really strike, plus I have an exam to study for, and a member of family in hospital…’

‘Do you think you could write something about the strike?’ (he was much more understanding, and much less abrupt than this, I’m summarising)

‘Well, I don’t know, I’ve got a lot on, and I’m not really sure what I could say – I mean I could try and think of an outline’

And, despite feeling like nothing would come of it, I sat at the computer. What could I add to the debate that people weren’t aware of? I was so tired! I had stuff to do. I hadn’t written much since Dad passed away, I was just trying to get things together.

And then I started writing:

“There is an ideal of a doctors. They work long gruelling hours, nobly accept thanks when another life is saved, and sacrifice their own lives for the sake of others. Except that it isn’t true. The problem is that we’re human. We get hungry, sick, and tired.”

And it seemed I couldn’t stop

So here is the article, and the one thing I wanted to add to the debate – we are real people, with real lives and families, and – until we get replaced by robots, or get given that drug from Limitless – we should be treated as such.

http://www.theguardian.com/commentisfree/2016/jan/12/junior-doctors-strike-contract-nhs

The Person-Shaped Hole

I haven’t been able to write for a while.

My father passed away a couple of months ago, and though it was what we wanted for him – painless, in his sleep, at home – I’d be lying if I said it wasn’t devastating.

It’s a rite of passage to be expected, but it’s still immensely painful.

Even harder, or perhaps, as hard in a different, additional way is that, as a carer, you’re suddenly left with a void in your life. The future carries a giant person-shaped hole that you keep falling into every time if you think ahead.

The person you shaped your career, and life, and obligations around is no longer there.

It takes a long time, I think, to rearrange the pieces of your life to cover that void, but I think it does happen, slowly. And I can’t fear feeling okay, because before I know it I remember the grief, and, like an attack, it’s there, fresh as ever, leaving just as mysteriously. No need to feel guilty about feeling normal, when the pain still resurfaces, if less frequently now.

I managed by living day to day, or when at my worst – minute to minute, so did my mother.

We were never promised forever with him, we never are, with the ones we loved. So we tell ourselves that logical truth, and then the emotional truth that he’s still with us, in our heart, and in who we are. It’s something that can’t be proved but feels utterly correct.

The life-span of a carer has its limits.

The Moving Target

So here’s something unexpected.

Before going to visit dad at hospital on Thursday I woke up to a headline where Health Secretary, Jeremy Hunt, was demanding that consultants worked 7 days a week. I was less than impressed. I may not have a lifetime experience of working in hospitals, but to be honest, one would need little more than a week to see that such a headline is meaningless.

Every hospital is like an ecosystem, dependent on many different departments and people for it to function, least of all consultants. And yet Jeremy Hunt appeared to attacking them as being unhelpful and obstructive, targeting their contracts and salaries as being the root cause of dissent.

The doctors? They were asking for financial and budgeting details. They were identifying that Hunt’s stats of increased mortality on weekend admissions is an international phenomenon with the cause not yet clearly identified (just like the increase in heart attacks on Monday). They were upset as they were already working on weekends, with many working towards a full 7-day service, and Hunt’s comments could thus only thus be interpreted as negative spin designed to place the blame on doctors, creating distrust between them and the public.

And yet it was Hunt demanding doctors to ‘get real’. How else could one interpret it but arrogant, blunt politicking, designed to destroy trust, and deliberately create an alternate focus of blame?

Well, it was the breaking point for me, and, as it turns out, for many of the thousands of NHS staff who work incredibly hard, but are sick of getting their credentials constantly questioned.

So I pitched an article to The Guardian.

That morning I pitched them the doctors’ point of view – a junior doctors’ point of view – trying to make it clear that consultants were such a small part of the patient experience. That though it seemed obvious (reasonably so) to the general public that consultants might be solution, the truth was nowhere near. Hospital dramas, which, whether we like it or not inevitably influence public perception of healthcare, always emphasise what doctors and nurses do – they barely touch upon the numerous support staff. They barely touch upon the single radiographer working through the night, the porter needed in five different places at once, the phlebotomist who is only paid till the middle of the day, meaning everyone else’s bloods during the day have to be done by doctors and nurses already overwhelmed by work (my pitch was a little simpler than this btw). The media is just as culpable in focusing too much on doctors as the controlling factor in hospitals. Please, that’s neither true nor desirable. There’s too much at stake for healthcare to be so myopic.

Unexpectedly (for me) the Guardian said yes. They did want to know why I thought consultants were not solution. ‘Make sure your point comes through’ the editor advised. I understood. Keep it simple.

So I took time out from seeing my father (well, I rattled off questions to his team and nurses, ensured he was comfortable, put his favourite music on, gave him a kiss and shot off home) because I couldn’t stand it anymore. I wrote an article in less than an hour. This included moments of self-doubt as I wondered if I knew what I was talking about, thinking about all the things I wanted to say but didn’t have time to; I felt nauseous about having to respond people’s comments. No, keep it simple, focus on what you want to say.

The article was published around 6pm on Thursday 16th July. Today it has over 8000 shares, and over 170 comments. It is found here: http://www.theguardian.com/commentisfree/2015/jul/16/hospital-consultants-jeremy-hunt-weekends

Because Mr Hunt finally hit a nerve.

After years of government statements, and helpful instructions from management to WORK HARDER, staff were sick and tired. Service users and NHS patients were sick and tired. WE/THEY ARE WORKING HARDER came the reply, and not just from me.

Numerous articles rapidly appear repeating my sentiment, but eloquently elaborating. A campaign was swiftly set up were doctors and all staff were encouraged to tweet and take selfies (on breaks or before or after work) making it clear just how much goes into weekend work (https://www.facebook.com/pages/Im-In-Work-Jeremy/441699912704995?fref=ts and https://twitter.com/search?q=%23ImInWorkJeremy&src=tyah). It was one of the highest trends on twitter yesterday.

The NHS needs to change, to get improve, to reform. It always has, since its very inception. Some healthcare workers will be resistant, that’s human nature, the majority desire it – but only from well-thought out and implemented reform based on fact. Not from confusing, misinterpreted data, myopic thinking and destroying credibility.

It’s easy to target the vulnerable. They can’t respond. In a similar vein, it seemed easy to target healthcare staff. Make people stop trusting them, accuse them of being obsessed with self-interest, and the majority are too overworked and exhausted to complain anyway.

Not anymore. The staff are talking to each other, organising themselves, to fight back. It’s overwhelming. It’s long overdue.