Dear consultant colleague,

The standard of consultant letters is very variable so we have decided to introduce a new proforma for consultant letters to GPs.

Patients attend many different outpatient departments and we intend to introduce a different proforma for every department in each of the hospitals to whom we refer. more…

Early morning and a young lad, hooded, trainers, hugs his bottle as he staggers home. Last night it started early; cider, beer, and tonic wine. Blue bags on a Friday night. Party time in the park as teenage boys and girls huddle drunken in the dusk. Monday morning, at the surgery. Mother fraught and adolescent spite. School is bad, behaviour worse, out of control. “You must do something.”

Cans strewn around the room, thrown into the fireplace, crushed on the floor. Another on the wet formica table, collecting butts—an impromptu ashtray. And, all around the sweet rottenness of last nights drink. In the chair, an unshaven shadow of a man, yellowed fingers, greying shirt, mustard eyes and sallow skin, slurs rambling remnants of mixed up words. “He’s upsetting other residents.” The sheltered dwelling’s warden stands accusingly “You must do something.” more…

Tootling along in the car on holiday. Brain idling, half listening to the radio when, out of the middle of an Irish language programme, jumped Ernest Hart. A former editor of the BMJ in whose eponymously named room we often have editorial meetings. But, on Raidió na Gaeltachta?

A historian recalled the spinning and weaving industry in Gweedore, a small town in County Donegal in the north west of the country. Ernest Hart, and his wife Alice, first visited and witnessed the terrible poverty and destitution in 1872. They returned in 1883 when Alice, herself also a doctor, was pivotal in organising local women and promoting weaving and spinning to provide a sustainable industry that continues today as Donegal Tweed. A remarkable woman who triumphed over considerable resistance both from local landlords and established textile manufacturers. She showed Donegal crafts at Olympia in 1888 and at a huge Donegal pavilion at the World Trade Fair in Chicago in 1893, and helped generate interest in the industry throughout North America. more…

Eighty thousand spectators hold their breath as they watch the penalty. Hushed anticipation. Fearful will he hold his nerve, handle the pressure, cope with the stress. But, is it that important? Nobody dies. Not like the decisions you make every day. For a surgeon or anaesthetist, fatal outcomes can be immediate. For others their mistakes may take a little longer. Life and death decisions, long term disability, or discomfort. But, let’s be realistic. Patient safety and sport—hardly comparable. more…

We live in our own little boxes. Maureen Bisognano from the Institute of Healthcare Improvement , in her keynote address, told us we need to get out of our own little boxes if we are to improve healthcare. Quality improvement means breaking out of silos. She told us we needed to focus more on our patients asking not “What is the matter” but, “What matters to you.” She urged us to look at the organisation of healthcare citing the benefits from multidisciplinary rounds and the importance of teamwork in reducing mortality in intensive care. Everyone’s voice is important and it is essential that everyone, clinicians and nurses work together, a point echoed later in the day by Hugh Rogers from the NHS Institute for Innovation and Improvement, who described the difficulties of reconciling different tribes in the operating theatre: anaesthetists, theatre nurses, and surgeons. Maureen also encouraged us to look to the community—we currently focus most of our resources on the 3% at the top of the healthcare pyramid and only 3% of resources on the bottom 50%. Can we challenge the community to look at their own healthcare? She told a story: more…

At the Commonwealth Games I met the cyclists. At the end of each day we grouped together in the television room to watch the edited highlights of the Tour de France. Towards the end of the Games, I went to watch the road race and was hooked. As the sun went down on my first sporting interest, I took up bike racing. It was fantastic. My learning curve climbed faster than my physiological decline and the racing was superb. more…

Andy Murray is the new Scottish Government Physical Activity Champion. No, not Andy Murray the tennis player. A real athlete—an elite ultra distance runner, Edinburgh GP, and sports medicine expert. He leads by example. Ultra marathons in the Gobi desert, the Arctic, the Indonesian jungle, never mind little diversions like the West Highland Way, a 95 mile trail race. He runs further in a single event than most people run in a lifetime. Heaven help the Scottish public if they are expected to follow him just part of the way. And, be warned. It’s not just about encouraging physical activity in the general population, his brief includes looking at the role of his fellow GPs. Pay for performance could take on a whole new meaning. more…

People in our wee country are the happiest. Unexpected, perhaps,  given the long history of violence and social unrest. But, people can be happy in the most difficult circumstances and happiness isn’t always related to the social or material environment. Almost impossible to define, we often only recognise true happiness when its gone. So, it’s great to see Northern Ireland in a positive light—we should celebrate this special feeling that we all knew and felt. Although, in truth, we didn’t know exactly what it was. more…

From le paradoxe français to a tiny tavern off a narrow alley in Kilkenny. An unlikely journey. But not, perhaps, if the barman is a cardiologist. Red wine has much more than cardiovascular benefits and it was such a pleasure to enjoy a glass with friends in the company of Michael Conway, with jaunty hat and easy manner, the owner, sommelier, and much more besides. A consultant cardiologist in Kilkenny Hospital, his “Hole in the Wall” wine bar is a museum, a link with the past, and a project born out of his love of history. more…

Another part time middle aged GP. Another almost apologetic explanation. Another slightly embarrassed colleague. Why is it that so many GPs in their prime seem to be going part time, retiring, or changing direction? This was a generation who selected general practice as their first choice career. They aspired, not to a specialist training, but to a place on one of the most sought after general practice training schemes in the 1980s. There were hundreds of applications to some schemes, and even the least desirable had a ratio of applications to places of 5:1. What happened to these committed high quality doctors? more…