You’re on board a small British merchant ship in the English Channel and you start to feel very ill. There’s no doctor on board. What do you do? If the year is 1844, you’re in luck. The Government has recently made it compulsory for all merchant vessels to carry medicines, to be kept in a small wooden chest. So open up, take a swig of the laudanum, and relax.

But before you drift off into an opiate-induced stupor, take a moment to consider the history of how a very particular set of drugs ended up on every British merchant ship. It’s a topic that started to interest me as I stumbled upon a collection of tiny pamphlets, each designed to be slipped inside one of the drawers of the ship’s medicine chest. With titles such as The Guide-Book to the Government Medicine Chest, they list the medicines to be taken aboard along with directions for use. Well before anything resembling the National Health Service, let alone the National Institute for Clinical Excellence, we have a government mandate to stock certain medicines. So, these chests, along with the accompanying pamphlets, provide a fantastic opportunity to study the early history of public health and the regulation of drugs.

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Since Hippocrates in early 5 B.C., Medicine has carried an ‘angel on its shoulder’; a reflexive gaze on the skill, and phenomenologies of healing between the doctor and his patient. Ethics is a code, a practice, and a guide amid the terrain of the hands that tend to the body using instruments of medicine’s enterprise. Referring to the Oath:

‘I will preserve the purity of my life and my arts’.

Daniel Sokol, Honorary Senior Lecturer at Imperial College, London and recently qualified barrister, undertook the challenge of fitting ‘ethics’ into our contemporary medical practice; whereby Medicine is confronted by a body unprecedented in relation to the ways in which we can perceive, examine, intervene, create, and prolong the existence of our bodies; our lives.

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Who are the big names in the history of child psychology? Anna Freud? Melanie Klein? John Bowlby? Certainly. But, according to Professor Sally Shuttleworth, in order to locate the origins of child psychology, we have to look to nineteenth-century literature, to authors such as George Eliot and Charles Dickens.

This is just one of the historical titbits to come out of the recent Stories of Psychology conference, ran by the British Psychological Society at the Wellcome Trust. In her paper, entitled Studying the Child in the Nineteenth Century, Shuttleworth argued that the emerging genre of the nineteenth-century novel was the first to take the psychological world of the child seriously. Whilst previous works may have dealt with comings of age, novels such as Dickens’s Dombey and Son began to investigate the psychological world of the child in its own right, particularly within the context of education. (In the novel, Dombey’s son has difficultly socialising and is sent to a number of medical and educational establishments in order to rectify this shortcoming.)

Shuttleworth believes that such literary explorations were picked up by the psychologists and educationalists of the time, citing as evidence the way in which psychological theories were put to use in debates over compulsory education.

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I’d hazard a guess that no matter how much editors like to think that readers enjoy having their ideas and prejudices challenged, theres nothing in practice that the average reader likes better than an opinion that chimes neatly with their own. Which, I’ve no doubt, is why I enjoyed reading Ray Tallis’s article in yesterday’s Times newspaper as much as I did. An erudite and amusing thinker, Ray Tallis writes about the impact of the European Working Time Directive (EWTD) on surgeons and on hospital doctors in general. In describing the unintended but, sadly, highly predictable consequences of the  EWTD on continuity of care, levels of provision, and training and mentoring opportunities, he argues that doctors are in danger of being  ”reduced to cogs in a standardised service and discouraged from giving full expression to a commitment to patients for whom they feel personally responsible.” more…

I’ve got a confession: I, and indeed a significant number of my fellow GPs, have got an unhealthy obsession with vitamin D. Or, to be more precise, vitamin D deficiency and the apparent inability of the NHS to make available to me, as a prescriber, the means to treat it in my patients. You see we can’t, quite literally, get the fix they need, at least not using our tried and trusted prescribing pad. more…

In this guest posting, Dr Ravi Shankar tells us how a FAIMAR Fellowship help him to develop and deliver a medical humanities curriculum in Nepal. Ravi writes…

Dr. Badyal, my good friend during my postgraduate residency e-mailed me in late January 2007 informing about a FAIMER fellowship in South Asia. At that time my knowledge and ideas about FAIMER were nebulous. I knew that it was an American organization involved in international medical education. more…

Coming up soon, the organisers of this conference, ‘Thinking about Health’, promise a different kind of conference: small, participative, interdisciplinary, and aimed at users, professionals and academics. It will explore the changing nature of roles and relationships in the NHS and their implications, focussing on the implications of change for the integrity and identity of individuals, professions and organisations.

The conference aims to address questions like does integrity mean anything in the contemporary NHS; is the nature of integrity, individual and corporate, changing; and how can integrity be exemplified and encouraged by policy makers, professionals and users?

Alongside plenary presentations, there will be structured, small group discussions and short contributions by practitioners and users to ensure discussion is earthed in the everyday life of the NHS. A final plenary will draw together the issues discussed, with a panel of leaders from academic disciplines and health care professions.

This is the third event organised by Think About Health. For more about the network see www.thinkabouthealth.org

To join Think About Health or to learn more about the conference contact J Calinas: jcalinas@thinkabouthealth.org

There’s an old adage in medicine that if being with a patient makes you feel depressed then there’s a good chance that person is themselves depressed. So how does this painting make you feel? Depressed, or hopeful? Safe, or vulnerable? Alone, or observed? more…

If you want to refresh your memory of the comings and goings in Geroge Eliot’s classic, Middlemarch, then look no further than Professor Rosin’s analysis in the June 2009 issue of Medical Humanities.

http://mh.bmj.com/cgi/content/short/35/1/43?q=w_mh_current_tab

If you want to follow a contemporary equivalent of medical marketplace machinations then you need look no further than what is currently happening to general practice in England and Wales. And specifically to the Orwellian world in which carers and cared for find themselves. A world where government announcements to the national news media of the universal introduction of Cognitive Behavioural Therapy are followed by the systematic reduction of mental health care services in primary care. In my own practice, in the past 6 months, first the PCT provided mental health care worker was removed and more recently the practice counsellor of 17 years standing was ‘let go’. But hey ho, never mind, NICE guidance has after all told us what to do: if a patient is suitable for CBT and it isn’t available (!) we can (and should) tell them to ‘hang on’. more…

So how are you coping? Are you managing to make the right choices in these difficult times? And what if you make the wrong decision? Do you worry you might be sued, or worse still that the care people receive will suffer? And no, I’m not talking about the stresses and strains of clinical practice, pressing as these can be in an ever litigious society. Nor am I referring to widespread anxieties about rising unemployment, including medical. Instead I’m talking about the admittedly niche ethics angst that is part and parcel of a modern journal editor’s lot. more…