An exhibition of recent work by artist David Marron opened recently at GV Art Gallery in London, writes Marina Wallace, curator of the exhibition. A catalogue, containing the writings of the artist, accompanies the show. Having installed his work, and having been present at the private view and the following days’ encounters with critics, journalists, and interested parties, David Marron returned to his shifts as a paramedic, working on an ambulance in London.

His first job after the intense exhibition period happened to be at Buckingham Palace, serving on an ambulance on the occasion of the granting of OBEs to a crowd of distinguished individuals. Distinction does not prevent illness, and the ambulance that David was on was there as a preventative measure in the case of accidents. David Marron specialises in witnessing accidents and providing emergency intervention. His art is the visual interpretation of a fundamental human condition, that of being between life and death, positioned between the objects that surround the body, and their symbolic meaning that survive it. Both Marron’s art and his occupation as a paramedic are about life, death, and acts of survival.

A number of photographers, since the 19^th century, have made images as a way of recording wars, natural disasters, killings, crime or pornography. Artists have produced varying kinds of visual records in the form of sculptures, paintings, or drawings, some also with a raw documentary urge, infused with a dose of the ingredients that rule aesthetic judgement. Writers have included in their oeuvre dramatic biographical stories and vivid accounts of tragic events, trying to make sense of them.

An example of one of the best contemporary accounts of this kind is Joan Didion’s phenomenally good book, The Year of Magical Thinking (2005), where the author attempts herself to “make sense” of what happened suddenly and unexpectedly when her husband died of a massive heart attack one evening at the dinner table. Didion remembers simple actions and objects that required her attention whilst preparing dinner: “I lit the candles. John asked for a second drink before sitting down. I gave it to him. We sat down. My attention was on the mixing salad. John was talking, then he wasn’t.”

As witness of the dramatic event, Didion forces herself to freeze the moment, to reconstruct the life events that preceded the instant of death as if to keep a comprehensible recollection of what happened.

“I have no idea which subject we were on, the Scotch or World War One, at the instant he stopped talking. I only remember looking up. His left hand was raised and he was slumped motionless. At first I thought he was making a failed joke, an attempt to make the difficulty of the day seem manageable. I remember saying Don’t do that.”

Trying to keep a sense of control over otherwise unmanageable events, we hold onto what we know best, and what is imbued with meaning. As if meaning, resurrected and reconstructed, had the power to bring one back from the dead. But meaning is not enough. Life is a continuous and testing struggle between intangible things, and utterly practical matters. Furthermore, we are never ready for what happens to us suddenly. Didion, needing practical help for her husband, after split seconds of searching for meaning, remembers that she had taped a card with the New York-Presbyterian ambulance numbers in the kitchen by the telephone. “I had not taped the numbers by the telephone because I anticipated a moment like this. I had taped the numbers by the telephone in case someone in the building needed an ambulance. Someone else.”

Didion’s story, the story of an artist/writer who lives the dramatic event from the point of view of the victim, and calls the paramedics in to help, observing them from her perspective, is all the more extraordinary if seen in relation to the work by David Marron and his point of view as artist/observer of such scenes from the viewpoint of the paramedic who is called in to help.

Didion writes:

“I called one of the numbers. A dispatcher asked if he was breathing. I said Just come. When the paramedics came I tried to tell them what had happened but before I could finish they had transformed the part of the living room where John lay into an emergency department.”

On returning home, Joan Didion sees the room where her husband fell and died after having been to hospital and having certified her husband’s death.

“When I walked into the apartment and saw John’s jacket and scarf still lying on the chair where he had dropped them when we came in from seeing Quintana ad Beth Israel North (the red cashmere scarf, the Patagonia windbreaker that had been the crew jacket on Up Close & Personal) I wondered what an uncool customer would be allowed to do. Break down? Require sedation? Scream?

I remember thinking that I needed to discuss this with John.”

Didion’s account, individual and universal, unfolds through many layers touching on social mores, on personal grief, on medical conventions and psychological conditions.

Imagining a conversation between Marron and Didion, and their artistic endeavours, I imagine Marron’s poetic lists alternating with Didion’s own emphatic words.

It is the body of the deceased or of the ill fated that Marron the paramedic takes care of, but the objects that surround the body are those that remain impressed in the mind of Marron the artist. Objects live on as audiences, when all doors are closed, silent witnesses of the life and death that gave them meaning and took it away.

Literary and artistic references enrich Marron’s work. He carefully reads Dante, Shakespeare, Goethe and Dostoyevsky, and looks attentively at Vesalius, Leonardo, Rembrandt, Goya, Delacroix and Gericault, whilst his part-time occupation as a paramedic underpins his artistic production providing much food for thought. The artist on an ambulance is an observer of life and death events, and has the privilege of seeing what many others normally can’t see.

The relationship that Marron has with the art objects that strike his imagination and impose their vivid presence on his mind, is complex and intimate. The portrait of Margaretha de Geer, wife of Jacob Trip, painted by Rembrandt in 1661, is one of such objects that remained with Marron for a long time, and left a memorable sign, that turned into a sculptural work of imposing presence, Imaginary Shipreck, shown on the upper floor of the GV Art gallery. Marron annotates the encounter:

I stumbled upon Rembrandts portrait of Margaretha de Geer accidentally one day and ended spending an hour or two stumped in front of it. It was one of those works that lodged in your mind and I would return often to spend some time with it, much like visiting some frail ancestor.

Margaretha is portrayed with sensational directness by Rembrandt in the last decade of his life. The artist makes no mystery of the aging conditions of his sitter. Her hands and her face display the signs of old age, her direct gaze is uncompromising and her body language reveals the years of experience that her looks indicate. Caught by the powerful image, and the extraordinary rendering in paint of the respectable old lady, Marron finds himself carried away on paper, and the many, intricate drawings that accompany his sculptural work are in themselves documents of his attempt at describing the solitary journey of the human body in its most intriguing aspects.

Marron’s sketches and notes reflect the fascination that Rembrandt’s portrait exercises on him. This impeccably painted seventeenth’s century image magically takes on the presence of an event, of a real person, complete with a wheelchair, and art and life, like life and death, are one again, inextricably linked.

The Sketches and Notes that populate the Notebooks that Marron keeps as he prepares to start a new piece or whilst he is engaged with a new installation anticipate his sculptures and are so poignant as to deserve a place of their own in the artist’s production.

What mostly stands out in these Notes is the idea of objects and rooms that witness silently and helplessly the dramatic events and the decline of their owners and occupants. The artist, left to observe the scene of an accident in the victim’s home (often waiting for the arrival of the Police) annotates lists of objects, significant signs of the dramatic event and, at the same time, of a former, ordinary life from a sweet, traditional English beer, to a tricyclic antidepressant

A Full Can Of Mackeson Stout

A Handwritten Account Book

A Birthday Card Signed Iris

A Post It Note With Chewing Gum Written Across

A Small Plastic Bucket, The Inside Encased In Dried Plaster

A Pair Of Black Shoes With Screwed Up Newspaper Shoved Inside

A Tin Of Emulsion Paint The Top Layer Hardened, With Dried Drips Around The Outside Of The Tin

An Unscrewed Plastic Bottle Of Water, A Single Daffodil Emerging From The Top

An Unused Envelope With Hastily Scrawled Shopping Items Written Where An Address Should Be

An Empty Packet Of Amitriptilyne Tablets Lying Next To A Farewell Letter

A Cut Out Newspaper Article Concerning The Plight Of A Macedonian Immigrant, Held To The Wall By A Drawing Pin

Reflecting upon the sights that present themselves to his eyes when he is at work as a paramedic – and looks around the homes of those who need help or are already beyond help - he records his thoughts:

‘Fragments of a life once led remain housed with the surrounding objects. Objects that have been displayed for sentiment, decoration, use or interest.”

Entering the space once inhabited by the person who was alive there and no longer is, and taking in the multitude of objects that silently populate the room, the artist writes:

“This object-audience regard the corpse with an impassive vacancy, their meaning lost to an uninterested world.” He continues in what is clearly a description of sort: “Anchorless and hollow, once salient with personal significance, now insignificant and bewildered. Their relationship to one another is one reduced to proximity. Empty.”

What strikes the most when thinking about the situations and physical spaces that David Marron inhabits during his work as a paramedic, is the idea of how difficult it must be for anyone present or involved to make sense of things.

The life-size figures that Marron constructs out of wire and plaster are encrusted with objects such as seashells, beans, cutlery, crockery, pins, nails, candles, soap, mousetraps, rubber gloves, swords, tools, etc. They function as collaged symbolic trophies tracing telling memories of life through the juxtaposition of fragments carefully arranged on what resemble human forms frozen in time. Marron’s figures stand, sit and crouch under our eyes quietly calling for attention, and refer to the parallel lives of the objects that surround us in life and of their strange relationship to survival and death.

Marron’s figures carry many visual references, from those to anatomical illustrations, to archaeological findings in ancient burials. They recall the flayed bodies rendered by Renaissance artists, by 18^th century wax modellers, by artists working in tandem with pioneering anatomists. With the major difference that Marron’s figures don’t aspire to anatomical accuracy, nor do they stand proudly to display the God-given spectacle of their wondrous bodily machinery. The surface of Marron’s plaster figures is rough and darkly pigmented, unlike that of 18^th Century Clemente Susini’s (1754-1814) pale smooth wax bodies. Yet a link between the two can be made in such details as a pearl necklace worn by one of Marron’s female figures that awkwardly holds up a baby and that partly echoes the celebrated reclining female anatomical model that displays a foetus in her womb, and a pearl necklace that hangs dramatically around her exposed, vulnerable neck. The famous Sicilian 17^th century wax modeller, Gaetano Zumbo (Siracusa1656- Paris1701), also comes to mind, with his sculptural creations of scenes that portray the putrid consequences of the Black Death, with decomposing and tortured figures set amidst the rocks of dark, symbolic caves.

However still and poignant, each figure modelled by Marron does not exist in isolation. The artist conceives of them as part of a tableau. Some figures are contained within narrow frames that recall cabinets of curiosity, complete with some of the relevant compulsory objects extracted from the worlds of naturalia and artificialia.

Some figures belong to a ‘collection’ of symbolic human forms, to be displayed together, in a circle, with a stringent plan that takes into account the geometry of the human mind, patterns drawn by nature and by the human hand. These are elements that create a sort of theatre of memory, or a memento mori encrusted with the curious jewels of life.

The symbolic figures that form part of Circular Ruin are also human “types”. For a long while Marron worked out the plan of the setting of Circular Ruin at the same time as developing each figure and its own particular world of references and connotations. As a complete work, Marron’s figures stand in a space that is pregnant with meaning but that, simultaneously, risks being, in his words “anchorless and hollow, once salient with personal significance, now insignificant and bewildered.” Such is the space we all occupy; such is the theatre of our life. Such is also the space of the gallery where art reflects on life, staging meaningful scenes with objects that make their brief appearance and disappear without leaving a trace.

David Marron’s blog can be accessed via www.gvart.co.uk or directly www.gvart.co.uk/david_marron_blog.html

Professor Glovers’ book comprises 480 pages of closely argued and well researched scholarship. A striking and recurring characteristic of all the cases he studies is the need- if ordinary people are to be persuaded to do extraordinarily bad things to other human beings-to dehumanise the intended victims. George Orwell, describing an experience during his time fighting in the Spanish Civil War, found himself unable to shoot the enemy soldier in his sights once he realised the soldier was undertaking the all too human act of urinating. This simple act provided such strong evidence of the humanity of the man in Orwell’s sights that he was no longer capable of taking his life. After all, this too was a man, with hopes and dreams and fears and children waiting at home to be tucked up in bed.

I haven’t read Jonathan Glover’s book since 2001 but I was reminded of it by a film a went to see recently called District 9. The title of the film refers to a refugee camp on the outskirts of Johannesburg, South Africa, set up for a million or so refugees. The locals don’t like or understand them but, with the eyes of the world and various international human rights groups keeping an eye on what they do, the government has no choice but to provide minimal facilities to the refugees. The refugees are shown sifting through the rubbish, urinating in public, despised for their love of cat food, likened to prawns, and tricked into signing away their rights by a mixture of threats and deception. And, as we learn later on the film, they are being spirited away to be subjected to inhuman medical experiments.

And, incidentally, they’re aliens. Aliens escaping some unspecified home planet disaster who arrive sick and malnourished above the skies of Joburg. Pitiful to start with but quickly and, it turns out, all too easily reviled, all too easily dehumanised. Now maybe you’re wondering whether dehumanise is the right term to use, after all these aliens aren’t, by definition, human. Right? And yet a human rights response is exactly the one their initial plight provokes. Until, after a while, as they grow in number, get bolder, and start to break out beyond the wire fence that defines their slum refugee camp, it is those things that make them different- their appearance, their apparent lack of social graces and mores and the different food they eat, that is emphasised and ridiculed.

As we hear yet more terrible news presaging the havoc climate change will bring, this time in the Phillipines, I can’t help but wonder whether the moral challenge for the coming generations will be whether and how we choose to humanise or dehumanise the many millions who will in the future be forced to seek refuge. Will we once more salve our consciences by focussing on that which differentiates the us from the them, the haves from the have nots, or will we instead look down the barrel of our gun only to put it down, unable to shoot at /to turn our backs on the human beings we see looking back at us. I hope the latter, but we should fear for and plan against the former.

On average, one or two patients per surgery, in response to my news, are so kind and generous or (about once every surgery) start to cry, that it is now a rare surgery that I come through with totally dry eyes. I have two more weeks to go and although I’m getting more able to cope with my own and my patients emotions I have to admit that I will now be glad when I’ve done all my news breaking. All of which, I suspect, will either ring true or sound more than a little overplayed, depending on exactly what sort of relationship you have with either your patients or your doctor.

In trying to explain to my non-medical husband what it’s like to say goodbye to a patient you’ve cared for over many years the best analogy I could come up with was this: I said it was like having to tell a member of your family that you couldn’t see them anymore. And this reminded me of how John Berger described the relationship between family doctors and their patients.

Berger said that the doctor becomes an honorary member of the patient’s family, allowed access to both the patient’s body and their inner world in a way that only family members are usually given. He reminded us that we are only given this status of honorary family member because in return we offer patients our skills and knowledge, and the promise that we will honour our professional commitment to do our very best for them.

Soon I will have new patients and they a new doctor. Over time I hope to earn their trust, to be invited in. But I will always have a place in my heart for the families I’ve left behind who for eight special years allowed me the privilege of being an honorary member.

As a doctor and the mother of four teenagers teaching young people how to avoid making harmful decisions seems like an admirable idea to me and, moreover, one where the insight from an expert and multi-disciplinary panel would be advisable. And yet, and I suspect to the surprise of few, concerns have already been raised in some quarters that these guidelines might somehow corrupt the world’s youth.

For an outline of this view see the September 3rd issue of Time.

http://www.time.com/time/health/article/0,8599,1920024,00.html

It is not however my intention to put forward arguments either for or against the UNESCO project. Instead I’d like to consider whether or not a medical humanities perspective, informing into the way in which the responses of various interest groups are understood and engaged with, might be of value. In order to do so I’ll begin by detailing the considerable expertise of the existing panel. My brief summary does not do justice to their many achievements but does suggest the different insights they bring to this important issue.

Peter Aggleton is a professor of education known for his analytic work on the cultural aspects of sexuality and has global experience researching the social aspects of HIV‐related prevention, treatment and care.

Arvin Bhana is a sociologist whose primary interest is in developing interventions that influence risky and health promoting behaviour of young people by engaging with young people, families, schools, and the wider community.

Doug Kirby is a scientist whose has systematic reviews have identified important common characteristics of effective sexuality education and HIV education programs.

Elliot Marseille is an economist whose focus is on the economics of HIV prevention and treatment in developing countries.

Elizabeth Mataka is the United Nations Secretary‐General’s Special Envoy for AIDS in Africa and a social worker by training. She has pioneered peer education in Zambia through the facilitation of the formation of over 2,000 school/community based Anti‐AIDS Clubs.

Sara Seims is a population scientist with expertise in international reproductive health issues, including teen pregnancy, and behavioural research in the areas of HIV/AIDS.

Alice Welbourn is a social development adviser, writer, trainer and activist in participatory approaches to gender, sexual and reproductive health. She was diagnosed HIV positive in 1992.

Jimmy Whitworth is responsible for the Wellcome Trust’s strategy and policy for developing scientific portfolios for research in low and middle income countries. He is a physician by training, specialising in infectious diseases, epidemiology and public health.

Even these much shortened bios give a good indication of the expertise and calibre of the individuals developing the guidelines. Clearly these people have an enormous wealth of expertise to bring to this important task. They know about the ravages that HIV/AIDS continues to inflict on so many young lives, they know about the options available to young people that, were they but to make use of them, could reduce the damage inflicted on them by unwanted pregnancies and sexually transmitted diseases, and they know, importantly, what works and doesn’t work in sexuality education.

So is there anything missing? Or rather are their any other perspectives that might usefully be enjoined to help those who see the UNESCO programme as a corrupting force to change their minds and thereby to help ensure that as many young people as possible can make informed choices about sexual behaviour.

Coming at this from a medical humanities perspective, I find myself wondering how the perspective of a literary scholar, drawing on the AIDS literature, on literature about the sexuality of young people and about relationships between the generations, might have shaped the way in which the UNESCO programme would have been conceived and then promoted globally. Or to what extent an anthropological perspective on the ownership of sexual knowledge and the understanding in different cultures of the relationship between sexual innocence and moral worth might offer insights into possible ways to bridge the gap between those for and against sex education. I’d also like to hear from historians about how and why sex and sex education remains and indeed increasingly is becoming such a controversial topic in certain parts of the world and in certain groups within different societies. Has it always been this way and, if not, how and be what route did we get where we are. And I’d like a specialist in film and media studies to explain what, and to what effect, young people are accessing formal and informal sex education via the internet, films, and on-line communities and the implications this has-for good or for bad-on the impact that UNESCO can hope to make.

I’m not, I hope, altogether naive. I realise that there will always be some minds, on both sides, that are determined to remain closed. I’m just saying that as well as the insights of educators, sociologists, economists, public health physicians and field workers this important issue would benefit from some of the perspectives that the arts and humanities have to offer on why and how people create meaning in their lives and why, in this instance, sex and the way in which information about it is imparted to young people has come to mean such different things to different people. Because at the end of the day, no matter how good the guidelines, there remains an uncomfortable and perilous gap between logic and intuition in the sex education debate. Medical humanities has, I’d like to suggest, a modest contribution to make to bridging it.

For an analysis of why seemingly intelligent and logical people, faced with the same set of facts, can sometimes reach diametrically opposed conclusions read:

Kirklin D. Minding the gap between logic and intuition: an interpretative approach to ethical analysis

http://jme.bmj.com/cgi/content/full/33/7/386

To read about the UNESCO project in detail go to:

http://portal.unesco.org/en/ev.php-URL_ID=42114&URL_DO=DO_TOPIC&URL_SECTION=201.html

Medicine Unboxed is an NHS initiative, in partnership with Cheltenham Literature Festival, so you may meet more than the usual medical conference crowd at this event. Speakers include  Jo Shapcott, Raymond Tallis, Allan Kellehear, Raanon Gillon, Patrick Leman, Raymond Tallis,  Gabriel Weston, Richard MacCormac and Jane Willis. All that plus lunch for £10 means tickets are going fast.

To find out more and to reserve a place contact Sam on sam.guglani@glos.nhs.uk

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

So as I pour through the numerous, and in many respects very helpful, protocols and guidance packages regarding the treatment phase of the H1N1 pandemic, my question is whether a similar mechanism is in place for the distribution of antivirals. If there is, I can’t find information about it anywhere. As chemists are not, at least in my area, dispensing antivirals (this takes place instead from designated distribution centres) I cannot ask them to deliver these when necessary, even when they are already delivering other required drugs such as antibiotics.

We need a system in place now, before things get even busier and before there are even less well people out there to act as all our flu buddies. I would suggest that chemists are in an ideal position to undertake this important task. To do so they will need to be given a stock of antivirals and a system of renumeration that  recognises the increased workload involved. That way flu patients whose buddy also has flu can still get the help they need. And the system needs to be publicised, especially to the elderly. So that older people, especially those already struggling on their own with flu won’t decide there’s no point asking for help because they’ve got no one to collect the antivirals for them.

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?

Whatever it makes you feel I’m guessing it’s making you feel something. According to first year medical student Amy, spending a prolonged period of time talking to the woman who inspired this remarkable painting helped her to feel, to understand on some level, the impact of living with years of depression. Better, I dare say, than any number of hours spent reading a textbook on depression.

Educator Louise Younie, who oversaw this project, talks about helping students to developed narrative competence, something closely related to emotional intelligence but in which close attention is paid to the life being lived by the person and not just the pathological process affecting their body.

We think this kind of innovative educational initiative is worth sharing with others and so in every issue we’ll be featuring at least one educational case study. To read about this one just follow this link.

http://mh.bmj.com/cgi/content/extract/35/1/54

For a number of years Londoner’s have been asked by charities to  refrain from giving money to homeless people. Doing so would, we were assured, only encourage the sort of self-destructive drug and alcohol fueled behaviour that led to these poor souls being in this pitiful position and would, furthermore, reduce their incentive to seek help.

Drugs, alcohol, victims, pity, and much more left unsaid, seemed sadly to sum up the existence and outlook for the people living literally and metaphorically on the sidelines of this bustling metropolis. And yet, no matter how compelling the logic of the argument to pass on by, I cannot be the only Londoner to feel a deep sense of unease each and every time I do as the experts have told me. To wonder what, if anything, can be offered to people who seem to prefer the gutter to the apparent relative comfort of hostels for the homeless.

Understanding behaviour and choices so different to those of the mainstream can be hard and so it was with great interest that I read, a paper about street youth in Toronto, submitted to the journal some months ago and published in the June issue.

http://mh.bmj.com/cgi/content/abstract/35/1/19

The authors describe a web-based storytelling project, involving street youth and professional writers, that encourage homeless young people to share their perspectives on their own experiences.

The researchers identified “an ‘arc of experience’, that ranges from living with abuse and despair, leaving home, living on the street, experiencing a crisis or turning point, accessing services and gradually moving away from street life toward self-sustaining independence and security. This arc of experience includes the stories of youth who have transitioned away from the street as well as those still facing homelessness” The authors conclude that the project “provided an important, creative outlet for the youths, and increased understanding of the challenges, stigma and resilience of homeless youth.”

Well it certainly increased mine and I can only hope that those working out how to achieve the goal of no one living on the streets of London by 2012 will read this paper and other work like it. Because after reading this paper, and the stories told by these youth, the words ‘drugs’, ‘alcohol’, ‘victims’ and ‘pity’ just don’t do them justice. Given their own voices these young authors draw on a much richer vocabulary to describe their lives, their hopes and their dreams. In drawing up policies to address their needs it is this vocabulary that policy makers need to refer.

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’.

And yet, and yet. In the Orwellian world in which I work, and patients need care, large tranches of money for elective investigations are diverted from the local hospital radiology services to a private contractor (because the former is deemed to be slow and inefficient) only-two years later- for the private contractor to be so overwhelmed that its routine delay- from referral to investigation- now magically mirrors that at the local hospital. The latter meanwhile, in spite of its much reduced budget, has been required to continue providing the rather less glamorous and more resource intensive emergency radiology. I could go on, offer more examples, enough to fill a bookcase with dystopian novels, but you get my drift.

Such talk is of course anathema to the UK government who would doubtless see my thoughts as yet more evidence of the reactionary, self-serving nature of the profession they seek to break. They hold no truck with the claim of so many of us that we actually care, deeply, about what happens to the people who entrust themselves to our care. They are it would seem incapable, too cynical, to accept that the shared professional values and the duty of care that is central to how so many of us practice, is an invaluable safeguard that patients are denied at their peril. The government, put simply, doesn’t get it, doesn’t believe that doctors are or should be anything more than instruments of the State and conduits of scientific progress.

Of course it could be me that’s cynical, bruised by the progressive manner in which the power of doctors has been traduced by the State. First off was the introduction of a system whereby GPs no longer had to provide patient care themselves but instead needed merely to demonstrate that someone in their employ had done so. This heralded the switch over from a system characterised by personal care by a named GP, ably assisted by other employed doctors, nurses, counselors etc, to a system where increasing numbers of GPs take on the role of over-qualified business managers providing little or no direct care themselves. Not all yet of course. So many good doctors struggle on, keep doing their best, refuse to give in. But it’s a struggle and it’s taking its toll.

Then came the seemingly innocuous requirement that GPs demonstrate, objectively, that they were providing a minimum quality of care in a select number of important clinical areas. Except that most already were and the administrative burden of proving they were has taken up an estimated 15-20% of doctor and nurse time, time previously spent on patient care. The added sting in the tail/tale of this system is that those doctors too busy caring for a patient to fully record that they have cared for the patient are financially penalised and are thereby, ultimately, forced to reduce the numbers of doctors and nurses available to care for patients. As counsellors, doctors, nurses, dieticians and phlebotomists are made redundant across the country, ironic just doesn’t do what’s happening justice.

Then of course the coup de grace-mass doctor un- and under-employment: the ultimate weapon of control for any government. By training more doctors than the UK health care system-focussed as it is on ill-conceived and exhorbitantly expensive IT systems, and dystopian systems for enforcing a reductionist model of medicine on a resistant but powerless populace- could ultimately afford,  the government must surely believe it’s time has now come, and that finally it can seize complete control of medicine and its delivery.

Like climate change, the pace of this politically driven seismic shift in primary care has surprised both patients and doctors alike. For many the inconvenient truth of where these developments are taking us is hard to accept. It will, sadly, take a little longer before the full extent of that change- of what took so many years to build and then so few to destroy- will be evident. Like climate change it is of course more of a worry for my children than me, which is, of course, why it matters so much to me and should matter to us all.