Patients versus doctors: whose time is being wasted?

The Telegraph today reports on a survey showing that many GP practices are giving receptionists the task of evaluating patients’ conditions and prioritizing their appointments, while doctors ‘said they were wasting too much of their time seeing patients who did not need to visit the doctor at all’.

In what universe does this constitute ‘news’ worthy of surprise? How are these ‘new findings’? I don’t remember a time when practice receptionists weren’t used by GPs as a defence system, and thus made decisions about who was allocated which appointment, and I’ve never been a patient at a practice where it wasn’t the adopted routine. The astonishing aspect is that there are supposedly eight-seven per cent of surgeries where this isn’t the system in operation.

GPs are undoubtedly wasting much time seeing patients who don’t need to be seen, but my own experience shows this is partly their own fault. The practice I am currently registered with has a website containing a captioned photograph of the partners and a link to the supposedly time-saving, automated EMIS service. This is in theory an excellent system; but the last time I tried to make an appointment through it, there were no appointments listed for my surgery after the Friday of that same week (when, of course, there were none free), because ― it transpired ― the surgery’s diary, and thus EMIS, hadn’t yet been updated with doctors’ and nurses’ hours… There is no information whatsoever on the website advising patients how to decide whether they need an appointment, or suggresting where else they might obtain advice, or supplying the dates of routine clinics, or showing when periodical clinics, such as annual flu jab clinics, are to be held and when and how appointments can be made for them. Online provision of this kind of information by all general practices should be fundamental and routine, and cannot help but alleviate pressure on staff, whether medical, nursing or administrative. The information might usefully be displayed in the practice waiting-room too; needless to say, it isn't.

I attended the surgery recently to collect a repeat prescription and asked whether I could order a blood test form for a routine, annual diabetes check. The form, which has to be authorized by a doctor, could be completed at a time convenient to the GP, and I could collect it when it was ready. I even mentioned what a waste of the GP’s time (and mine) it would be to allocate an appointment for this. The receptionist didn’t seem to understand what I wanted, however, and sent a query through to one of the doctors, making me wait while she laboriously typed it into the system; another administrator from the practice rang me later with a response that made no mention of the blood test at all! I eventually had to make an appointment to see a GP merely to have him prepare a form for a routine diabetes test ― after wasting a good deal of my time trying not to waste his.

GPs seem to spend much time these days insisting patients are wasting their time; but, with an extraordinary absence of empathy, they seem unable to appreciate that patients, being untrained, cannot confidently identify the conditions and circumstances that require intervention by medically trained personnel. The public is, furthermore, given conflicting information. A recent television campaign advises people to visit a doctor with some urgency if they have had a cough for more than three weeks, in case the cough is a symptom of cancer. Since the campaign began, four people have told me that they have followed this advice, but, instead of being thoroughly and reassuringly examined, have been sent away with only a strong sense of having made a fuss about nothing…

It’s up to the practice, and ultimately the GPs, to decide on the nature and quantity of both the information available at the surgery (including online data) and the training given to reception and other administrative staff so they can respond adequately to queries, direct patients appropriately, and prevent doctors’ time being wasted. If the practice’s information and systems are inadequate, patients cannot help but waste doctors’ time ― and their own, which doctors arrogantly seem not to consider.

What’s that saying about physicians healing themselves?

Money matters for degree decisions, by Sian Elvin

Another blog by a guest contributor.


Money matters for degree decisions

When the rise in tuition fees made the prospect of university all the more scary, it suddenly dawned on me that the decision of what degree to take was particularly important, with my investment of a mere £27,000 for three years of education. I’m one of those irritating people who has always known what I’ve wanted to do with my life as well – become a journalist – so for me, the massive decision was between passion or vocation.

A journalism course seemed the natural direction for me to take. However, I was put off by the lack of academic dimension. English had always been the one subject I enjoyed no matter what; I knew it would put me in good stead for a variety of future careers, particularly as the course was offered by all the top universities in the country. Yet the high financial investment, along with the high level of competition for a career in the media industry, made me wonder whether I should follow a direct path into journalism instead.

In the end it was my work experience placements that finally helped me make up my mind. Three editors told me they would rather employ a graduate of English rather than a graduate of Journalism, because apparently the former can ‘actually write’!

So here I am, studying English Literature at the University of Warwick, and getting involved with as much student media on the side as possible. And I can say that I certainly don’t regret my decision yet.

Grammar Nazism: An Apology, by Martin

The first of an occasional series of blogs by guest contributors.

Grammar Nazism: An Apology

It has become fashionable to diagnose yourself with an acronym. Everyone’s at it. We’re all getting OCD about our BMI, which only exacerbates our IBS. As a school-teacher, I’m exposed to more acronyms still. The lively kids are suffering from ADHD; the nerdy kids are in the thrall of their ASD… and then you’ve got the ODD kids, who are clinically incapable of being nice.

Amid this free-for-all of swirling capital letters, I want to catch hold of an O, a C and a D. Most people are obsessively compulsive about something, and if everyone else gets to diagnose himself on the internet with a proper-sounding excuse for his annoying habits, I want in. Some people can’t tolerate mess; some people can’t tolerate things that aren’t perpendicular to other things; some people can’t tolerate lactose. I can’t tolerate bad grammar. I’m allergic to hanging modifiers, and there’s nothing I can do about it.

This is my confession. Before defending grammar, I should acknowledge my innate and unthinking bias. Arguments aside, I find bad grammar ugly, messy and annoying. Yet good grammar isn’t just beautiful, tidy and satisfying. It’s also useful. This is the crux of my argument. Those of us who whinge at a ‘would of’, reel from a ‘writ down’ and laugh at a lax ‘literally’ are not trying to re-attach this or that dangling part to an ailing system; we just think there should be a system.

GCSE English never formally tests the grammar of its candidates. Some mark schemes punish errors in spelling and punctuation, but pupils are never required to name the parts. The nitty-gritty of the English language is allowed to remain a mystery.

I know formal English grammar is more subjective than people think — Dryden seems to have made much of it up as he went along — but effective communication is a massive life advantage. We admire those who are good at sport or music or sex. So why not admire those who are good at communicating? Sportspeople need their tactics and formations; musicians need their keys and time signatures; lovers, unromantic as it seems, need to know some pretty technical facts concerning anatomy; and anyone wishing to communicate would do well to familiarise himself with word classes, and the various moods, tenses, cases and voices in which they can be employed.  

The existence of the term ‘Grammar Nazi’ is a symptom of a sickness. Our culture doesn’t care about grammar. Those of us who like it, know it, value it… we are regarded as an eccentric special interest group — and that’s at best. More likely and more often, we are dismissed as out-of-touch snobs who obsess over our stuffy, yellowing rule-book because we hate the poor and the stupid. Stephen Fry and many others have argued that language evolves and we should not oppress one another with silly, old-fashioned rules. Who cares if the lone butcher at your local Butchers’ has erroneously pluralised himself with a misplaced apostrophe? We survive in spoken English without using or implying any apostrophes at all!

This completely misses the point. You can argue that the apostrophe rule is superfluous. You can argue that split infinitives are sometimes more poetic, and in any case work perfectly well outside of Latin. You can argue that ‘data’ has always functioned in English as a collective rather than a plural noun. You can argue that prepositions make just as much sense at the end of a clause. You can argue that distinctions between amount and number, between less and fewer, are unlikely to impact upon clarity or poetry.

You can argue all of that and much more, but only because you understand the rules and terms of grammar, without which the whole discussion could not happen. Those who rail against us Grammar Nazis commit their own form of elitism. The kids I teach respond better to the clear-cut rules of grammar than to the more prissy business of drawing inferences from texts. The idea that grammar should be the preserve of a pampered elite who have time for it, but that it needn't matter to the proles who just need to grunt basic ideas at one another... this is the real snobbery.

Studying spoken language and text-speak with teenagers has been a real eye-opener for me. Once you sacrifice grammar, it is possible to convey simple notions (if the reader takes charitable account of context), but it becomes completely impossible to convey nuance, irony, subtlety or complexity. For that stuff, you really need semi-colons and subordinate clauses.

I am in the process of helping out an aspiring writer with his work. He’s fourteen years old and has more natural talent than I have. He’s going to be great and it’s a pleasure to watch him become so. But for the minute, I’ve still got some stuff to teach him, and it is all incommunicable without reference to grammatical rules. He sometimes employs adverbs where he would do better to select a more telling verb; he sometimes uses tautological adjectives to compensate for a poor choice of noun; his desired rhythm and emphases would sometimes benefit from a more judicious application of dashes and semi-colons. I am at pains to explain any of this to him without reference to those crusty rules upon which our culture spits.   

But what about the kids who don’t have natural aptitude? Should we thrust them behind the wheel and tell them to careen their way through the labyrinth of English using just their instinct? Of course not; they need to know how the vehicle actually works. They will need to send emails and letters. They will need to win arguments. They will need to take out loans. They will need to apply for jobs. They will need to make friends and attract lovers. Some of them may want to write their own stories, plays and poems. They will need to inform, explain, describe, argue, persuade and advise in so many contexts for so many reasons. It is precisely the kids with the least flair who benefit from the most structured, practical and technical instruction. Who wants to tell me that the luxury of understanding how language works is a needless imposition on these children?

Snobs, that’s who. Snobs whose privileged exposure to so much good grammar at such a young age has left them unable to empathise with the majority of kids who take our culture at its word. We are raising generations of children who don’t know what ‘grammar’ means and resent the idea that they should. The grammar-deniers are engaged in a very unsightly attempt to ‘get down’ with these kids by means of the evolution argument. Of course the rules shift and change and die and get invented, but they don’t stop being rules.

Spelling governs the arrangement of letters into recognisable words, punctuation clarifies the rhythm and relationship between those words, and grammar decides the order in which they can be put. We can argue, we really should argue, about which rules work and which might be updated… but to militate trendily against the very idea of having rules at all? This is a dangerous game. Without the rules, Hamlet is just squiggles on a rag; I have a dream was just a noise coming out of a dead man’s mouth. Grammar is the foundation of the palace, the engine in the car, the biscuit base of the cheese-cake. It’s the bed of the flowers, and we trample it at our peril.

 

 

English literature: why not the basics?

The revised GCSE English syllabus is to include two Shakespearian plays, some Romantic poetry, a nineteenth-century novel, First World War poetry, and examples (but not extracts!) of post-1918 British fiction, poetry or drama, and of world literature in English. There’s also to be a more thorough grounding in grammar, vocabulary, and writing style. This is a good thing.

So is the focus on literary texts instead of literary theory. A first-year undergraduate student tells me that his school taught Freudian theory at English literature GCSE and again at A-level. Playing spot-the-phallic symbol might achieve a point or two, but — pardon the pun — it’s not hard. Some students may be advanced enough early enough to benefit from dream theory and psychoanalysis; but if many arrive at university unable to evaluate what a text is about, to articulate clearly what it’s doing and how it’s doing it, what’s the use of being able to spout second-hand speculations about the author’s subconscious? It isn’t worth a thing next to the ability to grasp meaning, motivation and method effectively; to construct a logical argument from well-selected points and evidence; to create a coherent, comprehensive and comprehensible piece of work, carefully spellchecked and proofread to remove inanities, inconsistencies and contradictions. Whether the student hopes to walk an academic or  a vocational path after school, these skills will be crucial; employers care about application, accuracy and attention to detail, not half-understood Freud and Jung.

School is the place to learn the basics: a solid grounding in reading, interpretation and comprehension; in communicating thoughts as well and as clearly as possible. School is the place to learn to name and recognize the parts of speech and the basic literary and poetic methods; to discover how to organize an essay or a report sensibly; to acquire a work ethic. School is the place to lay down the footings of adult competence and confidence. It’s a vital mission: the absolute prerequisite, the sine qua non. There is never again the time, the place, the opportunity to construct this foundation, the base on which everything else will rest.

Why, then, do so many English teachers apparently feel it’s not worth doing or even that it’s not their job?

English Literature: the edited highlights?

There are ‘fears that many children are currently able to complete GCSEs in English without reading whole books — particularly those written prior to 1900 — while focusing on small “extracts” of Shakespearian plays’ (Graeme Paton, ‘More Shakespeare in “toughened up” English GCSEs’, Daily Telegraph, 8 February, 2013).

Last year I took part in a university open day, giving A-level students an overview of core and optional English literature modules on English joint honours courses.

When I’d given the students some basics on first-year modules, I invited questions. One young woman immediately put her hand up.

‘Can I ask,’ she said, ‘do the modules cover the whole text or extracts?’

Surprised at the question, I said, ‘Whole texts.’ The young woman looked rather disconcerted.

I took a few more questions, then told the students about some of the modules on offer at honours level. Again I asked if anyone had questions; the same young woman raised her hand.

‘What about the texts on the courses for second and third year students?’ she asked. ‘Do you study extracts for these, or are they complete books too?’

Still puzzled, I said, ‘Whole books.’ The young woman seemed no happier at this answer than at my previous response.

I wondered then, and have wondered many times since, why someone who apparently didn’t like or want to read was applying for a joint honours degree involving a minimum of fifty per cent study of literature, a subject which patently demands extensive reading; and why on earth she thought that excerpts might be used instead of complete texts. Until today, I had no idea that a school might attempt to teach literature via extracts. Adding this new information to last year’s knowledge, and seasoning the mixture with a little cynicism, I’d say it seems likely that this method is not confined to GCSE.

Amazon tastes Nectar no more

I’m still taken aback by Nectar’s sudden parting of the ways from Amazon. Amazon’s website gives no reason at all, but simply reports the fact. Nectar, however, seems to be claiming the responsibility for the decision:

We are constantly growing and developing the Nectar programme to ensure that we provide collectors with a spread of opportunities through which to collect and spend their points. On occasion, when we add a new partnership, we review existing relationships with companies that operate similar businesses.

So far, so reasonable; yet none of the partner members listed by Nectar as alternatives sells books:

The good news is that you can still collect Nectar points through eShops at over 500 online brands such as ASOS, Next, Debenhams, Argos, Apple, Currys and hundreds more!

I contacted Nectar about this, and received a commendably quick response. Unfortunately, it merely introduced me to the existence of abebooks.co.uk and, from the information supplied, it was clear that I, as a long-standing customer, know more than Nectar about how abebooks works.

I replied pointing out that this was not an equivalent outlet, since abebooks

• is not a retailer, selling direct to customers, but rather provides a portal for individual booksellers;
• costs more in terms of postage, as each item bought attracts a postage fee, unless there’s a promotion running;
• largely features secondhand books;
• does not have an extensive range of audiobooks (which I buy a lot since my aunt went blind);
• does not offer any ‘Look Inside function’ for books.

I’ve yet to receive an answer to that email.

It’s up to Nectar to select its partner outlets for the points scheme, of course, but this feels strange. Perhaps the decision is really due to Nectar wishing to distance itself from a company implicated in tax avoidance; but, if this is the case, why not say so? (Unless taking the moral high ground might come back to bite Nectar…) To state that there are other partner members that ‘operate similar businesses’ is both unsatisfying and disingenuous.

Perhaps it’s simply a coincidence that Sainsbury’s now sells ebooks…

Computerized medical records

I had a doctor’s appointment this morning to organize some repeat prescriptions that I hadn’t been able to order online. It turned out the practice had a new computer system. Though many details had been ported across accurately, several pieces of information were missing or incorrect. In this case, I couldn’t order repeat prescriptions because the system showed the previous issue date as 30 January 2013. This, it transpired, was when my records had been ported in.

(I’ve been through this before. When my previous practice first computerized its records, much of the information held in the physical files wasn’t transferred. In my case, and my mother’s, this meant jettisoning the complete list of medication known to produce an allergic reaction. Since both my parents were allergy-prone, I started collecting allergies early in childhood; and over the years they have increased in number considerably. I was reasonably clear on the drugs that had demonstrated their hostility to me in adulthood, but not all those that had been noted on my medical records when I was a child. Having the information on the records was useful; it meant that doctors didn’t have to rely on my memory: they could see which drugs weren’t going to work for me, thereby saving me a greater or lesser amount of unpleasantness, and saving the NHS money. I’ve never understood why this transfer to the computerized system wasn’t announced in advance, so patients had the opportunity to obtain such crucial information before it was lost forever. If the drug-allergy information was important enough to write on my file in the first place, when and why did it stop mattering? A related question: why does no doctor or nurse ever read the ‘latex allergy’ warning written in huge red letters on the cover of my hospital records? They ask unexpected questions, and while I'm racking my brain for the response, they pull on the Wrong Colour Gloves, and then I'm in trouble for not telling them in time…)

Back to this morning. Because my current doctor’s system no longer showed that I had undergone an annual medication review in September, I had to have my blood pressure and weight taken, and then I had to answer the standard questions doctors are required to ask, seemingly at every consultation, on smoking (the system no longer registered that I gave up last year), drinking (somehow I still managed to be lectured, even though, in an attempt to lose weight, I had halved my intake to a maximum of four units a week), eating habits (somewhat curtailed: see drinking, above) and exercise (another lecture… If exercise gave me the endorphin hit everyone promises, keeping up the gym visits would be easier; sadly, it never does and never has. I’ve yet to find a doctor who can explain this to me).

Then the doctor started on the computerized prescription routine. As I watched her open each medication record individually, make changes to the date, and then hit OK, I couldn’t help thinking that, overall, the appointment hadn’t made best use of her highly-trained (and thus expensive) time. The vast majority of the appointment involved the doctor typing in blood pressure and weight figures, asking simple questions from onscreen prompts (‘Do you smoke?… When did you give up? … How many did you used to smoke per day? … How many units of alcohol per week?’ ‘Dunno, but I drink four glasses of wine’) and entering the answers, and inputting dates and other non-specialist data into the system.

No medical training is needed for this. It cannot be cost-efficient for fully qualified doctors to perform tasks that could be done by less highly trained, and cheaper, staff. Hospitals use a combination of nurses and administrators to gather and record preliminary information before the patient sees a doctor. Such functions could be carried out by nurses and administrators in general practice too, freeing up doctors’ time for tasks requiring their expertise. A practice with a do-it-yourself blood pressure machine could free up the nurses’ time for something more vital, too.

All this took at least 10 minutes. My surgery has several large notices stating that a patient should only raise one issue or problem per appointment. This isn’t rare: several people I know tell me their surgeries operate this rule, and some even impose a time limit. A quick trawl with a search engine shows that many surgeries’ websites operate a similar system. Twice, a doctor has politely remonstrated with me for bringing two — brief, and once, so I thought, related — problems in; so I know they are serious about it.*
 

I was, therefore, more than a little puzzled by what happened next. My doctor finished updating the records and clicked the onscreen button to send the prescriptions to the printer. At this point, a large pop-up box appeared on the screen. The doctor told me that it was a reminder saying, in effect: ask the patient if there’s anything else you can help with — thus completely conflicting with the well-publicized and apparently strict only-one-problem-per-appointment rule.

I'm not sure this new system has been well thought through…

* In November 2011, the NHS reported that doctors in general practice spend an average of 8–10 minutes with each patient; two months earlier, Dr Roger Henderson had suggested that the average is 7 minutes. A new survey is due later this year.

Prostate Cancer - still no screening

Cancer Research UK states that prostate cancer is projected to become the most common cancer by 2030. It’s uncommon in younger men, but ‘the incidence rates rise sharply from around age 50-54’. The NHS says that it ‘can usually be cured if it is treated in its early stages’ — so why is there still no national screening programme for men aged 50+?

 

Link: Prostate Cancer UK, Sledgehammer Fund

Married Couple's Allowance: archaic and unjust

The reported dismay over the government’s plan not to resurrect Married Couple’s Allowance  (MCA) in the imminent budget is puzzling.

Feminists in the UK argued long and hard for married women to be treated independently from their husbands, instead of being viewed as dependents — equivalent to children — even if they earned their own income. Until MCA was finally abolished in 1990, a wife’s income was treated as her spouse's for tax purposes, and reported on his tax return, leaving her no financial privacy from her husband, although he could keep his personal finances secret from her if he so chose. Quite apart from being demeaning, the system was open to abuse by a profligate partner.

While far from ideal, MCA made some sense when married women were expected to give up paid employment on marriage to focus instead on bearing and raising children, and were thus dependent — like children — on their husbands. MCA made less and less sense as more and more wives and mothers stayed in work.

MCA was replaced in 2000 by credits related to children: these were intended to offset some of the expenditure involved in bringing up children, while all working-age adults had a basic Personal Tax Allowance unaffected by their marital status.

In a society that entitles both men and women to work, and to be treated as independent adults in tax law, it seems pointless and unjust to return to an archaic system of tax allowances based on the formal union of two people (whatever their gender), and which thus penalizes adults outside that category, as well as the children of adults who may be unmarried for a variety of reasons, including widowhood and divorce.

Where's my Henry?

All I want’s a Henry, small and smiling,
A friendly vacuum cleaner for my floors,
To lift the fluff up from the kitchen tiling,
Manoeuvre round the table legs and doors.
Light enough to manage on the staircase,
Compact enough to fit under the stairs,
Well-rated as efficient (it won first place,
With suction ample for the dust and hairs).

I placed an order for a Henry cleaner
Last weekend, and paid more for ‘Superspeed’
With Amazon (the final price still keener),
Deliv’ry Monday morning guaranteed.
I stayed in Monday, all anticipation,
Intent to get the cleaning off the blocks;
But nothing came. I rang: no information…
Then they confessed: the wrong van had my box—

But it was labelled, so there’d be no barrier
In sending Henry on: and DPD
Were said to be a reputable carrier;
My missing pack would soon be here with me.
No. They insisted there had been no answer
(So why not leave a ‘out’ card in that case?),
Then the address was wrong (this man’s a chancer),
And then that there was no sign of my place!

The order was refunded without question,
I tried again: high cost, but problem solved,
And time in hand to beat the Yule congestion—
If only DPD’d not been involved…
Somewhere out there’s a Henry with my name on,
All poised and ready to spruce up my pad—
I need him here. I hate to pile the blame on,
But DPD, it really is too bad.

No Such Address (The DPD Song)

O DPD, dear DPD,
Why can’t you get my stuff to me?
My house was built in ’53
(or thereabouts): the maps agree
It’s there: why can’t your driver see?
It’s on the right. Or try the G.
P. S. to trek successfully
from there to CV23.

O DPD, sort out your mail,
I click the link to no avail,
The lead is false, a broken trail:
No tracking here, no Holy Grail.
I paid in full and on the nail,
But twice this week an epic fail—
Excuses have grown very stale.
It really is a sorry tale.

Where are the solutions?

My recent comments on the NHS preceded by a day the news that the NHS watchdog, the Care Quality Commission, has identified a failure of basic care for the elderly in 25% of hospitals. This is unlikely to be a surprise to anyone; I commented in September 2009 on a Patients Association report that found that many nurses clearly didn't feel that nursing, notably of the elderly, was among their duties or responsibilities.

It's appalling that, eighteen months later, this is still an issue; what's horrific is that this report seems to offer no intelligent or constructive solutions to the problem. Where are the recommendations for addressing the issue? For retraining, even disciplining, neglectful staff? For restructuring over-large wards and unclear hierarchies to make sure that patients are at the heart of activities and that someone is responsible for making sure they remain the central focus? For employing permanent staff who have commitment to their job and workplace, a sense of personal investment and responsibility, instead of relying on an ever-changing roster of agency nurses who have neither? For getting nurses in amongst the beds and patients, and away from the clutch around the ward's desk, far away from the patients — a too-frequent sight in many hospitals?

The CQC's mission statement is to "make sure that people get better care" and they announce:

We do this by:

• encouraging improvement across health and adult social care
• putting people first and standing up for their rights
• acting quickly to remedy bad practice
• gathering and using knowledge and expertise, and working with others.

Far from "encouraging improvement" and "working with others", however, the only solutions the CDC seems able to offer are the threat of fines, prosecutions and ward closures — who on earth will that benefit?

Speak clearly and listen well

My mother, an intelligent and articulate octogenarian, has recently been diagnosed with cancer. This takes the family into experiences that are indeterminate, unfamiliar and unknown; none of us has a medical or nursing background; we are uncertain what to expect both from the disease itself and from the treatments offered. The NHS and support services have been active — but sometimes less than helpful, and not always inclined to listen.

My mother's initial endoscopy proved a difficult experience, not simply because it is an unpleasant procedure, but because the staff simply didn't listen. My mother is completely deaf in her right ear, and explained this carefully when the nurses told her she would need to lie on her left side during the procedure. Unfortunately, the staff ignored this information and continually spoke to my mother as they carried out the endoscopy, presumably attempting to give instructions and perhaps also offering advice and comfort — my mother had no way of knowing. Unfortunately, the diagnostician hadn't listened either: my mother didn't realize he had spoken to her at all, and she and her GP both had a shock during an appointment the following week when the GP discovered my mother was still unaware that cancer had been detected…

Another issue is the use of euphemisms. My mother has to have a second endoscopy to have a stent fitted. The MacMillan nurse has explained the procedure to my mother and, in a separate conversation, to me; but it wasn't until this morning, when I was attempting to grasp what would happen, and what care would be needed, in the days after the operation, that I finally discovered — and only through dogged questioning — that what the nurse continually referred to as "discomfort" didn't mean "anxiety" or "slight pain", as English dictionaries define the word, but pain at a level requiring prophylactic painkillers. The word "discomfort" implies something on the level of mild, and passing, indigestion; but what is in fact expected is sustained and actual "pain", requiring painkillers to be taken regularly to alleviate, and preferably avoid, it. So why not say so, clearly and unambiguously, instead of using misleading euphemisms that are meaningless to the patient, and thus make the work of the treating practitioners more difficult?

In a similar vein, there is other loaded language to be negotiated. For instance, when the MacMillan nurse says "Ask me anything you want to know", this should not be mistaken for either a general expression of support or a platitude, as it can seem to be. In fact, the sentence means something very specific and very important: "I have information about your condition, but I am not going to offer it to you in case I tell you things you might not want to know or be ready to handle." The problem is that you, whether patient or patient's relation, must work out this translation for yourself — and then work out what information the nurse may have and thus what questions to ask. Whilst the underlying sentiment of "Ask me anything…" is sound, sensible and kind, its construction results in obfuscation, especially for those unused to such cautious and indirect phrasing; and vital questions about proposed or ongoing treatments may thus not be asked at all…

UCU: going for the easy option again

Plus ça change… Members of the University and College Union are soon to vote on industrial action over threats to job security and pensions. What action is being planned? Surprise, surprise: assessment boycotting and strikes — both of which are likely to affect students more than anyone else. Funny how lecturers always choose these kinds of actions. They never suggest systematically withholding publications, although research is constantly declared to be more valuable to universities than teaching and is the source of external funding and kudos… But then, that option would mean lecturers making professional sacrifices, wouldn't it?

What use is training in humanities? (1)

What use is training in humanities? Someone has to teach academic writing to scientists… Final-year science students who don't know, for instance, that bacteria, data and criteria are plural nouns, still less what the singular forms are, have clearly not been properly trained by teachers in their own disciplines.

How-to-spell Rap

Talking of spelling, here's a clever spelling rap. Not suitable for use in schools though…

Spelling and grammar? What next?!

Apparently examiners are to begin (again!) penalizing pupils for bad spelling and grammar - and about time too, though one can't help but wonder, after a generation or so in which many seem never to have been taught any grammar at all, who is going to teach it to them and how competent the examiners will be to assess it…

What does Ofgem do?

Surprise, surprise, gas prices are being hiked again. Funny how the energy companies can respond so quickly to rising wholesale prices when it's apparently so difficult to pass on savings to their customers when prices fall. 

Adam Scorer, of Consumer Focus, points out that "wholesale prices are around half of their peak in 2008, and yet in the same period customers' prices were cut by less than 10%".

Ofgem, supposedly the regulator, says nothing on the matter, and seems likely to do even less. npower's recent refunds to customers who overpaid for gas in 2007 seems to be largely due to the efforts of the self-styled "statutory consumer champion" Consumer Focus, which continued to work with the company when the Ofgem investigation resulted in an average repayment of only £6 to 200,000 customers.

Ofgem's website says that "Protecting consumers is our first priority", and it boasts, in its latest Consumer Bulletin, that it is presently (and ungrammatically) "propos[ing] making energy suppliers give 30 days [sic] notice of price rises". Customers everywhere will feel relieved about that, and doubtless very proud of Ofgem for taking such a stand on their behalf.

It's always good to know these regulators have their priorities sorted — especially since the utilities' retail customers fund them. As Ofgem says, "We recover our costs from the licensed companies we regulate. Licensees are obliged to pay an annual licence fee which is set to cover our costs". Presumably that fee is ultimately added into the utility bills…

Health and Safety - even madder than you imagined

Council workers employed by Tower Hamlets Homes apparently thought they were following heath and safety advice issued by the Fire Brigade when they went on a spree removing washing lines, hanging baskets, doormats, bicycles and security gates. They were halted by a nun, Sister Christine Frost, who pointed out that local yobs were far more pressing a problem.

The council must have realized in advance that its actions would not be popular, as it arranged for police officers to accompany its workforce. Residents understandably considered this a "heavy-handed" approach (and, to add insult to injury, presumably had to pay for the officers out of their Council Tax). 

Housing CEO Jonathan Gregory promised that commonsense would be applied in the future. Why not apply it in the first place?

Amazing that any borough council in these penny-pinching days has the time and money to waste in this way.

Below the belt?

The BBC News website supplied a strangely ambiguous breadcrumb the other day:
The link led to a report under the headline:
This still doesn't entirely clarify the situation. Someone at the Beeb obviously realized that the headline was not entirely clear. By the next day, it had been changed to:
which is an improvement, though it's still not beyond doubt whose offensive weapon he was using…

For the curious, it turns out that
But why did she wait so long?