Changing the rules (slightly)

DISCLAIMER: What follows are purely tongue-in-cheek suggestions and are meant for discussion purposes only. In no way, shape or form am I trying to suggest that I have the religious knowledge and/or authority to advocate such suggestions on a serious level, so please don't take them that way.

Three days into Ramadhan and it's already proving to be quite tough. Fasting from approximately 4am to 8pm (16 hours) is proving to be quite a challenge. The struggle tends to start just as my afternoon surgery is getting underway, round about now actually (2.30pm), with a general woozy feeling. Then as the surgery progresses, I keep getting head rushes, headaches and the lethargy kicks in. I feel sorry for the last 2-3 patients as I am barely concentrating and just want to finish and get home. After concluding the surgery, I manage to muster the energy to drive home and just collapse on my sofa. Hopefully it will get better as the body adjusts, but judging on past years, I'm not that optimistic, especially as I'm getting older.

With the long hours only going to get worse over the next few years as Ramadhan moves into the peak summer months, I was wondering whether it's fair for us to be fasting for this long. Because the Islamic calendar is based on the moon, it's shorter than the standard Georgian calendar and as a result moves backwards by 10-11 days every year. Ten years ago we were enjoying relatively comfortable fasts during December/January. At the time I was at university and spent most of the time sleeping, woke up at 4pm and broke my fast a few minutes later. Now, the fasts have more than doubled in length and sleep is no longer an option.

Looking back at the origins of Islam and fasting, it's maybe significant to recognise that it was a religion revealed in the Middle East - in Saudi Arabia. Looking at the times for sunrise and sunset times in Mecca and one can see how little variation there is over the course of a standard (non-lunar) year. In December, the gap is approximately 12 hours and in August the gap is about 14 hours, with only a 2 hours or so variation across the year. Here in the UK, the variation is much greater, 10 hours in December and 16 hours in August (18 hours in July).

It just doesn't seem fair. Perhaps the rules of the fast need to be looked at. Islam was brought to a region where the fasting time was stable and maybe we should follow that. Of course as Islam has spread all over the world, people have needed to adapt with the country or region that they live in, but surely it is not a good idea to have muslims fast for so long when our brothers and sisters in the Middle-East are "enjoying" relatively shorter times.

If you think I'm being silly, what about our brothers and sisters who live in Scandanavia? In the northern regions of Scandanavia it is daylight for six months and darkness for the other six months. The rulings seem to vary, but from what I have read it seems to be the general consensus to follow the fasting times of the nearest country with actual sunsets and sunrises. That's not much of a relief as during the daylight months the nearest country will have upto 20 hours of daylight but during the night months, the nearest country will have only a couple of hours of daylight - a huge fluctuation.

In this country as Ramadhan enter July/June over the next few years, the fasting times will get longer. As a doctor I seriously question the health implications of fasting for such a long time. People will obviously want to complete the fasts for the blessings and rewards it brings, but at a cost to their health. Is that a good idea and is that something God would want? And it won't be just the elderly or unhealthy who will be affected. So, instead, how about just a fasting timetable that follows Mecca for everyone, all over the world? 12-14 hours all year round - seems fair to me. What do you think?

Whilst we're on this topic, by extension perhaps we should apply a similarly fair policy to other rules in Islam which perhaps haven't stood the test of time. The shortening of prayers is a classic rule which is often taken advantage of; in Islam, we are allowed to shorten the afternoon and evening prayers if we have travelled over 14 miles in one direction after crossing our home town border.

This ruling was introduced when travelling was a great undertaking at the time of the Prophet in Saudi Arabia. To ease the burden, Muslims we're allowed to shorten their prayers. The travelling rule also applies to fasting, you don't fast when your are travelling, again to ease the burden. Nowadays, travelling is not such a great undertaking - I travel 90 miles on a daily basis just to go to work and back - and so the shortening of prayers is just a time-saver and nothing else, (by the way, I pray the full length prayers at work as it's a regular place that I visit, so the same rules don't apply). Perhaps, this ruling needs to be looked out, it can either be abolished or modified according to difficulty. Of course there will still be people in the world for whom travelling is difficult, but for others particularly in the Western world it isn't such a problem.

However, if the ruling exists, then we should at least stick to it and follow it properly. People will conveniently follow the shortened prayer rule, but not the no-fasting rule when travelling. The shortening prayers saves us time, the no fasting rule causes more inconvenience as it means we have to make up the fast at a later date. As a result people tend to pick and choose what rule to follow and it is something that I have been guilty of in the past. Whilst the rules exist, we should follow them all and not pick and choose at our convenience.

Finally, another one maybe worth looking at are prayer times. Who has decided that Fajr prayer time is 1-1.5 hours before sunrise? Why is the time for Isha up to midnight only? I don't think there was such an accurate concept of time at the time of the Prophet. Surely Fajr should be just before the point of sunrise and the time for Isha should be up until the time for Fajr, just as Asr can be read up to the time for Maghrib? Actually, I'm probably nit-picking here, but for the purpose of this blog, I thought I'd try and find a third rule to discuss before passing out from the hunger!

Like I said at the beginning, this is all meant for discussion only, I am not trying to claim that I know best and that these rules should be passed, but simply typing out a few suggestions. If you can, please comment on what you think.

Take care all,

Thoughts just flow, when do they have to make sense?

Fed up with Iran

I am feeling very disillusioned right now. Iran has been getting a lot of press coverage in recent months with the general election and the events following the resutls and frankly I'm getting more and more fed-up with the stories that keep coming out. As one of only two Shia-majority and Shia-governed countries (I am not yet counting Iraq as a third), the values and ideals that the country represents does not go along with the values and ideals of Islam and more specifically Shia Islam.

Let's start with the general election and work our way from there. The election saw a supposedly landslide victory for President Ahmedinajad for a second term. The polls before the voting all indicated it would be a close affair, but Ahmedinajad supposedly won large majorities in both urban and rural towns and even in the towns of his main rivals. It was approved by the Supreme leader Ayatullah Khameni within 24 hours and everyone was meant to accept it as halal.

Clearly this did not go down well with the voters leading to large protests and demonstrations, something which the government found unacceptable. The security forces under orders from the government, employed heavy handed tactics to try and quell the protests leading to the deaths of, officially, 30 people, but perhaps as much as 250 people unofficially. 100's were also arrested and several are currently under trial for crimes against the regime.

As the trials got underway, allegations emerged that the arrested had suffered torture, abuse and even rape whilst held in prison. Many people mysteriously disappeared, whilst others are currently being held without charge. All in all it has been a very messy few months for Iran and the Iranian government.

All this has added to my growing disillusionment about Iran and it's activities. It upsets me to think that this is what a Shia government can do. I am probably being incredibly naive, but I just don't understand why it appears to be so wrong. Ayatullahs are meant to be highly educated, highly spiritual and highly regarded as leading religious authorities, but having political power just seems to change all that. How else can you explain what is going on, the atrocities that are occurring in Iran?

This leads me to ask one big question. What would the 12th Imam do? Right now, if he were the supreme leader of Iran, would it be different, would it be more humane, more correct? The answer has to be yes. As the Imam of our time, as someone who is infallible and closest to God, surely he would lead in a completely different way.

Would the Imam allow heavy handed tactics to deal with protesters leading to their deaths? Would the Imam allow the alleged abuse of prisoners? Would the Imam allow potentially rigged elections? Again, perhaps in my naivety, I can only answer 'no' to all these questions. And yet, if I can see that with my lack of religious knowledge and authority, how can someone as grand as an Ayatullah supposedly not see that?

Perhaps I am mistaken in placing such a great deal of faith in our Ayatullahs, in fact the more I think about it the more certain I become that I am indeed mistaken. That doesn't come as a relief, but just serves to depress me even more. Can it only take a mausoom, an infallible man to make the right choices and decisions? Are us mere humans simply not up to the task? Is having power and control in a government really that corrupting? The more I think about these questions, the more I think that the answer is 'yes'.

This realisation is probably the most depressing, the most upsetting. The one main Shia governed country in this world is a big mess. I realise that I am being terribly simplistic about this all. Trying to criticise and comment on an Ayatullah when I don't have even 0.001% of his knowledge and faith is not the right starting point, but looking from the outside, these recent events just add to the growing disillusionment. What are we meant to do?

Finally, just to add more damage to the faith we may have in Ayatullahs, you may have read of a new ruling passed by a Shia Ayatullah in Afghanistan which permits men to deny basic maintenance towards their wives (i.e. food, clothes, housing etc) if they are denied their sexual demands. This ruling is basically allowing marital rape. If an Ayatullah can permit that then what is the world coming to?

Take care all,

Thoughts just flow, when do they have to make sense?

PS. Ramadhan mubarak to all!

Abuse of the NHS

I see the NHS has been coming under some scrutiny this past week or so, mainly from politicians in the US. This seems to be because Obama's administration is currently trying to pass through new health care reforms aimed at providing medical cover to the entire population and not just those who have private insurance. As the debates rage on, the NHS has been put up as an example of how to do it rightly and wrongly depending on what side of the argument you stand on.

Last week a Tory MEP, Daniel Hannan on US television, much to the delight of Republicans, labelled the NHS as a "60-year mistake" saying that "he wouldn't wish it on anyone." This has understandably and rightly led to criticism from various politicians including the Prime Minister and Health Secretary who has labelled Hannan's words as "unpatriotic" and as "an insult" to the 1.4million workers in the NHS - including me.

Am I insulted? No, not really. I don't agree with Hannan's opinions nor do I find them particularly helpful, but I am not insulted by them. Like all large organisations, especially government funded, the NHS is not perfect, it has some major flaws and issues which need improvement (in some cases drastic improvement), but as a form of health care I believe it is a far better service than what is available in the US.

Interestingly Hannan has previously made some suggestions about how to improve or adjust the NHS, but they have all been ignored and overshadowed by the comments he made in the US. Obviously taking things out of context and being attacked by opposing party politicians is standard fare these days so it's no surprise about the reaction Hannan as recieved in light of these comments, but it does highlight how sensitive a topic the NHS is and will remain to be.

The main issue with the NHS is it's role as a universal health care system for everyone. Everyone is entitled to free health care but the quality of care varies with each condition. Studies have shown how the NHS fares in dealing with certain conditions compared to other Western countries and it seems that it struggles to match the success of other countries. For example in Britian, males have a 51% 5-year cancer survival rate, compared to 57% in Finland and Switzerland. Similarly in care for patients with heart disease or strokes, the figures show that the NHS continues to lag behind our European neighbours.

However, looking at pure statistics ignores the main concept of the NHS - I feel that it is the universal aspect of the NHS which is it's main problem. No other country has a health care similar to the NHS - the idea of it being completely funded by the taxpayer for everyone is unique. I believe that this is the main cause of it's struggles and failures.

In my experience (of 5 long years), people's attitudes towards their health is derived from the NHS. Because care is free, people are more lax and carefree towards their health. The majority of patients I see are so dumb when it comes to their health. I'm not just talking about the un-educated or working class, I'm talking about lawyers, accountants, bankers (although maybe they're just generally dumb) and other professionals. They just appear to have no idea about what to do and what not to do about their general health. Today, the health costs are huge to look after people who have problems related to alcohol, drugs, smoking and diet and most of them do not care. The care is free so they'll carry on abusing themselves.

I have repeatedly asked patients about what they should be doing to improve their health and am repeatedly met with blank expressions, offering no suggestions. People are not interested. Instead of a doctor-patient relationship, it often feels like a parent-child or teacher-student relationship, although in this case the child/student doesn't seem to learn, they just carry on as before. Of course, I am generalising, but the impression that I have built with my experience is that of a population that is not all that bothered about their health. Is it any surprise then that our survival rates are so poor?

In other countries where there is a mixture of government funded and privately funded health care, the care is better. Perhaps it's because people care about themselves. Of course there will be patients who suffer from alcohol abuse, smoking etc, but I don't think it's as bad as it is here in the UK. I've mentioned this before, but offer something free and inevitably it will be abused. The NHS is being abused.

I've discussed the options of charging for health care before and I am not going to head down that path again, but there has to be some repercussions for not looking after yourself after you have been given the necessary and correct advice from your doctor or health professional. It is arguably the most infuriating aspect of my work - seeing patients repeatedly for the same problem mainly because they refuse to help themselves. They keep turning up expecting solutions, when the main solution is to improve themselves and change their practices.

I leave you with an example from this morning's surgery. I saw a 20 year old female who keeps presenting with recurrent abdominal pain for the past 5 months. She is overweight, has a poor diet, takes recreational drugs and is currently unemployed. She has never tried to modify her diet ("it's too difficult") nor has she undertaken any exercise ("I don't have the time"). On her notes are clear documentations of plans other doctors have suggested to her to try and improve her symptoms and she has barely followed any of them. Because health care is free, she has had investigations including an ultrasound scan and various blood tests, all of which have been normal and yet she keeps coming back expecting us to have a quick-fix for her that doesn't require her to make any serious or strenuous modifications. I am afraid it just doesn't work like that.

Before people complain that she probably has psychological issues and can't change herself even though she wants to etc. First of all in this case it isn't true, I've asked, secondly, if that was the case she would still be able to get the psychological help, but I doubt it would make any difference and finally, do you not think there would be a change in attitude if there was some sort of repercussion for not looking after herself, or for not taking the necessary advice? I think there would be.

In the end, many improvements are needed in the NHS, of that there is no doubt, but one of them is to place more onus and responsibility on the patients who the NHS serves. Stop placing all the blame on the NHS itself and perhaps start focusing on the people who continue to take advantage of it - the patients.

Take care all,
Thoughts just flow, when do they have to make sense?

The drugs don't work

It never ceases to amaze me how much rubbish the media get away with on a daily basis - how much they blow things out of proportion. Actually, "amaze" is the wrong word, "irritate" is more appropriate. However thankfully it's an irritation that doesn't get on top of me as blowing things out of proportion seems to be the main occupation for a lot of journalists and I'd be pulling my hair out if I got irritated every single time.

King of "blowing things out of proportion" is arguably the the Daily Mail and today was no exception. The front page lead with the headline "Tamiflu turned my children into hallucinating, sobbing wrecks" accompanied by a picture of the journailist Richard Price and his family. I'm hoping most if not all of you know what Tamiflu is - the drug used in the management of swine flu.

Apparently, Price's children were prescribed the drug by an on-call GP after they rang NHS Direct seeking advice about their children who had developed a cough and high temperature. They subsequently went on to develop unfortunate side-effects from the drug leading Price to stop the treatment and claim:

"So what happened when we defied government advice and eschewed Tamiflu in favour of Calpol and cuddlies? Within 24 hours both of our children were completely recovered, save for those with runny noses"

Similarly on Monday, there was another article in the Daily Mail about how GMTV presenter Andrew Castle almost lost his daughter to the "swine flu 'danger' drug", when he revealed on TV the side effects of the drug prescribed to his daughter whilst interviewing health secretary Andy Burnham. The drug was apparently handed out at her daughter's school by the Health Protection Agency when a pupil was suspected of having swine flu. The side effects of the drug apparently caused severe breathing difficulties requiring Castle's daughter to be hospitalised for three days.

Before I launch into my main points about these articles, let me quickly describe my own experiences of dealing with swine flu and the prescription of Tamiflu. Before the launch of the National Pandemic Flu Service (0800 1 513 513) a couple of weeks ago, we were being inundated with phone calls from patients with symptoms ranging from runny nose to full blown fever and bodyaches. I was typically taking over 20 calls per day dealing with potential swine flu concerns. To date, I have prescribed Tamiflu a grand total of two times.

As GP's, we are getting weekly updates on the lastest treatment suggestions for swine flu - it has constantly changed, but one piece of advice has remained the same - the use of our clincial knowledge and skill as doctors. In all my phone calls I take a detailed history, ask about close contacts and for me the key is the temperature control. Remember, swine flu in a healthy person is like any other flu. It causes the same symptoms and should resolve in the same amount of time (5-7 days). The important feature is how good is the temperature control. If paracetamol/ibuprofen are controlling the temperature and patients are seeing an improvement then the patient can continue with the treatment without requiring further intervention.

On the two occasions I've prescribed Tamiflu, once has been on a GP's insistence for themselves despite my misgivings and on the second occasion for a person who suffered with other chronic health problems and I felt the Tamiflu could potentially limit the extent of the flu for at least a couple of days and it seemed to help. There are different guidelines for unhealthy people, patients who suffer with chronic illnesses which would make swine flu more damaging, but for this blog, I don't want to get into that since I am assuming that both Price's and Castle's children are otherwise normal, healthy kids.

Sometimes, when consulting with patients, they are not happy when I suggest Tamiflu is not necessary. At that stage, I discuss the risks and benefits of the drug and explain what it is for. So far, all patients have agreed they rather hold off the prescription and wait to see how their symptoms progress. This is why Price's article irritates me. He casually states that the on-call GP "was pretty certain they had [swine flu] and it was better to be safe than sorry,"

I'm sorry, but I struggle to believe that. No doctor (GP or otherwise) will prescribe medication without discussing the benefits and risks of the treatment. I cannot believe that the GP would not have explained all this to Price before recommending the treatment. If he didn't, then Price received sub-standard care which is an exception and not something to blame the government or NHS over. If he did, then Price is omitting information in an attempt to exaggerate his article.

Like all drugs, Tamiflu has side effects. A quick look in the BNF (British National Formulary) reveals the side-effects include: "nausea, vomiting, abdmonial pain, diarrhoea, headache, less commonly rash, visual disturbances and neuropsychiatric disorders in children." These all sound rather alarming but then have a quick read of the side effects of common antibiotics used to treat a variety of infection. For example, amoxicillin's (used for chest infections, tonsillitis, cystitis) side-effects include: "nausea, vomiting, diarrhoea, rashes." Or cefalexin (used for cystitis, pneumonia), which can cause "nausea, vomiting, diarrhoea, abdominal discomfort, rashes, headache, fever, liver damage, hallucinations, confusion, dizziness." All very similar and yet I don't remember reading a report about someone's outrage after suffering from side effects caused by common antibiotics and attacking the government and NHS for prescribing them in the first place.

Among the side-effects of Tamiflu, there is no mention of respiratory problems which is what Castle's daugther suffered with after starting the treatment. It is however, a symptom of swine flu and it's not clear from the article whether Castle's daughter was suffering from flu symptoms prior to starting Tamiflu or not. It seems disingenuous to attribute the symptoms to Tamiflu when there is no evidence that it causes the symptoms that presented. However, to be fair, there is too much information missing from this story and it needs further clarification.

As far as swine flu goes, it is a new strain of virus (H1N1) which usually causes flu symptoms just like other flu viruses in healthy people. It can be more dangerous in patients who are already unwell, and like other flu viruses, there will be occasions when it can cause a lot of damage. It has caused national concern because it appears to be a lot more contagious than other flu viruses but the consequences remain the same. Over 12,000 people die annually in the UK from the flu and so far (as of the end of July) there have been 41 deaths from swine flu related illnesses, the majority in patients who had other chronic illnesses as well.

I come back to my original point, I feel that it has been blown out of proportion by the media. The government and the NHS are doing there best to manage the spread of the virus and reports such as Price's are not helpful in the slightest. There will always be people who suffer from side-effects and to try and blame the NHS is not fair. When Price concludes that:

"Yet the sobbering fact is that today alone, the NHS will hand out Tamiflu to thousands of vulnerable little children who will go through needless suffering as a result of scaremongering about an illness which is no more dangerous than seasonal flu.

Take it from us: it really, truly, is not worth it"

Who does he think is responsible for the scaremongering? How about the Daily Mail for articles such as this, this and this? Maybe Price should've taken advice from the Daily Mail's own GP about the use of Tamiflu:

"Q: Is it better for me to fight swine flu naturally if I am otherwise healthy, or to take Tamiflu if offered?

A:All medications come with potential side effects so, if there is the possibility of treating an illness more conservatively and still making the same recovery, doctors always prefer to do that. If you are otherwise healthy, it appears that swine flu is a mild illness lasting for three to four days with no complications: therefore, many GPs have been advising patients not to take the Tamiflu. So far many of those with confirmed cases of H1N1 have opted out of taking the drug and made a normal recovery."

Take care all,

Thoughts just flow, when do they have to make sense?

The cost of not turning up

There was a news story this morning highlighting the cost of missed appointments in the NHS. Apparently it cost the NHS approximately £650 million between 2007 and 2008 for missed appointments. For every person who failed to turn up for their appointment in hospital or general practice, it cost about £100.

Working in general practice, there is a fair share of missed appointments, on average 5-6 per week. Often no explanation is given and when the patient does turn up at a later date there never seems to be much bother about it. Is it really that surprising? Offer someone a free service and people will take advantage. It's no cost to the patient not to turn up, so if they can't, they won't. When I mention to my patients that they missed previous appointments, it's usually met with a shrug and mumbled excuse about how they couldn't get to the phone cause they dropped it in the toilet or something!

The NHS is attempting to address this by trying to setup a text/email service to remind patients about their appointments. In GP-land, different practices have different policies. For example, in my current practice, we tend to phone the patients who have made emergency appointments to make sure there hasn't been an adverse event preventing them from attending. For standard appointments, it is documented in the system and then for the doctor to discuss the missed appointment at the next consultation.

Although it may sound like I'm complaining about missed appointments, it's actually the opposite. I quite like the chance of free 10 minutes in the middle of my surgery - it's like a free gift. If it's busy it gives me the time to catch up, otherwise I get a 10 minute break to relax and get ready for the next patient. During my hospital time, it was even more valuable as all the clinics would overrun and missed appointments would seem like a blessing and allow valuable catch up time. There's mention of hospitals over-booking, but I hope they're careful about how much they overbook - if there's even 60-70% attendance then it will get chaotic.

There was no surprise to read that the worst offenders were young men in their early 20s. They obviously have better things to do. However, in my experience there doesn't seem to be any particular age group - across the board, people miss appointments without giving a reason.

I believe when it comes to missed appointments, there should be a more ruthless approach. A system needs to be developed where patients pay a fee for missing an appointment without at least 24 hour notification (allowing for certain emergency situations - having the plumber run late at home is not an emergency situation).

How you implement this fee is the difficult part. When it comes to health care - charging for the care of someones health is an extremely alien concept in this country. Refusing to see patients unless they pay their fee for missing a previous appointment won't work, especially if the patient has a serious medical problem. Asking the patients to pay out of their own goodwill won't work - patients don't have goodwill. Perhaps getting the patient to pay a deposit prior to the appointment, which is then returned if they attend could be an option. It will be fiddly to say the least and time-consuming, but if patients know there are repercussions for missing an appointment perhaps they won't miss as much.

Finally, whilst we're on the topic of charging, here's one report last month, which looked very interesting. Charging to see a GP? Don't worry, it's not something I support, access to health care should always be free in this country - after all, what are we paying taxes for? Interesting however to see a think-tank have the courage to display such ideas, don't see it taking off somehow. Can you imagine the political damage it would cause if it was backed by the Tories or the Labour party? They wouldn't survive.

Take care all,
Thoughts just flow, when do they have to make sense?

The long-awaited return

It's the time of year when I find myself with a lot of spare time and after exhausting all other options I return to the blogging world. Admittedly this wasn't planned and neither is it something I particularly want to do but for some reason, yet again, I'm back for some random ramblings about anything and everything. Once again I find myself in the front of the keyboard with time to kill and thoughts to express so let's see how long this return lasts.

You'll be glad to know that my time as a GP Registrar is over - I have qualified as a fully-fledged GP. Finally let loose onto the general public without any supervision. The qualification brings with it a lot of uncertainty, for the first time since I qualified, I am officially self-employed and currently without a permenant position. As a result for the next few months I am a GP nomad (or locum) working here, there and everywhere. Selling my services for an hourly rate to any surgery that needs a doctor. Thankfully demand is high and as it stands I'm fully booked upto mid-November.

Although it has only been 5 days since I qualified and started working as a locum GP, already I am seeing the benefits and why some doctors remains locums for years. My job is pure service provision, I turn up and just see patients. No paperwork, no prescription signing, no letter signing, no home visits, no telephone calls, just a morning and an afternoon surgery for a total of 5hrs and my work is done. Without going into specifics, 5hrs a day earns me enough to want this locum gig going for as long as possible.

The plan is to eventually get a permenant job as a GP partner, ideally in a practice close to home. Until that opportunity arrives, I'm more than content to carry on as a locum, scouring the job ads in the various medical journals waiting for the right job to turn up. I've already had a couple of interviews for partnerships one near the place where I trained (i.e. miles from home) and the other slightly closer. Although on both occasions I got down to the final 2-3 candidates, I was unsuccessful. Still, good experience etc etc. Good to know that my CV is up to scratch and at least I'm getting the opportunity. What the locums have afforded me is the time to make the right choice as and when it arrives.

Other than that, life remains pretty much unspectacular. Not much has happened in the past 5 months or so since I last blogged. Yet again as I restart blogging, Ramadhan is around the corner. It was 2006 when I first started this blog and Ramadhan was about to start, then again last year when I returned it was the same thing again, and now the third time I'm back just before one of the most important months in the Islamic calendar. No doubt I'll be attempting to type about some religious topics which I hope will prove insightful.

So there we go, a brief introduction back into the blogging world and hopefully there will be a lot more to come. After all, my free time has increased further. Before people start moaning about the amount of time doctors waste, using me as an example, may I remind you all that I am no longer paid for the free time. As a locum GP I am paid an hourly rate for the work I do in the morning and afternoon, no more no less, so this is now a free of charge service I am providing for you readers. Isnt' that thoughtful? How faecious of me!

Take care all,

Thoughts just flow, when do they have to make sense?

Our search for knowledge

"The one who seeks knowledge is like a warrior in the cause of religion for the way of Allah." (Imam Ali a.s.)

Do you have enough knowledge to call yourself a warrior for the way of Allah? No, nor do I. No doubt at one point or another we find ourselves motivated to learn, to seek knowledge by way of lectures and reading - more often then not this commonly occurs during the first 10 days of Muharrum but soon enough we find ourselves increasingly distracted and subsequently find it hard to fit in the time to make an effort to seriously learn, revise and spread our knowledge of Islam.

Our basic Islamic understanding tends to come from the education provided by our parents or perhaps the few years spent at the Saturday/Sunday madressa, but how much of that knowledge do we retain today, and how much more have we sought ourselves? The information we have learnt from a lecture or a book is only one step in increasing our knowledge. Studies have shown that knowledge can only stay fresh in the human mind for a short period of 24hrs after which it needs to be revised in order for it to be retained. After listening to lectures, ask me what I learnt the next day and the information is limited.

Either out of laziness or naivety, we don't tend to enhance what we have learnt from lectures with further revision. I often think that when the time comes, I'll be able to seek the knowledge from various books or knowledgeable friends, but rarely make the effort to search for knowledge out of choice. It is important to know about the basic Islamic beliefs. I'm sure like me you find yourself in debates with Sunni's or non-Muslims and often come unstuck when your are unable to identify a viewpoint they have as incorrect. You know it's wrong, but can't back it up. The historical fact or quranic verse or narration of that particular event is missing from your mind and you end up looking foolish. 

For us Shias it's even more important. There are several topics that are controversial for Sunnis and it's important to be able to talk about them with the correct information. I've previously touched upon temporary marriage and dissimulation and there are other topics which seem to be unique to the Shias although backed up by the Quran and Ahl-Bayt, and often cause great difficulty for us simply because we don't have the knowledge to back ourselves.

Islamic law and jurisprudence is arguably the most difficult simply because of the level of detail that is needed to have a proper understanding. However, even if we stick to the basics, how much knowledge do we have? Do we know what invalidates our prayers, what breaks our ablution, what needs to be performed after certain events? It is not good enough to simply argue that our intentions are pure and therefore God will accept our mistakes or lapses. When we have the ability to learn and clarify our practices, then there can be no excuse for being lazy - shaitan thrives on this laziness and lures us into a false sense of security.

I remember a hadith as a child (I don't have the authentic source unfortunately) where a man dreams about the shaitan. He sees him in a room lining up some equipment - a rope, a pipe, some string, a tree trunk etc. He asks him what is he doing. The shaitan replies that he's preparing his tools for distracting people during their prayers. Some people's faith and concentration is so strong that only a push with the tree trunk can distract them, for others a rope is sufficient to distract them and others, a piece of string. The man asks what he needs in order to distract the Prophet, the shaitan says that no power on Earth can distract the Prophet during his namaaz. The man confident about his namaaz having learnt it from the Prophet, asked the shaitan what he used to distract him. The shaitan put all his equipment away and said for you I don't need any of this, just a pull on my little finger is enough to distract you.

Ever since I've heard this hadith, I've always thought is shaitan using only his little finger to distract me? Sometimes it is so easy to get distracted. To strengthen our concentration we need more knowledge of what namaaz means and how important it is. We can't just say that our intention was pure, we need to constantly strive to improve our concentration levels at all times. Maybe then the shaitan will need to use something stronger to distract us - we can safely say that he won't give up - but our struggle to defy him can get stronger with more knowledge.

Having identified what we need to do, what is the best way to achieve it? Starting from scratch would be the best bet. Identifying the basics of Islam - the wajab and haram acts and then checking how much of it do we actually know. There are plentiful sources online such as Al-Islam.org and Madressa.net, both have excellent resources of knowledge, easily navigated and easy to read.

After exploring the basics, reading books which go into more depth will make more sense. Al-Islam.org has a vast amount of lectures and literature composed by a variety of scholars, our Imams and the Holy Prophet. There are also quite a few resources for watching lectures online such as ShiaTV.net and AIMIslam.org which again are a useful source of knowledge and information.

Armed with this ever increasing knowledge will not only increase our faith and beliefs and thus bring us closer to God, but also allow us to engage in debate and discussion with confidence and a certain level of authoritativeness. Obviously people will always try to catch us out, but having more and more information can only help. If you get a chance and inshallah have the motivation, check out the above sites and see what you make of it all. I particularly recommend the fact sheets of Shi'ism as a starting point, indeed many of you might recognise them from my blogs which have been based on them in the past and no doubt I'll be referring to them again in the future at some stage.

Before wrapping up, I want to congratulate Liverpool for the sumptuous thrashing of Manchester United last week and then commiserate as once again they face Chelsea in the quarter-final of the Champions League - it's going to be tense once again and I always hate the tension that surrounds these games, being a supporter is not that much fun.

Lastly, the new series of The Apprentice starts next Wednesday. It's always been entertaining for one thing - how dumb the candidates are. No matter what their background, some of the things they try in their tasks are just so inane, you wonder how Sir Alan could hire any of them. Should be entertaining.

Take care all,

Thoughts just flow, when do they have to make sense?

Mind draws a _____

I've been sat staring at the screen for the last 15minutes thinking of something to blog about and my mind is completely blank. How sad. It's just been one of those typical mundane weeks where nothing much has really happened. Patients come and go, most are well and don't need my help - it has been a boring week to say the least. What follows now is some random chatter about nothing, so if you're reading then you've probably had a boring week as well.

Actually to start things off, I did have an interesting patient present last week in my surgery. A young Irish lady came complaining of multiple mouth sores/ulcers. Nothing interesting about that you may say, but then as part of my general health screening I asked about her job (as stress can be a cause for mouth ulcers) and she revealed that she was a fire-eater! I don't know how many fire-eaters you have met but she was my first one. As part of her act, she had to hold large quantities of liquid paraffin in her mouth and then spit it out on a naked flame to get a fire-eating effect. She works in the entertainment industry (unsurprisingly) and was part of an event group which organised shows and displays for corporate businesses. Her group appeared on Dragon's Den last year and were signed up by James Caan. 

As I had a bit of time to spare before my next patient, I asked her about her experiences of James Caan. You may know that Caan was actually born as Nazim Khan to muslim parents in Pakistan. He changed his name when he saw the actor James Caan in The Godfather because he liked the spelling of 'Caan', plus, no doubt, he wanted a name that wouldn't sound like a muslim! Anyway, the patient described him as a bit of sleaze, always slightly drunk and hitting on the ladies at various parties. She then went on to say that during Ramadan whilst she was fasting, he was happily eating and drinking. 

Pause for a moment and read that last sentence again. She was fasting? Immediately I interrupted her (going against all GP principles) to double check what she had just said. Indeed she was muslim, and had converted (re-verted) several years ago whilst living in Egypt. She was married to a son of a sheikh and converted after reading the Quran looking for answers about life. She spoke fluent Arabic andhad previously worn hijab but was currently reflecting on her experiences before hoping to resume the hijab once again. Rather enlightening to say the least. A fire-eating Irish muslim - surely one of a kind!

Anyway, back to the boring stuff. Liverpool's title challenge has lasted longer than most years this season and this weekend sees them face the might of Manchester United at Old Trafford. They need a win to have any chance of challenging for the title. Already 7 points behind, to fall 10 points behind with defeat would spell the end of their challenge this year and would mean that Man Utd would match the record 18 titles that Liverpool have won in their history. I started supporting Liverpool properly in 1994 and at that point Man Utd had won only 8 titles. Fast-forward 15 years and whilst Liverpool haven't budged from 18, Man Utd are about to catch up unless something can be done starting from this weekend.

It's ridiculous the amount of criticism Liverpool get on an almost daily basis for not being good enough to maintain a challenge. Everyone ignores the simple fact that Man Utd simply have far more resources because they have been able to spend a lot more money than Liverpool. At a quick glance, Man Utd have at least 5 players worth over £20 million, (not including Ronaldo) whilst Liverpool have only one (Torres). With that in mind, it's impressive that Liverpool were able to maintain a strong challenge for as long as they did this year. 

Moving on briefly to mention 24. The show continues its resurgence with Day 7 this year. It has been a true return to form and I've forgotten about the drab that was Day 6 back in 2007. The last few episodes have been especially good. If you've never watched it, I truly urge you to go out and buy Day 1 NOW! I'm not going to talk about it any further until the season finishes as I don't want to spoil anything until it has completed.

I should conclude now, as I'm sure if you've persevered and read on to this point, you'll be grateful for the finish as well. I leave you with a YouTube clip of Michael McIntyre Live at The Apollo just to cheer you up after that boring read.



Take care all,
Thoughts just flow, when do they have to make sense?

Temporary marriage and Dissimulation

I received a rather disturbing YouTube link to a video by Watford Man. The clip is by a American born Sunni 'scholar' criticising Shia's and Shia beliefs. Normally, this would not cause any concern, there have been many before and there are sure to be many after that will criticise Shias. However, what made this video stand out was the person speaking. "Sheikh" Yasir Qadhi was born and educated in America and then completed further Islamic studies in Saudi Arabia. He is a prominent speaker on the Islam Channel and Peace TV. Rather than the usual Arab nutjobs who rant and rave against Shias, his presentations tend to be calm, reflected and researched with Shia sources - making it sound very convincing. Have a listen, see what you think and then I'll attempt to discuss some of the points he raises.



He recently visited the UK for a Global Peace and Unity event hosted by the Islam Channel and had some Labour politicians as guests. Along with his views about Shias, he has also expressed derogatory opinions about the Jews and the Holocaust - so at least we're not his only targets - and so to have him at a Peace event is rather worrying.

Dealing with the issues he raises in the above clip, he picks on the most often used topics to criticise Shias - namely Muta (Temporary Marriage) and Taqqiyah (Dissimulation). Both of these concepts, he claims, are practiced by Shias and both are against the teachings of God and the Holy Prophet. To support his claims he quotes from Usl-al-Kafi, a collection of sayings from the 6th Holy Imam.

If I get into these two topics in depth, I could be here for hours. However, what I will attempt to do is discuss the two topics using the Quran and also touch upon the history of these practices and then hopefully you can decide how accurate his claims are. As always, the best place to start is the Quran. The concept of Muta revolves around one main verse in the Quran:

"(...Except the forbidden women) the rest are lawful unto you to seek them with gifts from your property (i.e., dowry), provided that you desire protection (from sin), not fornication. So for whatever you have had of pleasure (Istamta'tum) with them by the contract, give unto them their appointed wages as a duty. And there is no sin for you in what you both agree (in extending the contract) after fulfilling the (first) duty. Lo! Allah is ever Knower, Wise." (Surah 4, Verse 24)

The word 'marriage' is specifically not mentioned in this verse, it is instead the word 'istamatatum' which translates to muta (temporary marriage). It was a practice that was allowed during the time of the Prophet and according to many Sunni books was later prohibited by the second caliph, Umar. Referring to the main Sunni book of hadith - Sahih Bukhari, we find a narration stating: "The Verse of Muta was revealed in Allah's Book, so we performed it with Allah's Apostle, and nothing was revealed in Qur'an to make it illegal, nor did the Prophet prohibit it till he died. But the man (who regarded it illegal) just expressed what his own mind suggested." (Sahih Bukhari, Book 60 - Prophetic commentary on the Quran - Hadith #43). The man mentioned was Umar the second caliph.

Furthermore, in Sahih Muslim, the claim that Umar banned the act of Muta is confirmed in the following hadith: "Abu Nadra reported: While I was in the company of Jabir b. Abdullah, a person came to him and said that Ibn 'Abbas and Ibn Zubair differed on the two types of Mut'as (Tamattu' of Hajj 1846 and Tamattu' with women), whereupon Jabir said: We used to do these two during the lifetime of Allah's Messenger (may peace be upon him). Umar then forbade us to do them, and so we did not revert to them." (Sahih Muslim, Book 8 - Book of Marriage - Hadith #3250) So, with the aid of Sunni sources, not mentioned by the "Sheikh", it seems as if Muta is allowed as according to the Quran, practiced during the time of the Prophet and was subsequently forbidden by the second Caliph. As a Muslim, I think it's important to follow the Prophet rather than the second Caliph, don't you?

Having tried to prove the authenticity of Muta, obviously it is a topic that raises much debate because of what it means. I don't want to get into the rights and wrongs of Muta. It was introduced at a time when fornication and prostitution was rife, it was used at a time when men went to war and would be separated from their wives for long periods. Like any other rule or act, it is open to abuse. By all means criticise those who abuse the laws of Islam, but to abuse the act when it is clearly allowed by God and his Prophet is wrong.

Moving on to Taqqiyah and the act of dissimulation - i.e. to hide one's true faith in the face of provocation and risk of life, let me begin again by referring to the Quran:

"Any one who, after accepting faith in Allah, utters Unbelief,- except under compulsion, his heart remaining firm in Faith - but such as open their breast to Unbelief, on them is Wrath from Allah, and theirs will be a dreadful penalty." (Surah 16, Verse 106)

"A believer, a man from among the people of Pharaoh, who had concealed his faith, said: "Will ye slay a man because he says, 'My Lord is Allah'? (Surah 40, Verse 28)

"When Moses came back to his people, angry and grieved, he said: "Evil it is that ye have done in my place in my absence: did ye make haste to bring on the judgment of your Lord?" He put down the tablets, seized his brother by (the hair of) his head, and dragged him to him. Aaron said: "Son of my mother! the people did indeed reckon me as naught, and went near to slaying me! Make not the enemies rejoice over my misfortune, nor count thou me amongst the people of sin." (Surah 7, Verse 150)

The above three verses all go some way to explaining the concept of taqiyyah. The first verse states that taqiyyah is permissible only in the times of need, in the second verse a believer was forced to conceal his faith at the time of the Pharaoh for fear of prosecution and lastly even a Prophet of God had to engage in taqiyyah in order to save his own life. Infact, the Holy Prophet himself had to engage in taqiyyah during the first 3 yrs of the revelation to prevent Islam being obliterated at the very beginning.

The concept of taqiyyah is clearly supported by the Quran and one that is engaged by Muslims at times of persecution. It doesn't mean that we have become liars and cannot be trusted. Qadhi goes on to quote Usul-al-Kafi and the remark from our 6th Holy Imam: ""Nine tenths of religion is Taqiyyah (dissimulation), hence one who does not dissimulate has no religion." (Al-Kafi, Volume 9). From this he has concluded that 90% of the Shia faith is based on lies. Typical Sunni course of action, taking one quote completely out of context.

Ignoring the fact that the Qadhi himself ignores the Quran, let's discuss the above quote. This statement was first made at a time when true Muslims were under severe prosecution. The rulers of the Arab world at the time were extremely corrupt and keen to abolish Islam altogether. To prevent the risk of death and punishment, many Muslims had to engage in taqiyyah. This is supported by Sahih Bukhari: "Anas said, "I do not find (now-a-days) things as they were (practiced) at the time of the Prophet." Somebody said "The prayer (is as it was.)" Anas said, "Have you not done in the prayer what you have done? Narrated Az-Zuhri that he visited Anas bin Malik at Damascus and found him weeping and asked him why he was weeping. He replied, "I do not know anything which I used to know during the life-time of Allah's Apostle except this prayer which is being lost (not offered as it should be)." (Book 10 - Times of the prayers - Hadith#507)

The above hadith testifies that the practices of the Holy Prophet had been changed and even the namaaz was being altered. During this time, where were the true Muslims? If they weren't raising their voice, they remained in hiding to save themselves. When the 6th Holy Imam states that 90% of the religion is taqiyyah, then that is because 90% of the religion being practiced by the rulers was corrupt and not the true religion of Islam. Anyone who wasn't engaging in taqiyyah, but was instead following the rules of the caliphs at that time was not practising true Islam.

More importantly, fast-forwarding to today and post 9/11, Muslims throughout the world are being prosecuted and victimised. In the face of such aggravation what are we meant to do? In some situations people have no choice but to hide their true beliefs. To interpret taqiyyah as a form of lying and not telling the truth as Qadhi accuses Shias of is plain wrong and again extremely convenient for his style of preaching.

I've attempted to touch the surface of these two vast topics. I feel that using the Quran, as the main source would be a good starting point and also provide some clarification about the two practices. There is much more detail to go into about these topics and I finish with some links for further reading if any of you are interested about it.

Muta
Taqqiyah

Take care all,
Thoughts just flow, when do they have to make sense?

Tiredness is killing V

Friday is not a good day to blog I have decided. I'm just too tired - man I sound like a broken record. The weeks efforts takes its toll on me so from next week I'm going to pick another day to blog instead. In the meantime, not wanting to disappoint my many readers (all five of them), I might as well type about something before the weekend.

First of all, I passed my exams! Boy, what a relief, I have never been stressed out for results before in my life (except perhaps my driving test), but there was real pressure on these results - approximately £1400 worth of pressure to be precise, so to pass was a big, big relief. I can now qualify as a GP this August inshallah - who knows, you may suffer at my hands one day in the near future.

I'm sure many, if not all of you have been following the Oscars earlier this week and the remarkable success of Slumdog Millionaire - a rag to riches story of a boy from the Mumbai slums, explaining through a series of flashbacks, how he came to know the answers to the questions in the gameshow (Who Want's To Be A Millionaire?) whilst growing up in the slums.

I watched the film last week and although entertaining, I'm not sure what all the fuss is about. I've seen far better Bollywood films over the years, but because this was a British film made in India with Indians, suddenly it became this huge phenomenon. The actor, Dev Patel is from Harrow and can barely disguise his British accent and Anil Kaoor (the show's host), was the third choice behind Bollywood icons Amitabh Bachchan and Shahrukh Khan - although I bet they regret turning it down now.

Amusingly, have a look at Amitabh Bachchan's blog to see how much the films success seems to irritate him. In his latest blogs this week he's pasted several newspaper clippings all having a go at the film - jealous perhaps? He continues to argue that he is simply inviting debate, but interestingly all the views are negative. Never mind Big B.

Alongside the awards for Best Picture and Best Film was the award of two Oscars for A.R. Rahman for Best Song and Best Score. It was great to seem him perform both songs from the film in the Kodak theatre in front of all the Hollywood superstars. However, the music was not his best work, but again, because it's a British film, it got the recognition that no Bollywood film could get on the international stage. All in all a remarkable success story.

With that, I think I'll give up, I'm too tired to type further. I think I'll quit and grab a nap before my afternoon surgery which starts in one hours time.

Take care all,
Thoughts just flow, when do they have to make sense?

What is the point?

As always I find myself on a Friday afternoon absolutely shattered. Having a baby is not as easy as I first thought. I think my wife and I had been riding the confidence and excitement wave for the first 3 months, but now things have taken a turn for the worse. My daughter seemingly never wants to settle down. She is forever waking up in the middle of the night, demanding some attention so that she can get some sleep and it's taking its toll.

Last night, for example, she woke both of us up at 4.30am crying her head off. She would not settle until she had a feed and then would only stop crying if she lay between us in bed. At this point we were both half asleep but instead of sleeping, she decided that now would be a good time to start playing, kicking and making noise - she was wide awake! Naturally being the one who has to go to work in the morning I tried to go back to sleep but I just couldn't. The end result meant that I didn't get to sleep at least until 5.30am and I am experiencing the "thrill of feeling tired!"

Anyway, moving on. In the months I've been away from blogging, the months of Muharrum and Safar have just completed in the Islamic Calendar. I have already blogged awhile back about the importance and significance of Muharrum here, here and here, so I'm not about to repeat myself but nonetheless it will always be a very religious and spiritual time for all Shias across the globe.

During these months, as I attend majalises and continue to gain further knowledge about Islam, the Quran, the Prophet and the Imams I always try to make sure that this Muharrum is more fruitful than the last and that the motivation remains for longer after its conclusion. The basic aim is to keep the motivation going through to Safar and then extending towards Ramadan when I get the next injection of motivation.

To help, I like to employ discussion about a variety of topics with my family and friends. I'm extremely lucky in that I have a group of friends all of similar age, with kids etc who are all Shia and all motivated to explore Islam. One such discussion I had was particularly interesting and I wanted to share it on the blog (don't worry, everyone will remain anonymous).

What is your opinion on the meaning of life? Why are we here? I've often thought what is the point of it all? Why did God create us to lead the life that we do? If you think about it from a very pessimistic/negative point of view you can get caught into thinking that our existence is pretty rudimentary. God has created us on this Earth in order to judge us. Everything we do will be judged as right or wrong and then if we are deemed worthy we will be rewarded by being sent to heaven, otherwise the punishment is hell. Would it not be easier if we didn't exist at all? Why go through all this for such reward whilst at the same time running the risk of severe punishment.

These questions led one person to comment that knowing what they know about God, Day of Judgement, heaven and hell etc, they would rather not be human. Why not be an animal or a plant who doesn't have the same 'burdens of life' instead? Another person went further to say why exist at all? They felt it would be better had they not existed at all because then they wouldn't have to face any of this trail of life. An interesting thought, although incredibly flawed because the person could only have that viewpoint because they existed in the first place. However, it got me thinking that hypothetically if I had a choice, would I want to exist? If say, God had me in heaven and showed me the trials and tribulations of mankind, would I want to join it and face those trials?

As we explored this further, we came to realise that this opinion stems from our understanding on the meaning of life. Are we here simply to achieve the reward of heaven or does our reason for existence lie deeper than that? The answer is the latter. God did not create us as a hobby, he did not place us on this Earth simply to blindly follow him so that we can be rewarded and sent to heaven. Our creation serves a much more important purpose.

The one quality we possess that defines us from all of Gods' creations is 'free will.' Us (and jinns) have the ability to make our own decisions with no outside force from God, shaitan or anyone else. We have the ability to do whatever we want, we have to ability to choose to worship God. Our purpose on this Earth quite clearly is too worship God out of our own volition, God puts in clearly in the Quran: "I created the jinn and humankind only that they might worship Me." (Surah 51, Verse 56). This ability to choose is what separates us and elevates us beyond all of God's creations, even the Angels, as they do not have this choice.

God takes our purpose further when he states: "Say: Lo! my worship and my sacrifice and my living and my dying are for Allah, Lord of the Worlds." (Surah 6, Verse 162). It is clear that we have been created to worship God. We're not here to achieve heaven or avoid hell, we have a greater purpose than that. If we think purely about heaven or hell then we are missing the point. Heaven or hell is our reward/punishment depending on how we go about our worship of God.

An analogy would be to compare it to our career. We study for a qualification in order to achieve a successful career. It's not the other way around. We cannot aim for a career without the relevant qualifications. Similarly, we can't just think that we're here to try to get to heaven and forget to worship God. By worshipping God properly we have a chance of achieving a place in heaven.

By worshipping God, it means we are compelled to follow his commands, his Prophets and his Imams. The worship determines our type of life. It is not good enough to just say we worship but then do nothing to qualify that worship. Every action we take as to reflect on our worship, we must constantly be striving to seek God's pleasure and that is what the trial is all about. We are here to be tested for our worship of God. Being possessed with free will ensures that we have that ability to choose and hence when we choose the right worship and follow God as prescribed by him our reward will inshallah be greater.

Thus, we should not become too preoccupied with the punishment in hell or the rewards of heaven. Instead we should focus our energies in elevating ourselves spiritually and following the legal-moral-ethical guidelines of Islam with certitude and conviction and voluntary submit to God because He is worthy of our submission.

I often feel that atheists are who they are because they're lazy. They can't bring themselves to follow God and his commands and therefore deny his existence. I'm sure that many of them know that God does exist, but purely can't be bothered to acknowledge it because it would mean too much work for them. I'm sure God will 'reward' them appropriately for there laziness.

So, to wrap things up, our purpose on this Earth, our creation on this Earth is for us to worship God. Nothing more, nothing less. If you still have doubts about the point of existing, or harbor secrets desires of being a tree or a bird, I leave you with the words of our first Holy Imam: "O God, I do not worship You out of fear of the hell-fire because this would be the worship of a slave. Nor do I worship You out of desire for the pleasures of paradise because this would be the worship of a merchant. Rather I worship You because You are worthy of worship."

Take care all,
Thoughts just flow, when do they have to make sense?

Change of perceptions

As promised I am back. Who knows whose reading, but frankly I don't care. It's good to back typing, good to be back to the blogging world. Since I last posted over two months ago, a lot has happened and I've made a startling discovery - GP life can be hard! Shocking, I know, but also true - I've experienced it first hand.

Before you get all cynical on me allow me to explain. When I last blogged in December I stated the reason for the pause in blogging was due to my study commitments, however, during the time off my day-to-day work has been extraordinarily busy. This all came about due to a change in practice. Until October my experience of GP-life was cozy to say the least. I was working in a sleepy rural town filled with the "worried well," patients who had too much time on their hands and would often come with problems that were trivial and often non-existant. It was mainly an exercise in reassurance.

However, since October I've seen the (dark) light. My trainer has been off sick since August last year and as a result it was rightly felt that I should switch practices as my training was suffering. My new practice has been the complete opposite. I've been working at a urban, town centre practice which has been absolutely manic.

In the past I have been critical of GP workloads and how they don't really do that much, but that was based purely on my experiences of working in a quiet GP practice. Now I have seen the other side of the coin. Since October my GP work has been busy to say the least. My morning surgery starts at 9am and the schedules appointments finish at 11.30am. However, extra appointments made on the day ensure that I finish at 12.30pm. I then have at least two home visits and after that have to go through a ream of blood results and hospital letters and I finish the morning surgery by 1.30pm. The afternoon surgery starts at 3pm, scheduled to finish at 5pm, but invariably by the time I leave it is nearer to 6pm.

And it doesn't stop there. A lot of the patients have serious health problems and suffer with a variety of chronic diseases, sometimes more than one which require a lot of help and intervention, so inevitably the appointments run over the allocated 10 minutes. It doesn't help when the majority of the patient population are from the poorer end of the social class, meaning a lot of the time they don't have clue about how ill they really are - "the unworried ill."All in all it has been the complete opposite to my experiences in the quiet rural practice.

On top of all that, the workload has been increased further with my continuing use of the ePortfolio and revision for my nMRCGP exams (the results of which I await at the end of the month). It's amazing to see the range of workloads across different practices and different GPs. In my previous practice the GPs would enjoy a leisurely break at the end of the morning surgery, often go home to have lunch with their families and then return refreshed for the afternoon session. At the new practice, it seems the GPs just about have enough time for lunch. But the significant thing out of all of this is that both types of GPs are paid around the same amount - in fact the GPs in my previous rural practice probably earn more as they also dispense drugs which brings in additional income.

So where has this left me? It's been a complete eye-opener. From being critical of GPs, I now find myself at the opposite end - a GP defender! Having experienced life as a busy GP, I no longer will be joining the GP-bashing brigade. The more important question is what type of GP do I want to be in the future? I find myself in a bit of a confused state. I'm sure most of you will expect me to claim that the rural GP is the life for me, but I'm not sure. This new practice has been busy, but along with that it has actually been interesting. I'm not just dealing with the bog-standard "coughs and colds," but also actual medical problems that require my intervention to improve patients quality of life. I'm managing long-term chronic conditions and seeing progress in a patients life and it seems to be surprisingly motivating. Could it be that I'm beginning to appreciate what it means to be a doctor?!

I'm not sure at the moment where this leaves me. This month I have changed practices once again as the busy practice was a temporary solution whilst we had hopes that my original trainer would be returning. As that is not the case, I have been allocated another trainer in a different practice. This practice is actually spread across four different sites and seems to offer a cross between a rural and an urban type patient population. This sounds ideal to me and will probably help decide where I want to be in the future once I qualify inshallah.

Interestingly, during the first meeting with my new trainer, we had the usual "getting to know each other" meeting. In the past, I've been frank and honest and said that medicine wasn't the most interesting thing in my life and I didn't enjoy my work, but it was something I was good at. Although this time I explained all that once again, I actually suggested that perhaps that perception was changing, following my recent experiences in a busy practice. I'll keep you all posted as this new sense of appreciation develops in the next few months!

Take care all,
Thoughts just flow, when do they have to make sense?