A Tale Of Two Consultants

I have reached an age where urinary infections are impacting on my quality of life. But my recent experiences with managing the problem has highlighted inconsistency in the urology expertise of the NHS.

I have been troubled for many years with Urinary Track Infections ( UTI ) because of an enlarged prostate. After a particularly bad infection which developed into Prostatitis I was put on a bag catheter and then eventually moved onto Intermittent Self Catheterisation ( ISC ) to reduce the risk of any further UTIs.

My story starts with two consultants at different hospitals. Let me label them consultant A from the Urology Department in one hospital and consultant B from the other hospital. After recovering from Prostatitis an appointment was made with consultant A for further tests and to discuss the best way to manage my health problem. When I met with consultant A he advised me to stop using the catheters. Life settled into making sure that I was drinking enough water and carefully marking out the location of public toilets! The situation was tolerable and I was beginning to feel that this was the new normal. When I left the consultant I made an appointment to review the situation in six months time however the hospital cancelled it closer to the date. When I hadn’t received a date for an appointment I contacted the hospital’s help line to be told that they hadn’t forgotten about me and I was still on the waiting list. After about 18 months and with no signs of an appointment with consultant A I discussed the situation with my GP and asked to see another consultant who had helped me in the past and I was switched to consultant B. I received an appointment within a week and if I hadn’t been travelling abroad I would have seen him before the month was out. Two long haul flights later and I came down with a bad UTI which required 3 weeks on antibiotics by which time I was on my way see consultant B. In consultant B’s Urology department I we went through a series of tests and a questionnaire about how the medical problem was affecting the quality of my life. During the consultation I explained what had happened over the last few months and then consultant B explained that I had been sitting too long and should have used my catheters. He then went on to explain why I needed to use the catheters for the rest of my life and how they ensured that my bladder was emptying. When I was leaving I asked if he wanted to see me on a regular basis for example annually he replied that that would not be necessary because he felt that I was competent enough to manage the situation.

Under the new catheter regime looking back I realise that I probably had a low level urinary infection since I saw consultant A. I now feel a lot better and the inconvenience of using the catheters is insignificant when compared to the improvement in my quality of life.

Looking back over my experience with both consultants I realise that I had assumed that the level of expertise of urology consultants across the NHS would have been approximately the same. I say ‘approximately’ because I realise that due to the complexity of the human body and we all have different medical histories. However, I felt that my condition was not uncommon in older men and therefore the diagnosis and medical support should have been the same.

So what could have contributed to the difference in advice? Lack of resources between the two hospitals could have contributed to the difference in advice with consultant A not having enough time to analyse the test results and have an in-depth discussion. There could be a wider issue of the organisation of Urology departments which are under increasing pressure from changing employment contracts, a challenging on-call system, changing training requirements as well as the increasing threat of litigation. All of these factors could have contributed to the difference in advice. However, I think that the difference comes down to the approach. Consultant A viewed my medical problem as a problem where he prescribed the appropriate solution a bit like a mechanic fixing a problem on a car. Consultant B looked at the problem from the patient perspective and by increasing my knowledge of the underlying problems and taking the time to explain why the course of action would improve the situation. Consultant B took a patient centric approach where I was seen as part of the solution.

I remember listening to a surgeon on the radio where he said that curing medical problems boils down to two approaches: medicine or surgery. We automatically think that medicine comes in a bottle or a tablet, but it could come in the shape of knowledge, and it is how it is applied that makes the difference.

Big thanks to the Nurse who helped me overcome my fear of inserting a catheter as well showing me a few ‘tricks of the trade’, both urology consultants and their staff and my GPs for their on-going support.

Engineers in the Media

Much of the public’s perception of engineering is gathered through the media, in particular the news on television, where somebody is wearing a HI-Vis vest, wearing a hard hat and discussing the failure of a large building project. It is no wonder that engineering struggles for recognition. How can this perception be changed?

Many years ago I was standing around a coffee machine with some colleagues discussing the usual office politics when one of them mentioned that they had to complete a project about the public perception of engineers through the media as part of their degree course. The puzzled silence was broken by a few more coins pushed into the coffee machine and as it filled up our cups a few examples emerged. First name was Kevin Webster who ran the garage in the long running TV soap opera Coronation Street. But was he an engineer or a mechanic? We weren’t sure. Next was Tom Howard in the series Howards Way who designed yachts but always seemed to be in a psychological state close to a nervous breakdown. Anyway we only ever saw the back of a drawing board and there was a discussion about whether he was holding his pen correctly. Our time at the coffee machine was coming to an end and the last name that came up was Scotty from the long running series Star Trek who always managed to get a few more drops of power out of the overstretched warp drives just in time to save the USS Enterprise! We wished our colleague lots of luck with their project and headed back to our desks.

Over the years there have been some new TV series with engineering themes for example MacGyver and Scorpion but their lead characters had super human skills which didn’t relate to everyday engineering. Other programmes included: Scrapheap Challenge that shows the creativity of engineers but reminds me of the local blacksmith and not the high tech environment of a racing car company, Robot Wars which is more about entertainment rather than making the world a better place, and a few documentaries for example Engineering for the World and Extreme Engineering but they concentrate on how the cars, planes etc. worked rather than the creativity and problem solving that the engineers used in developing them. There have been a few notable attempts to show the impact of engineering on peoples lives. For example the comedian Robbie Coltrane in his series Coltrane’s Planes and Automobiles tells the story of some of the greatest engines that have been built and explains how they work and their impact on society. Another is the film The Boy Who Harnessed the Wind (2019) where a young schoolboy in Malawi overcomes many obstacles to save his village from drought by building a windmill to power an electric water pump. But overall there has been no improvement in media of engineers and therefore it should be no surprise that it is seen as a poor option compared to other careers such such as a marketing director, lawyer or celebrity!

But there is an engineering skills crisis in the UK with around 186,000 skilled recruits needed each year until 2024. The demand will only increase with major challenges such as the impact of climate change, feeding a growing population, and improvements in health and social care. Therefore we need to encourage more people into the profession.

What engineering needs is a ‘Brian Cox.’ to increase the awareness of engineering and inspire the next generation of engineers. The Brian Cox Effect has increased the number of people taking A-Level physics by 20% and UCAS reported that applications to university physics courses increase by 52%. We need to see a similar improvement in the take up of engineering. The engineering equivalent of Brian Cox would bring their enthusiasm and communication skills to a wealth of material. For example how about a series on the engineers behind the everyday things that we use and affect our lives such as heating, electricity, transportation, the internet or mobile phones? Or covering the engineering being used in current research for example using Formula 1 technology being applied in the construction of skyscrapers or using AI to optimise the materials used in constructing solar panels. Finally speculating about future engineering challenges, for example the engineering that will be required to scale up lab grown meat to full production so that we can reduce the amount of the Green House Gas methane from cattle.

I doubt whether there will be any coffee machines in the future for people to gather around and discuss the issues of the day. But wherever they gather lets hope that the discussion starts about an engineering programme that they have seen on television, or other devices, that is presented with the same clarity and enthusiasm as Brian Cox!

New Leaders Wanted To Tackle Climate Change

Many years ago in an engineering lecture, one of my fellow students put his hand up and asked the lecturer a cheeky “What is the point of this degree?” The answer has stayed with me ever since and with climate change starting to grip political discussion his reply has become more relevant.

The lecture was part of a degree in Agriculture Engineering which covered a broad range of skills from mechanical to electronic engineering and included science and economics. We were developing skills that would be used to improve the productivity of agriculture and horticulture through mechanisation and automation. It was the early seventies and there was a lot of economic and political turmoil and therefore there was an air of foreboding. The lecturer, who was a favourite amongst the students, took the question in his stride and replied “if society ever broke down then as an Agriculture engineer you would survive because we could grow crops, rear animals and build machines to generate electricity and pump water”. However, in the silence that followed his reply, we looked at each other, rolled our eyes, and quickly got back to his lecture.

The lecturer’s reply remained with me more as a curiosity rather than a serious comment. But recently there has been a number of reports published where his reply may be relevant. For example the paper: Deep Adaption: A Map for Navigating Climate Tragedy concluded that all of the initiatives discussed to reduce the human activity on climate change will fail and there will be “a near-term collapse in society”. In a similar vein Simon Kuper’s article Emission impossible? Harsh facts on climate change where he supports the view that climate change will happen and it will take global collective action to limit climate change. He goes on to say that the current political leaders are using green ideology as add-ons to policies that are contributing to the climate change and will not be effective. The article continues “As temperatures rise, the hotter days will start to dominate politics with problems such as less water, more illness, lower productivity and unliveable regions of Europe, a permanent cordon.” And points out that political debate will eventually revolve around which huge engineering projects to finance, and that the current political leaders do not have the expertise to make those decisions. The article concludes with the identification of a new type of climate leader who has an engineering background. Currently, there appears to be a lack of leaders with an engineering background, for example amongst the UK MPs there are none.

Of course the type of engineering background required will be significantly different than the one that I was trained in over forty years ago. Scientific knowledge about the environment and the climate along with huge advances in technology provides new opportunities to tackle the problems of climate change. And although there are new branches of engineering for example geoengineering specialising in reducing the effect of CO2 or limiting the sunlight that reaches the earth they do not face up to the possibility that the initiatives will fail and therefore there will be social breakdown. What is required is a new type of engineer that uses a broad range of engineering skills but also takes the social context into account when mitigating the impact of climate change. The engineering-savvy leader will have many traits For example, being skilled in the use of both the media and social media, and using it to effectively communicate to different sections of society at the local and national level. Image persuading a small seaside town that they will all have to move inland because of rising sea levels or convincing different governments to build a transnational water pipeline so that drinking water can be transported from a wet country to a dry one. Also, because of the global nature of climate change they will have to be recognised as strong climate change leaders with enough credibility to make the compromises that will be required between nations. They will need to be critical about the current and future initiatives to mitigate the effects of climate change so that resources will not be wasted on unfeasible ideas as well as cutting through a cacophony of consultants predictions to get to the core of the problems. They will be passionate, with clear goals and show great courage in taking action against a background of criticism and setbacks.

Although our lecturer’s reply to the question was about how we would survive as individuals if society broke down, the future leaders will be looking at societies and nations as a whole and if the increase in extreme weather is a sign of a climate crisis then lets hope that new type of leader emerges soon!

Health Advice From Uncle Albert

During my regular chats with my mum, the conversation quickly turns to her health problems and how her GP has not helped. Yet the health advice from her Chiropodist is fiercely defended when I challenge its scientific basis. Why does the health advice from her Chiropodist, which is anecdotal, have such a strong influence on my mum ?

I remembered listening to a radio programme where the concept of an Uncle Albert Syndrome was discussed. There is a lot of public health information available for example on reducing weight, a balanced diet, increasing exercise, reducing alcohol consumption and how stoping smoking will extend your life. But in every family there is an ‘Uncle Albert’ who drinks like a fish, smokes like a chimney and has a balanced diet of cooked breakfast, fish and chips and pies and who is living a healthy life well into their eighties! When compared to public health information, which is science based, many people follow Uncle Albert!

There are many reasons for people relying on their Uncle Albert for health guidance rather than science based health information. For example the reliability of public health information. There seems to be regular headlines that contradict some earlier study. Should we eat more or less butter, drink a glass of red wine per day or abstain, drink more or less coffee? - all of these questions, and many more have swung between yes - maybe - no over the last thirty to forty years.

There are subtle reasons for accepting health evidence from Uncle Albert. In the case of my mum’s Chiropodist, who has many clients, he can gather examples of what medical solutions are working and what is not. With the NHS resources stretched he is filling the gap between them and low level aches and pains that irritate but are not serious enough to book an appointment with the GP.

At the end of my chats with my mum, I usually receive clear instructions to go off and buy whatever her Chiropodist has recommended which luckily only requires a few clicks on a web site. His track record so far is: the special fruit juice for her stomach which didn’t work and had adverse consequences, the copper band for arthritis is still under review and the knee brace to reduce the pain on her knee seems to be working. The easy acceptance of evidence for health of an Uncle Albert is very complex. For many of the complex and serious health problems such as cancer, diabetes etc. then a science based approach will be always be needed. But for the everyday minor aches and pains then it looks as though finding a good Chiropodist could be the best solution.

Advice About Discovering Ideas

I recently read about the death of Brain Magee the TV presenter, philosopher, broadcaster, politician and author best known for bringing philosophy to a popular audience. I never met him but I wrote to him and he replied.

In the late seventies television had only a couple of channels and the Radio Times could get all of the programmes on two pages! One day I was quickly scanning through the schedule when I came across Men of Ideas with Brian Magee. The series introduced the audience to philosophy and particular areas such as Marxist philosophy, the Frankfurt School, the ideas of Noam Chomsky and modern Existentialism; all names that sounded strange to me. During each programme, Brian Magee discussed the ideas of the philosophers with a prominent contemporary philosopher in a way that made it accessible. In the late eighties there was a follow up sreies The Great Philosophers, which discussed the major historical figures of Western philosophy with fifteen contemporary philosophers. The series covered the philosophies of Plato, Aristotle, and Descartes, among others, ending with a discussion on the philosophy of Wittgenstein. Both series had a big impact on me and I have read philosophy ever since.

When I read about his death I remembered that I had wrote to him about a few ideas that I had and which should be published. Looking back it makes me laugh at my naivety given how difficult it is writing this blog on a regular basis. In his reply he listed all of the organisations that I could either join or submit an article. But then he went on with some advice:

“Will you permit me to issue a warning? The great danger facing intelligent people who study philosophy alone is that they keep re-inventing the wheel. They get some very good good ideas about something of fundamental importance, which they’ve genuinely thought of themselves, and they get all excited about it and want to tell the world, when it has in fact been a commonplace in the world of ideas for two or three thousand years, and is already familiar to every serious student of the subject. To put the same point another way, if a clever person starts thinking about a particular problem seriously for the first time they are certain implications and certain explanations that will naturally present themselves to him. They are genuinely his, but they have already occurred to most other people who have given similar thoughts to the subject. One has the experience when teaching: all one’s brightest pupils, one after the other, get the same good ideas, and each one thinks he is the first to have thought of it.

    So think twice before you attempt to rush into publication”

Over the years I have found that his advice has been applicable in other areas other than philosophy when discovering new ideas. A large part of my career has been involved in product development and for every hundred new ideas discovered to improve a product about ninety nine had either been tried before and failed or the competition had developed a better idea. Even today when I am discussing problems and possible solutions involving a new idea a quick search on the web usually finds that it has already been found. However, it is important that people are encouraged to discover and explore ideas for themselves, even if they have already been discovered by others, because of the excitement the discovery brings.

I am indebted to Brian Magee and his TV series and the subsequent books for opening my mind to the world of ideas in philosophy and for the gentle reminder that if I was thinking about publishing any philosophy then I should be prepared for an uphill struggle. I followed his advice and never attempted to publish anything. However, I continue to read philosophy, and if I feel that I have discovered a new idea then I enjoy the moment but quickly realise that I am following in the steps of others!