Make room for the shock doc

As I grow older and theoretically wiser, it is becoming clearer and clearer that I am turning into my dad - who is, incidentally, an authority on wisdom: he says things like "that would be wise" on the phone.

Balding - tick
Inability to lie-in - tick
Buying anti-freeze in bulk - tick
More than one pair of brown shoes - tick

Read the rest here.

Charity, recession and micro-loans

Understandably people give less in charity during a recession. At the very least it forces us to re-examine how, where and to whom we give.

I recently came across Kiva, a microfinancing scheme which involves lending micro-loans "to unique entrepreneurs around the globe" "for the sake of alleviating poverty".

Reading around, there appear to be some drawbacks, most notably the exorbitant interest rates charged to borrowers. This latter aspect flies in the face of the microfinancing envisaged by its creator Muhammad Yunus, recipient of the Nobel Peace Prize in 2006.

Does anyone have any experience of being involved in such a scheme? Would you consider it as an alternative to "traditional" charity? Share your thoughts here.

The snow has gone

The snow has gone. All of it. As a fully signed up member of the pro-snow brigade I mourn its passing. (Although rumour has it that it may well be back on Wednesday).

As the snow dusted the London cityscape, I continued to regress further into childhood. The mere sight of snow brings back vivid memories of sledging, dysmorphic snowmen and the sheer delight of school cancelation. My wife thought I’d gone insane as I eagerly peered out of the flat window and made my minute-by-minute snowfall pronouncements, cheering on the subzero temperatures and blizzards.

Read the rest here.

How to measure a mountain

Managed to sneak a letter into today's Guardian review in support of the Persian polymath al-Biruni (973-1048) against Renaissance hegemony.

Letter and accompanying cartoon.

Who am I to argue?

Health, London ©Tauseef Mehrali 2010

Beyond Begum Syndrome

As a house officer I think I was just too busy to dedicate time to selecting the attributes that would constitute my bespoke "heartsink patient". More senior colleagues had seemingly highly refined criteria for the awarding of such an accolade to a patient. Thankfully my own portfolio of heartsink stereotypes never really took off. Perhaps I became more empathic through my training, or perhaps I just became desensitised? However, one stereotype does live on and continues to baffle me: Begum Syndrome.

Read on here.

A GP unable to prescribe antibiotics is like...?

A (non-medic) friend recently tweeted this story from the BBC to me. The headline commands GPs 'must cut use of antibiotics'. His additional tongue-in-cheek note was "is this your career unravelling?" peddling the longstanding myth that antibiotics form the solitary weapon in a GP's armoury.

The latest diktat is from the European Centre of Disease Prevention and Control and warns against inappropriate antibiotic use and increasing bacterial resistance. This is nothing new. Fortunately the powers that be have realised that the situation is not down to an incestuous relationship between GPs and drug companies but public (un)awareness. The government apparently launched a major advertising campaign earlier this year telling people that antibiotics do not work on coughs or colds.

Anecdotally patients I've seen seem less resistant to the idea that rest, fluids and over the counter medicines should see them through a viral illness. My family have stopped asking me for advice, safe in the knowledge that they can pre-empt my suggestion of "take some paracetamol and let's review things in a couple of weeks".

This year the picture's been complicated somewhat by the perpetual fear of swine flu that appears to be regarded by most patients as just a notch down in severity from the bubonic plague. An interesting result of the heightened swine flu awareness though does appear to be an increasing appreciation that antibiotics do not treat viruses.

What are your experiences?

On being Mr Wolf on Saturday mornings

A couple of Saturdays ago I found myself being awoken at 08:00 by an alarm I couldn’t remember setting. I lay in bed for a few moments toying with the idea of returning to sleep knowing full well that I’ve inherited my father’s inability to lie in. By 09:00 I was showered and shaved and working my way through a long list of neglected emails and admin. This was going to be a productive Saturday.

At 09:30 the phone rang. I didn’t recognise the number. Ordinarily I would have let it ring out but something compelled me to answer.

Carry on reading here.

On Meat Free Mondays

The next BMJ blog entry is now live:

My grandfather used to counsel my mother’s worries about my insatiable carnivorous tendencies as a child by suggesting that the only solution would be to ensure I gain a butcher as a father-in-law. I would frequently be teased at dinner parties when it looked like I was struggling to make it to dessert with mock incentives such as the profiteroles actually being meatballs. My meat eating was so ingrained by my teens that an aunt felt compelled to proclaim that I should stop making my stomach a graveyard for dead animals.

Read the whole post here.

On Ladybirds and Tree-hugging

From last week's Editor's Choice over at the BMJ:

And still in London, general practitioner registrar Tauseef Mehrali watches a film depicting brutal social realism as part of a training session on child protection: "We were challenged to investigate our own triggers for initiating child safeguarding proceedings and to confront subconsciously held stereotypes: is the failing of a parent to conform to our own usually middle class social norms a justifiable trigger? Perhaps more importantly, is conforming sufficient reason to overlook? ... The UK is the worst developed nation in which to be a child, according to both UNICEF and the Good Childhood Inquiry. General practitioners are at the forefront and therefore perfectly placed to guide a redressing of the balance. Encouraging trainees to discuss these issues in novel ways can only help this process."

Read the blog entry here.

On War and Medicine

The BMJ blog marches on:

My practice recently revamped its provision of short-notice medical appointments by transforming the Emergency Surgery into the (so far so good) Rapid Access Surgery. In essence, patients can now no longer pitch up to the practice between 11 am and 12 noon and definitely see a doctor regardless of their complaint, or lack thereof. This apparent erosion of choice has in fact seen the replacement of the dichotomous old system, which offered only routine and emergency appointments, for a myriad of appointment options: 24-hour access, 48-hour access, minor ailments being addressed by the nursing team and routine appointments. There are now more ways to see the doctor than means by which senior bankers can avoid saying sorry.

Read more here.

On Casting the Safety Net

You can bring yourself up to date with the 4th instalment of my BMJ Blog here.

Sweet Cider

It was worth making the effort to get to the penultimate showing of Sweet Cider, Emteaz Hussain’s stage debut for Tamasha productions. It helps that I am enamoured with the plethora of Turkish grill restaurants, or mangal ocakbasis, that encircle the Arcola theatre in Dalston. (My cousin recently changed my life by introducing me to Hasan Meze & Mangal whose grilled onion with pomegranate juice, olive oil and lemon juice is simply superb).

The play itself was both charming and challenging. The audience is invited to share an unspecified period of time with two Muslim girls from somewhere near Manchester as they rebuild their lives having been forced to relocate to a women's refuge. It was refreshing to see the idiosyncratic Northern Anglo-Pakistani dialect replicated so wonderfully well on stage.

My only criticism would have to be the writer's succumbing to dealing with seemingly every single issue affecting British Muslim youth at the expense of character development. A noteworthy debut nonetheless.

Attack of the Clipboards

View episode 3 of the BMJ blog here.

The Bundu Khan Rollercoaster

We made a surprisingly impulsive decision to eat at the brand new Bundu Khan restaurant in Whitechapel the other day. (In reality it was a neuro-linguistically programmed predestined decision as several people had mentioned the eatery in conversation over the previous fortnight.) We drove past, made the mental connections and somehow found a parking space.

The Bundu Khan phenomenon was born in Karachi. It soon spread across Pakistan (with four restaurants in Lahore) and is now truly international. It boasts branches in Australia and the US and, with this yeast-independent expansion, is probably within walking distance of where you're reading this from now.

Our experience was mixed. The decor was understated and crisp. The staff were overstated and seemed more numerous than actual choices on the menu. The poppadoms were far from crisp and were probably vestiges of the Raj. The fish curry was the best I'd ever had. The 'special Bundu Khan paratha' was essentially a deep-fried nan. We disagreed over the relative merits of our drinks as well as those of the palak-paneer. The cocktails left a lot to be desired. "Like toilet cleaner" apparently.

I'm trying hard to convince myself that this was a memorable trip. It was. But for all the wrong reasons.

The Universal Strategy

Read the second instalment of my BMJ Blog here.

Whole Lotah Love!

I’ve always wondered whether Iris, my housekeeper at university, ever thought to herself why on earth I had a watering-can in my bathroom despite my digs being totally devoid of any greenery whatsoever. Not even a sprig of mint or coriander for garnish. She (thankfully) asked no questions and heard no lies.

The lotah, ibreeq, bottle-shottle – call it what you will – is a utensil found in many a Muslim bathroom. In its simplest form it’s a jug with a spout that’s used as a hands-on bidet. Despite the allure of triple quilted toilet paper, we continue to prefer to combine forces, or the brave just simply wash and go. It’s an ubiquitous feature of life, reflecting religious injunctions on cleanliness and ritual purity.

Traditionally it looks like an oversized teapot without a lid and is made from metal or plastic although the variations in size, shape and colour are almost endless. Logistical nightmares can arise when you’re unexpectedly faced with a different style of lotah to the one you’ve grown up with. Left-handers seem to be at a distinct disadvantage when adhering to the left hand – dirty, right hand – clean, convention.

An increasingly common modern variant of the lotah is what the plumber recently working on my uncle’s house subtly referred to as the ‘bum-shower’. These often frightfully complex gadgets are nothing more than a modified hosepipe. Attached either side of a toilet they can be the source of epic flooding disasters if the owners don’t clarify instructions before you find yourself using one.

Equally traumatic experiences can arise from finding yourself in need of a lotah when there just isn’t one around. Spurred on by the embarrassment of always taking a bottle of mineral water to the toilets or sneaking around them with moistened toilet paper, creative individuals have found an ingenious use for collapsible plastic bottles.

On honeymoon in Malaysia I encountered a Japanese inspired toilet with a built-in retractable bidet which perhaps offers the perfect harmony between water and manual input. We can only live in hope…alongside the Andrex puppy.

Flashmob Iftar

Last Tuesday, as the sun set, I found myself sat on some tarpaulin in Lincoln' Inn Fields, one of London's soup kitchen corners, sharing some food with family and randoms. This was my first flashmob experience, and a flashmob iftar at that.

The chaotic spontaneity combined with an act of goodwill really helped to practically apply the ethos of Ramadhan that so often remains theoretical and abstract. So many people sharing thoughts and stories over food with strangers showed a wonderful flip-side to the usual tabloid typecasting.

Read the organiser's thoughts here and the Guardian's Sarfaraz Manzoor sheds some light on the flashmob iftar phenomenon here.

On the frontline as a GP registrar

From this week's British Medical Journal Editor's Choice:

New guest blogger Tauseef Mehrali is about to start a year's stint as a GP registrar in London, fully aware that his future will require the utmost in flexibility and lateral thinking: "Central London has the dubious distinction of being the epicentre of changes to primary care provision, and I'm already eyeing up a corner of my local Tesco Express to set up shop in. I wonder how many reward points patients will accrue on agreeing to see me as they wander past the frozen veg."

Yes that's right, I now have the cyber-equivalent of a holiday home. Read more here.

Commercial Cambridge

As the digressive_mind and I strolled through Cambridge yesterday, even the warm late-afternoon glow of the colleges along Kings Parade couldn't disguise the overwhelming commercialisation of the town. The preponderance of (admittedly discreet) malls and high-street franchises renders the place less quirky and more capitalist.