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Hold the front page
DISSECTING ROOM
LIFELINE Raj Bhopal Raj Bhopal graduated from the University of Edinburgh, UK, in physiology (1975), medicine (1978), and as a doctor of medicine (1991). After house-jobs and general practice he trained in public health medicine in Glasgow, UK. After working as a lecturer at Glasgow and a senior lecturer at the University of Newcastle upon Tyne, he became professor and head of the department of epidemiology and public health at Newcastle in 1991. He returned to Edinburgh University as Alexander Bruce and John Usher Professor of Public Health in 1999 and was appointed head of the department of community health sciences in 2000. Which research event has had most effect on your work, and why? Undergraduate electives in Labrador and India lured me from biosciences to public health. What is the best piece of advice you have received, and from whom? Covet education—from my mother who never went to school. How do you relax? Sleep, embrace my wife, wine, books, music, golf, meet friends, play with my children (in reverse order!). What alternative therapies have you tried? Did they work? The Alexander technique—a solution for neck pains—while the benefits of chiropractic were short-term. Do you believe there is an afterlife? I hope so! We live on in the memory of others, and our atoms are recycled forever. What is your favourite book, and why? Barry Unsworth’s Sacred Hunger—a powerful tale of slavery with insight into human motives. Do politics, spirituality, or religion play an important part in your life? Politics is the lifeblood of public health; religion and spirituality are like my skin—it’s always there. Do you apply subjective moral judgments in your work? My values guide everything and are subjective. Where were you in your sibling order, and what did you gain or lose as a result? Seventh of 11 births; fifth of nine who survived childhood. My older brother died in infancy so I was desperately wanted. Being in the middle teaches one diplomacy.
2008
Hold the front page y local newsagent winked cheerfully as he handed me the local paper. “You’re on the front page again, Doctor”, he chuckled, clearly regarding me as some kind of attention seeker, craving B list celebrity status. True enough, there was an embarrassingly large photograph of me staring out from the newspaper, under a sensational headline about cuts in local district nursing services. This is not the first time I have used the press to highlight problems with local services and some of my colleagues are divided about the strategy. Some think it is brave and outspoken, while others cringe and consider it rather unprofessional. So what do I really hope to achieve? Well, this time my anger was directed at cuts in our allocation of district nursing time. The district nurse arrived one day and announced that because of staff shortages, a number of visits to my surgery during the next month had been cancelled. Furthermore, all clinics were now being restricted to half an hour, with wound dressing the only procedure to be done, and no more than three patients booked per session. If those in charge of nursing management had taken the trouble to contact us and explain why this particular strategy had been adopted and what action was being taken to deal with the problem in the long term, I would probably have been sympathetic and cooperative in finding a way out that suits everyone. The obvious response would be a letter or telephone call of complaint, but experience has taught me that this would only elicit an anodyne response, without any real improvement. So I called the local paper. I would like to be able to compare the power and efficiency of the press favourably with the ineffectiveness of the local health bureaucracy, but in fact the local paper was even more understaffed than the health service. In fact there was only one person in the office, who was dealing with all incoming calls and trying
M
to balance coverage of local events with news items like mine. “Can I ring you back?” he kept saying, getting ever more breathless and panic stricken as the telephones rang all around the office. Eventually, I managed to convey the gist of the problem in the simplest possible terms: acute nursing shortages in the community, patients suffering, action urgently needed. However, after so many interrupted calls, I had no confidence that this harassed reporter would make any sense of the issue, and if he did, his report would probably be tucked away between Pets’ Corner and Obituaries. A couple of days later a photographer turned up at the surgery, so I knew something would appear, but I was still unprepared for the detailed and powerful presentation on the front page. Reading it, I was relieved to see that my concerns had been fully and accurately represented, and there were comments from the local Community Health Council, and a nursing spokesperson, I could not really have asked for more. My immediate problem had been transformed into a serious local issue and accompanied by a public demand for explanation and action. When I got to the clinic, the staff had already put the cutting on the notice board and patients were clearly delighted to see local cuts being highlighted in this way. Although few of them use the services of the district nurses, they see this as part of a wider issue of threats to services, and there was much shaking of hands and comments of “keep up the good work”. My colleagues were more muted in their response. A few were pleased that the issue had been brought to public attention, but most were conspicuously silent. Was this because they regard going to the press as sensationalist, self-aggrandising, and unprofessional behaviour? Or perhaps they wished they had the nerve to do it too? Peter Kandela
THE LANCET • Vol 358 • December 8, 2001
For personal use. Only reproduce with permission from The Lancet Publishing Group.
LIFELINE Raj Bhopal Raj Bhopal graduated from the University of Edinburgh, UK, in physiology (1975), medicine (1978), and as a doctor of medicine (1991). After house-jobs and general practice he trained in public health medicine in Glasgow, UK. After working as a lecturer at Glasgow and a senior lecturer at the University of Newcastle upon Tyne, he became professor and head of the department of epidemiology and public health at Newcastle in 1991. He returned to Edinburgh University as Alexander Bruce and John Usher Professor of Public Health in 1999 and was appointed head of the department of community health sciences in 2000. Which research event has had most effect on your work, and why? Undergraduate electives in Labrador and India lured me from biosciences to public health. What is the best piece of advice you have received, and from whom? Covet education—from my mother who never went to school. How do you relax? Sleep, embrace my wife, wine, books, music, golf, meet friends, play with my children (in reverse order!). What alternative therapies have you tried? Did they work? The Alexander technique—a solution for neck pains—while the benefits of chiropractic were short-term. Do you believe there is an afterlife? I hope so! We live on in the memory of others, and our atoms are recycled forever. What is your favourite book, and why? Barry Unsworth’s Sacred Hunger—a powerful tale of slavery with insight into human motives. Do politics, spirituality, or religion play an important part in your life? Politics is the lifeblood of public health; religion and spirituality are like my skin—it’s always there. Do you apply subjective moral judgments in your work? My values guide everything and are subjective. Where were you in your sibling order, and what did you gain or lose as a result? Seventh of 11 births; fifth of nine who survived childhood. My older brother died in infancy so I was desperately wanted. Being in the middle teaches one diplomacy.
2008
Hold the front page y local newsagent winked cheerfully as he handed me the local paper. “You’re on the front page again, Doctor”, he chuckled, clearly regarding me as some kind of attention seeker, craving B list celebrity status. True enough, there was an embarrassingly large photograph of me staring out from the newspaper, under a sensational headline about cuts in local district nursing services. This is not the first time I have used the press to highlight problems with local services and some of my colleagues are divided about the strategy. Some think it is brave and outspoken, while others cringe and consider it rather unprofessional. So what do I really hope to achieve? Well, this time my anger was directed at cuts in our allocation of district nursing time. The district nurse arrived one day and announced that because of staff shortages, a number of visits to my surgery during the next month had been cancelled. Furthermore, all clinics were now being restricted to half an hour, with wound dressing the only procedure to be done, and no more than three patients booked per session. If those in charge of nursing management had taken the trouble to contact us and explain why this particular strategy had been adopted and what action was being taken to deal with the problem in the long term, I would probably have been sympathetic and cooperative in finding a way out that suits everyone. The obvious response would be a letter or telephone call of complaint, but experience has taught me that this would only elicit an anodyne response, without any real improvement. So I called the local paper. I would like to be able to compare the power and efficiency of the press favourably with the ineffectiveness of the local health bureaucracy, but in fact the local paper was even more understaffed than the health service. In fact there was only one person in the office, who was dealing with all incoming calls and trying
M
to balance coverage of local events with news items like mine. “Can I ring you back?” he kept saying, getting ever more breathless and panic stricken as the telephones rang all around the office. Eventually, I managed to convey the gist of the problem in the simplest possible terms: acute nursing shortages in the community, patients suffering, action urgently needed. However, after so many interrupted calls, I had no confidence that this harassed reporter would make any sense of the issue, and if he did, his report would probably be tucked away between Pets’ Corner and Obituaries. A couple of days later a photographer turned up at the surgery, so I knew something would appear, but I was still unprepared for the detailed and powerful presentation on the front page. Reading it, I was relieved to see that my concerns had been fully and accurately represented, and there were comments from the local Community Health Council, and a nursing spokesperson, I could not really have asked for more. My immediate problem had been transformed into a serious local issue and accompanied by a public demand for explanation and action. When I got to the clinic, the staff had already put the cutting on the notice board and patients were clearly delighted to see local cuts being highlighted in this way. Although few of them use the services of the district nurses, they see this as part of a wider issue of threats to services, and there was much shaking of hands and comments of “keep up the good work”. My colleagues were more muted in their response. A few were pleased that the issue had been brought to public attention, but most were conspicuously silent. Was this because they regard going to the press as sensationalist, self-aggrandising, and unprofessional behaviour? Or perhaps they wished they had the nerve to do it too? Peter Kandela
THE LANCET • Vol 358 • December 8, 2001
For personal use. Only reproduce with permission from The Lancet Publishing Group.