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The Winter of Discontent

The Winter of Discontent

Now is the winter of our discontent, Made glorious summer by er, Someone? Anyone? It’s really cold and everyone’s striking, and all this sounds vaguely familiar. I was born in the middle of the Winter of Discontent, the cold, bleak winter of 1978-1979. I had […]

My wonderful moustachioed man at Heathrow.

My wonderful moustachioed man at Heathrow.

When I was 16 years old my big brother went off on a gap year, backpacking around Australia. I was jealous and wanted to go too but there was a problem – I was only 16. Eventually my parents compromised, I could go, but to […]

Part 2: Creative Commons: the best medicine?

Part 2: Creative Commons: the best medicine?

In Part 1: A rising tide floats all boats, I took my position on the side of Us v Them – free open access sharing v the old established order. Naive you may think but that’s led me to more discussions (and ranting) about Copyright and Creative Commons (which is healthy isn’t it?).


As a former commercial photographer I took part in numerous debates around copyright and protecting our work from the thieves who would use us to make their own money. I didn’t ever really flatter myself to be honest, but I have seen others being taken advantage of by big and small businesses. I would get grumpy when clients used their phones to shoot my printed proofs in order to stick them on Facebook. One day though, I had a call from a client’s friend who had seen such posted pictures and wanted their own. It led to work, directly to work, passing Go and collecting way more than two hundred pounds. That’s what happens when, as a creative, you share.


Medical research though, is not a photograph. Yes, OK, let’s get dreamy eyed for a second: a picture can say a thousand words, we all love a good image but photographs are not medical research. Dare I say it, they aren’t quite as important (in this context of course). Preventing access to important research by making it inaccessible to those who can’t pay should not be the future of healthcare in any economy.

The far reaching consequences of keeping research behind paywalls, using scarcity and inaccessibility in order to profit, is I would say, questionable.


Sure, photographers, creatives, medics, publishers, we all have to put food on the table. I understand that. Be that as it may, I want my work to be seen and shared as far and wide as possible, shared and discussed…that’s what leads to new work and in medicine, that is what could lead to better outcomes. If you want the best of both worlds, of sharing and protection, you could always turn to a Creative Commons license.


Creative Commons was the brainchild of Lawrence Lessig – a prof at Harvard Law School. The idea was actually to protect the laws of copyright. You can use Creative Commons licenses for your work and set conditions of your choosing. You could say…Sure, I am happy for you to use my work, just say where you got it from, make sure you acknowledge the source. Seems reasonable. Again, does this accessibility make it less worthy? Not solely on the grounds of being free it doesn’t. Does a CC license then infer some credibility? Maybe not.



If you are splashing the creative commons logo on everything and feeling good about it, well done. Forgive me a second for getting all idealistic but you are still slapping rules and caveats on it that are there solely to protect yourself…if you’re a photographer that is. If you are a researcher, I would disagree. It seems a good start in a move towards open access and I suppose it does make everything feel a bit more legit, for now. It’s a start.

Having been shared and having been acknowledged, that’s when your discussions, your collaborations, the joining forces, the arguments, the further sharing can get going. That’s when the magic can start to happen that leads to better outcomes for patients. That is after all, why you did the research isn’t it?  Mmmm?

Copyright laws are about the protection of original material for the creator, to keep on feeding their family and that’s fair enough. Copyright and access though are different things. I’m not talking about profiteering from the hard work of others. I’m talking about access for decision making directly for treating patients. If that material is incorporated into education resources which are sold as courses then yes, we have a different problem, whatever your intentions.


It’s a tricky one.


We all might agree that it is all kinds of moral badness to deny treatment to people (or whole countries of people) on the grounds that they can’t afford it. Yet we are happy for this to continue in medical research and education. I would argue that it is just as unjust.

Keeping information behind paywalls is leading directly to the pirates, the copyright rule breakers, the ones who think it is right they should have all the information to make decisions for their patients. It is making criminals of those wanting to do right by their patients. Is it worse to be the one breaking copyright or to be the one denying access to people who could potentially benefit – and easily so in this new economy of easy sharing? Simon Carley answered my comment in his recent post about pirate platforms by saying you are distinguishing only between two evils. I strongly believe which one is the greater of those two evils and it is not the one breaking somebody else’s copyright rules in an age of world wide access and new economy publishing.

We need to put an end to journals who use scarcity in order to increase their own wealth – to the detriment of those who can’t join in. I haven’t yet quite figured out how (believe me, I’m working on it) but creative commons licenses and copyleft ideas might be a good place to start. A compromise on the way to Open Season.


So we should choose wisely how our research is shared and what can be done with it…or question why we did it in the first place.




I have just been challenged on all this though and here’s a new question I have been asked…

If you are so outspoken about free/open access to everything, what about your medical data? Should that be freely accessible?

Now there’s a question…and one for part three.


Some linked interesting-ness…


Creative Commons

Open Educational Resources Commons

EMJ Blog: What’s the future of medical journals?

Richard Smith: What will the post journal world look like?

Link tax is a thing? Seriously?


Please add your thoughts to the comments section below….





I wasn’t expecting that – more encounters with suicide.

I wasn’t expecting that – more encounters with suicide.

I wasn’t expecting this. I wrote about my next encounter with suicide because I needed to think through how I was feeling. It had come up with some colleagues recently and I boldly claimed that we needed to be able to talk about it more. […]

A rising tide floats all boats.

A rising tide floats all boats.

  I was having a discussion about disruptive technology in medical education (as you do) and in a reply one particular line stood out for me… I think the world is now mature enough to be sceptical about what we see and hear on the […]

It is your reaction that is the problem.

It is your reaction that is the problem.

I’ve been feeling a little uneasy about Scott Weingart’s opening talk from SMACC. It was an extraordinary talk, recorded live on stage for the EMCRIT podcast and it took quite a few people by surprise. He talked about meditation and negative contemplation….all good things, if they work for you, but still I am uneasy and here is why…


A few years ago I started a year-long job that was a bit of a distance from home. Far enough that I wasn’t going to be driving home after 13 hours at work only to come back again the next day. So I rented a hospital flat and was away from home for that year. On the first day, during induction, I was asked how I was going to cope being away from Mr Edge and our girls.


At the time, my answer was very clear. They are safe, they are well looked after, they are happy.
I was pretty chilled about it all because, and I can recall it so clearly, it was a time of horrendous fighting in Gaza and I had been watching online the devastation happening in the Middle East. The hashtag that stuck out for me was a chilling call for the International Criminal Court to deal with Israel. Now this is not a political blog post and I have nothing to say about that. Whatever the circumstances, as a human being, it was harrowing. In particular I saw a series of traumatic photographs of a broken man, walking a broken street with a plastic bag. He was picking up the pieces of his child, who had been torn apart by a bomb. The final image was shocking, it was a close-up of the contents of that bag. I think about that image often.

Scott was getting at this… Imagining the worst case scenario will always set you free to make a leap, because it will make you realise the unlikeliness of that scenario coming true. It will give you the strength and courage to face the difficulties of your day. But do we really need to be so graphic? I think about that image a lot. Perhaps that is my own personal negative contemplation. My children are safe, they are well looked after, they are happy but it is a painful way to remind myself that this is so.


I play along with the rhetoric and philosophy of the Stoics. I keep Marcus Aurelius at arm’s reach in my school bag. In fact the Meditations of Marcus Aurelius was the book I took with me to Dublin (did I think I was going to get a chance to read it?). Like Seneca himself I could probably be considered slightly less than stoic at times…but that’s OK, I am after all a work in progress. For a start I do not join in deliberately with any Negative Contemplation. I don’t ever deliberately visualise my girls dead in my arms. I don’t feel the need to go that far. This is something that Scott brought up in his talk, he says he does this, deliberately, daily. Understandably he was met with stunned silence in the large auditorium. He went on to explain how this and meditation helps him get through the tough stuff and how you too could make a start yourself on the path to inner peace.

In this arena full of high achievers, we all want this to work for us too. Since SMACC I have heard a few people say that they are going to start meditating. They are rushing home to give it a go. But this is a bit of a word of warning…beware that it may not bring what you’re looking for and that’s OK.

I am not being a #meditationwanker and I am not having a go at Scott Weingart, VERY far from it. We are looking now to a future where our wellbeing is considered much more important and we can discuss mental health issues more openly. This can only be a good thing. In the past this would have been unconscionable. We need people like Scott, with the reach and influence he has, to say that it is OK to seek out help like this and to suggest tools that could help. I’m just saying, personally, I struggle with the meditation that he suggests and negative contemplation feels to me like the sort of self flagellation I accidentally achieve daily anyway. As long as I channel it to positive outcomes then that’s fine and it doesn’t necessarily have to be quite so traumatic.


So what CAN I do?

For me it is writing. I write a lot. Only a tiny portion ever reaches publication – the rest is all shit (you might argue the published bits are shit too). I am guilty more than anyone of trying something only a couple of times before moving on when I am not suddenly representing my country or winning awards but

My point?
Do what floats your boat.

I have friends and colleagues who meditate and boy do they do go on about it. I spent a lot of time punishing myself for not finding it helpful. I did this too when I couldn’t find what I was looking for in Tai Chi…I gave it a chance but after I while I went back to kickboxing because really I just needed to punch and kick people to help me feel peaceful.

It doesn’t matter if you can’t do what Scott Weingart says. Give it a try. If you try (and like anything, you need to give it time) and it doesn’t work for you, recognise that you didn’t fail and you don’t have commitment issues. It just wasn’t your thing. Stoics see it like this – it is not the problem that’s the problem, it is your reaction to the problem that is the problem. If this doesn’t work, don’t go beating yourself up…and it is not Scott Weingart’s fault either. So,


Don’t meditate
Imagine the worst case scenario
or don’t.
Watch Football

It is in the deliberate and in the mindfulness that you find your thing.

Strike your own match against whatever is going to set you on fire.

Just make sure you strike it somewhere and remember it is unlikely to be your last match and that’s OK.

Facing personal biases and my next encounter with suicide.

Facing personal biases and my next encounter with suicide.

The Friday night school disco was always an awkward, fun, silly affair with smoke machines, rotating disco lights and the occasional shifty bottle of MD:20:20 smuggled past the headmaster. I had danced with Harry, the new boy. He was a bit different, I liked him. […]

Speaking out: teams, juniors, leaders and what SmaccDUB taught me.

Speaking out: teams, juniors, leaders and what SmaccDUB taught me.

Landing on the wrong runway has left with me a story to tell for life. It probably gets more animated each time I tell it over a drink or two…but for once, I’m not the guilty party…ish. I say “..ish” because I wasn’t flying the aeroplane, I was […]

A Touch of Mountain Medicine

A Touch of Mountain Medicine

WMT’s Mountain Medicine Course

You have the chance to be an expedition medic. Which group would you choose to join?

  1. A charity walk with thirty people climbing Kilimanjaro?
  2. A school trip to India with thirty 14-18 year olds?
  3. A high altitude climb with a small group of fee paying climbers?

It’s not what you might expect to be debating, sitting on the side of a hill on a beautiful calm October day in the Lake District. The small group of doctors (and one nurse) joining the Mountain Medicine course run by Wilderness Medical Training had some interesting and entertaining views. They were views based on a range of experiences and it made for an excellent weekend.

The Wilderness Medical Training courses including the 2 day Mountain Medicine course are open to doctors, nurses and medical students interested in medical care far from home. This October the group was made up of one nurse and a range of doctors including a few FY2s, a couple of FY3s, GPs, anaesthetic trainees and Consultant physicians. They all gathered at the Grasmere Hostel for a weekend of Mountain Medicine. Some were there taking their first steps to find out a little more and others there to add to their already impressive experiences.

The Grasmere Hostel was an excellent, very clean and modern facility with kitchen, dining area, sitting room, sauna and conference room space (as well as a drying room which wasn’t needed). There was no real need to venture out to the local pub next door but we did of course. We had some pub grub with one or two beers whilst getting to know the others arriving for the course ahead.

The chat was about previous courses, about current jobs and about the hot topic of the junior contract, though all these things seem pretty distant when you’re sitting there watching the sun set over Cumbria.

The first day started with bacon and eggs and introduction talks from the instructors who were straight to it, imparting their knowledge and clear expertise. This wasn’t teaching from the books, this was teaching from experience, and it showed. Talks included how to prepare for an expedition and basic navigation.

The reality of being an expedition medic isn’t just about knowing your ABC from your um, elbow. Being part of the team leading an expedition means that the medic on board should know what’s going on around them. That’s true for the preparation, route finding, navigation, security on steep ground and all things expedition related as well as being the one dealing with emergencies. The course covered these and more. Day two covered topics such as high altitude and cold injuries.

Walking in the hills in smaller groups allowed time to discuss relevant topics between group activities. Discussion points included group dynamics, water purification, medical kits and communication technologies, until it was time to deal with an injured climber on the hill, secure someone on a steep patch or cross a river.

Back in the conference room after a warming dinner and with the wine flowing, the instructors each gave a personal, inspiring talk. In one evening we went from breathing bottled Oxygen on top of Everest to taking prophylactic Diamox at altitude in the Antarctic, to sipping cold champagne in the Frozen Arctic for a romantic honeymoon story. A final talk gave insight into how we could find our way in the world of Wilderness Medicine and it was all very positive. Two days just aren’t enough though and this introduction to Mountain Medicine really only gets to scratch the surface but it was enough of a scratch to get this medic hooked again.

And my answer to that earlier question about which trip I would choose? Can’t I do all three?

A doctor taking a rest inside the Gamow Bag

A doctor takes a break inside the Gamow Bag


It helps if you have some knowledge of navigation to start with as time is short. Knowing your Ordnance Survey maps, the scales and the symbols on them will help. Also, you have to be fit enough to be able to walk in the hills for an afternoon or two but vast previous experience is not necessary on this course.


Excellent preparation information and joining instructions. Use of social media to bring the group together to help with transport prior to joining. Very nice and clean hostel facility. The clear experience and professionalism of the WMT instructors. The Medic Course Notes book is an impressive manual of all things Wilderness Medicine. This take-away manual covers a lot more that the two day course can.


Two days just isn’t enough time! Parts of the course felt a bit rushed towards the end in order to fit it all to the time allowed.

The costs:

At £420 for the weekend, it will bite into your training budget but it compares well to other two day post graduate courses. You get a lot for your money, including an impressive hostel and 12 CPD points if that’s what you’re after. You will have to pay for travel to Cumbria.

Other courses run by the group include Chamonix Mountain Medicine courses in Winter, on skis and in Summer as well as the annual Morocco Mountain Medicine Course.


WMT’s Commercial Director Barry Roberts walking down with the group after a beautiful October day in the hills.




Small town excellence

Small town excellence

Sometimes you have to turn things on their head and look at them in another way. I was made to recently by the boss…who had a slightly different (and of course far more experienced) point of view. I was grumbling to some colleagues about a subject that seems to […]

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My Diary

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Now is the winter of our discontent,
Made glorious summer by er, Someone? Anyone?

It’s really cold and everyone’s striking, and all this sounds vaguely familiar.

I was born in the middle of the Winter of Discontent, the cold, bleak winter of 1978-1979. I had no idea at the time of course but if you look up anything about that winter, it makes for pretty grim reading. Rubbish bags piled up in the streets and dead bodies piled up unburied as strikes by public sector workers became widespread. Of course, this had no direct effect on newborn me, but I have long been against striking. I have long believed that it does not make any difference, merely causing heartache and grief for the strikers and their families, for very little reward.

I have always maintained that striking is utterly pointless – but whilst those around me support putting down their stethoscopes and writing pens and picking up placards, I support their right to do so and I’m happy to have my mind changed, if it works.

As a postgraduate student, I have no classes today. I should have been learning about research methodology in historical studies. OK, it’s not the sexiest of subjects when there are Kings and Queens and beheadings and battles and syphilis to learn about, but you need the nuts and bolts classes too. Well, I’m not having a nuts and bolts class this week because my lecturer (and his colleagues, the librarians and admin guys) are taking industrial action over the proposed plan for them to be crapped on from a great height. An email to my lecturer came back with an out of office reply stating that he was sorry he couldn’t reply straight away as “he was supporting the UK-wide strike against the plan to decimate the academic pension”. He put it more eloquently than I did.

Yes, it has cost me a lot of money to be here. Yes, I am mildly irritated, but I would rather that money went to the people who are making a difference to me and my life. It’s lining someone’s pocket but definitely not theirs. I’m just still not convinced that striking will help anyone.

There will be people queuing up to show me examples of when striking has worked. Don’t think I started pondering this without looking for some myself. My favourite has to be the Liverpool gravediggers during that 1970s winter. They agreed to a 14% pay rise after two weeks of letting the bodies pile up. Apparently, people don’t like the thought of piles of bodies awaiting burial. The problem for lecturers (and university staff) is that I’m not sure anyone gives a stuff about the effect of all this on students or university/academic work.

Even the junior doctors walking out didn’t change anything at all. I watched from my comfortable #HuntFreeZone in Scotland as doctors (including some friends) in England got nowhere and I was clear in my conviction that if I was in England, that I would NOT have gone on strike. It was an easy stand to take when it wasn’t my working hours or my patient’s safety being threatened. I am very much aware that this puts me in a position of privilege. Don’t mistake that privilege for a lack of sympathy. I support them, and I support their action, doing what they think is necessary. I just don’t think there’s any hope for a decent result.

Without a class to go to, I went along to a Teach-Out arranged as part of the protest, in a very cold church hall outside the university grounds. A bunch of students standing in solidarity with the handful of lecturers, all shivered together. The talk, about the local history of protest, was very interesting and thought provoking. I learned new things, but I couldn’t help but conclude that our local history of protest has never been terribly successful. It felt more about the struggle than the desired result. Perhaps that was confirming my own bias, but it wasn’t helping the cause. I would rather have been in my classroom across the street.

It has been 39 years since the Winter of Discontent. It is freezing, it is snowing, and I am working at home today. Nothing changes. I am yet to be convinced of the point or usefulness of strike action.

Now nurses – if they went on strike…