Category Archives: Professionalism

To Reykjavik for the Nordic Congress of General Practice

Back home now after a week in Iceland. Primarily for The 20th Nordic Congress of General Practice, a huge event with 1,500 delegates in the magnificent new Harpa Conference Centre and Concert Hall for which I and four fellow GPs ran a workshop on the subject ‘Doctors as Social Activists’. Link to my presentation

Views of the astonishing Harpa conference centre

I was describing my efforts since retirement to challenge organised climate change denial. Link to my presentation

1,500 Nordic GPs coming out for coffee break from one of the plenary sessions in the main hall

This was the very opposite of a freebie because we paid all our own expenses and discovered, having dutifully followed the advice to book flights and accommodation well in advance, that all five of us would have to pay the £700 registration fee for the conference.

This was on top of Reykjavik being, with Tokyo, currently the most expensive capital city in the world, even without the devalued pound, so that everything – food, trips, entrance to exhibitions, goods in shops – was more than twice as expensive as at home. Nonetheless, Lesley and I gritted our teeth, tightened our belts (I lost 3½ lbs on the trip) and took the opportunity to see something of this fascinating country and its admirable people.


Apart from the conference we were lucky to be in Reykjavik for Iceland’s National Independence Day (from Denmark : 1944). In spite of a cold wind and intermittent downpours, the atmosphere was festive and friendly. We felt it a real privilege to be there. We heard the President give a speech and then an actress gave a beautiful recital of a poem in Icelandic. Then there was a parade to the fair-ground around the lake, where there were circus acts and the world’s oldest strong-man competition.


The houses and buildings in Reykjavik were extraordinarily varied, often brightly painted, and quite a few had large murals painted on them.


The famous Hallgrimskirkja cathedral dominated from the top of the city, It was striking outside, although the concrete was currently under repair – testifying to the extreme harshness of the climate. The inside was serenely beautiful, with the most magnificent modern organ I have ever seen, being played while we were there.


We were unlucky with the weather, but we shared a car for a day out to the Snaefellsjoekull National Park north of the city, and took a coach trip around the ‘Golden Circle’ on our last day – our only really sunny day.

The Golden Circle is very much a tourist route but you see the junction between the American and the Eurasian tectonic plates (separating at about a centimetre a year) at the Þingvellir National Park, the magnificent Gullfoss Falls, and the geysers at the Haukadalur Geothermal Area.

Everywhere you see beautiful blue lupins, apparently a recent, deliberate introduction to stabilise and enrich the soil (lupins of course being nitrogen-fixers) which are proliferating at an incredible rate and seem to be broadly welcomed.  You can see them in the foreground and in the hills in the picture bottom right above. We were told that the country was 85% covered by trees when the Vikings arrived, but they cut them all down for fuel, housing and ships.

 

One thing which surprised us was the sheer size of the country – more than 300 miles East to West and 200 North to South. So we only saw a small part close to Reykjavik.

And this yellow door was the entry to our little room, with its blind to make it dark when it ought to have been night.

A tribute to Robert M. Pirsig

This is a photograph of author and philosopher Robert M. Pirsig taken by Ian Glendinning at Chester, England on 7th July 2005

Talking in some depth about things that seem important – by J A R Willis


This article appeared in the December 2000 issue of Medical Humanities in the series Medicine through the Novel.  It is repeated here as a tribute to one of my greatest inspirations – Robert M. Pirsig – who died two days ago (24 April 2017)


‘Unless you are fond of hollering you don’t make great conversations on a running cycle. Instead you spend your time being aware of things and meditating on them. On sights and sounds, on the mood of the weather and things remembered, on the machine and the countryside you’re in, thinking about things at great leisure and length without being hurried and without feeling that you are losing time.’ (p 17 of 416)

The gentle voice is incredibly familiar, heard now for the third time, a voice that seems to have got itself into my deepest being. Continue reading A tribute to Robert M. Pirsig

Old talks that still seem relevant

I am still working out how best to use this site.

Although it got several likes, which were much appreciated, I think my Sea Monster and the Whirlpool address is much better placed on its own page rather than here on the chronological blog. So I have moved it to its own page, tidied up the formatting and added some of the slides. That lecture, which I gave as the keynote on ‘Science’ to the 50th Anniversary Symposium of the Royal College of GPs, attracted thousands of hits when I posted it on my first website www.friendsinlowplaces.co.uk and was largely responsible for me coming up as the first ‘James Willis’ on Google for several years a decade or so ago – not bad for what is a fairly common name.

I have now added another talk which meant a lot to me and which I still believe said something important. Professionalism – Red and Grey – discussing the meaning of that confusing word and arguing that we need to restore respect for its more subtle, but ultimately more fundamental, colour. Flavour, if you like. Of course, I would love to receive comments, contributions and discussion. To this end, I have appended the complicated Venn diagram of the two aspects which I and my colleagues developed at the time – you can see that it is very much work in progress. If you are intrigued, have a look at the talk itself.

Red Grey chart

 

 

What happened to the nation that bred Lord Nelson?

Every spring the Alton Society which I belong to organises a voluntary litter-pick to tidy up the town. This year it has  been decreed from on high that all the volunteers must now sign  a legal disclaimer before taking part.

Rather than accepting that this is another step on the great march of progress I thought that it was completely misguided. I care deeply about the dreadful problem of littering in this country and in our town and as an active member of the committee of the Society I have always seen this event one of the best things we do. I definitely wanted to contribute as usual. So I made a point of doing my litter-pick that morning (last Saturday) on my own responsibility, using my own equipment, and I didn’t sign anything for anybody.  So there.

Here are my reasons why I think this apparently naughty behaviour is establishing an extremely important principle.

First a picture:

Litter pick pic 1
The organised litter pick – volunteers assemble (photo by my wife)

Here are my reasons:

  1. The document is not signed to protect the volunteer, it is to protect the organisers from the fear of litigation
  2. It is assumed that failure to perform this ritual would invalidate the organisers’ insurance, but this protection is illusory because insurance companies are notorious for finding reasons not to pay out.
  3. This is an example of treating a tiny relative risk (the risk of the organisers being sued by a volunteer who hurts themselves) as an absolute risk which must be protected against, irrespective of the cost, financial and otherwise (see below).
  4. Signing the form does not make it the slightest bit less likely that an actual accident will happen.
  5. By taking responsibility for my own actions I was able to clear rubbish in a place which would probably have required a road closure if done by a public employee, and in another which probably involved trespass.
  6. I am told that many of the volunteers who did sign the disclaimer agreed that it was completely bonkers. This brings proper precautions into contempt and breeds cynicism.
  7. It also feeds the growing trend to see all accidents as someone else’s fault and for people to feel they are victims and entitled to compensation.
  8. Cultivating the belief, particularly among young people, that you can only pick up litter if you have joined a group, donned protective clothing and signed to make someone else take responsibility for your actions, is counterproductive to the real object of the exercise – to change the culture so that we have a litter-free town.
  9. It is noteworthy that people who believe proper precautions and rules should be strictly adhered to, as I do, are the same ones who oppose the paying of lip service to token precautions.
  10. This kind of obsessional aversion to minute, theoretical risks is an affront to people, again like me, who are properly concerned about the all-too-common denial of the unimaginably-larger risk of global warming.
  11. I worry about the next logical step – the next click of the ‘ratchet of progress’. I understand those who signed the disclaimer, including the MP and other dignitaries, mainly did so without reading it. And that it was actually a general-purpose disclaimer which included the hazards of cliff edges and seashores.
    I worry that when the next step is taken down this logical road it will be just as impossible for people like me to argue against it without appearing equally irresponsible.
    For example: it is not hard to imagine that in a few years time someone will decide that it is no longer good enough just to obtain token signing of a meaningless mantra in this way, and organisers will start being required to provide video evidence that they really did line the volunteers up and show them how to cross the road. It will then be just as impossible to argue against this increment of  progress and avoid accusations that you have failed in your duty of care by not going along with it. Especially in court after an accident, with a lawyer bent on apportioning blame,  however freakishly unlikely that accident may actually have been. At that time the manifest failure to comply with the ludicrous ritual automatically becomes the crime, regardless of any other circumstances.
  12. As I said in my 2001 book Friends in Low Places, after giving an imaginary example of mindless regulations blighting the professional lives of teachers:
    That is hardly an exaggeration and certainly not a joke, the reality is beyond parody – and certainly beyond a joke.
  13. And that’s my last reason – I wrote two books and numerous articles about this sort of thing, and lots of people said they agreed with me. So I simply had to make a protest last Saturday to be true to myself – even though it added loneliness to the squalor of the morning’s work.

 

Litter pick pic 2
All my own work. Six big bags and there’s a second recovered supermarket trolley out of shot. That strange mixture of disgust and satisfaction.

But, as I said in my first book, The Paradox of Progress, one person taking a stand achieves something amazingly powerful – it stops anybody ever saying again that ‘everybody goes along with it in the end’. That’s why I solemnly record that one person didn’t go along with it this time.

The age of foolishness

A key change in the ‘new way of doing things’ is a wholesale substitution of externally-imposed rules for personal judgement and common sense. This is not so much a tyranny by the arbitrarily powerful as an abdication of responsibility in which we all are complicit.

This dutiful subservience to rules gives us a seductive excuse for abandoning the immensely difficult task of building up and then maintaining throughout life a soundly-based personal understanding of the way the world works. This is particularly true in the fields of technology and science, which are now deemed by many, if not most people, to be too advanced and abstruse for non-specialists to even attempt to understand. Thus, at a time of unprecedented freedom of access to information we have the perverse phenomenon of people everywhere, and at all levels of society, actually making a virtue of ignorance. And in consequence we are seeing everywhere, and at all levels of  intelligence, the fatuous certainty which is normally characteristic of  the very stupid. Nowhere is this more starkly and terrifyingly apparent than in the organised denial of the science of evolution and climate change which has become the orthodoxy throughout the immensely powerful American Republican party.

It is my instinctive recognition of this looming problem – and heaven knows where it came from – that has underlain my opposition to the systematisation of professionalism (for example in the form of blind subservience to ‘Evidence Based Medicine‘) which has dominated my career and motivated me to write my two books, numerous articles, and to give so many ineffectual lectures.

The Divided Brain… Iain McGilchrist

After reading Iain McGilchrist‘s extended essay The Divided Brain and the Search for Meaning I was trying to summarise what it said, it being itself a summary of his great book The Master and His Emissary , to daughter Becky on the ‘phone. Here is more or less what I found myself saying:
When you look at a brain, not just a human brain but any animal brain, the most striking thing about it is that it is separated into two halves. When you look more closely you find that the connection between the two halves (the corpus callosum), deep inside, is surprisingly small in size. And when you look closer still, using sophisticated techniques of modern science, you find that 80% of the messages passing though this connection are inhibitory. On the face of it this is very strange. It seems that the two halves of the brain, the seat of what seems, self-evidently, to be a unified self, are being carefully kept apart.
McGilchrist pointed out another strange thing in The Master and His Emissary: People who have had their hemispheres completely separated, as is sometimes done as a desperate remedy for intractable epilepsy, are not greatly incapacitated as a result. He asks “why ever not?”.
He further points out that the two halves of the brain, when closely compared, are not mirror images of one another, but are actually quite different in both shape and internal structure.
His explanation for this profound division of the brain is that there are two ways of modelling the world, both necessary, but completely different from one another. And one half of the brain is adapted to do it one way, and the other the other. We need both, but most of the time they must be kept separate. This is because they are completely different kinds of things – or different kinds of models.
But how can we describe this difference between these kinds of modelling? Shall we say that one brain (the right) is touchy-feely, instinctive, direct experience, while the other is measured, analysed, codified, processed? Perhaps. But the idea that I found myself repeating to Becky was simpler: one (the left this time) is the map and the other is the territory. Which ties in with the old adage: ‘the map is not the territory‘. The two are not the same, not even when they appear to be. I see this as important in the modern world because the more sophisticated the ‘map’ becomes the stronger the illusion that it actually is the territory.
Another idea of mine is that the right brain model is analogue (like a vinyl record) and the left digital (like a CD) – again entirely different in kind, but all-too-easily producing the illusion of being exactly the same. But I would like to know what McGilchrist thinks of that.
That is what I said to Becky, but McGilchrist also  goes on to show that these two different ways of modelling the world are reflected in different ways of organising society and deciding its priorities. That both are necessary, but that the society we are living in at the moment leans far too much towards the left-brain model.
Of the myriad aspects of life to which this analysis is applicable, I am currently preoccupied with the difference between living according to the rules and living according to something beyond the rules. I see here an explanation for how reasonable people are currently disagreeing violently over the question of whether it is right to avoid paying tax by means of clever manipulation of ‘the rules’. In this case the violence of the disagreement arises from the fact that each party sees it as self-evident that his or her approach is correct. I would go as far as to say that people who spend a lot of time playing sport are used to seeing the clever manipulation of rules as self-evidently virtuous. And that links with a visceral distaste I feel for the current tendency to describe people engaged in human activities as ‘players’. So, while the terms of such arguments appear to be the same, in fact they are so different that they cannot be meaningfully compared. They ought to be kept separate, in two carefully divided halves of comprehension, but here they clash with a terrible thunder.

The sell-off of our National Health Service

I have to think they cannot understand
What they have done;
They cannot understand
What made us tick.
Perhaps they lack some vital cog
Like cripples with important bits missing.
I try to see that as their loss

But I can’t.

I am too angry
I am too sad
They do not understand
That they have killed for me a deeply precious thing.

And they have cheaply flogged
Something that was ours
Without our leave
Having promised
Honest injun
That they never would.

But promises they made elsewhere
Have mattered more
Than ones they made to
Coarse proles on streets outside their Club
How could such people understand
What they have done.

The world’s too full of greed,
Too full of hate,
Too full of deceit,
Too full of self-interest,
Too prostrate before the worthless rich
To have destroyed a thing so deeply good

Just because its warmth and wisdom
and the awkward fact of its success
Shamed
Those who denied the world could work this better way.

This balm for the new callousness
This moral for the new amorality
Had to be destroyed
Or they’d be proven wrong
These modern barons,
Pathetically locked in counting up their spoils

So, we must not let them once deny
the fact that it worked
Yes
For half a century it worked
This inspirational dream
Of far far greater men.
And, though they cannot understand what they have done,
That simple truth will live
Must live
To prove that they are wrong
All along
About it all.

JARW  13 March 2012