Cross Country Skiing

Lots of people go on skiing holidays at this time of year, and the vast majority are purely downhill or alpine skiing, where you queue up at the bottom of a ski lift, get pulled up a mountain side and then ride down it, only to repeat the whole thing over and over. A bit like riding a rollercoaster I suppose.

Cross country skiing is different. Firstly, you have to ski up hills as well as down them. Secondly the skis are longer and have different bindings - you're only fixed at the toe which apparently makes them harder to control but safer in terms of not breaking your leg or tearing your cruciate ligament.

We stay in a cabin about 900m above sea level in the Numedal region of Norway, just outside the town of Veggli. It's pretty basic, with no mains electricity, bottled gas for cooking, a wood burning stove for heat, water from a well and a composting toilet.


The cars are parked about 400m away down the hill, and on arrival you have to do several trips up on your skis with rucksacks full of clothes/food/booze. Virtually impossible to walk up as the snow is about 4ft deep and you just sink up to your thigh.


Kids had a great time. The big two are pretty good on their skis now, and even Sophie at almost 4 years of age had a go. We built an igloo that stood for all of 5 minutes before collapsing for no apparent reason (wrong sort of snow probably), and several snow men/cats/chickens!

Piano Lessons

Had another piano lesson yesterday - I seem to be making good progress.

When I started these lessons I was worried the teacher would try and take me back to basics and have me playing really simple stuff but not so - she's asked me to have a go at a Rachmaninov prelude which I think is more difficult than anything I've tried so far, but she thinks I'll be able to do it. I'll post a video when I can.

UK NHS

Whenever I travel across to England to teach on a course, or attend a conference, I inevitably hear all about the problems in the NHS over there. We're lucky on the Isle of Man that we don't have the same level of political or management interference as they do over there.

Here's an example. The 18 week rule was brought in to ensure everyone gets quick treatment. However, what they don't advertise is that if someone 'breaches', then a miss is as good as a mile. A patient was recently listed for a hip replacement at a large Mersey region hospital. A manager there found he was after the 18 week limit, and promptly cancelled his admission so that another patient could be done in his place who hadn't breached. As far as the rules are concerned once he's waited 18 weeks and a day, he may as well wait for 3 years - the figures look equally bad once collated as required by the government. I find it unbelievable that clinical priorities and fairness can be distorted in this way.

There are many other examples involving the 'choose and book' system, or the 'pre-appointment physio triage' system. I'm glad we don't have these set-ups here.

More Golf

Played 11 holes today at Douglas with William. Had my best round ever, starting with a genuine birdie at the 1st (genuine as in no 'practice shots', and no mulligans), and a handful of bogeys. No disasters - worst was an 8 on the usually uncomplicated 5th, all down to my poor bunker technique taking 3 shots to get it out of the sand. If my performance over the 11 holes is extrapolated to a full round I'd justify a 22 handicap or thereabouts. Definitely felt like I'd made some progress today.


William did OK. Like every single golfer in the world he can get frustrated if shots don't go well, but his drive on the 10th made up for it all - about 150yds straight down the fairway. I was envious after I hit mine about 160yds, into the rough on the left.


Photo is looking back down the 5th fairway. Beautiful day today for golf. Spring, hopefully, has finally sprung.

Sunny Golf

Today has been a gorgeous day weather wise, quite unusual for February on the Isle of Man. I took the opportunity to play a round of golf with one of my radiology colleagues. He's been playing longer than me and is much more consistent. At my stage virtually everyone I play with is much better than me which I find quite nice. It means that I'm not under any pressure to do well, and if I halve or even win the odd hole it's an achievement.


I started well today, with a 4 for par on the 1st and 4 for a bogey on the 2nd. Rest of the round went OK, with only a couple of disaster holes, a few decent drives and a noticeable improvement in my putting. Had to play at Peel today - photo is of the 12th green - as they had a 'shotgun' competition at Douglas which meant the course was full. I've played Peel a couple of times before, and this was by far my best round there.

18 handicap by the end of the year is my aim, and I think it's at least possible.

Piano videos

Got round to recording a couple of videos of me playing the piano and posted them on YouTube. First one is my attempt at a famous Chopin Nocturne. A couple of dodgy notes in there but not bad overall.



Second one is a medley of old Queen tunes - Bohemian Rhapsody, You Take My Breath Away, Melancholy Blues and back to Bo. Rap at the end. Apparently Freddie Mercury played a Bechstein Grand on 'A Night at the Opera', so it's not a coincidence that my little Bechstein sounds quite close to the tone at the start of Bohemian Rhapsody - at least it does when you hear it live, rather than having been recorded through a mobile phone.

Waiting lists

When it comes to health service politics and management one of the biggest issues is the length of time patients have to wait for treatment, and I understand why this is the case. The problem is that the issue is far more complex than managers and particularly politicians seem to understand.

For a long time in the UK waiting lists for appointments and surgery were far too long. It was a running joke in the NHS that you waited a year for an appointment, followed by 18 months for a scan and then a year or so for your operation. By spending huge amounts of money, which a number of my UK colleagues have spent on Lamborghinis and the like, the Labour government has brought waiting times for treatment down significantly. At least that's what we're told.

Short waiting times aren't necessarily a good thing. They can lead to overtreatment. A number of conditions will resolve or improve spontaneously with time. If I saw and operated on everyone with a slipped disc on day 1 I'd be doing 90% of the operations unnecessarily. They also lead to inefficiency. If patients know they don't have to wait long for treatment there is a tendency to cancel appointments at short notice for seemingly frivolous reasons. Thirdly, a short wait for a specialist appointment means the GP's threshold for referral decreases giving a reduced conversion rate in clinic and a loss of balance between inpatient and outpatient work.

There has to be a happy medium. The UK's 18 week limit from referral to operation is in my opinion too short and inflexible. If I made the rules they would be to aim to see patients about 3 months from referral, and to aim to operate on them within 3 months from the decision to do so.

Maths

Finished my first OU maths course - a little ahead of schedule as it's not due until June. I got ahead as I wanted to finish the first course before starting the second in a couple of weeks. Last night I completed the final written assignment to send off to my tutor, and also the final computer marked assessment. This first course is worth 30 points which is a twelfth of the final degree, so at this rate I'll get my BA or BSc, whatever it turns out to be, in about 2014.

Backache

Everybody gets back pain. More precisely, about 80% of the world will get a significant episode of back pain at least once in their lives. Mostly, back pain is self limiting, such that whichever modality of treatment is used (from nothing through physiotherapy, chiropractic, osteopathy right through to surgical fusion) it usually gets better. Most successful predictors for chronicity (that is long lasting) of back pain are employment status, social class, psychological profile and presence or otherwise of a legal case. Put simply, back pain will never be eradicated until everybody has a job that they like, plenty of money and somebody to love.

Every clinic I do I see patients who have chronic back pain, and who hope that I will be able to fix it. Surgery can rarely, if ever, fix back pain. The same is true, even more so, for neck pain. There are of course rare exceptions where significant pathology is present, but generally speaking surgery has little role to play in the treatment of spinal pain.

I often see patients whose expectation of treatment differs from mine. They come to clinic wanting me to fix them, and take my inability to do so as either an unwillingness to treat them or as a lack of interest in their problem. Neither scenario is true. As a surgeon, I've been trained to recognise problems that can be alleviated by an operation, and have learned when to operate and more importantly when not to operate. I can understand that patients with backache are looking for a solution. Unfortunately, a solution is often not available.

Recommended Businesses

On a positive note, following my last post, here's a list of businesses with good customer service. This is obviously not all there are, but ones that spring to mind.

Phil Woods butchers - Kirk Michael
Fine Furnishings - Onchan
Peter Luis - Douglas
Island Aquatics - Douglas
Wine Cellar - Douglas

So that covers meat, wine, clothes, furniture and lizard consumables (!) - what else matters?

Recession

It seems to me that so far the Isle of Man has to a certain extent escaped the consequences of the global economic meltdown. The high street still seems buoyant, Douglas nightlife is thriving, house sales although down in numbers are not down in price, and restaurants are busy. I know this because we went out for dinner last night and the restaurant was full, and a couple of others we phoned before to book a table were full without us.

However, I've no doubt that at some stage in the near future the crunch will hit, businesses will suffer and people will lose their jobs. So which businesses will go down? No names here, but it'll be those whose customer service skills are below par. For example the jeweller who charged me £12 to change a watch battery - I've not been back since. Ditto the furniture shop who refused to return a deposit after what we'd ordered (based on wrong information from the proprieter) turned out to be unsuitable, and the cafe who didn't let me in because I had 3 kids with me and they only had one table left.

In times of economic downturn people stop buying jewellery and new furniture and stop eating out. We have lots of jewellers, furniture shops and restaurants. Some will close down. For ripping me off over the watch battery one jeweller has lost out on several hundred pounds of potential business as now I go to Corlett's. The furniture shop who held on to my £150 deposit has lost out on several thousand pounds of business which has been gratefully received by Juan of Fine Furnishings in Onchan. On a small island like this it only takes a few disgruntled customers and word gets around. I may not have posted the names of the rogue outfits, but I've certainly told people about my experiences.

Businesses with poor customer service - be warned.

Maths

Maths is without question the purest discipline worthy of study, and throughout my school days it was my best subject. I almost carried on with maths at university instead of doing medicine, but what finally made the decision for me was that maths may be fascinating, but at the higher levels of post-graduate maths, it is fundamentally almost certainly pointless. Being a surgeon is probably more useful to humanity.

I've always read about maths, and done loads of maths based puzzles, and I always said that one day I'd do an Open University degree in maths. Well I started it in October, and have almost finished my first degree level maths course, and am soon to start the second. If all goes to plan I'll graduate in 2014.

So far the course has been fairly easy for me, as I covered most of the material at A level about 20 years ago. I've got scores of 100, 100, 98 and 97 so far - in the latter 2 papers I'm sure the tutor was looking for somewhere to dock me marks. Hopefully the next level course will be a bit more challenging.

Electric Guitar

It's listed on my manxortho.com website that I play classical piano and rock guitar. It's probably more correct to say that I used to play rock guitar, as I rarely pick it up these days. I was pretty good. For most of my 2nd year at medical school I skipped lectures and played for 6 hours a day, and at that stage my technical skills were quite impressive.

Since then I've played only occasionally, with long periods of inactivity interspersed with bouts of fairly intense practice. I recorded some tracks about 2 or 3 years ago, and the best of my efforts can be heard on the little iPod touch mock-up in the sidebar. One of the tracks, 'nothing original', is all my own work. By that I mean it's not a tune by an established guitarist, but it's not quite original as the themes are based on Chopin's Fantasie Impromptu, a classical piano piece. As for the rest, 'Adagio' is a famous classical piece on guitar, 'Always with me...' is by Joe Satriani, and all the rest are by Vinnie Moore who is arguably the best instrumental guitarist in the world today.

The thing about the electric guitar is that it is not the ideal instrument for others to listen to, and unfortunately for them it should be played loud. I play through a Marshall 60W valve amp with 2x12" speakers - trust me it's loud. So when I play, I may think I'm playing the greatest, most technical solo in the world, but to everyone else it's just a noise. They all prefer the piano, and for now at least I'm concentrating on that.

Rowing

I've been exercising with a Concept II indoor rower for about 7 years now. I started after a fairly unpleasant bout of back pain, when I decided I needed to lose some weight and get fit, and I quickly got addicted to it. For about a year I was fairly obsessive, monitoring heart rate, power output, and plotting graphs of my best times, but now I just work out regularly on it.

I bought my own machine just over 2 years ago - cost about £1000, which is about 3 years gym membership, so it's almost paid for itself. I've rowed over 1.5 million metres since I've had it. It's sometimes hard to motivate yourself to get on the thing and row, particularly when it's dark and horrible outside and all you want to do after a full day's work is sit down with a stiff G&T, but I'm sticking with it.

Target for the year is to get back to under 7 minutes for 2000m, and under 19 minutes for 5000m. I used to be able to do these sort of times easily, but I'm getting older, and it seems to get harder to maintain performance let alone improve it. At least though I'm slowing the decline.

Piano Lessons

I've played the piano since I was 7 - I can't really remember ever not being able to play the piano. I had lessons between the ages of 7 and 9, and then again from 11 to 12. My technique was always way ahead of my ability to read music, and as a kid I hated practicing classical pieces, so I didn't play much, did grade 4 at age 12 and then gave up lessons.

I've recently started playing a bit more intensely, and even treated myself to a nice grand piano. I even had a lesson the other day - first one in about 26 years. Fortunately the teacher is not going to start me off on grade 5, and is happy to work with me to help me improve my technique playing pieces that I want to work on. Current project is Moonlight Sonata, particularly the difficult 3rd movement. When I've got it reasonable I'll post a video.

Windy Golf

Played a round today at Douglas - teed off around 11.15, weather was pretty fine. When we got to the 6th it started getting a bit windy, a little earlier than predicted by the weather report. By the time we got to the 12th we thought about quitting, but carried on anyway. Glad we did as I parred the horrible par 5 13th - my best hole of the day. I also managed to land the green on the 17th from the tee - not bad for me.

No idea what my final score was - had too many really bad holes to bother to add it all up, including taking 12 for the 9th. Aim by the end of the year is to have a handicap of 18, and at the moment I'd do well to get the maximum 28. A bit more consistency is all I need, as I've now managed to either par or bogey most of the holes on the course.

Photo is taken towards Douglas bay from the 6th fairway.

Second Post

Just filled in the details on my profile - well at least what I don't mind others to know.

Main issue at work at the moment is the proposed change to the pension scheme. I personally find it difficult to get worked up about, as being a relative youngster I can't quite envisage being retired. I don't believe that changing the scheme will lead to a mass exodus of the medical staff on the island, as most of us are either tied here with golden handcuffs, or would find it nearly impossible to find an equivalent UK job. The problem will come gradually as recruitment suffers. For a non-Manx person to come to work on the IOM is a leap into the unknown at the best of times, and I certainly had doubts 3 or so years ago. If I'd had to come to non-standard terms of work it probably wouldn't have happened. Government, be warned.

First Post

Just set up the blog, don't know what to post really. Planning to include progress with my maths studies, golf, piano playing, and maybe work related stuff, but obviously I'll have to be careful there. I'll see how it goes anyway.