A new broom

What are we doing in Afghanistan? What precisely is our military objective. In answer to that question this is what Ms Harman said:

We do not want anyone to be in any doubt about the importance of this mission in Afghanistan. It is important to ensure that in the mountainous regions surrounding Afghanistan and Pakistan, we do not have a crucible for the development of terrorism, which threatens people not only in those countries but in the wider region and, indeed, the whole world.

Dr Grumble would be the first to admit that terrorism is bad. Dr Grumble has seen bombs go off. The consequences are terrible. But it is actually something that you can live with. We did it with the IRA. And we got back on the underground after 7/7. You can respond by saying that you will take action to eradicate the perpetrators but real solutions may come from engaging with them. Many terrorist leaders grow up to become political leaders. By the time this happens the terrorism evaporates. There is a message there somewhere.

You could say that Muslim terrorism is not quite the same as, say, the IRA. You could say that engaging with a religious fanatic is not quite the same as engaging with somebody who has a political agenda. You might be right. But Dr Grumble remembers when the IRA were viewed as fanatics who should not be talked to. Even their voices were banned. How mad was that?

One thing is for sure. If you cannot eradicate home-grown terrorists when they are in your own country, you cannot possible eradicate them from the barren and remote mountains of Afghanistan. Even if you could they would just slip across the border into a neighbouring country or just go somewhere else altogether.

Look again at the military objective in Afghanistan:

It is important to ensure that in the mountainous regions surrounding Afghanistan and Pakistan, we do not have a crucible for the development of terrorism....

How can this objective ever be achieved? It is simply not on. It is obviously so. It should have been obvious before we entered Afghanistan. It was obvious. Who could have been so misguided as to have got us into this mess? Another religious fanatic?

A new broom sweeps clean. Dr Grumble is warming to the coalition government.

Coalition collusion

The coalition government is behaving just like New Labour in cunningly manipulating public opinion. Doubtless you will have heard that our new government has even less money than anybody realised, the public sector has grown hopelessly out of control and the pensions of government workers are going to be even more unaffordable than we thought. This rhetoric in advance of a budget is, of course, contrived to prepare us for something very bad the idea being that when we finally hear what is in store for us we will be so inured that we won't quite feel the need to riot on the streets. That something very bad will be a wholesale assault on the public services.

The other day Dr Grumble met a nice lady. She works for a chain of high street chemists. Dr Grumble rarely visits such places. There is a reason for this. The average chemist stocks scarcely anything of value to Dr Grumble. Toothpaste, razor blades, soap and shampoo are about all Grumble needs from the chemist. Most of what is for sale is of no value to Dr Grumble whatsoever. Dr Grumble asked what this charming lady did in the chemist's shop. It turned out she was a health advisor which, of course, interested Dr Grumble. He is, after all, aware of the enormous number of snake oils that some of these high street stores now seem to stock. The number and range of useless pills and potions, vitamins and supplements they peddle is remarkable. Why people buy them is puzzling. They are certainly not cheap. After talking to the charming health advisor, Dr Grumble was to become even more perplexed. He asked what sort of advice she gave. Her answer was clear. She advised people who come into the shop that they do not need these various pills and potions provided they are on a good diet. The amazing thing is that, despite this advice, the shoppers buy their useless vitamins or whatever and then fall hook line and sinker for the 3 for 2 offer. They not only buy what they never needed but they end up purchasing three times more than what they didn't even need in the first place. It is quite extraordinary. Not that Dr Grumble should be surprised. He gently tells his patients that they really don't need to pay out for these things and they too take absolutely no notice.

You don't have to keep your ear very close to the ground to hear from the coalition that the only honourable sort of work is work in the private sector. Work in the high street chemists would be an example. These industries, you will be told, are the only ones that generate wealth. These hard working types beavering away in the shops earn the money to pay those of us fortunate to have a cushy number in the public service. We do not generate wealth. Those in industry do. In short there are the grafters in the private sector and the spongers in the public sector. That anyway is how the coalition would have you see it. Because it then follows that the spongers need to go and the grafters should be encouraged.

This is, of course, utter nonsense. If you work for a company that makes, say, bottled water you are doing a job that is completely useless. We just don't need it. We used to manage without it. Somehow society has been persuaded by a less than honest industry that everywhere we go we must have a bottle with a teat on it which we should swig from regularly as if we are newborn babies. Even the Grumble hospital has been persuaded to spend thousands on bottled water for the convenience (and, apparently, health) of staff and patients alike. It is crackers. It costs a fortune. A man in a van has to deliver it at great expense producing CO2 on his way. Loads of plastic is wasted and meanwhile water of the same, perhaps better, quality flows freely from the taps.

Only $55 (without the girl)

Think about this. What wealth is the bottled water company creating? What value is there in the high street shop which sells snake oils? All these organisations have achieved is the perpetration of an enormous con on the public. They have somehow deluded us (well not Dr G) into believing that we need to buy this stuff. It's bonkers. We do not need these private con artists. They are the spongers. They are the wastrels. There is no wealth creation in providing us with water we already have coming out of our taps or patent medicines with utterly no efficacy.

Now compare the private bottled water company with your local state school. Has your local school conned you into believing that your children need to be educated? No. They didn't even advertise. You know your children need education. You know it is of value. Are the people who work in the school educating your children spongers? No. Of course not. They are working hard and creating real wealth deposited in your child. It's an intangible wealth. It will be a long time before it comes to fruition but there is no doubt about its importance and its benefit. We all know it. Don't let the coalition tell you otherwise.

The public sector is not just a bunch of spongers. We need them. Whether it is the council mending your roads or or the university or school teaching your offspring, we need these things more than the snake oils in the chemists or the ubiquitous bottled water. Don't let the colluding coalitionists tell you otherwise. We need to stop the waste in the private sector. A hefty tax on bottled water and snake oils would be a start.

Why are fat people fat?

Dr Grumble's clinic is increasingly full of increasingly fat patients. They are so fat that we no longer have standard chairs in the Grumble clinic. Instead we have ginormous chairs so that fat people don't feel awkward and, well, fat. Our managers insist on this. It is about respect for patients. The obese should be allowed to be comfortable about their size. The downside is that normal-sized people end up looking like Tom Thumb which is not exactly respectful either. But at least small people can still sit down. Grumble's fatties can no longer fit between the arms of a standard chair. Regardless of the need to offer respect to fat people, the extra large chairs are now essential. Last week even one of the special chairs could no longer take the strain and broke. It is not the first time this has happened. We have a big, big problem.

Many years ago Dr Grumble was appointed to work for the Queen's physician. Unfortunately this famous personage had a heart attack not long before Dr Grumble was due to start working for him. As a result he took the decision to retire early and Dr Grumble only actually worked for him for one day and that day, being January 1st was a Bank Holiday. Why your last day at work should be January 1st Dr Grumble has no idea but doubtless there was some good reason. Dr Grumble remembers it because this one day enabled him to put the great doctor's name on his CV. It looks good to have worked for the man who was Head of the Royal Medical Household. Retirement is said to be good for a doctor's longevity. Despite the problem with his coronary arteries, the Queen's physician went on to live to the age of 89 and by some strange quirk of fate died on the Queen's very own birthday.

The man who beat anorexia.

It was as a result of the precipitate changes resulting from the unexpected retirement of the Queen's physician that Dr Grumble found himself with effectively no job and so it was that he ended up working instead for an esteemed professor. It was he that taught Dr Grumble why fat people are fat.

"Why are fat people fat, Grumble?" asked the prof on Grumble's very first ward round. This was a bit of a fast ball for the ignorant Grumble who had only just started working in endocrinology. Grumble responded by muttering something about hormones.

"Nonsense," shouted the esteemed professor in his dour Scottish accent. "Fat people are fat because they eat too much." Grumble thought about this for a moment and although even the most ignorant reader might think that perhaps the professor might have a point he did think he should query this wild accusation. By then, you see, Grumble had listened to countless fat patients who had told him that all they ever ate was the odd lettuce leaf. So Grumble, perhaps unwisely, spoke up and asked what evidence the professor had for such a wild accusation.

"Fat people have fat pets," he said.

Whether this is still thought to be true or not Grumble does not know but it is a study that could easily be repeated at the vets. All you need to do is weigh the animal, weigh the owner and see if there is a correlation. Grumble's informal observations suggest that fat people do indeed have fat pets. The question is an important one. If fat people really have fat animals then it must be the case that fat people are fat because they choose to eat too much just as they choose to feed their dogs too much. It is to do with the behaviour of fat people and nothing much else.

Why do people eat too much? What have we done to create this enormous and worsening problem? Are we doing our population a favour by giving them extra large chairs so that they don't actually feel fat? Have we been right to allow the proliferation of fast-food outlets so that you can stay in your armchair and phone for a pizza? Is it right to give VAT relief on the electric vehicles which propel people, too fat to walk, at great speed through our shopping malls without burning a single extra calorie? Is it right that we go everywhere by car and have it washed at the weekend in a great machine at the service station?

When Dr Grumble was a child we had hardly any of these things. The world has changed. Our society has colluded with our primitive urges to gratify ourselves. Have you never noticed all those ads that tell you that "you deserve it to yourself" or some such nonsense. Don't listen. You might think you deserve a treat but you don't need it. You really don't.

And amongst the things we don't need is too much food. Industry, always just out to make a buck, has conspired to use every opportunity to entice us to buy highly palatable grub that will make us fat. Look at the underhand tactics they use. Think of all those enticing fattening things they lure you with while you wait idly at the checkout with your screaming children in tow. And, as part of another sleight of hand to get us to spend more, portions are getting bigger and bigger. Understand that you are being manipulated. Don't play along with it.

But lets get back to reality. The curmudgeonly Grumble may be able to discipline himself and maybe even his offspring but many cannot. They feel happier in denial hiding behind the cheery smile of the man who beat anorexia. But, please, all this is now beyond a joke. What should we do about it?

Method to the Madness?

So, after being pressured into discharging patients as soon as possible, hospitals are now to be fined if patients have to be readmitted. Is there method to this madness? You decide:

Sick Notes by Tony Copperfield

Dr Grumble is easily flattered into things. A few months ago he received a personal letter from an important personage at one of the Royal Colleges. It began:

Thank you again for delivering one of the very funniest and most incisive bar none talks I have ever had the privilege of hearing.....

Dr Grumble has written many letters like this. He knew as he read it what the next sentence was going to be. It would contain a request to give another lecture. And sure enough it did. People are so full of themselves that recipients of letters like this fall for the flattery every time. Dr Grumble is no exception. Before he had had time to register that nobody can possibly give a lecture quite that fantastic he had sent a reply saying how happy he would be to grace a national meeting with his presence.

Sometimes Grumble even allows himself to be flattered when no flattery is intended. So when Sam from monday books got in touch offering him a copy of Sick Notes by no less a writer than Tony Copperfield, Dr Grumble immediately thought that he had been singled out for this special favour as a top medical blogger. But such is the power of Google that it is quite easy to find out that quite a few, perhaps all, the medical bloggers have been offered a copy, many of them long before Grumble himself. There are few secrets on the world wide web.

Flattered or not, Dr Grumble was not going to agree to review the book. Oh no. A contract is too much pressure for poor old Grumble. Sam was to send the book for free and would have to take his chance. Dr Grumble does not have much time for reading books and he is rather a slow reader.



Copperfield, as you may well know, is a GP. Well sort of. He is actually two GPs. So Grumble was a little surprised when he saw the front cover of the book. They say you should never judge a book by its cover but that chap on the front dresses like a consultant and not an ordinary jobbing doctor. Actually not even Dr Grumble dresses like that any more because the infection control witches nurses insist he goes around in an open-necked short-sleeved shirt. And that pale blue stethoscope is definitely of the toy box variety. Book covers are strange things. Publishers with their eyes on sales want an image to convey whatever it is that will trigger a punter into making a purchase. Clearly the way of conveying an image of a proper doctor to the public is still with a pinstripe suit. Dr Grumble's Harley Street colleagues would agree.

Anyway Dr Grumble started the book at the beginning of the weekend and he has already finished it. Now that must say something. By page 5 Grumble felt that if he was a publisher this was a book he would take on. It was not long before young James Grumble was asking why old Grumble kept cackling. It is, you see, a laugh-out-loud book.

You might think the world of general practice is rather different from the world of the hospital consultant. But there is a lot we have in common. The vagaries of Choose and Book play havoc whichever side of the great divide you work on. And we have the very same troubles trying to find ways to work around the frightful admindroids that plague today's NHS. As for trying to impress management by trotting out the buzz words that miraculously make them putty in your hands, we do that in the hospitals too. It's laughable that it works but work it does. And we too struggle trying to find the right form for the job. The Copperfield solution for this problem, by the way, is simply brilliant. But for that you will have to buy the book.

Thank you, Sam. It was a good read. Anybody who reads Dr Grumble and has got to the end of this post should enjoy Sick Notes. You can download an extract here.