GP: ‘How I gave myself fibromyalgia’

A few years ago, before my final GP exam, I was stressed. It didn’t help that it had cost me £1,600 to take. Continue reading “GP: ‘How I gave myself fibromyalgia’”

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‘And another thing doctor…’ – four words that can ruin my day

I should start by saying that I like my patients – even the ones that are difficult. I don’t want anyone to think that this is just another rant by an arrogant doctor complaining that his patients are hard work. The hardest patients are often the most rewarding.

But my job is busy. Today, for example, I saw 29 patients, visited one at home and had telephone consultations with 4 more. On top of that there were 23 letters, 26 prescription requests and 34 blood results waiting for me when I got into work this morning.

Each one of them takes time and concentration. Some are fairly quick but others take much longer; the number of patients with complex health needs is increasing. At one point this morning I was running half-an-hour behind.

Please don’t misunderstand me, I am not complaining about any of this. I love my job. But that doesn’t mean it isn’t hard.

So much to do, so little time…

In order to do my best for everyone I need to be organised and run roughly to time (a half-an-hour delay isn’t actually that bad).

In a 10-minute consultation, time is tight. Most patients will talk for at least a minute before I can ask any more questions. In the nine that remain, I need to understand the patient’s story, examine them, formulate a diagnosis and management plan, write a prescription and/or request some further investigations, like blood tests and x-rays. I must then communicate all of this with the patient and make sure they understand.

I only have time for one problem

I have lost count of the number of times patients have mentioned another problem, just as I had been about to say goodbye.

It is usually “just one more thing” or “there was something else as well, doctor” asked in a hopeful, sometimes pleading way. The one I can’t stand is “while I’m here” as if I exist entirely for their convenience.

However they say it, my heart sinks. At that point in the consultation I have already mentally moved on to the next patient. The cogs in my head take a second to adjust.

Just tell them to f*** off

I know that there are lots of GPs who will very firmly, even to the verge of rudeness, inform the patient that they can only deal with one problem per consultation, and that they will have to re-book.

There are three reasons that I don’t say that myself:

  1. I have a natural curiosity in people’s illnesses. Could these new symptoms be related to the ones we had just discussed? If so, then the new information could be the key to making a diagnosis
  2. On two occasions in my career a patient has said to me, “And another thing doctor: I’ve been getting this heavy pain in my chest that goes into my left arm”. Both patients were having heart attacks.
  3. I am far too polite for my own good.

So when you next see your GP stick to one problem, book a double appointment or tell them upfront that you have several issues, so at least you can decide together how to approach them. Write a list if that helps you remember.

Limiting the time you spend with your GP will mean that someone else can get a bit more. After all, there is always someone who needs help more than we do.

Rise in type 2 diabetes in young people in England and Wales – BBC News

This is shocking but not surprising.
Obesity is by far the leading cause of type 2 diabetes and more children are getting fat.

It really is as simple as that.

But why are children getting fat?

Our body makes use of every precious calorie that is fed into it. Allah has made our biology incredibly efficient. Nothing is eliminated unless it needs to be and any excess nutrients are stored for later use, mainly as fat.

The maths of gaining weight are easy:

If,

calories eaten each day minus calories used each day is more than 0,

you will gain weight.

A 500 calorie daily excess equates to roughly one-kilogram of weight gain each week.

So eating an extra chocolate bar and packet of crisps every day would make us about a stone heavier in just six weeks.

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A chocolate bar and a packet of crisps is about 500 calories

And the opposite is true:

In order to lose a stone in 6 weeks, we need to consume 500 calories less each day than we use.

From this you can see that losing weight quickly by dieting is hard

However, the thing that makes dieting work is time; eating 500 calories less each day may be hard but eating 50 calories less each day is easy – that’s the calories in one Jaffa cake, or half a medium-sized banana.

It may take you 60 weeks instead of 6 to lose that stone, but it will happen.

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There are about 50 calories in half a medium-sized banana

Couldn’t I just exercise more?

Well, yes, you could but that requires hard work and dedication too.

According to fitnessblender.com there are at least ’50 Ways to Burn 500 Calories’, here is a selection:

11) Jump rope for only 42 minutes;

28) Kayak for 55 minutes;;

32) Do one hour on the stair stepper;

38) Do 65 Minutes of water-skiing;

48) Ice skate for 50 minutes.

So to lose a stone in six weeks by exercising alone, you would need to do one of those activities every single day, whilst not eating a calorie more than usual. And as we all know, exercise makes us hungry.

But again, time is our friend. We can burn 50 calories in about 5-10 minutes of average-pace walking; the weight loss won’t be fast but it will happen.

Too many people set themselves unrealistic goals when it comes to weight loss: aiming to lose a stone over a year is much more achievable than any fad-diet.

The biology of weight loss is simple – the reality is much more complex

Hunger is one of our most basic survival instincts. Our bodies evolved at a time when food was scarce: you would be lucky to have one meal a day when you had to go out and hunt it yourself. And food back then was much lower in calories. Today we have incredibly energy-dense foods that our bodies can process with ease.

It is now possible to eat more calories than you can burn off without even feeling full.

Just think about that 500 calorie chocolate bar and crisp combination: it might get you through a mid-morning slump but you will still be hungry come lunch-time.

Activity levels have fallen at almost the same rate that calorie intake has increased. People drive, work in offices, order everything online and sit on the sofa watching TV. You could quite easily live your life these days without walking much more than a hundred steps a day.

Then there is the fact that basic biology education in schools is limited, and making filling low-calorie foods require a basic knowledge of cooking, which is surprisingly absent in many people in Britain today. Poverty, of course, has a key role to play.

How I would tackle childhood obesity (in five easy steps)

  1. Teach basic nutritional science to children at a young age – even primary school would not be too early. Make sure that everyone understands the direct link between eating too much and gaining weight.
  2. Make doing activity easier. This would mean making sure there are open spaces, cheap or free leisure centres, better public transport and more cycle lanes. Have daily PE lessons in schools and incentivise pupils for walking or cycling each day.
  3. Make the most energy-dense foods less attractive, either by increasing the price, banning adverts or putting it in plain packaging, a bit like cigarettes. At the same time make healthier options cheaper and more convenient.
  4. Make food technology a compulsory lesson at secondary school up until the age of 16 and normalise the idea that both boys and girls can and should enjoy cooking.
  5. Encourage everyone to try intermittent fasting.

Steps 1-4 are already done a greater or lesser extent: the government introduced a “sugar-tax” earlier this year making many fizzy drinks more expensive, and in supermarkets chocolate bars have been moved away from the checkout to discourage impulse buying.

Step 5 is the one that I suspect would be the hardest to convince most British people of, but for me it makes logical sense. Let me explain:

Lots of people have very inflexible views when it comes to food – I say that because I have spoken to hundreds of patients who have struggles to lose weight.

The idea of ‘three square meals a day’ is entrenched in most of them – anything less and they might waste away. I have lost count of the number of patients I have seen who have tried dieting, only to give up because they felt hungry all the time.

Once again, Islam has the answers

During Ramadan this year the period of fasting between sunrise and sunset was just a little over 19 hours on the longest days.

The first few days are always the hardest but amazingly quickly our bodies adapt and we feel less hungry. When we do break our fast in the evening we will often end up eating only a small amount.

Islam teaches us that our bodies are perfectly able to survive without food or water for an entire day. Not only does this help us to understand our bodies and the strength that we all have within us, it also makes us appreciate food in a way that nothing else can.

If you can fast for an entire day, you have to wonder whether you really need to have that extra chocolate bar.

via Rise in type 2 diabetes in young people in England and Wales – BBC News

Who’s watching Muslim porn?

For the past few years Pornhub, the world’s biggest porn website, has been publishing an annual review of its statistics. Some of these are truly staggering. In 2017 the site had 28.5 BILLION visits, and received 800 search queries A SECOND. To watch all of the videos uploaded last year would take 68 years of non-stop viewing. Ouch!

There are two things you can say about this:

  1. Lots of people are watching a lot of porn;
  2. Good on Pornhub for bothering to look at the statistics.

Of course, the reason they have invested so much in analysing their vast amounts of data is so they can work out how to keep their users logged on for as long as possible: the longer someone is on the site, the more adverts they will see and the more money Pornhub will make. It also helps that statistics they produce are really interesting and often get picked up by the media which can’t be bad for publicity.

I visited Pornhub to do some research. Honest.

Do you think my wife will believe me when I tell her that?

When I typed “Muslim” into the search box there were 1,861 results. I didn’t watch any of the videos (honest) but looking at the first page of thumbnails they seemed to be a mix of professional movies made by big American producers (in which the actors and actresses were pretending to be Muslim) and home-made amateur videos of, I assume, real Muslims.

So, who is watching Muslim porn?

Well, that’s a hard question to answer. Pornhub have yet to publish a detailed report on the subject so there is no way to know for certain.

But the majority of people searching for Muslim porn will be white men. I feel confident to say that because the majority of people watching porn of any sort are white men. It might be the exotic nature of it that appeals to them, or it could be the thrill of something that they feel is forbidden.

However, I think it is also safe to assume that many of the searches will be done by Muslims themselves. Yes, I know pornography is considered haram, but you would be naive to think that means that Muslims don’t watch it.

Part of being a Muslim is about learning to suppress our basic desires in the pursuit something greater. That doesn’t mean we don’t have those desires.

Just look at Ramadan, the month where we try not to eat or drink anything between sunrise and sunset. Denying our thirst and hunger is not done as a punishment, or because we don’t feel hunger like other people, but to teach us what our bodies are capable of and remind us to appreciate what we have.

In the desert a BURKA makes a hell of a lot more sense than a BIKINI

Burkas have their origins in the Middle East. What to they have a lot of in the Middle East besides oil and war?

Sand.

And not soft, damp beach sand. Hot, dry desert sand. The kind of sand that can be whipped up into a storm by the slightest breeze.

Sandstorms are painful

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A massive sandstorm in Sudan

I don’t know if you’ve ever experienced a sandstorm but if you have you will probably have run for cover, shielding you mouth and eyes as you did. Millions of tiny grains crashing into you at high-speed is not a pleasant experience. In an environment where sandstorms are common, covering as much of yourself as possible makes complete sense. Even covering your eyes with a mesh doesn’t seem like a bad idea.

Do you know what else they have in abundance in the Middle East?

Sun.

If I were to venture out into the desert at midday I would burn in minutes. I have weak melanin. Even people with naturally darker skin can’t stay out for long in those temperatures. When people started wearing burkas, Nivea had not yet started making sunscreen and air conditioning was not a thing, so the only way to prevent skin damage and stay cool was to stay out of the sun as much as possible.

Sunburn is not fun and skin cancer is even worse

So maybe wearing a burka or niqab had more to do with protecting women from the harsh desert than from the carnal desires of men?

Certainly there are tribes in the Sahara, like the Tuareg, where men routinely cover their faces as protection from the sun and sand.

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A Tuareg village

Most Muslims, at least that I know, do not think it is a good idea for women to wear the burka or niqab in Britain. Just like everyone else, Muslims communicate with our faces: smiling, frowning, biting our lips, gritting our teeth and a million more micro-expressions that can signal any one of our complex emotions. By covering her face a woman denies others the ability to read these signs and this certainly affects her ability to have a full and active role in modern society. She may not be being oppressed by a man or a religion, but she is choosing to oppress herself.

I support any woman’s right to wear a burka in Britain, but it is not a decision that she should take lightly. Are the advantages, as she sees them, worth the negative consequences?

 

 

More Sudanese people would be terrorists if it wasn’t so damn hot all the time

The Metropolitan Police revealed details of the suspect they have detained in relation to the Westminster attack in London yesterday.

When I read that he was originally from Sudan I was surprised: most Sudanese people I know couldn’t be bothered to carry out a terror attack – not that any of them have the inclination.

You see, the pace of life in Sudan is slow – people don’t tend to rush around when daytime temperatures routinely exceed 40°C.

But Sudan is a Muslim country, so they must be terrorists right?

Except, if you were to compare Sudan to somewhere like Saudi Arabia you might not realise they were Muslims at all. For example, there are no laws against women driving, going out without a male chaperone or wearing their hair out.

Most women do wear the hijab by choice, but many – especially younger women – do not. And nobody bats an eye. The people enjoy music and dancing and singing as much as anyone in Britain, if not more.

Sudan is a pretty relaxing place

A view across the Nile in Khartoum, Sudan

I once played cards and drank cardamom-spiced coffee late into the night, at one of the many busting cafes on banks of the River Nile in Khartoum, and honestly I cannot think of anywhere I have felt more at peace.

It seems to me that whatever caused this man to attack Parliament yesterday, it probably has more to do with his experiences since coming to Britain, than anything at all to do with Sudan.