Probably

Apologies that is is taken 4 years to think of this offering...

But you know when Pudsey the Dog got 4 Yesses from the Britain's Got Talent judges? 

Do you think her trainer/ owner went home that evening and said:

"My dog's got no Nos"

Real

I am spending a lots of life second guessing life but it takes time.

I don't want to, but I live in systems that demand it. And I haven't managed to escape.
Yet.

I have to think 10 minutes into the future.

I am careful not to live in the past but I'm not allowed to live in the present. Which is usually okay by me because I don't really agree with living in the present. It hurts too many people. But that's another story.

When you are building and preparing, you're constantly sitting on a building site, you're constantly standing in rubble, in the rain.

You're constantly in danger of losing the bigger picture.

And even when you build your Trump towers, there's no million dollar windfall waiting for you.

Today, the most interesting thing I did was spent 45 minutes talking to a producer of an upcoming BBC programme.

Which was pleasant because she was dealing charmingly and energetically with the practical difficulties of living in the real world.

And that's where I live.

I don't protect myself from the outside world with marble and granite.

I don't retire to my inner circle, largely because they've long since abandoned me and my ideals.

I don't hide behind the infantry and I don't seek out a second row to protect me from reality.

I live on the front line. 

In a tin hat. 

And sometimes not even that.

I'm not saying anybody should care about that, and believe me I am used to the fact that they don't. They largely mock my choices.

But for whatever else they are. They are at least mine. 

But talking to somebody that I feel lives on the front line and that person being in the media .. that's irony.

Somebody dealing in facade turning out to have more reality than my own subject area should be improbable.

Because I'm a medic. Physician, if you know the difference. You probably don't.

Most of my peers have sold the real world for a supply of marble and granite and Le Creuset.

So I can't show you marble.I don't have any.

Any granite I have goes into the consultation. I don't have it on my living room floor.

And I won't even tell you where I buy my pots from.

I work hard to make my tiles interlock but they are the tiles of life, not of my cold new kitchen floor.

But there are voices...

There are voices out there that are real.

Voices like mine.

We just need to look beyond the obvious.

And don't be nervous. 

Because all that is waiting for you is reality.

It's only harsh when you're not used to it.

Two Things I Can No Longer Stomach and One Thing It Seems I Can

1. Anybody who wishes people "Happy..{insert day of the week here}.

It's not 1984. Grrrr

2. Agonising plinky musical introductions on promotional youtube videos. Grrrr

3. Steamed some asparagus today for the first time - didn't mind it. What's it to you, monkey-face? Grrrr

Nexting

Sometimes you will be happy with your day, your month, your year.

It will be delivering to your expectations. 

Lucky you.

But sometimes you won't.

And what you do in the next moment will define a great deal of who you are and how you are perceived by others.

So how do you react to that fundamental question?

Do you even know how you react?

Do you recognise your own mantras and your own self tortures?

Because if you don't, you haven't asked the question yet. And I'm getting you a little early.

I'm suggesting answers.

Except I'm not.

I am offering you mine. Take it. Leave it. It's your choice.

And it's only mine "at the moment", because when I'm bored with it, when response fatigue sets in, I will have to switch it out for something else.

So that all those moments when I don't deliver or reach my potential, when I have underperformed by my own judgement...

I ask myself that question.

What am I going to do now?

I don't suggest you borrow my answer because it's pejorative.

But I can be pejorative to myself without recommending it to you.

And it is pleasingly, mercifully brief. 

What on earth am I going to do now?

Better.

I'm going to do better.

Community Chance

I bumped into Hugh Fearnley-Whittingstall a couple of days ago and filmed a little sequence with the Newcastle Can production crew. 

It's an ambitious project.  I've signed up for all Hugh's campaigns. I am now a model recycler, and I've managed to reduce my personal consumption of fresh ivory by 20% in the last 6 months alone.

This is an interesting project because it's a population change.

Even public health departments are spectularly ineffective at that. 

Setting it as a Challenge is a good way to go because success is not guaranteed.

Of course, ownership must be given to the people.

And the hope is they will take it up!

But look at the comments on this website for Hugh's recent visit:

http://www.chroniclelive.co.uk/news/health/what-happening-greys-monument-today-12486999

The comment-maker rightly points out the Newcastle already has quite a lot going on for the  already motivated. The question being how to reach the unmotivated.

But this is the telling line in his comment "They'll need to move quickly though to make some changes within a year".

Notice the way he says THEY and not WE. 

That is people sitting back waiting for a magic wand to be waved.

Doctors have failed at this over and over again.

Doctors TELL people to lose weight, but it's the creeping threat of death sidling and sliding into view in the wing mirror that makes change stick. When it's a little late.

The dietician hands out dodgy government advice, changing that advice with the wind. Still believing that leaflets change people.

A strange rival creature called the "nutritionist" busily promotes all sorts of bogus nonsense that gets flogged in Holland & Barrett.

Between us, we've all confused the nation. 

Low-fat diets? It defies all logic that anybody would think eating fat would be a bad idea for homo sapiens. 

Low-cholesterol foods? We make cholesterol. We don't buy it in.

Gastric bypass surgery? Ask any gut surgeon and he will tell you it's the best thing since sliced bread and refer you to his private clinic. He will surgically butcher your intestines and yes, you will lose weight.

And yet it is possible to reverse type II diabetes in 2 weeks without surgery. That research came from Newcastle.

It is possible to get people up and get people going.

But not by telling them.

It might be a little bit of push, but it's also a little bit of pull. Pulling people along, and people pulling together. Giving them a reason to bother.

Change is a vector. 

Targets are good but momentum is better. 

Life-shortening habits decay more and more when people are just busy surviving. 

Tricks and hacks are really what people need. It needs to be fun - with a little game theory thrown in for good measure.

And the irony with a population approach, is that you need to find the trigger for the individual. That's tough.

So you need people to help find each other's trigger. Push each others buttons.

Can an individual lose weight? Of course.

The one thing we've learned from TV diets is that any single diet at all works perfectly well. It is being followed by a camera crew that makes it successful. Another paradox. The day they disappear, of course, they are back to square one.

Last night there was a BBC programme following Frank Gardner - the disabled BBC journalist. He was birdwatching in Papua New Guinea. Sadly, the tribe they met had been visited in the past by American missionaries who brought them down from the hillsides to convert them to Christianity. By the time that the missionaries left, the tribe had culturally lost the skills to survive on the hillside, and now the children were suffering from malnutrition. The reason for Star Trek's Prime Directive, I suppose. 

It is oddly easy to cherry pick the most motivated without having any impact on a population.

Populations are not individuals. It's a counterintuitive thing.

There's a lot of counterintuition in healthcare. Tell somebody to stop smoking for example and most people get so anxious that they have to run off to their favourite purveyor of fine tobaccos and buy a pack of fags. 

Can a community do it? 

What do we even think community IS at the moment?

A community has to be built or rebuilt before it can be charged with a task.

But we have a growth of anxiety, shyness, depression, and people who can't function unless they are staring at a portable telephone.

How do we bring sustainable long-lasting change to a population?

Well, you can't follow everybody with a TV camera.

The project is to make a City healthier. Not an individual.

Of course, the great thing is that the end result - a TV programme - is exactly the sort of thing can reach into all those houses. The only problem then is that the audience we really need to get on board is actually watching ITV2.

The one thing we know for a racing certainty is the problem is getting worse, despite all the public health measures that have been thrown at it.

The one thing we know for sure, is that everything we have been doing so far is, at a population level, failing.

It's a question of strategy.

Take the glut of psychologists we are currently churning out...America did this in the 80s when everybody had a counsellor and a free course of Prozac.

Now we too have never had more psychologists...and, guess what,  we have never had more mental health problems.

It is an absence of strategy.

The psychologists cherry-pick easy cases.

I can tell you what happens to the people who really, really need help....... 

They get discharged from the caseload.  They become invisible. 

They don't darken the day of the cognitive behavioural therapist, because they prefer somebody a little bit more fragrant. A little bit more attractive. A bit easier.  

The angry man who is too angry for anger therapy? Case discharged. 

The shy man who is too shy to turn up for his session? Case dismissed.

The depressed patient who is not getting better? Discharged from CBT services.

The man who is crying  for help so loudly in A&E, that the staff nurse calls the police? Case removed.

But these people don't go nowhere.

Medicine is the art of communication; doctors its supposed experts. That means expert with everybody.  No cherry-picking.

If you're a psychologist or a dietician and your pony can only do one trick, you have a problem. 

So they dismiss those people from their caseload and that problem appears to disappear. Ta-daaa! 

These populations are full of people who think everybody's forgotten about them.

You don't change populations without at least trying to change the tough cases. Because that is when you must the right question. 

And the right question is... "How can I help?" 

You might start with "Why is what I'm doing not working?" But that is ego.

The question really is... "How. Will. I. Help?"

 

A good strategist has multiple options in play.

Different strokes for different folks. 

I'm an optimist. I know this is all possible. I spend most of my life disagreeing with doctors who suggest it's all a waste of time, who won't use their time to work out strategies with their patients, who prescribe drugs over personal change.

I look forward to watching the show on TV and punching  the air at the zenith

Unless I can find a fish to have a #fishfight with.

Presents of Mind

The great thing about kids, when it comes to presents, is that it's all about the present.

And so it bloody well should be.

All this... "It's the thought that counts nonsense"... That's an affectation. Boring nonsense.

That's the sort of stuff that begins when you start thinking of saving the paper for next year instead of ripping it open and causing a right bloody mess.

It's a present. So it's about the present. 

Witness as I fairly recently caused.. a kid unwrapping a Christmas present from yours truly.

The look of horror on her face when she ripped open the paper and saw that it was a book.

A book.

A bloody book.

How dare you!

Not a game. Not chocolates.

She held her look of utter horror undiminished, nowhere to recede.

"A fucking book,what you want to do with that?", she didn't say. 

"Bloody well, read it or something, dipshit? she didn't add. 

Are you mad?

Of course all this was portrayed by just one look of utter astonishment at the bloody-minded nerve of somebody giving her an actual book.

And she was absolutely correct.

I was totally on the same page, if you forgive.

How dare anybody give somebody a book ? 

Everybody knows that the only type of book acceptable as a gift is the Annual. That most seasonal of gifts that never in history has  lived up to expectations.  But entirely appropriate.

And not the Blue Peter annual either. Whose life is going to be improved by using Peter Purves, Yvette Fielding or John Leslie as role models. I'll give you Mark Curry because I liked him on Change That. 

But after that I draw the line.

The male members of my immediate family have a particularly chequered history in the giftgiving department.

Not a huge amount of thought. Not a huge amount of present.

My Dad, I'm pretty sure, never bought a present in his life.

I think he probably regifted a couple of things in his later years and sent his girlfriend to Primark with a fiver once or twice, to minimally acquit responsibility. But that would be about it. 

Santa was always Mum-shaped. 

And yet bizarrely he was very keen to receive a nice gift. And would feel totally free to comment if  he felt otherwise.

Funny isn't it?

So I gave her a book. I can still see that look of horror.

She handled it like a dirty dishcloth.

I can't remember which boring classic it was. I'd like to think Treasure Island but I have  feeling it was something like Gulliver's Travels. The point was not the text however. It was the thickness of the paper.

And as it fell to the side, it fell open.

Out fell gold coins from its secret compartment. 

Chocolate of course.

And just one  silver one. 

Milk chocolate of course. 

Just one though.

I'd eaten the rest.

Resolutions

I am completely on board with this "Dry January 1st" thing that is so popular nowadays.

I really do think they should make it a regular thing.

Because after 35 days of heavy drinking ever since, my eyes are going and I'm totally ready for another day off.

Praise It

We wash in it. 

We drink it.

We apply it as a poultice.

It is supposed to cure everything from multiple sclerosis to eczema.

We imagine that it lowers our sugar levels or stops us burning in the sun. 

We put it in yoghurt and then eat it. Or splash it all over.

We open retail units dedicated to it.

We inject it in tissues. 

Some  are thinking of using it as fuel.

And what has it ever done to us?

Simply asked for our obedience. Nothing more.

Is that too much to ask?

As for the rest of it, please stop this madness.

Save the Aloe Vera**

** Warning: possible carcinogen. May cause the shits