Katherine Teale

Katherine Teale is a consultant anaesthetist in Greater Manchester

How a bullying culture can be contagious

By Katherine Teale - 8th March 2010 1:02 pm

It’s one crisis after another. Not only is my husband facing possible redundancy, but my daughter has had an incident of cyber bullying.

Her latest craze is the Moshi Monsters website, which allows preteens to spend their evenings sending misspelt messages to friends they’ve just spent all day with, instead of getting on with their homework. Inevitably this leads to tears.

Our deputy head has spoken severely on the subject of cyber bullying on Facebook where apparently “4 letter” words were being used by some of Year 6.

My daughter has a firm idea of what constitutes bullying (“someone saying something nasty about you”) but unfortunately it’s not always so simple. It’s got to the point where you can’t actually raise your voice above a soothing whisper without being accused of harassment. Like any word which you repeat often enough, the word bullying has become practically meaningless.

That’s not to say ‘real’ bullying doesn’t go on. The only surprising thing about the bullying in Downing Street debacle is that anyone was surprised by it.

Fans of In the Loop like me, have known for ages that bullying is endemic in politics. Perhaps it’s something about the sort of people who get on in Whitehall - kindness and politeness probably don’t get you very far.

Just imagine the atmosphere when the minister realises their pet policy has failed or the media questions their ‘non-dom’ status - our dreaded senior managers’ meetings must seem like a WI coffee morning by comparison.

The problem is that, just as in a school staff room, a toxic atmosphere at the top filters all the way down - the hyper-aggressive attitude to targets is transferred from Whitehall to SHAs, to hospital executives, to middle management, and finally to us at the coal face.

But let’s be careful what we mean by bullying. Recently a consultant surgeon wrote a letter to BMA News because his clinical director kept sending him emails telling him to roll his sleeves up on the ward round, in compliance with trust policy. These repeated demands constituted, in his view, bullying and harassment.

I disagree. Bullying is not being told to do something which your trust has accepted as policy, but which you, personally, happen to disagree with. Nor is it, for instance, being asked to stay late to finish a list (as overtime) provided saying “no” isn’t penalised, even if it makes you feel uncomfortable.

The toxic atmosphere of hospital management does, however, lead to a certain scenario: that of middle managers being expected to meet impossible targets and being criticised for their inevitable failure; these middle managers then repeatedly ask frontline staff to do extra work and become extremely stressed and angry when those staff refuse; and, frontline staff become stressed about constantly being asked to do extra work and either don’t perform well, or go off sick.

I’m sure many of us recognise this. How much of this constitutes real bullying I’m not sure, but it certainly creates massive amounts of unhappiness.

My daughter’s bullying episode was easily solved - a quick call to her friend’s mother, a couple of nice messages posted (“boys aren’t worth falling out over”) and an early night with her favourite reading material (the Argos catalogue) and everything was forgotten.

Now I just need as clean a solution for work…

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It could be worse - we could be teachers

By Katherine Teale - 22nd February 2010 11:23 am

This Sunday has been a difficult day for the Teale household, although, glancing at today’s headlines, possibly not as difficult as Gordon Brown’s.

My husband has spent the day writing his CV in preparation for reapplying for his job. The school of which he is headmaster is being amalgamated with another due to falling school roles. Worryingly, all the recent local amalgamations have appointed external head teachers, making the sitting tenants redundant, so it’s a nail-biting time for us.

My husband tells me, bitterly, that doctors don’t know they’re born, which makes for lively dinner-time conversation - but in some ways I have to admit he may have a point.

Despite the attractive holidays, being a teacher is not the sinecure it’s widely thought to be. As a school governor, I recently sat on an appointments panel for a newly-qualified teacher. We had 138 applicants for the job, and short-listed 11, all of whom had fantastic CV’s with only marginally fewer ‘A stars’ than those I used to see during my college tutor days. Of the eight we interviewed, all were articulate, bright and appealing young people. This for a starting salary of £25,000.

Once fortunate enough to be appointed, teachers have to undergo regular scrutiny by their senior management team, and then, during thee-yearly OFSTED visits, by the dreaded inspectors, who make personal criticisms of their teaching and grade them from inadequate to outstanding.

For a lesson to be graded good or outstanding, the teacher will need to have prepared the lesson in detail, with clear lesson targets, and also be able to demonstrate whether those targets were met. They must have a clear idea of, and plan for, the progress of every child in their class. The head teacher is personally judged by OFSTED, and has his or her name plastered all over the local papers should the school get a bad report, which, unlike the case of MPs, generally results in a resignation.

Doctors have so far been largely spared this sort of direct and public scrutiny, other than by the imperfect appraisal system, and, for surgeons, having their mortality rates published on systems such as Dr Foster. Nobody’s standing in the corner watching us give an anaesthetic or take out someone’s lumbar disc, or run a chronic renal failure clinic. This may be the future, though. 

To keep the peace I’ve conceded that teachers have a tough time - however, one thing we both agree on is that both schools and the NHS are unfairly criticised for things beyond our control. The NHS is castigated for not  producing the longest life expectancy and the highest cancer survival rates, but it can no more cure all the obesity, alcoholism and depression which are the by-products of the society we live in, than schools can prevent delinquency, teenage pregnancy and poor parenting.

If we seriously tried to prevent these problems happening in the first place, we probably wouldn’t need to be looking at front-line service cuts at all. Let’s hope the next government tackles this end of the equation, although I don’t hold out much hope. It’s just much easier to blame the teachers and doctors for not being able to sort out the mess. 

Two weeks until interview day. By the time you read my next blog, I might be the family’s sole breadwinner, so wish us luck…

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Jump on board the cost cutting bandwagon

By Katherine Teale - 8th February 2010 9:26 am

“To implement change successfully, first engage your staff”. 

To this end, the trust has launched a staff competition for suggestions on how to save £15 million. Stage one is to think of a name for the new campaign - something which seamlessly combines the concepts of fantastically top-flight hospital and pathetically inadequate budget in one catchy phrase.

My suggestion of “NHS lite: we’re slimmer and even safer”, was rejected on the grounds it might upset some of our bariatric patients, which are the only cases we make a profit on.

A lot of the money-saving schemes seem to have one thing in common - they involve other people. So, for instance, the medical staff seem to have it in for nurses with clipboards, and obviously getting rid of managers is very popular. Other groups, however, have posted the following suggestions. “Abolish merit awards and discretionary points”. “Audit SPA time”. “No pay progression for three years”. “Sack all the orthopaedic surgeons” (OK, that one was me). “Stop operating on people who make themselves ill by eating too much”. And “try turning the office lights off now and again”.

I really hope the executive isn’t relying on this competition for serious ideas - otherwise we’ve got a serious problem.

All this is just tinkering round the edges. There are limits to what individual trusts can do to save this amount of money, especially those which are locked into expensive PFI contracts. What needs to happen is some policy changes from our government, and top of the list must be calling a halt to any more of these PFI deals.

Figures recently released showed that London PFI contracts amount to six times the value of the buildings they’re paying for.

Second to go must be any further expenditure on ICATs and ISTCs, which have been an incredibly expensive waste of taxpayer’s money.

Third, get a grip of the drugs budget by increasing generic prescribing and regulating pharmaceutical companies so that new drugs aren’t overpriced.

After that, they could perhaps take a look at the NHS’ legal budget - especially the non-clinical litigation bill. Every year hospitals have to pay out tens of thousands of pounds for staff, visitors and patients who’ve slipped on  wet floors, stubbed their toe on door lintels, or had polystyrene ceiling tiles fall on their head (I kid you not). Why not put a strict cap on all this, so that we can spend the money on actually looking after patients.

Last week the CBI, whose membership might possibly include some individuals involved in private health care provision, claimed that megabucks could be saved by providing care for patients out of hospital and near their homes.

They don’t explain how using taxpayers’ money to build brand new “polyclinics”, doubtless run by the private sector, to replace existing outpatient departments, actually benefits patients or  taxpayers. Nor, unless they plan to build one on every street corner, do I see how it equates to bringing treatment “nearer to the patients’ homes”.

The truth is that the current NHS funding crisis is being seized upon by diverse groups to push their own particular ideology, without actually justifying how it would benefit patients or save money. In other words, look out for passing bandwagons.

Read another blog on how the NHS could save money.

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Something fishy about the public’s expectations

By Katherine Teale - 23rd January 2010 5:42 pm

It was Aneurin Bevan who, in 1948, said of the NHS: ”We never shall have all we need. Expectation will always exceed capacity.” How true that is, as much now as it was then. 

On this occasion our capacity was particularly inadequate: the NHS allowed our patient’s fishfingers to defrost. It would never happen in the private sector.

Our patient turned up on our same-day admissions unit, built in a desperate attempt to reduce our length-of-stay, along with five bulging carrier bags of shopping. She casually asked sister to put the frozen food in the freezer while she underwent surgery. Her argument was quite logical, if you’ve actually lost touched with reality some time previously. 

“The doctor told me I wouldn’t be able to go out of the house for two weeks”, she explained - the possibility of doing the shopping on the day prior to admission evidently not having occurred to her. And why stop there, perhaps she’d like us to pop round and spruce up her cushions or walk the dog while she’s in recovery?

I must suggest it to our PR department: it might give us the edge over the opposition  on Choose and Book. But, back in the real world, our theatre fridge was already full of rather more important materials such as drugs, blood and my sandwiches (only joking), so we were unable to satisfy her request. It resulted in the ’bad outcome’ of defrosted food which probably merited an adverse incident form.  

I can feel the complaint winging it’s way towards us as I write. No doubt I shall be instructed to alter our patient information sheet to include the words: “Please do not stop off at ASDA on the way to the hospital to do the next month’s shopping”.

Of course, patients, or consumers as they should now be called, have been allowed to think that healthcare is a commodity like any other, which they have a right to demand whenever and wherever they like, preferably online and with a home-delivery service. The sad truth is that no health care service in the world can ever deliver such a service to everyone - not the NHS, and certainly not the American system where you’re at the mercy of your insurance company, should you be lucky enough to have one. 

Even France, with whose health system we are always unfavourably compared, has recently been reducing the range of services covered by it’s social insurance system because it’s become so expensive. Some one up there in Whitehall needs to have the courage to stand up and tell it like it is - although, come to think of it, any politician who told such an unpalatable truth just before a general election would have about as much chance of being elected as one of my patient’s soggy fish…

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Snowy crisis? Pah! It’s not a patch on 1947

By Katherine Teale - 10th January 2010 5:31 pm

“There’s no business like snow business”, says the sign above theatre reception. It’s certainly very bad for business, and we’ve all just about had enough now.

One or two days building igloos in the back garden may be fun, but now things are getting out of hand. The supermarket shelves are empty as panic-buyers fight over the last baguette, the streets of Hale and Wilmslow are littered with abandoned BMWs, and  local radio broadcasts lists of all the schools which  are closed even though there hasn’t been any actual snow now for two days.

“Those teachers - how much holiday do they want?” I ask my husband. I think I catch the words “Health & Safety”, but they were a bit muffled by the duvet.

Meanwhile those of us with jobs on the frontline have to struggle in to work. On Tuesday, we had the deepest snow that Manchester has seen for 30 years.

The hospital was on red alert and all elective surgery was cancelled. There goes our non-clinical cancellation target, for a start. In one day we cancelled more operations than we normally do in two months. 

There were many tales of heroic efforts to come to work - my lead ODP (a cycling fanatic) ran 13 miles to work. Gridlock was so bad that one colleague sat for four hours with nothing to do but a Sudoku (not unlike his usual neurosurgical list, he commented). One of my recovery nurses laid all her spare clothes behind the car wheels in order to get off the drive.

Altogether, we managed to keep the emergency service going and a consultant colleague volunteered to be resident overnight. Many nursing staff stayed in local hotels rather than risk the journey home - although, once they’d seen the inside of the local hotels (they have interesting plumbing, I’m told) they probably quite fancied the idea of three hours through black ice.

Needless to say, we did have some other members of staff for whom getting to work wasn’t quite such a high priority, including some who  lived within walking distance of the hospital but appeared to be snowed into their beds.   

Now that the acute emergency is over (for the moment at least) and the blitz spirit has dissipated somewhat, we are in the midst of bitter recrimination. Those who tried to come in on Tuesday but were unable to make it are outraged at the suggestion that they should be docked a day’s annual leave, whereas those who heroically came into work don’t see why their colleagues should get an extra day off. Those who just stayed in bed are keeping their heads down. 

There’s fresh disaster today - ice has prevented the bins being emptied. My elderly neighbour is outraged. “We had a worse winter in 1947 and everything carried on as normal”, he tells me. Events this week demonstrate the pathetic lack of backbone and work ethic of today’s youth, government and society in general.

Perhaps the fact that in 1947 there were only two cars on the road, everyone walked to work and kept hens in the back garden might have had something to do with it. Incidentally, hospitals only carried out three operations a week, and hadn’t just outsourced their sterilising units to Liverpool. Oh for those simple days…

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Foxed by a surge in injuries to elderly ladies

By Katherine Teale - 31st December 2009 10:46 am

My sister-in-law is wearing a dead fox on her head. It’s Boxing Day and, despite ten years of Christmases at the in-laws, I have forgotten to give the local town a wide birth and am confronted by the Hunt.

Unfortunately in my anxiety to buy the last remaining copy of The Guardian in Yorkshire, I forgot that the whole place would be swarming with red coats, including most of my husband’s family. On closer inspection, I discover that what appears to be just a dead fox is in fact a dead fox fashioned into a hat, but retaining all the bits, such as paws, eyes and teeth.

She has started a cottage industry making head gear out of fox pelts - an obvious niche in the market, if you want to make a statement with your hat. I’m sure Lord Sugar would approve, although I wonder how plentiful the supply of dead foxes is these days, what with hunting being illegal. My sister-in-law seems strangely coy on this subject…

Other than that, it’s been a good Christmas, enlivened of course by the snow. On Christmas day we took the kids sledging - it was the most fun I’ve had on Christmas day for many a long year. At least it was for my husband and me, the kids just whined because their feet were cold.

Of course their generation isn’t used to the cold and, sad to say, doesn’t really know how to enjoy itself unless there’s a screen involved. After two days breaking up squabbles over the Nintendo, I’m quite glad to be back at work.

Only a few years ago, hospitals used to wind down over Christmas and New Year. In fact, for two weeks hardly anything happened anywhere except for emergencies and repeats of Only Fools and Horses.

How things have changed - now Christmas is just a super-duper shopping opportunity, with half the country logging on to the sales at midnight on Christmas Eve instead of hanging up their stockings.

Now hospitals too are businesses and can’t afford to stop - we are supposed to work as normal, with elective lists planned up until 7pm on Christmas and New Year’s Eve.

In fact, Christmas is completely incompatible with the current business model. As it turns out, not all our patients are on-message with the new system (or perhaps they’re just anxious not to miss the sales) so we haven’t filled all our elective lists this week. This is just as well, as we have 12 elderly ladies waiting to get to theatre with fractured wrists.

I assume that they all slipped on the ice but I am wrong. One of them has another classic Christmas injury - she fell over her slippers. She had been given some of those novelty ones with big stuffed Scooby Doo’s on the front, and the next thing she knew, she was on the floor. We now have a small series of these and I’m composing a short publication.

I might have also identified another lucrative area for expansion of the family dead-fox business…

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The clinical director’s survival guide

By Katherine Teale - 10th December 2009 1:12 pm

Being a clinical director is like being the manager of the England Football Team (minus the huge pay packet) - everyone thinks they could do a better job until they find themselves in the hot seat. 

Having been a clinical director for two years now, these are some of the hard lessons I’ve learned. 

The first thing to remember is that it’s your fault - even if you weren’t in the hospital. Get used to saying sorry.

Learn the four essential rules of email:

1. To avoid extra apologising (see above) always check your facts thoroughly before sending an angry email. Better still, don’t send angry emails.

2. Never say anything in an email that you wouldn’t mind everyone in the hospital reading - because there’s a fair chance that they will.

3. The chance of an email achieving its purpose is inversely proportional to the number of people copied in. Some things are best discussed face-to-face. The only emails not copied in to 50 other people are thanking you for something which has gone well (very rare). Emails pointing out some gross failure on your part are always copied into half the hospital.

4. To avoid email overload, some emails may safely be deleted immediately - these include any which contain the words “it’s unacceptable” (translation “ I  personally don’t like it but can’t actually come up with any coherent reasons”), or “it’s a disaster waiting to happen” (ditto), or any mention of the word “status” (they’ve obviously lost the plot completely). 

Then comes mobile phone etiquette. If answering calls on the rare occasions when you’re not at work, always say you’re “off-site”. Never admit to being “at home” - clinical directors aren’t supposed to have them - nor is being “on holiday” considered an acceptable excuse for being uncontactable. Try to give the impression that you’re at an important meeting at PCT headquarters. 

Learn to accept that it’s virtually impossible to change other peoples’ behaviour, however irrational. You can only change your reaction to it. The following responses, though tempting, are not recommended: screaming, weeping, physical assault, or any combination of the above. The only sure-fire way of persuading colleagues to change their behaviour (i.e. holding a gun to the head) is unfortunately frowned on by HR.

Be grateful that you still do your day-job at least part of the time, and so have a get-out clause. Giving anaesthetics is great - I know what I’m doing (more or less), get instant results, and people are occasionally grateful. How different from the daily grind of the full-time manager, who has no relief from the tyranny of meetings, angry emails and conflicting targets.

Overall I’ve learned that most colleagues, from support workers to consultants and managers, are decent, hardworking folk who try their best most of the time. When people behave in an apparently irrational way, it is not (always) simply to annoy you, but generally due to some underlying problem which is nothing whatever to do with the matter in hand. Understanding this can save you a lot of aggravation. 

Finally, there are two areas of personal development which are essential to the survival of all successful clinical directors: firstly, a good sense of humour; and, secondly, friends outside work. You’ll need both in spades.

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Unmask the truth behind evidence-based medicine

By Katherine Teale - 22nd November 2009 9:55 pm

Evidence-based medicine used to seem quite simple to me, until this week. My mother-in-law, at 78, has decided to stop taking her enalapril on the grounds that she was “getting hooked on it”.

I’ve just taken her BP, and it’s 208/118. Mine is now 220/100 because I’ve just spent half an hour trying to describe the evidence for long-term blood pressure control in the elderly.

All in all it’s been a trying week - someone told me recently that we are happiest during our twenties, and then not again until we hit 60. That would explain a lot, as I’m slap-bang in the middle of the “happiness trough”; and it would also explain my mother-in-law’s permanent state of euphoria.

All she requires for happiness is a pot of Yorkshire tea and Corrie on the box. Perhaps a complete lack of insight really is the only way to achieve happiness. To this end I’ve decided to try a little experiment - henceforth I’m only going to read celebrity  news, concentrating on Katie Price and Peter Andre’s ongoing life-choices (so there’s plenty of material), and see if I’m any happier after a couple of weeks. 

Meanwhile, at work, life is being enhanced by a heated argument involving clinical autonomy and the evidence-base for wearing surgical facemasks. Theatre management is attempting to enforce a universal facemask rule - but we have some surgeons who adamantly refuse to do so (particularly, and in my opinion somewhat bizarrely, the gynaecologists) and obviously all the anaesthetists take it as a personal affront.

Of course the evidence for facemasks reducing infections is sketchy to say the least, although it has been demonstrated that wearing them reduces bacterial growth on agar plates placed near the op site.  

But it turns out evidence isn’t what it used to be. For a start, it changes radically from one year to the next - one moment it’s dangerous to drink alcohol, the next it’s good for you, then we’re being told that the calorie limits we’ve all used for years are too low (although frankly who cares, since everyone ignores them anyway).

If we can’t even agree on things for which there is copious evidence like evolution or global warming, then what chance is there for something as nebulous as wearing a facemask?

Basically we’ve got to wear masks because the trust thinks it’s good for discipline, and, in conjunction with other things, it may (or may not) help to reduce infections. In the anti-mask camp, the following convincing arguments have been advanced: A. they’re itchy B. they’re hot C. they make people sneeze, and D. we don’t like being told what to do by a set of jumped-up managers who probably wouldn’t even recognise a Chi squared test. Talking of which, where are the double-blind randomised controlled trials which we demand for anything we don’t want to do?

I only wish that I had so few things to worry about that I could be upset about wearing a face mask. Really, on the scale of life’s tragedies, it doesn’t really float my boat.

On the way home, I notice the headline in the paper “Peter left me for Nanny” Katie Price exclusive. Now that really is something worth getting worked up about.

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Vaccination is the only way to enjoy the X-factor

By Katherine Teale - 12th November 2009 2:41 pm

Today I’ve spent several hours searching for my keys, which have mysteriously disappeared.

The most likely scenario is that, during an episode of the impressive multi-tasking required to keep this household afloat, I’ve made what is known as a ‘human error’ and instead of replacing the keys in their proper place (the fruit bowl) I’ve put them somewhere really stupid. 

This kind of thing is becoming disturbingly frequent, and I’m seriously beginning to wonder whether my husband isn’t practicing some sinister Fanny by Gaslight scenario and deliberately hiding things to make me think I’m going mad. 

Every time I enter or leave a room I now have to complete a mental checklist to make sure I haven’t forgotten something.

Or, of course, it could be an after-effect of the swine flu vaccine I had this week, causing my cerebral hemispheres to gradually disintegrate so that by the end of the week I’m going to be enjoying the X-factor.

Despite the whole swine flu thing obviously being part of a huge government and pharmaceutical company conspiracy, I decided to take the jab. My reasons for this are A. young fit people are dying of swine flu which, in my book, tilts the risk/benefit see-saw towards doing something to avoid it, and B. if the rest of my family go down with the disease I want to be well enough to look after them.

Also, I suppose it would be good if we had a few doctors still fit enough to care for patients, although given the uptake of the vaccine at work, I might be pretty much on my own.

Occupational Health have thrown all their resources (and she didn’t look too happy about it) into going round the wards offering the injections to front line staff so my trainee and I took turns to pop out of our orthopaedic list to be vaccinated. We were unable to persuade any of the surgeons to follow suit, but, as they pointed out, we could probably just about manage during a flu pandemic without relying on the help of orthopaedic surgeons.  

There are lots of reasons why people are choosing not to have the vaccine: a healthy distrust of authority and too much reading of tabloid newspapers, as well as rumours about how awful the vaccination makes some people feel. Although, I’m guessing, a dose of swine flu is going to be more awful.

A recent poll in a medical journal revealed that over half of doctors wouldn’t be vaccinated.

Obviously contracting swine flu simply isn’t pushing people’s panic button yet, and we are not alone in this skepticism. Polls in France reveal that only about 10% would have the vaccine. It will be interesting to see how many patients have to die - perhaps even a celebrity or two (I could nominate several expendable ones but then how would they run X-factor) - before the uptake improves.

So far I can report that, apart from the keys incident, my only ill effect has been a sore arm for 48 hours. I am feeling a bit tired today, but I’m putting that down to rashly agreeing to host a sleepover for a load of eight year-olds last night.

So far, so good…

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Clinical innovation on the M6 north of Preston

By Katherine Teale - 2nd November 2009 10:33 am

Holidays are meant to be opportunities for rest and reflection, and I’m having plenty of time for that as I’ve taken leave during school holidays. This really winds up the executive, as I’ve thereby personally placed the trust’s precious 18-week target in jeopardy.

If  they’re not going to allow a full-blown flu pandemic to relax the target, they’re certainly not going to be swayed by my feeble preference for spending holidays with my husband (a teacher) and daughter (a child) instead of solo, decorating the spare bedroom in the middle of November.

The timing also allows us to enjoy the family tradition of having a full-blown domestic argument while stuck in a traffic jam on the M6 north of Preston (one of the more depressing stretches of our motorway network).  The argument focuses on the following points: why do we only every get to go on holiday when everyone else in the country is deliberately clogging up the M6? Should we simply turn round and go straight home again or should we try to find an alternative route? Whose responsibility was it to put the road map in the car and why haven’t we got a satnav?

The answer to the last point is “my husband”, whose responsibility it is to pack the car, and who is also solely responsible for insulating our household from any contamination by twenty-first century technology on the grounds that it would inevitably lead to loss of essential life skills. For instance, map-reading (hence no satnav), remembering to take food out of the freezer (therefore no microwave) and washing-up (no dishwasher)…

The traffic jam goes on for so long that I find myself thinking quite fondly of my neurosurgical list, which is what I should be doing at this moment if I was at all corporate in my outlook. In fact during this period of rest and reflection, I come up with several cracking ideas for improving things in theatre.

We’ve already instituted the WHO surgical checklist, which is fabulous for getting staff to actually speak to each other before they start cutting bits out of patients.

But why stop there? On a trip to Tokyo several years ago I was really struck by the habit of the theatre staff and trainees of lining up outside the operating theatre and bowing to the consultants as they arrived. We could easily institute that, and it would look great in our theatre ‘etiquette’ policy, which the executive wants to be more stringent.

On top of that is the whole thorny issue of theatre wear for those who need to leave theatre to visit their office (or occasionally the ward) during a list. I think we should introduce bright pink theatre suits for this purpose, both to discourage this undesirable activity, and to break down gender stereotyping. Not all of this is evidence-based, of course, but then the evidence-base for a lot of our spinal surgery doesn’t bear much examination, and no-one’s suggesting not doing that.

Meanwhile, I see Junction 34 approaching and we decide to take a chance and turn off - along, it turns out, with around 10,000 other people.

Perhaps redecorating the spare room isn’t such a bad idea after all. I wonder what the leave diary is like for November…

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