Thursday, July 26, 2012

I love worlidays

Worliday….Ever heard of that term? One which I first heard about on a BBC news programme- and evidently it’s a modern day holiday- whereby while you are sipping on a drink beside the pool, you open your laptop and keep on top of your work. All for the benefit of not having to return to work with an avalanche of pending emails and tasks. Interesting concept no doubt and one which I seem to have become au fait with nowadays. Reason? I don’t think the out of office message actually dissuades anyone nowadays, and I hate having to come back from a break to have all my regained energy sapped away by the mountain of emails to go through. Better to do “work” while on holiday- albeit at designated times….

So, with that in mind, off I went to the Isle of Wight for a “break”. I am never sure how to take this, but when you mention to someone you are off for a break, nowadays the standard response seems to be “ deserve one”. Erm, does that mean I am starting to look ragged, the worry lines are appearing? (Must invest more in that Oil of Olay!!) Anyhow, who knows…maybe they are just well wishers who want me to “take it easy”.

So the IOW it was…and a lovely place in Godshill..pretty much in the middle of nowhere! Surrounded by farm animals, family in tow (for those who liked my tribute to my parents last week, they came along too…visiting their son all the way from the City of Joy, Calcutta) was a bit like being detached from modern life. The sun was out, there were opportunities for walks…heck the local pub was stunningly amazing…and it was to put it in one word…relaxing. And here surfaced the benefits of a worliday. I could pick and choose which emails to answer and which bits of work to be involved in. Get up at 10 in the morning, munch on a bacon sandwich, sip some tomato juice, get those rock star shades on…out in the sun, the IPad was such a lovely friend. Kids running around in front being chased by the farm dogs, mum fussing over my breakfast habits, my need for a hair cut (Mum, I am 38!!)…I flipped open the Ipad…And worliday was great fun!

What sunk in however was one fact…it was so difficult to detach myself from my work! Questions and ideas keep swirling in my head…what about the nurse post recruitment for the community? What about the added foot clinics? What about the NHS Innovation role? What about the type 1 service….challenges, challenges…so much more to do…..ideas keep cropping up..and I jot them down…try a different negotiation tactic, maybe which will unlock that particular puzzle…

Workaholic? Possibly. Any different from what my dad used to do when I was a kid? Not in the slightest. I looked back at him through my Ray-Bans…the man, the epitome to me of what dedication to a patient stood for, my inspiration…mellow now, playing with my 6 year old, breaking out into some sort of random shared joke- one which only a granddad and grandson share…and it was clear…the baton had passed on. He tells me he is 70…looks far younger than that…still fretting about his “patients missing him in Calcutta”…the fire hadn’t died down…but the man who never showed a sign of wear and tear was certainly taking a well deserved and earned rest.

And you know what…a worliday was fun! You pick the best of both worlds..enjoy the time with your near and dear ones, enjoy feeding straw to the horses…ignore phone calls from the hospital at leisure, time to write a blog for Roy Lilley…and answer emails at leisure. 3 of those emails were from my Type 1 patients….and I looked at them and paused for a second. Ignore as on holiday…there are plenty of other folks around? Then I saw their names…3 of the most difficult to engage young ones…and they had put faith enough to email me about a problem. Break the promise to “always answer” and lose their trust? A split second decision for me…and you know what? Pat came back some grateful “Cheers doc”. Ahh…Who the heck needs awards, eh?

5 days spent in the IOW passed in a blur…and in spite of the non-detachment from work…I walked back into the bowels of the sparkling hospital of Portsmouth….walked into the department…buzzing with ideas. Much more to do…and I now have a master plan….if executed, will be a path blazer. What was it that Bruce said…”it's not who you are underneath, it's what you do that defines you”…and when I am done, all this will hopefully define what I stand for..beyond all the brashness, all the cockiness, all the charm…you see….a break does help to give you a good deal of clarity of thought. 

Tuesday, July 17, 2012

Don't ask me why

Tired. Really tired...and just genuinely happy that am just about to go on holidays for a few days. Long journeys do tend to take a lot out of you, however comfortable they are and I am writing this blog while travelling back home..all the way from Liverpool. Been part of a roadshow, asked to talk about our local model of care and as part of that been to Manchester, Birmingham, then to Newcastle, followed by London and finally finishing in Liverpool. Just to clarify, all done on my own time by taking out annual leave or by making sure clinics were not cancelled. Not on my high horse, but whenever you do these sort of things, people tend to assume that the rich, spoilt Consultant is skiving from the NHS to do personal "gigs". Some sense of morality still runs deep, so for the doubting Thomases put that in your pipe and smoke that.

GPs, Clinical Commissioners, Managers, Practice Nurses, Consultants...they were all all the cities and it was a fascinating group of people..some disgruntled, some willing to engage...and in front of all of them, the roadshow unfolded. There were sessions on discussing the patient with complex diabetes, there were sessions on the pitfalls of clinical commissioning, there was discussions about public health engagement...all in all, an interesting day of discussions.There was a debate about appropriate treatment of patients with diabetes..about how it was beyond simple rules and algorithms...but about the patient in front of you. "Horses for courses"..."fit the drug to the patient"...all of these were discussed and debated...and somewhere during the day, the healthcare professional bound by rules and guidelines stood down..and the clinician who had time to look up from his prescription pad, and resist the urge to fill out a computer screen..emerged.

In my session,I tried to showcase what we had done locally. The usual caveat was added about this not being a session to "tell anyone what to do"...but this was our story...the story of the Portsmouth Diabetes centre, the journey of ours from 2009...and this was an interesting story to tell. It was the story of a tight knit team, the band of Four Consultants...the old 3 musketeers who took the young D'Artagnan under their was fun to relate a "heroic" story, a story laced with intrigue, mystery and triumph....but mostly this was about paying homage to the nurses who made this happen, respect to the colleagues who stood firm, the managers who understood and formed an amazing ally..but foremost there was a genuine sense of pride to say..."We come from Portsmouth".

And during the course of this meeting, there were the others. Beyond the organising company...there was Emma Carroll...bouncy, vivacious...but beyond all, a project manager par excellence.When you have 5 such events on the trot, and have speakers to manage, their travels, delegates attending, not turning up, catering etc to handle...and that goes without a must be pretty darned good! Throw in a few other good eggs (Danielle, Bradley)..a trip to Pizza Express, a discussion about Gary Barlow ( don't ask) and they were good folks to hang out with. The professional side of it never goes away..I was there to do the talk...they were there to make sure the event went well...but when you are scoffing down a pizza and sharing a joke about who can get how many Take That references in a just makes such meetings just that bit more fun.

I made new friends..Stuart, Sailen...bumped into old colleagues, Richard, Fiona, Brian...and heck you know you are among people who speak the same lingo as you. Folks who are keen to make a change, but also who knew not to take themselves too seriously. You hear from Stuart, a healthcare professional on an insulin pump mentioning about how rarely his doctor has discussed a hypo with him...and you know how much you have to travel yet.

And finally there was the Pharma folk...and the dichotomy creeps in. Do we see them as Pharma...or do you see them as colleagues in the same industry trying to do their job...and perhaps forge friendships with them beyond their employer? Do I genuinely believe that being friends with a folk who works in the Pharma industry will make me prescribe his drugs...or do I take that as an insult to my intelligence? Heres an analogy....I have a good friend who flies planes for British Airways...I am not sure that has made me fly ONLY British Airways...on the contrary I tend to use the airline which suits me best for the travel and/or gets the job done, is safe and a lower cost does help too...heck that nearly sounds like how a level headed professionals uses pharmaceutical drugs too....doesn't it?? So there was Christian, there was Hannah, Sophie, Susie...a group of folks who are...what can I say...good fun. Is it an act to con me into prescribing their I being lulled into some sort of Vulcan mind melt so I forget all forms of evidence based medicine...well I darned well hope not.You know what they say...don't piss off Partha Kar....he holds the longest memory in town....I may come from the land of Gandhi...doesn't mean I believe in his "forgive and forget" motto :-)

To end, I would like to finish with a little story. My talks as usual was delivered with the usual passion...the usual "Come on guys and girls..we can do it"...and after each talk, I was greeted with "keep it up/can I contact you/don't let anyone get to you/inspiring" etc etc which was just so...lovely. Not a single person criticised it, not a single specialist held their head in anger or disbelief. This was an audience away from the usual politics of diabetes, who had never heard of me, senior folk who had seen so much of the NHS..and yet were with free with their praises for this young gun. Swelled the ego? Betcha...who doesn't like platitudes and appreciation?

And elderly lady who introduced herself as a GP for 36 years, of Pakistani descent...walked up to me in Birmingham. I turned around and extended my hand to accept her which she asked me to bow my head. Slightly apprehensive..I did. She placed her hand on my head ( where I come from, it's a sign of blessing from your elders) and murmured in Hindi " your parents must be so proud of you...all my good wishes are with you, my son". I straightened up...and she was gone...slowly mingling into the crowd milling for coffee.

I am not one to show emotions, lower my guard..but at that moment, I had this solid lump in my throat. Every single accolade I have won so far melted into insignificance, every single criticism lobbed by cowards from the undergrowth didn't matter any more...In a flash, I remembered those hard days when my parents worked so hard to give me that education I needed, stood by me during my rebellious teenage years, those late nights when my dad used to struggle back from work..or those long evenings when my mum waited patiently for me to finish my muddy football game...heck, they made me who I am...and this elderly lady had crystallised that in one small gesture.

I had to lower my head, smile, while clenching my jaw...there was this speck of dust which had just landed in my eye...and I just had to clear it time, I see you,mum and dad..I give you a hug. Just don't ask's just one way of saying..."thank you...for everything".

Thursday, July 12, 2012

With great power....

It's always nice to get an invite to prestigious conferences ,especially when there's an email from Jonathan Levy and Steve Gough asking you to "contribute to the event". To boot,the programme looked good and the speakers, present company excepted, looked to be of high calibre, and it was in Oxford too, that place which evokes imagery of high knowledge and august reputations.  I was asked to chair a workshop on Integrated care pathway, possibly because of our local work and although I am no expert on said topic, was happy to contribute and if not anything else, to also find out what exactly were other views, what else was happening etc. Backed by Big Pharma, it didn't look like a product placement event, though cynics would suggest that it's the subliminal message which is getting drilled into all of us....ahh those dastardly folks with mind melting skills...someday you shall have your place in the pantheons of Doctor Who villains.

So I travelled. All up the way the A34, scorching the roads as was late coming out of a job planning meeting, which all things considered was a reasonably pleasant affair. Usual challenges from management which to be honest, is relished, if not for anything else, to showcase to all and sundry the work the diabetologists do...yep, same argument,same repartee...but say it enough times, perhaps finally it's sinking in that we are there to get diabetes care sorted, not backfill other departments. Sorry, I digress but suggestions that we are medicines poor cousin does make my blood boil...Anyhow, a few friendly faces around the table, few jokes, few serious debates and boom! A bit late, but a bit more pressure on the accelerator and I was on my way to Oxford.

Now Oxford is a lovely town, but certainly not built for arrived about 5 minutes before my start time...was greeted by Jiten Vora in his inimitable style and then walked into a room. And I couldn't help let loose a wry smile. Anyway I turned there was folks I have looked up to, listened to in meetings and here I was chairing a workshop with them as delegates! There was Charles Fox, there was Cliff Bailey, the was Roland Guy, Dan Flanagan...either I had arrived in life or the organisers had run out of speakers...whichever it maybe, butterflies seemed to develop very quickly within the stomach. Hiding behind the veneer of nonchalance and playing it uber cool, I started off trying to engage the folks in the workshop. There was a mixture of folks in the room, some from the old guard, some from the new lot, some who have settled into their new roles..and it was fascinating to hear the interchange of views.

There were the hard boiled folks who have seen this before, but never come across such financial challenges but still happy and eager to put in ideas, guide the youthful upstarts such as their workshop Chair, there were the new guys who were trying something new and were keen to share, bravely going where no diabetologist has gone before.. and then there was the third group which were...I don't know..just cynical. There wasn't any evidence for any of the things suggested, so why try? One could sense an unwillingness to change the status quo or was it because of their local experiences? They were unhappy with what was happening, unhappy with changes suggested ( it wouldn't work) , unhappy at lack of engagement from patients, disenchantment at politicians for not being bold enough to say the obvious or tackle the food industry...crossed arms, pursed lips...and don't get me wrong, this isn't a criticism at them but simply a thought at why motivated individuals had become reduced to such. You wanted to go all Bugs Bunny on them and shout "whatsup doc?" I know people say to someone like me..."you will learn, let the hard knocks come"...but I work with 3 other guys with me, who have been in the NHS for about 10-15 years who are always brimming with enthusiasm, ready to try something what is it that creates such despair? Maybe it IS the local experience, maybe it's the incessant headlines which says we all provide inadequate diabetes care, maybe it's the system....but whatever it is, that level of cynicism can only create a degree of inertia which sludges everything up. Anyone who thinks all of my plans work, must be kidding with anyone else, you have your share of triumphs and falls... But when you fall, you dust yourself up and go another round, don't you?

Anyhow, end of workshop, we had to summarise our findings and again from the audience, a similar mixture and then someone who asked where the patient was involved in the care pathways we were talking about. He wanted to take some notes away as learning points. Here was an audience for whom working beyond the confines of an acute Trust was I had to ask a few reverse questions back. What do you do if your Trust doesn't get the contract or hasn't bid for the community work, hasn't got any foothold in the Out of Hours work? Do you step outside your Trust work and engage with GPs, paramedics, think of working differently to help your patient OR do you hold to your contract, do something else to make up your 12 PA contract (please sir, can I do some umm acute medicine, a bit more general medicine, anything?)? Who is responsible for the ill being of that patient in the community? and how is it right to criticise your GP colleagues for "poor care" when you haven't shown the chutzpah to work with the community to help your GP colleagues, and have decided to stay within your bastion and not come out? Does your patient actually care who you work for..and finally who do you owe your allegiance to...the Trust, the NHS ( of which the community is a part of) or your patients...with the view that I will work for anyone, anywhere, any place to help the patient? Answer.... A deafening silence...associated with some gentle nodding of the heads (maybe in approval, maybe not)

2 weeks later, I am in Warwick at a New Consultants meeting organised by ABCD... This meeting held a degree of poignance for me, an issue over which I had a bitter dispute with a few I had trusted previously. For me, once you lose my trust, I don't have much time or interest in you. Bottom line, once that trust was lost with those individuals, I wanted this meeting to be under ABCD as the specialist organisation, not anyone else....and as with most things, if I put my mind to know the rest. So to the meeting I arrived and I am thinking "here we go again". Another meeting where I am about to meet some more cynical folks.

But then what a pleasant surprise it turned out to be. Dev Singh gave an inspiring talk about mentorship, the passion burnt through...he was someone who still believed, someone who wanted to help! The workshops were engaging and the delegates were bubbling with energy. I had Dipesh Patel, Tristan Richardson with me as energetic speakers, sharing the vision, staying away from the doom and gloom.... and then there was Yohan, there was Rajeev, there was Abd...and they were keen to look at opportunities to change, opportunities to grasp the nettle...and I felt once again enthused. Mike Baxter was there, a man with amazing management and clinical credentials and perhaps one of the coolest dudes around..with his love for fast cars...and it was fabulous listening to him, learning. It was a pleasure to listen to Chris Walton...very much like Yoda, watching all the Young Paduans scrap it out, itching to be let loose. 

Forget those arms crossed few in Oxford, here was the ones who were the future, the ones who would stand side by side as we battle the politics, battle the naysayers ...and who were the ones who would lead diabetes care in the future! They will be there as we redefine the future, redefine what a Consultants role should be. Not just as a specialist, but also as an educator, also as the person who would take responsibility for the patients with diabetes in the area they work in, not be afraid to challenge colleagues either in primary or specialist care if they weren't up to the mark. These guys had got the message...being a Consultant wasn't about just turning up, doing your expert thing and going home. With due respect, a good staff grade can do that. 

A Consultant gets those big bucks to show leadership, take responsibility for his patients....and the delegates at this meeting knew it....and you know what, after a long time, I went back home with a smile. This wasn't a lone battle any more. The troops are definitely in place, change is coming and there is now enough of us to wrest the initiative away from the doom mongers, the naysayers.With great power. comes great said Uncle Ben...and those words are as poignant for Spider Man as it is for those who are given the mantle of being a do, please, accept it with humility and broaden your shoulders...remember those days we griped about Consultants not showing the way? Well..we are "it" now...and we are the ones we have been waiting for.So let's make a difference, shall we?

Thursday, July 5, 2012


Another day, another award for the Portsmouth Diabetes Team. But this was different..all of the awards won so far have filled me with pride but this was different. You know that moment when a long standing project gets recognition? When something which you have sweated blood over gets reward...yep, this was one of those moments. Super Six...that's what I had named the project...and oh boy, wasn't there enough doubters? "What kind of name is that??" ;" This is just self promotion"; "Partha thinks of only himself"...and beyond all the nonchalance, it hurt. Have tried not to care for what others think of me, but it hurt. And it hurt because folks thought this wasn't about patient care. I maybe brash, I maybe cocky but I have never ever compromised on patient care, so a vindication always helps!

So it has come to pass. Winner of Care Integration Awards 2012. Beating out a slew of similar minded folks, peers I respect, peers I find as like minded souls...this was recognition amongst the best of the best and yes, very very happy. Happy that we have some forward thinking GP commissioners who were willing to listen.Happy for those nurses who have finally gained recognition for their work in the community. Jane Egerton and Debbie Fishwick, recently joined by Julia Mackay..take a bow ladies..this is down to you. Any proof needed how valuable specialists nurses are to diabetes care..well here you go. A fabulous achievement and do bask in every moment of pleasure this award brings. To those who says GPs with special interests are a waste of space, do come and meet Tim Goulder. Always someone with vision, maybe perhaps hampered by the politics but certainly someone who wanted to make diabetes care better...and that I do respect. Glad to see him the at the award ceremony holding the trophy...the community diabetes project was his baby way back in 2006 and however unassuming one is ( which Tim is) this must have been an extremely proud moment too.

And then there's my colleagues...seniors who placed faith in the vision, believed in the model, believed their young CD would deliver and for that I am grateful. I have always said that the strength lies in our team and the camaraderie we a token thank you folks. We will continue to pull each others legs at work, do silly stuff like steal Iain Cranston's jelly babies and replace them with a kidnap note( don't ask)...but deep within, a strong mutual respect and trust runs...and it makes us what we are.

Finally...what about me? Personally if you must know my style of leadership, then go and check how Jose Mourinho unconventional style of leadership. Exude cockiness, confidence, say outrageous things like "I am the special one"...and before you know..2 things happen. One, all attention, managers, Commissioners, Chief of Medicine, Trust's focussed on you. You shield the whole team from anything and everything external and it frees up your team to do what they do best..provide high quality patient care. And two, your team respects that and stands behind you. Result? You create a winning mentality and a strong tight knit team. And that's my the process if along the way, you become unpopular and gain grudging admiration, so be it. Perfectly comfortable with being the Dark Knight :-)

And we still have plenty to do..but if my first 3 and a half years are any indication, and going by the calibre of the folks around me, they will be resolved too. So to my friends, anytime anywhere you want us to share what we are doing...just ask.

To the critics who like sniping from the underground? Want to challenge what we are doing? Go get the chutzpah to take us on. Don't like it? No sweat. Do something else where you are.
Just remember this. In these days when the talk is of integrated care, the defending champion of Care Integration Awards is...Yep, you guessed it right. Give us time, we WILL make this the best centre of diabetes care. Champs don't believe in coming second....the battle goes on, and on behalf of the patients, we win.