Are we becoming too well informed to think?

Today I came across a newspaper article in which we read how a body builder/personal trainer was advised by an NHS nurse that her BMI (body mass index) was too high and that she should eat less and exercise more. The newspaper article was accompanied by a picture of the body builder. She is what my sons call 'stacked'. Maybe you don't like that particular kind of body shape, and that's fine. But this woman has clearly worked very hard on getting her body to look the way she wants it to look. I'm pretty sure her body fat percentage is very low, but muscle weighs far more than fat, so a very muscular person, on the basis of BMI alone will register as overweight or even obese.


I think it's safe to say that the nurse in question made no effort to address the woman's unique case. She unquestioningly followed a single set of guidelines as issued by the NHS.


We seem to have guidelines for everything these days. So much so, that I wonder whether we're in danger of giving up the effort of thinking for ourselves.


Sometimes guidelines are treated as inflexible rules. I mentioned once before on this blog about a friend of mine whose baby was struggling with reflux problems. She was worried about him, because when she laid him down to sleep, he would spit up and start choking. Because I had a son with a similar problem (apparently it's quite common for baby boys to have a slightly underdeveloped valve between the end of the oesophagus and the start of the stomach - it usually resolves once they become able to sit up by themselves), I suggested that she try laying him down on his side with a rolled up towel behind him to hold him in position, so that if he spit up in his sleep, it wouldn't get caught in his throat. Her response was "Ooh, no. We're not allowed to do that. The health visitor says we have to put him down on his back." Not allowed to. Not allowed to make a decision in respect of your own child that is contrary to what the health visitor has recommended based on the guidelines handed down to her by a faceless organisation that has never met the individual child in question.


A few years back, we read glowing obituaries for a traffic engineer in Europe (I wish I could remember more details about him) whose view was that more information to drivers made roads less safe. He was credited with revolutionising traffic safety by removing most of the information given to drivers and allowing them to take ownership of their own driving habits.


Now that I have health and safety guidelines that tell me it isn't safe to stand on a chair on top of a desk to change a light bulb, and warning signs over the hot taps in public facilities telling me that the water is hot, and labels on bags of nuts telling me that they contain nuts... do I need to do any thinking for myself? Perhaps the rationale is that it frees up my brain for important things. But I maintain that the more we are protected from the possibility of making stupid choices, the less likely it is that we will make inspired ones.


I have no research to go on here, but I wonder if it isn't a bit like a sine wave. The ubiquitous 'they' are trying to remove the bottom half of the wave, but actually what's happening is that the entire wave pattern is getting flattened as the top half is reduced proportionately. Spike Milligan is reported to have hated the medication that took away the swooping lows of his bipolar disorder (or manic depression as it was known back then), because it also robbed him of the soaring highs. The two things aren't directly related, of course, but I wonder, if in the process of trying to move the whole wave upward, we don't actually just reduce its amplitude. And if we reduce it enough, will we all just, well, 'flatline' a la the movie Serenity?


Surely being allowed to make a few stupid mistakes, will encourage us to think a bit more? Surely looking at a competitive body builder, a nurse can set the BMI guidelines aside? Surely the mother of a baby with reflux can experiment to see what works best for her own baby?

Relieved of the need to think

I was recently at an event planning meeting in which I heard that the local doctors in our town find it very hard to live up to the expectations of the very large Polish population we have. Apparently, "Their expectations are very high," and their confidence in British doctors very low. I was the only non-British person present at the meeting, and it was pointed out with some surprise that Poles know "the names of all the different types of doctors" and expect to be able to access these directly.

It sounded rather as if the Polish medical system was not dissimilar to the one I knew in South Africa. If you have a skin disorder, you make an appointment with a dermatologist. If you're a woman, you make a routine annual visit to your gynaecologist. Until your kids are 12, you are just as likely to take them to the paediatrician as the GP. You know your radiologist from your oncologist, and your ear, nose and throat specialist from your cardiologist.

In the UK, the practice is that you go, in the first instance, to your GP. Always. You will then be referred to a consultant. And that process can take months. Been there. Done that. Nine months for me, last time.

When I expressed surprise that the well-educated, otherwise knowledgeable people present at the meeting didn't know "the names of all the different types of doctors", one person rather proudly pointed out that, with the way the NHS works "we don't have to!"

I had often wondered why all specialists were rather generically referred to as 'consultants', but this explains it. You see a generalist. The generalist refers you to a specialist. The specialist's secretary sends you the details of your appointment. You attend. The specialist reports back to your GP. Your GP reports back to you. You don't ever initiate contact with the specialist. So you don't need to know what sort of specialist s/he is.

I find this approach quite disempowering. I don't feel the need to be looked after in this way. I feel quite capable of identifying the specialist discipline needed in each instance and making an appointment. I feel quite capable of providing said specialist with an accurate history and conducting a conversation about my ailment/condition.

Many Poles obviously experience the same frustration, because they are quite prone to taking their ailments back to (as one Polish woman puts it) "a proper doctor" for a diagnosis that they feel they can trust. This doesn't really help, though, because when they come back from Poland, and feed the information back to the local doctor, the local doctor will not accept histories or diagnoses from abroad, and wants to go back to the start of the process again.

I can think of so many situations in which traditional workplace practices reflect a similar approach. I would far rather see individuals given the freedom to run their own initial diagnostics and then to access to the resources they believe they need in order to get the information/support required, apply it and move on with the day job. Of course they will get it wrong from time to time. That's part of learning, too.

Too much second-guessing can result in a culture where people are waiting to be taken care of, to be told what to do next, have no idea which kind of person/resource holds the solution they need, instead of taking charge of their own lives and figuring out their own 'what nexts'.

Sometimes, taking too much care of people is even worse for them in the long run than taking too little care of them!

10 reasons it's good to be home

You know what it's like - you go away on holiday, you eat too much, you sleep 10 hours a day, you do very little of anything that smacks of work... and then you have to go home. So, on Sunday night, with the post holiday blues, I decided to draw up a list of 10 reasons I was glad to be home. A bit of a "count your blessings" exercise if you like. It probably has no relevance to learning, but what the heck, here goes...

1. My bed.
I LOVE my bed. We have a fat, down-filled duvet (dooner to Aussies, I don't know what it's called in North America) that I use all year round. On holiday, we had sheets and blankets that kept falling off. Also, we had twin beds on holiday. At home we share a standard double. Much cosier.

2. Driving
In Spain, they drive on the right hand side of the road, in the UK it's the left. I have never driven on the right. Nor has my husband, but he was daring enough to have a go, so we hired a car. Our first trip was to our hotel, 70 or so kms from the airport, which we had to undertake in the dark, since we landed around midnight. All the unconscious means my husband uses to judge his position turned out not to work so well on the other side of the road, and I spent the entire journey in stark terror, as we ventured far too close (by my estimation anyway) to the edge of the road. I was NOT a good passenger, and I opted there and then out of trying my hand at driving. Coward. I know. The morning after we arrived home, I slid behind the wheel of my car and tootled up to the shop to get milk. I appreciated again the first sense of liberation one gets on becoming a driver. Which brings me to

3. My car
I don't have a fancy car. I drive a silver 2006 model Peugeot 307 HDi. It is my second one of these. I traded in the previous model when it went out of warranty. When I got that first one, it was a 3 month old ex-demo model and the newest car I had ever owned. Oh, sure, my husband has had newer, fancier cars, which have been a dream to drive. But this was mine. I have always had a thing about cars - I spent my very early years side by side with my Dad under cars, acting as his toolhand, and my stepdad later taught me to service and maintain my own car so that I wouldn't get ripped off by unscrupulous mechanics, so I was often to be found with grease up to my elbows, face first under the hood of my car, tinkering contentedly (I wouldn't know where to start on the modern models, however!). I tend to drool over cars in a way usually associated with the male of the species. From they day I got that first Peugeot, I stopped drooling. Sure, I would still like to own a 1979 MGB in British racing green or pillar box red, or an Audi of almost any description (just not the TT - you can keep that), or a nice Mustang or Buick (both of these are in short supply in the UK), but I'm content.

4. My cats
I have two moggies. Molly and Daisy. While we were away, our neighbours fed them and kept an eye on them. They came to no harm at all - they are cats, after all, and very self-sufficient. When we got home, they were somewhat startled - it was 2am after all - but they quickly recovered their equilibrium and told us at great length about the adventures they had had during our absence. Of course, they tried to persuade us that they were starving and hadn't been fed in two weeks, so needed double portions immediately, but the evidence was against them. They grudgingly conceded defeat and lavished affection on my husband. Note: they are my cats, and John is a dog person. No matter - they both adore him and allow me to feed them and change their litter and clean up after them and brush them and and and

5. Being understood in shops... and understanding the replies
In spite of having a foreign accent, I never have trouble making myself understood when shopping in the UK. In Spain, I was often unable to explain what I was looking for, and even when I was (for example: "donde esta la leche" - even if it isn't correct grammar was close enough so that the shop assistant knew I was looking for the milk), the rapid fire answer left me looking blank. I have similar experience when we go to Sweden to visit my in-laws. My Swedish is now good enough so that I can frame questions and make simple statements, but I'm bamboozled when these elicit a response from the natives!

6. Finding the products I need
The whole time we were in Mallorca, we never once saw any fresh meat for sale. We could buy processed meats of various descriptions, and the restaurants were obviously able to source the stuff from somewhere, but the supermarkets didn't stock it, and we didn't see a single butcher. We also got confused about where to shop for other things. Pharmacies only stock medical type items. If you want nail varnish, cosmetics or aftershave, you need to go to a perfumery. Neither of us smokes, but we noticed that supermarkets don't stock cigarettes - these must be bought from a tobacconist.

7. Business hours
We needed to find a pharmacy on one occasion. We knew of 3 in the town, but none of them appeared to be open for two (week)days in a row, even though their business hours, posted outside, were shown as 10-2 and 4-6. On the third day, they were all open, even outside of those hours. Many shops close for two or more hours over lunch time, but then they stay open until 8 at night. Nothing much is open before 10am. I'm sure if we were to live there, this would become normal, but we're accustomed to the hours in the UK, so we kept getting the timing wrong.

8. Church
We attend a very lively, pentecostal, charismatic church in the UK. We didn't see any churches at all in Cala Millor. We know they exist, since we saw evidence that people had attended a service. Chances are, of course, that any church would have been Catholic, so the service would have been even more alien to us than even the language difference would indicate, and we would have been unable to participate. Of course, we observed Easter together as a family (no Easter eggs - those aren't available in Spain), but we missed the wild and woolly bunch with whom we normally spend our Sunday mornings.

9. Familiar etiquette
I have no desire to imply that Spanish or German (the nationality of most of the other holiday makers) people are rude, but the protocols are different. Several times, we would hold a door open for someone, and they would march straight past us without even acknowledging the act, let alone thanking us for it. We felt very slighted. No doubt we frequently offended people in our turn by not observing some or other protocol of which we were unaware. Perhaps we offended by holding the door open, thereby implying that they were incapable of doing this for themselves!

10. Dog poo
No, I haven't returned to a mound of the stuff. Quite the contrary. In the UK, dogs must be on leashes at all times if they are outside of their homes, and their owners must clean up after them or face a fine. Many people ignore this rule, but most are pretty good. I have never seen a dog wandering about on its own in the UK. We saw several in Mallorca. Even when the owners were with their dogs, though, and even when the dogs were on leashes, there was no attempt to clean up their - ahem - leavings.

And one thing I will miss...

It appears that the nanny state does not exist in Spain. At least not in the same measure as it does in England. It seems people have a measure of freedom that has been lost here. Of course, this has its downs as well as its ups. Some of the issues I've covered above are the result of that freedom. And there are other negative points, too - smoking is still permitted in many restaurants in Mallorca and, where there are signs that say that it is forbidden, the people smoke anyway. I saw a woman backhand her child across his face in a store, and no-one turned a hair. In the UK, she would have been in serious trouble.

However, the State has not seen fit to dictate to people about every last aspect of their lives, and they get on with the business of living, raising their children, ruining their health, running their businesses and walking their dogs in the way they see fit. In the restaurants, the proprietors were prepared to let us make the choice as to whether our children may drink wine or sangria, rather than citing a rule about ages. There don't seem to be rules that govern every little thing (or perhaps there are and people just ignore them, like the prohibido fumar - smoking prohibited - signs) which means that people have to take ownership themselves, and be grown-ups.