blog post

Retired husband syndrome — Wet fallen leaves

Japanese men have an identity crisis

Not as unpleasant as that other material you occaionally step in

The great extent to which Japanese men are encouraged to commit themselves to work is another barrier to change. Retired workaholic men are described as a nureochibazoku, or “wet fallen leaf”, because, lacking hobbies or friends, they follow their wives around like a wet leaf stuck to a shoe. A staple magazine article offers advice to wives suffering a severe case of “Retired Husband Syndrome”. For men, the pain of being considered a nuisance by their lifelong spouse can be immense. Mr Fukushima laments that “so many men sacrifice themselves for work to provide for their family—only to realise later in life that they don’t belong at home.”

Departure time 2023, arrival 1943

Timothy Garton Ash in the NYRB

When I started writing my book Homelands: A Personal History of Europe five years ago, I thought that in order to bring home to young Europeans the horrors against which postwar Europe has defined itself, I must hurry to track down some of the last surviving elderly Europeans with personal memories of the hell that was Europe during World War II. So I did, in Germany, France, and Poland. But today all you need do to experience such horrors firsthand is take a train into Ukraine from the southeastern Polish town of Przemyśl. Departure time 2023, arrival 1943.

Don’t aim to work in the NHS

A little while back, Lisa and I were out for dinner at a friend’s house. The mother, ’M’ was a doctor and the husband, ‘H’, worked in finance. M ticked all the boxes for what you might wish for if you were a patient: technically competent, deeply caring, and worked way beyond her contractual hours. Nor did she park her patients in some tidy box somewhere: her job was part of who she was.

M and H had a few children under 11. As often happens, while watching the children play and interact, the question was asked what they might end up doing as a career. H spoke immediately and with conviction: ‘I just hope neither of them ever works for the NHS.’ Note, not I hope they do not become doctors, but rather I don’t want them ever working in the NHS.

I find it hard to imagine this same conversation a quarter-century ago. Things have changed.

Training is in tatters as doctors prioritise urgent care and discharges | The BMJ

“During my last job on an acute medical unit, one of the FY1s would sit in a box room separate from the doctor’s office for three days a week and write up to 15 discharge letters a day. It’s farcical to suggest that’s rounded training.”

“Prioritising training for juniors isn’t just about having competent and confident doctors in the NHS but actually having them at all. It’s hard to feel compelled to pursue a career in the NHS after a week in which your sole learning point was how to make the ward photocopier work,” she said.

A dog at the master’s gate predicts the ruin of the state. (William Blake)

Shit life syndrome

The Enlightened Economist | Economics and business books

The over-burdened welfare state is not quite coping with people suffering from what (I learned here) doctors describe as “Shit Life Syndrome” when they go to their GPs for help with depression or other mental ill-health conditions. And there will not be enough money to fix any of this unless growth picks up. But that would require a competent, effective government able to take clear decisions, build cross-party consensus, devolve money and powers, and stick with the plan without changing ministers and policies every 18 months.

As a med student I remember sitting in with an Irish senior registrar in psychiatry as he saw a young woman whose life seemed to consist of one random but state-induced tragedy after another. That she could still get out of bed and care for her numerous children seemed to me to attest both to her sanity and her moral character.

The psychiatrist’s assessment was blunt: the patient had no need of a physician, but needed to join the f***ing labour party and mobilise for office. Quite so.

Rees’s law of education

(After a John Hennessy quote that the time to assess a Stanford degree is ten years (or more?) after graduation).

Any real education is incapable of a robust widely accepted psychometric assessment of the sort that will satisfy a professional regulator.

Another formulation:

If you can reliably assess knowledge within a standardised and regulated framework it is not education.


Went to see The Who last night at Edinburgh castle. Great show, and the weather blessed us. First time I had been to a concert in the open air since seeing Van Morrison at Stirling castle over a decade ago. Playlist here.

Two ‘wee guys’ sat in front of us. The seats were not made to measure. The two of them must have weighed in close to that of the French front-row. They were both thirsty, requiring frequent radiator top-ups; leakage was not marginal.

They were close, perhaps brothers or cousins. Each time a song started they would turn to each other, make  eye contact, smile, and then start what I can only describe as star-jumping within a combined space. When they looked around, if they saw that somebody else too had guessed the song from the first bar they would beam big smiles. I was so honoured.

Towards the end of the show, one turned around, facing me, and said The Who was his Dad’s favourite band. Eyes full of tears, he wanted to say more but, unlike Roger Daltrey, choking up, his voice couldn’t manage it.

Plain silly

Economist Daron Acemoglu: ‘When mistakes involve powerful technologies, you’re going to have trouble’ | Financial Times

He imagines a day when teachers could use AI to create individual lesson plans for every student, or nurses might be able to take on much greater roles in, for example, diagnosing diseases. “Why is it that nurses cannot prescribe medications? Why must everything go through this very hierarchical approach where you have to call a doctor [to do that]?” As it is today, the people who spend the most time with patients — nurses, not doctors — are those who are paid and valued the least. Using technology to empower such workers would raise overall productivity and quality of care while also raising wages.

Why not? Simply because doctors and nursing are complementary professions. If you do the prescribing and diagnosing, you become the doctor. The danger is that the whole ethos of ‘caring’ — what was once so central — is being lost. I remember the teaching point: nurses sat on beds talking to patients without seemingly doing anything else are working.

The book the FT is reviewing (Power and Progress: Our Thousand-Year Struggle Over Technology and Prosperity) has been well received but the argument behind this quote seems to me very superficial.

My disease is more important than your disease

by reestheskin on 19/06/2023

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Acute myeloid leukaemia – The Lancet

Acute myeloid leukaemia accounts for over 80 000 deaths globally per annum, with this number expected to double over the next two decades. The 5-year relative survival for patients in the USA diagnosed with acute myeloid leukaemia is currently 30·5%, improved from only 18% in the year 2000.5

Sometimes raw numbers — rather than rates — are appropriate. But not often. Instead, I suspect authors quote raw numbers to bolster ‘importance’. I have even see figures projected into the next quarter century. Why stop there, why not the next century?

In general and in this case the authors should have quote mortality rates. The standard, which usually works is per 100,000 of population. In the case, AML, a truly dreadful disease has a mortality rate of close to 1:100,000. The rate figure allows easy comparisons with other causes of death without having to check on the population numbers of the world population or other denominator.

It just bugs me. The Lancet is full of this sloppy editing. And how much of the projected increase is due to changes in the age structure of the world population? Yes, it all matters, but the frequent coupling of partisanship and hype needs a polite divorce.

The medical student as ChatGPT

by reestheskin on 26/05/2023

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I am amused that people are slow to realise that large language models (ChatGPT etc) do not understand what they are saying, or that they make things up — that is, they hallucinate. Performance on “surface layer” testing does not equate to competence. Anybody who has taught medical students knows that humans are quite capable of exhibiting the same behaviour. It was one of the values of the old fashioned viva. You could demonstrate the large gulf between understanding (sense)on the one hand, and rote — and fluent rote at that — simulation on the other (garbage).

The medical educationalists, obsessed as they are with statistical reliability, never realised that the viva’s main function was for the benefit of teachers rather than learners. It is called feedback.

The medical student as ChatGPT