Give the Doctor Somewhere to Go

Why reading your own clinical results and asking the right questions turns a consultation into a collaboration.

An AI-generated infographic on the blog content. (Click to enlarge.)

An Unexpected Appointment

Once again, I found myself in hospital, more times than I would have liked in a single year. I have lost count. I had no reason why this appointment had been scheduled, and my anxiety was not assuaged when, just over a week before, I received a call telling me to attend the diabetes centre.

It was a poorly delivered message. The department I used to attend had been relocated to what was once the Diabetes and Endocrinology Department, but you can imagine how I felt until I received clarification.

In any case, it would have come as a great shock, because nothing in my blood test results indicated any cause for concern in that area.

A Confusing Journey

When I did set off from home, I realised the bus was running seven minutes late. Although I had given myself enough time to find this new location, my appointment notice had not been updated accordingly. So I returned to the old place, where the receptionist registered me before advising me to take a seat.

A few minutes later, the receptionist came to tell me I had to go to another department. She gave directions, but the signage left me navigating a labyrinthine route, unsure whether I needed to explore further down or check with someone else. I did eventually find the place, and it was kitted out like a temporary setup, with patients barely out of a daze from the trouble of getting there.

Checks and Confusion

A nurse called out my name to check my height, weight, and blood pressure. Having arrived later than expected, and given the discombobulation that ensued, I feared the readings might be high. I took deep, controlled breaths and folded up my sleeve; they fell within the normal range. Phew!

Half an hour after my arrival, another nurse came to check what I was there for; it seemed the relocation had also introduced inefficiencies. Apparently, I had been invited for the second jab of the HPV vaccine, which, when I took it, proved quite painful.

Being My Own Advocate

This is part of my personal medical advocacy. Literate people should spend some time reading and understanding their clinical results, because doctors sometimes do not have enough time to tease out the issues with you. 

I recognise, too, that not everyone can do this alone; those constrained by education or digital access may need a trusted interpreter, whether a family member, carer, or advocate. That is precisely why those of us who can engage should and could do a little more.

When I do raise something, it is rarely idle curiosity. My questions are usually a way of satisfying myself whether a course of action is genuinely necessary. If you notice something outside the normal range in your results, bringing it up immediately elicits a response, whether an assurance that there is nothing to worry about, or an investigation requiring further tests.

Working With, Not Around

This is where prompting matters. When my consultant noticed my name on the board and invited me for a chat, my question about the creatinine levels gave the conversation somewhere to go. Those levels had been off the scale in late July, indicative of either an infection or kidney problems; if it were the latter, a change of medication might enter the fray.

Had I not raised it, the consultant might reasonably have assumed there was nothing more to discuss. Advocacy of this kind is not working around the doctor; it is working with them.

Along with the vaccine, a urine test was ordered, and late last night the results returned well within the normal range. I did not need a doctor or a consultant to tell me that, and my concerns were immediately allayed.

Essentially, we underserve ourselves in the quest for the best clinical outcomes if we leave everything to doctors as omniscient experts on our bodies, when we should be doing a bit more to keep them apprised.

A Gemini Notebook AI Podcast on this blog

Whom Is Pride For?

An Early Farewell

The Manchester Pride Weekend comes to an end today, and it could not have come much sooner. The August Bank Holiday, from Friday until Monday, is taken over with festivities, revelry, and debauchery, depending on what takes your fancy.

I would rather be elsewhere, however. Last year I was in Cape Town, in the company of my husband and taking things at my own pace.

Falling Out

In the thirteen years that I have lived in Manchester, I have grown progressively disillusioned with the event, both for its commercialisation and its seeming lack of broad representation.

From the day in the Easter break of 2013, when a friend and I were refused entry to a club for no discernible reason beyond bouncer ego and racism, I have fallen out with Canal Street, which constitutes the main part of the Manchester Gay Village, along with the adjoining streets.

What frustrated us further was that there seemed to be no recourse, no obvious means of registering our displeasure. Yet a search of the Internet turned up news reports of exactly these discriminatory door policies, predicated not on fact but on prejudice, assumption, or the subjective judgement of the door staff at many venues.

An Unfair Assessment

That experience coloured my view of the Gay Village and left me with the impression that all the associated voluntary support organisations were of the same ilk. It was an unfair assessment, I concede, but it took hold because none of the ones I hoped might help were willing to do anything.

I live on the border of the village, yet I am the least engaged with the place, apart from walking through it if I need to get to other parts of the city.

Rights and Nuisance

As for Pride itself, the whole area is cordoned off into an enclave of activity that requires a ticket to attend; even so, you cannot be denied the public right of way to traverse it if you need to get through.

That, some years ago, became a point of contention between the security personnel, who did not know the law, and the police, who affirmed our rights.

Beyond that, there is the unneighbourly inconvenience of the cacophony, and of inebriated and sickly attendees becoming a nuisance on our side streets.

Not My Demographic

For what is supposed to be a community event, given the cost to attend and the interest in whatever entertainment is arrayed, I have found that I am probably not the demographic best served by most of what goes on there.

When I have deigned to purchase a ticket, I have never attended any of the performances; and once caught in the thickened crowd, I am already suffocating, so I rush back home for respite.

It is simply not a place of any comfort, whether alone or in the company of others. Now, I avoid it altogether and skirt the place, rather than insist on my right of passage.

Losing Its Way

Beyond community, Pride is supposed to help good causes, and we have many that represent different interests.

A few years ago, the establishment running Pride hiked prices, made their greatest profit, and then reduced their charitable contributions. It had lost its way, trying to rival and outdo the events in Birmingham and London by bringing in global acts best viewed at entertainment venues.

These acts were an exorbitant waste of resources in the quest for fame, and it led to the eventual, and just, collapse of the organisation, which still owed lesser acts who had given their time, resources, energy, and talent in the community spirit.

A Case for Change

This year, we were assured that the event would be more representative. I have not noticed as much. The ticket prices were still high; and whilst the acts celebrated more local talent, so that the total cost came to twenty per cent less than what was paid to the main act last year, I am still failing to find any sense of engagement.

My premise for sponsorship is broader accessibility and affordability, without anyone having to declare that they are in straitened circumstances to qualify for a concessionary ticket, assuming any are available at all, or so few that access becomes a lottery.

The influence sponsors hold over Pride management should be codified as invitational rather than institutional, never commanding or directing what Pride can and cannot do. There must be strict autonomy, alongside broad community representation in the decision-making process.

Watching from Afar

Apart from stepping out of my apartment block onto the street with my folding chair to watch the parades on Saturday, which had over 150 distinct participants, including organisations, companies, clubs, charities, establishments, and political parties, I have done nothing more.

The clouds did gather and rain on the parade at certain times, but it did not dampen anyone's enthusiasm. I was in my rain jacket and poncho, which kept me dry, though some braved the chill and the wet as if it were a bright summer's day.

Even the Service for Pride at Manchester Cathedral, which I would usually steward and sometimes take part in, I gave a miss. Two invitations to garden barbecues I ignored, rather than offer my regrets and risk being persuaded against my own inclination.

Protest and Celebration

It is my view that the Pride principle has long deviated from its founding ethos of both protest and celebration; it has become an over-commercialised affair that now merely grants access to those with the means, rather than a broad community celebration that recognises the diversity it comprises, in groups large and small. Pride has drifted from access towards exclusivity.

So the question remains: whom is the modern Pride for? The answer I have seen suggests it is not for everyone, nor for the well-meaning members of the wider community who wish to embrace one another in the pursuit of human rights and dignity, both for those affected and for their allies. These are all reasons why I am no more supportive of Pride in Manchester today than I have been for the past few years.

No Curmudgeon

As peace returns to my city by the end of today, I am not being curmudgeonly. We can simply agree that not everyone is energised by these things, and that there should be acceptance of this without heaping on any kind of excoriation.

Maybe, next year, I shall be just as absent from this annual charade, in the company of my husband, who, for his lack of exposure to these settings, is far too easily excited about Pride events for my liking or comfort.

Thought Picnic: Identity Formed by Timing

Returning After War

Way back in my late teens, I had a friend, or someone I thought was a friend. We were agemates, and something interesting and significant caught my attention. It seemed that those who returned from the UK at the end of the Nigerian Civil War integrated better, taking up the growing opportunities in a recovering country, than those who did so almost a decade later.

Between those who returned well under the age of ten and those in their early teens, there was a generational difference in adaptation, a sense of being caught adrift. Staying in the UK for longer proved less beneficial to their sense of belonging or identity; though they had better English accents, they were unsettled, and sometimes having a less prosperous time of it.

A Shared Beginning

For some context, the people I write about and I were all born in the UK in the 1960s. I returned to Nigeria well under the age of ten, having barely been exposed to inner city mechanics and situations; they returned in their teens, late in the 1970s. What separated us, then, was not origin but timing. We were cut from the same cloth, yet a few years of divergence would shape us differently.

My observations are, of course, anecdotal rather than academic. Even so, I think the age-of-return hypothesis is significant, and I have alluded to it in other blogs. It is the quiet variable running beneath everything I am about to describe.

An AI-generated infographic on the blog content. (Click to enlarge.)

What They Brought

What they brought into the fray was a sense of fun. They were the best chess players and had figured out how to solve the Rubik's cube, though they were not better Scrabble players. The Nigerian educational system was a challenge, amongst the other things that left them yearning to return to the UK, if only they had the opportunity.

They were a restless lot, and of the many, there were two who, on reflection, had been exposed to the race and deprivation politics and the discrimination of the 1970s into the 1980s. They carried the scars of inner-city influences, influences that would not have engendered the most positive sense of self and status, even in Nigeria.

They were suspicious before they were trusting, questioning more than listening, ready to respond with violence on a dare without first putting things in perspective. That people envied their exposure, without understanding how they were the personification of a social construct beyond their control, one that amounted to a material deficit, could make for an interesting study.

An Identity Formed at Home

Here is where the timing mattered most. My blackness was always simply part of me, and that was settled in Nigeria, quietly and without apology, long before it was ever questioned. I grew up where blackness needed no explanation and carried no burden; it was simply the ground I stood on. There was nothing to defend, because nothing had been challenged.

So, when I returned to the UK, and the racist abuse came, as it did, it met an identity that was already whole. The abuse did not shape how I saw myself; it had arrived too late for that. I could regard it as a reflection of the abuser rather than a depiction of myself, precisely because the depiction had been drawn elsewhere, at home, on my own terms.

The teenage returnees, I suspect, had that sequence reversed. Their sense of racial self was worked out amid the hostility, not before it, and so the hostility got inside, where mine never could.

A Sudden Slap

This friend of mine gave me a stinging slap after a dare, a playful situation that suddenly turned strange. It taught me a few things. I would not rise to a dare that I had no intention of acting on in the first place. I do not care if I am called a chicken; they are the hardiest and most abused of animals, and they probably possess the greatest survival instinct and resilience in the animal kingdom.

As a consequence, I have no fear of missing out. I am usually told that I do not know what I am missing, to which I would respond that I cannot miss what I do not know. A slap is a momentary event with no follow-on; the embarrassment quickly fades into irrelevance. My temperament is not conditioned for violence. I am comfortable letting things slide, because what defines me is character, not machismo. Class is always understated, never dramatic.

On Character and Circumstance

I think environments and societal settings can influence character as much as mould it, though to varying extents. I cannot speak to the sociological truth of that. Yet I am left wondering whether my own equanimity was truly character, or simply the good fortune of a gentler formative environment, a self settled before it was ever tested.

Perhaps that is the paradox worth sitting with. The returnees had the richer exposure by one measure, the metropolitan UK, the accents, the chess and the Rubik's cube, yet the more unsettled outcome by another. I had the lesser exposure, yet the steadier sense of who I was. Sometimes, it seems, less can be more.

A Gemini Notebook AI Podcast on this blog

Contempt from the Ringside Seat

The Ringside Seat

Imagine having a ringside seat at a boxing match, not because you paid good money for it, but because you share such a close relationship with the boxer that no other person would be allowed to take that seat, even when you were not present to sit in it.

The person you are supporting is the challenger for a title, and through the rounds they are pummelled and battered. Every round portends a possible knockout, yet the challenger endures. They keep going, taking the blows but never being beaten, and the points tallied at the end of each round add up to hand the challenger the victory and the belt.

Then, in your telling of that encounter, you speak of bloodshot eyes, of mouth guards being knocked out, and of the uselessness of the challenger, insisting that you could put up a better fight and walk away unscathed. That becomes the report you file, neglecting the simple fact that your person was the victor.

Telling My Story

In the story of my life, about which I have written quite extensively, there are many strands of adversity and failure; but the successes and triumphs bookmark the telling of this story, so that it would seem strange to major in the misfortunes.

One narrative could have been given in this light. Akin has had such a blessed life. I have watched situations of failure, joblessness, two debilitating bouts of cancer, and challenges that seemed insurmountable.

And yet you would not look at him and think he had been touched by anything but the good fortune of scaling through life on sheer luck and almost undeserved providence. What an inspiring story he has, should he ever wish to talk about it.

Rather, of all that could have been said, what got relayed back to me was a mis-telling of my story: a conflation of events, suffused with half-truths, then given the veneer of a wastrel and ne'er-do-well, constantly down on his luck because of his irresponsibility.

There is a useful distinction to be drawn here between interpretation and misrepresentation. Two honest witnesses may weight the same night differently, one dwelling on the punishment absorbed, another on the resilience shown; but neither is entitled to erase the result. Perspective explains emphasis; it does not license fabrication.

There is every possibility, like the person invited to the ringside seat, to tell a different tale with the outlook of a curmudgeon incapable of seeing the good in anything. We own the filters of our perspectives on things.

The Four Pillars

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The architecture of trust, whereby your ringside supporter reports your story in the best light possible, the truth and not embellishment, the honest and frank assessment of what was observed, rests on four pillars: care, concern, consideration, and confidence. One could define those four Cs in the terms that follow:

Care: the baseline emotional investment a person has in your wellbeing.

Concern: the active protective instinct they feel regarding your vulnerability.

Consideration: the cognitive foresight to understand how their future actions might actually affect you.

Confidence: the secure container that the first three pillars create.

Blog: Thought Picnic: Confidences, Not Secrets

The Honest Retelling

An honest retelling, then, is one the subject can recognise, even when it is unflattering. You may wince at a true account, but you will not fail to find yourself in it. When the portrait no longer resembles the sitter, the fault lies with the painter.

Honesty also requires proportion. To recount the joblessness, the two debilitating bouts of cancer, and the seemingly insurmountable challenges, and yet omit that I am still here, still working, still writing, still standing, is not honesty; it is selective editing masquerading as candour.

When to Speak

With that in mind, it is difficult to understand how reality and retelling could diverge so far, so hurtfully, and so much to another's discredit, for reasons best known to the teller. When a portrait is this false, one feels there is little option but to confront it and to challenge the narrative set loose about you.

Invariably, if you have nothing good to say about someone, you are not obliged to say anything at all out of a need for conversation, small talk, spite, malice, or anything else. Your silence does not have to be bought; it is a quality of self-control to bridle your tongue.

Brian’s Point of View: Words Can Break Something We Thought Was Safe

A Gemini Notebook AI Podcast on this blog

Essential Snobbery 101: The Slow Death of Proper Address

A Stringent Beginning

It was almost a decade ago when I underwent a stringent vetting process with all the officialdom that extracted more information from me than I would willingly have volunteered. This process was supervised by a department within the organisation to which I was contracted to offer professional services.

When the process was completed, I received a notice from a member of staff confirming that I had passed all the requirements. It began with "Hi!" Just "Hi", without a name, stripped of all formality, dignity, and function, as though we shared the familiarity born of mutual friendship going back decades, rather than mere acquaintance.

I was reeling and altogether taken aback; this could not seriously have come from within the company with which I held a formal contractual engagement.

Insult and Injury

To add insult to injury, the person who signed off the message bore names suggesting a common Nigerian heritage, where the expectation is that a modicum of formality should greet those with whom you have never interacted before. Only after you have introduced yourself and established communication through a cordial response and acknowledgement should informality be considered.

This was analogous to an ingénue who had abandoned the sophistication of speech for grunts and howls.

From that day, I wanted nothing to do with that individual, and I made a point of expressing my displeasure at such an approach to their manager. My own manager attempted to apologise on her behalf, then suggested that we might have become old-fashioned.

Manners Never Age

Maybe we were; but good manners, in my view, can never be old-fashioned. They should always be fashionable and properly taught. Comportment, decorum, respectful address, honour, regard, and etiquette make the person and exude character.

I have worked in places where informality is the culture, yet I would still address you by name, and with deference, because I was brought up that way, and what you give out comes back to you in spades.

The Order of Greetings

Whilst I have spent four decades in the corporate world, any first contact with a person would always come with a greeting for the time of day: good morning, good afternoon, or good evening. Good night is usually goodbye.

Then comes the person's name, which might be preceded by a standard, academic, religious, military, royal, or political title. Professions deployed as titles, apart from "Dr" for medical doctors, are an exercise in pompous superfluity and self-aggrandisement.

At other times, it is "Dear" and the person's name. "Hello" is for friends. Then I close my messages properly, with a variation of "regards" and my name. In speech, it is formally the greeting for the time of day; I introduce myself with purpose if required, or await a response with names and preferences.

Pronouns and Coherence

On the new trend of pronouns, especially those that challenge the natural flow of the English grammar I learnt from well-appointed schooling, I would rather use a name than defeat the ends of coherence and adherence.

Good and traditional forms of address will always establish the standard of communication and the protocols of language. If someone is too well-spoken to use expletives in any way, it is unlikely others would deploy them when speaking to you; or at least they are guarded, and moderate their language with apologies for any unfortunate slips of the tongue.

The Art of Subtlety

Maybe, indeed, I am old-fashioned. I would rather be that than uncouth and uncultured. From my youth, my mode of address has earned me consideration, respect, and a hearing. Yet if I am overly formal in beginning a message with "Dear Mr Jones", when we have always been on first-name terms, you need not read any further to know that this is an expression of great displeasure.

Subtlety and discretion; the polite turn of expression that, on first reading, seems complimentary, until some thought is put to it. It is the way of the English, an art of communication lost to many for whom a good education might have been a luxury. It is not their fault.

You Do Not Get A Painter to Fix Another's Art

The Value of Vindication

Vindication comes in different ways, not to gloat or to point fingers, even if, after all is said, the concern you raised has been proven true. Good communication, alongside the ability to articulate one's thoughts even in the heat of the moment, remains the most critical skill every time.

In a long-running saga of urgency and wits, from which workplace stress can be the damaging consequence for motivation and wellbeing, withstanding authority and office in the quest to improve a proposed solution, so that it works as intended and engenders confidence, is not a battle for the fainthearted.

There are so many ways to express oneself, and the power of persuasion comes in the form of words that walk people down a reasonable lane of acknowledgement, misgiving, challenge, and requirement, before acquiescing to the notion of a willingness to engage and always help.

A Question of Ownership

In this instance, after a solution did not work as intended, a project manager had the bright idea that it was now the job of the implementor to fix the problem with a complex set of orchestration scripts; scripts that the implementor had long before determined would not deploy cleanly, for various reasons previously given but seemingly ignored.

The truth was that collaboration had never quite been on offer. What passed for it at the outset was minimal, closer to an imposition than an invitation, and it was only our steady, well-argued pushbacks that drew out any real interaction. Even then, we were working with architects whose confidence outpaced their familiarity with the environment in which their solution was meant to run.

The first line of my response was that his reading of the situation was wrong, and I then went on to make the case for why, starting with a simple analogy. Because scripts and programming are an individual's way of thinking and a style of expression for what they want to achieve, and without the full immersion of others in the coding process, "You do not get a painter to fix another artist's work of art."

An AI-generated infographic on the blog content. (Click to enlarge.)

I appreciate that there was something I could do, but what was requested was input; it could not be interpreted as taking ownership of the solution. The fundamentals of the intended solution were sound, but its enterprise deployment, so that it consistently works once rolled out, requires the inside knowledge of the implementor to point out why certain constructs will fail, so that the developer takes those ideas seriously when modifying elements of the proposed solution.

Back to the Canvas

The response of the project manager was at first patronising and then emotional, but the artist, the developer, understood the import of my message and got back to work fixing their solution, which is now in its fourth iteration and possibly still a work in progress nine days on.

As far as I was concerned, what I intended was achieved: to draw out the work of the implementor, before the solution was complete, and to inform of the essential changes and improvements needed to make it deployable.

Invariably, I believe the result would not only be fit for purpose; once fully done, all sides of development, through implementation, to the end-users would see the intended benefits the solution would offer.

The whole trajectory now sits in the slipstream of practical engagement with the implementation process, rather than in acquiring accolades from promising the client outcomes that, from the onset, would never have worked, back when the first ideas were put to us over two months ago.

Authority and Consent

One higher management person did interject in the email chain, suggesting we were involved in verbose communication; the same person who used the lexicon of grief to explain the effects of change some months ago. None of these replies required a response once the artist was back to fixing their work of art, rather than hoping another might attempt a dash of graffiti to improve it.

The authority to propose still requires the consent to implement. Badly designed systems tend to be a symptom of the same thing: responsibility placed in the wrong hands, and too little respectful engagement with those who must carry a complex solution through deployment.

Had the environment been understood from the start, much of this could have been avoided. In the workplace, this is the challenge faced by many who need the kind of articulation that ensures a solution has the best set of inputs to work.

We are not seeking perfection, just something good enough to understand, implement, manage, and hand over cleanly, when the time comes.

Related blogs

Blog - Badly Designed Systems Are Just That

Blog - Authority Without Consent

Blog - When Change Borrows the Lexicon of Grief

A Gemini Notebook AI Podcast on this blog

Thought Picnic: Confidences, Not Secrets

Confidences, Not Secrets

In the broad scheme of things, we have no secrets; what we have are confidences that too often get betrayed in unguarded yet frank moments to others. 

Much as I hear and listen to a great deal, I am guarded about how I use what I have learnt. I could form opinions about people, but I am very flexible and, hopefully, tenderhearted, making allowances until indifference or unkindness breaks the bond.

Indifference is, for me, the most wicked form of expression in any communication, because it means there is no care, concern, consideration, or confidence. Whatever confidences you might have thought you had in that setting are then ready for the careless abandon of reason and a carefree dissemination to anyone.

An AI-generated infographic on the blog content. (Click to enlarge.)

Words have an effect, a great effect, when what should have been kept in mind finds an outlet to others. I am also a believer in the biblical saying, “From the abundance of the heart, the mouth speaketh.” Even discretion and moderation can scarcely stand in for self-control once you have resolved all inner contention and convincingly arrived at the conclusion you have uttered.

Being Spoken About

From people I trust, I have heard the most hurtful things, sometimes directly, though usually relayed to me through other channels. I bat them away most of the time; yet, in other situations, the covenant is broken beyond redemption, and the relationship sours or is terminated for my own peace of mind.

What we cannot avoid is that we will always be spoken about by someone else: in praise, in jest, in commendation, in spite, in jealousy, in rancour, or much worse. That is a given.

I have the outlet of my blog to reflect on these many things, and perhaps to limit the impact of malevolence whilst maximising that of benevolence.

Words That Wound

Perhaps decades ago, it was a guardian relating to someone else that I had been picked up off the street. I am grateful that my story, which has had many failures, has been greeted with amazing successes.

Another, whilst I was in the throes of personal angst and the loss of confidence to project myself, grew fed up with the process I took towards rebuilding character and purpose. Out of nowhere came words to the effect that my inability to produce results was inimical to their social standing; I was the illuminant of a bastard.

To them, that was a kind of radical intervention to jar my senses, but it did the opposite. It fell into that rubric of dripping criticism, the kind that strips you of your dignity to force a reaction and their view of the right result. It is about them, rather than you.

Shedding Old Skin

For me, there was no second instinct; I ceased initiating communication from that point. It is the kind of talk the speaker believes is necessary, but which the listener, with an appreciation of nuance and the use of language, would find, basically, unforgivable.

Yet these examples might tempt a recipient to deem such incidents forgettable, until you are broadsided by the notion that you are living a fake life. I do wish a whole lot of things were fake: the losses, the cancers, some experiences, a few tragedies. But what kind of a life would that be?

Perhaps, for once, I am not remotely my own harshest critic when I allow myself the pleasure of living, of loving, of existing, and of doing my own thing, unbothered by what others think, because that is their problem and not mine. Yes, the words do hurt, but they must not dampen the spirit of the joy of living. Like moulting, or the shedding of skin, some old bonds need breaking for the renewal of self.

A Gemini Notebook AI Podcast on this blog