Ahmad wrote
<<I know that almost everybody got their heads down in the nose bags and
cannot think beyond the end of the day with all its EBM, thrapeutics
and the NHS stuff. However, one must have a vision. A vision that
sees the horizon, yet, able to see the immediate practical step towards
achieving that vision. Most people get hung up about the bit in the
middle between the horizon and the next step. That middle bit is
irrelevant and I tend to forget about it.>>
Right on! Reminds me of the story of the karateka punching his fist thro a
brick wall. His fist is here *now* and in a second it will be *there* on
the far side of the wall. The wall does not exist for him.
Same psychology as goal-setting. Read Brian Tracy's book Maximum
Achievement on goals---"Those without goals end up working for those with
goals or some such." His web site is
<<http://204.252.166.4/tango/bti/bti.email.qry?function=form>> or so my
address book says.
Setting a goal works----the mind then moves to reach it---incredible as it
sounds, anyone who seriously sets goals will agree.
But allow me to take a shotgun to the "middle bit" cited by Ahmad. The NHS
bureacracy is irrelevant to the *practice* of medicine---it is only of
relevance to payment, job security and stuff like that but the essence of
the consultation and of the work (the RCGP morons sometimes do get it right
tho usually more by good luck than anything else) really has nothing
whatsoever to do with the NHS machine. Consider that the NHS bureaucracy is
held by many of us to be the biggest risk to the practice of medicine these
days.
As for EBM? Been there, did all that years ago, moved to GP and saw that
life was not black and white like it is in RCT land and realised that such
heresies as learning by anecdote, sometimes putting the patient's feelings
ahead of the medicine and varying the treatment according to the
circumstances were not only permissible but also necessary.
Remember that the NHS is a socialist experiment *in progress* so that all
these moves etc are experimental, not fixed in stone and not to be taken
too seriously.
Declan
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