The Nuisance of Smoking Bans

Less than four weeks ago it became illegal in England to smoke in a car carrying anyone who’s under 18. As a medic, I think the new legislation is a great idea. To me, the earlier 2007 ban on smoking in indoor public spaces was a no-brainer. It has helped to bring down rates of lung and heart disease. But there’ve been consequences I’m less keen on.

FreeImages.com/Adri Claassens

Enter (or rather exit) the denizens of the local Social Club, as it calls itself.

Its cheap booze and bar billiards attract drinkers from miles around.  Except that they haven’t all come to sit in the warm convivial atmosphere. A sizeable contingent of patrons are lounging against the lamp-posts, or parking their backsides on neighbouring walls so they can enjoy their tobacco habit.

There’s not an e-cigarette user among them tonight. These are hard-core, like 18-year old Chloe whose birthday was last weekend. She spent her summer in Ayia Napa, got a cute new tat on her left buttock, and broke up with Jason cos he shagged Melanie. I know all this because Chloe has the dulcet tones of a foghorn and her fav smoking spot is under our bedroom window.

This, by the way, is Cambridge, and about as far from punting and Pimm’s as you can get.

Punts on the River Cam

I go to the window and catch a glimpse of Chloe through the blinds. She has a backside the size of a shire mare’s and I begin to fear for the wall.

She’s not talking to herself, of course. All the cool people go outside to smoke these days. Darren is a gas fitter but he was laid off last week, and his mum’s got a new boyfriend. By the light of the street lamp I make out another woman, a guy in an Iron Maiden T-shirt and what’s left of his hair scraped into a pony tail and, and a man who’s clearly thought ahead because he’s got on fingerless gloves, plus a bobble hat pulled down to his eyes.  

I jam earplugs further into my ears. It’s obviously going to be a long night. As a medical journalist, I’m often asked to reel off the dangers of smoking. Now I can add earache and insomnia to the list.

2 brands of earplugs

The Social Club has long shut but that doesn’t matter because someone’s brought tinnies. Nobody goes anywhere until about half past midnight when a taxi shows up. Whose taxi is it?  A punch-up ensues to settle this.

None of these soothing sounds feature on my app of atmospheric tracks to doze off by. There is Australian Beach, Cape Cod, and Whale Music. Oh, and Night Ambience, though it’s not anything like this. Could be a gap in the market.

beer and cider tins

After the taxi episode, I hear tins been kicked in the road, followed by a particularly good joke which has the revellers laughing like drains. Around 1.30am a car alarm goes off. We’ve had around two minutes’ sleep so far.

What will the ban on smoking in cars with youngsters bring? Hopefully only good, but I’m not holding my breath.

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Warning: A Doctor Rants

Vaccines had a bad press a few years ago, but things have changed, or so I thought. That’s why I was surprised when this week a university student refused the freshers’ dose of meningitis C vaccineFreeImages.com/Antonio Jiménez AlonsoI was even more surprised when he told me that his father, a doctor in another European country, was against vaccination.

What would you have done?  

University students are at higher risk of meningitis. One in four 15-19 year olds carries meningococcal bacteria in the back of the throat, as opposed to one in 10 of the general UK population. And, if you haven’t been a fresher for a while, imagine all that mingling with hundreds of other young people, often in crowded conditions.  

There’s lots of useful info on meningitis, and on vaccines.  Alas, I only know sites for fluent English speakers, and the lad in front of me wasn’t one of them.

I jokingly told him I wanted words with his dad. But in reality that was never going to happen. In general practice there’s barely time for a long discussion with a patient, let alone with family. Photo by Jean Scheijen FreeImages.com/Jean ScheijenConsultation rates with GPs have gone up in the last 20 years to around eight consultations per person a year. Along with that, patient expectations have risen. No bad thing in itself, but it requires more time.

Many areas are bulging with an influx of new patients. London has a particularly mobile population but it’s not the only place where there are migrants, refugees, or simply new housing. Some arrivals speak little English, so interpreters are needed, and the consultation takes twice as long as a result.

The pattern of work has shifted. As hospitals shed more care onto general practice, and send patients home sooner, GPs inevitably must do more. Around 90% of medical care now takes place in surgeries, by GPs, nurses and other members of the health team.

National Health Service logo

The structure of health care has changed with the advent of clinical commissioning groups (CCGs). In my view, that work takes a lot of good GPs away from face-to-face patient care.

Professional development makes demands too. I have to keep up to date, and these days I also have to prove it via appraisal and revalidation. People believed something had to be done post-Shipman, so now we spend time counting lots of things that don’t count. I hope that changes, but meanwhile preparing for annual appraisal takes two hours a week.

Providing good medical care is now a real struggle. GPs are retiring, and a sizeable chunk of medics are leaving the country.

Australian and UK towels on the beach

There’s nobody to replace them.

Like many GPs, I teach medical students. That time too must come out of a busy week. But here’s what really worries me about teaching.  

In the last 10 years I’ve noticed that fewer students now want to be GPs. Yet not so long ago new doctors were falling over each other to join practices.

It’s no wonder that doctors in the UK are angry and fed up. New changes imposed by government are likely to make things worse. In many areas, NHS general practice can barely provide a decent service five days a week. How can it stretch to seven days?

I’m not against change. General practice changes all the time. That’s part of its attraction as a speciality. But the developments I’ve lived through now make it almost impossible to do the job properly.

doctor's bag

You may like to read: 

Numbers of NHS doctors registering to work overseas could reach unprecedented record in the Independent, September 21, 2015

A fictional GP reflects on What They Don’t Teach at Medical School

I muse on What Happens when You Become a Doctor.

Easy tweet: What’s wrong with general practice? http://wp.me/p3uiuG-15w A #doctor rants #NHS via @DrCarolCooper

Why Do Authors Love Setting Novels in London?

There are a zillion places to set a novel, even more if you include locations that don’t exist yet, but this side of the pond London is at the top of the list.

It’s no surprise that London’s attractions shape my writing: I was born in the capital, and after a junket of a decade or two came back here to live and work. But even if you’re not a Londoner there are plenty of good reasons to set your action there.

Abbey Road crossing

1 Things happen all the time in London: knife crime, break-ins, births in hospital carparks. So you can slip in a fictional car-crash or multiple murder and it won’t seem nearly as odd as it might in a dozy village.

2 London is incredibly romantic, even in the rain. That means lots of places for your characters to wander arm in arm in Highgate cemetery, should you wish them to. 

Highgate cemetery

Or, if you prefer, to argue on the top of Primrose Hill.

Primrose Hill

3 Everyone knows something about London. Its iconic features can be used as a kind of shorthand, such as the Tower, the London Eye, and the Tube. However, if you want to include real detail, there’s no substitute for the author joining the melée and checking it out.

Tower of London, field of poppies

4 Medieval buildings can be found all over the place, including smack dab by Big Ben.

© Elvis Santana (tome213)

Then again, there’s no shortage of great new architecture, and more to come, judging from the number of cranes.

The Shard, London

5 It’s very green. Should your characters wish to stretch their legs, or their children’s, offer them Regent’s Park, Clapham Common, or perhaps just a walk by the Thames. Time it right, and they can watch Tower Bridge open.

Tower Bridge

6 London is very diverse, with some parts that are distinctly upmarket, like trendy Marylebone, where my novel One Night at the Jacaranda kicks off.

Waitrose, Marylebone High Street

I’ve also included Edgware Road, where you’d be hard put to find any newspapers that aren’t in Arabic.

There, groceries spill out onto the pavement, with watermelons as big as Beirut, and shiny aubergines, pearly white onions and wrinkly green things that I’ve forgotten the name for, all lying with fat bunches of sweet-smelling herbs.

On the street there are always clusters of young men in T-shirts and jeans, standing on corners as they shout into mobiles or talk urgently with their hands, and, during the annual Saudi summer invasion, streams of women with pushchairs, most of them in a black abaya, some veiled so you could only see their eyes. They glide by, with their Fendi handbags and large retinues of children, while older men sit outside cafés and juice bars, smoking shisha. The men stared hard at passers-by, at any passing Mercedes. They have nothing else to do.

No surprise my next novel is also set in London.

Royal Albert Hall

7 It’s full of characters, like the woman walking down Finchley Road with a black bin liner under her hat. And when I say walking down Finchley Road, I mean in the middle of the bus lane. Or the man in Goodge Street dressed from head to foot as an African grey parrot. This being London, nobody gives either of them a second glance.

8 Finally, consider the US market: to Americans, London IS Britain.