For the want of a ruddy shoe

Tomorrow I shall be turning up for a hospital out-patient appointment with a Consultant Orthopaedic Surgeon. I don’t particularly want to, but I have no choice.

Why do I not want to go? Quite simply because its a waste of my time and more importantly a waste of the surgeon’s time and a waste of NHS resources.

Why do I have no choice, but to go? Because the bloody stupid system says I have to.

You see, I need supportive shoes for my foot deformity –childhood poliomyelitis but that’s a long story. The upshot is I have a limp and without strong supportive footwear to correct the talipes equino-varus of my right foot, I am unstable and can slip and fall - as indeed I have, many a time.

Many years ago I saw an orthopaedic surgeon who tried half-heartedly to offer me corrective surgery. Risky venture I thought to myself. The trade-off for me was between my present state (pain free, but with a slight limp that is hardly noticeable with the correct footwear) and the risk of surgery going wrong with the possibility of some but by no means guaranteed improvement in the stability of my right foot. I

No, thanks, I decided, opting instead for corrective footwear. So off I went to a very nice orthotics expert and over the years I have been one of their more satisfied customers, turning up every autumn to ask for a new pair of shoes made to my measurements with the right shape and support for my right foot.  They offer to make me 2 pairs but each time I decline, on the basis that I can only wear one pair at any time, but to be honest feeling somewhat guilty that I am getting a free pair of shoes.

Fast forward then to Oct 2011, Andrew Lansley in charge, Health and social care bill going through Parliament, 20 billion to be saved. I ring up the orthotics dept. ‘Please can you order me a new pair of shoes; my present pair is getting worn and losing its grip, I am sure you have all my details with the measurements and the correction needed.’

‘Ah yes indeed we have your details but things have changed, we can’t order  a repeat pair without a new referral from the oprthopaedic surgeon’, says the nice orthotics dept receptionist. The system had changed, someone in management decided that people were turning up with alleged deformities and getting shoes made for free without clinical need. After all some deformities do get better with a couple of aspirins. Maybe the human foot has acquired the organic ability  to grow back into the normal shape.

Anyway, there was no point arguing, it wasn’t her fault, she was just doing as she was told. 

I rang the Orthopaedic secretary, repeated my story to her. She was really sorry, she understood the situation, she said,  but (sounded ominous that 'but') she was equally helpless; the orthopaedic surgeon was not allowed to refer to orthotics without assessing the patient, and she couldn’t make an appointment for me to see the surgeon without a fresh referral from the GP. In fact they could only make so many follow up appointments before needing a fresh referral.

Again no point arguing, it was the system you see. You can argue with an unreasonable person, you can even reason with an argumentative person, but there is only one thing you can do with a stupid unreasonable obstinate system. Give in and go along with it.

So I sent an email to my GP; you see ever since I wrote an editorial in the BMJ about telephone follow up, I have been a fan of e-comunication if it saves the time of busy professionals.

My GP, being an independent contractor and basically a sensible chap able to decide how he works, was not under an obligation to a silly system. He could so easily have said that he could not make a referral without seeing me and my allegedly deformed foot. No, being a sensible chap, he referred me to the Consultant Orthopaedic Surgeon.

And so that’s how I am reluctantly turning up to clinic tomorrow. I have no doubt we’ll have the same conversation as we had all those years ago (its not the same surgeon you see, so I'll have to repeat my story), we’ll come to the same conclusion (its the same foot, the same deformity, the same disability and so I can’t see how we can reach a different conclusion, unless the clever lab boffins have found a way of growing a whole foot from a toenail); I’ll be sent off to the orthotist who will finally order a corrective shoe for me.

Meanwhile I shall be off with my old pair to Timpson’s in the High Street and explain to the friendly fellow there why I want him to put a double thickness sole on the right boot but only a single thickness sole on the left shoe. That should last me for a few months.

Saving costs is an expensive business. 

Gifts

I have just come back from a visit to my local town centre; depressing and enjoyable in equal measure.  Enjoyable because it was a bright, if somewhat cold, and it felt good to be among people busy with the routine excitement of a Saturday outing.  Depressing because of the forced jollity of the seasonal decorations that far from being a reason for good cheer somehow seemed to remind you that we needed it if only to counter a general mood of economic malaise.  

And so to shopping – not for the essentials but for those other things that allegedly brighten the day – gifts.  

Conventional wisdom has it that gifts are a wonderful thing. The recipient and the giver are both blessed, or so it is often believed. And buying gifts definitely benefits the retail sector and therefore  the economy. (Though as far as the economy goes, what’s important is that people spend their money on buying things. The giving of whatever has been bought as a gift is not necessary for any economic stimulus – unless it is a battery operated thingy, in which case it is good for the battery trade.

But conventional wisdom is subject to the corrosive effect of convention.  Routine and custom gives rise to perfunctory duty rather than joyous spontaneity in much the same way that familiarity breeds contempt.  Expectation of a gift leaves the recipient vindicated rather than fulfilled if the gift materialises at all and disappointed if it does not.  A sense of obligation to give converts what might have been a voluntary and joyous act into a reluctantly discharged duty.

In A Thousand Splendid Suns Khalid Hosseini describes the gifts that Jalil makes to his illegitimate daughter as ‘half-hearted tokens of penance, insincere, corrupt gestures meant more for his own appeasement than hers..’; ouch!

With marriages, anniversaries, birthdays, Divali, and now Christmas, not to mention special days like father’s day, mothers day and the soon –to-come new year’s day presenting not-to-be-missed opportunities for giving and receiving , the potential for trouble is immense. The appropriate gift must be chosen, bought, packaged and presented with the right element  of generosity. The recipient has to show the right degree of surprised pleasure taking great care to hide any disappointment at the choice of gift. 

Altogether too many opportunities for getting things wrong with serious consequences for 

social and family relationships.

A few of us discussed this over dinner one day and came up with a set of Rules of Gifts (based loosely on Isaac Asimov’s rules of robotics). I propose that universal acceptance of these rules  will promote harmony, reduce conflict and enhance relationships.

Rule 1. The potential Giver has the right but not the obligation to make a gift.
Rule 2. Once a Gift has been given, the Recipient has sole rights over its fate.

Rule 3. The Receiver has a duty to accept the gift in the spirit in which it is given but has no further obligation to the Giver.

Rule 4. All other parties are irrelevant to the transfer of the gift from the giver to the receiver.

And that is my gift to the thorny problem of gift-giving.