Doctor's Free Time

Site update

noreply@blogger.com (2yyiam) — Wed, 29 Dec 2010 16:59:00 +0000

I've started a new blog to discuss various Shia Islam and general Islam issues.
Please visit Truth About Shias

Thanks

Take care all,
Thoughts just flow, when do they have to make sense?

Guess Who's Back V

noreply@blogger.com (2yyiam) — Wed, 22 Dec 2010 15:24:00 +0000

You didn't think I would go the entire year, 2010, without a single blog did you? Well you would be right if you did as I wasn't planning on blogging but then something changed my mind!

I've blogged in the past about the importance of Muharrum and with it being Muharrum once more at this time of year, the message of Imam Hussain (a.s.) continues to inspire and motivate and has led me to return to blogging to discuss some important and relevant topics about Islam over the next few weeks inshallah. Having attended some excellent majlises leading up to Ashura last week, I want to build on this feeling rather than let it all fade away as we all have done over the years.

Inshallah, you all will visit once more, (after I let you all know about it!) and together we can discuss some important issues about our great religion, Al-Islam.

Take care all,

Thoughts just flow, when do they have to make sense?

Changing the rules (slightly)

noreply@blogger.com (2yyiam) — Tue, 25 Aug 2009 13:11:00 +0000

DISCLAIMER: What follows are purely tongue-in-cheek suggestions and are meant for discussion purposes only. In no way, shape or form am I trying to suggest that I have the religious knowledge and/or authority to advocate such suggestions on a serious level, so please don't take them that way.

Three days into Ramadhan and it's already proving to be quite tough. Fasting from approximately 4am to 8pm (16 hours) is proving to be quite a challenge. The struggle tends to start just as my afternoon surgery is getting underway, round about now actually (2.30pm), with a general woozy feeling. Then as the surgery progresses, I keep getting head rushes, headaches and the lethargy kicks in. I feel sorry for the last 2-3 patients as I am barely concentrating and just want to finish and get home. After concluding the surgery, I manage to muster the energy to drive home and just collapse on my sofa. Hopefully it will get better as the body adjusts, but judging on past years, I'm not that optimistic, especially as I'm getting older.

With the long hours only going to get worse over the next few years as Ramadhan moves into the peak summer months, I was wondering whether it's fair for us to be fasting for this long. Because the Islamic calendar is based on the moon, it's shorter than the standard Georgian calendar and as a result moves backwards by 10-11 days every year. Ten years ago we were enjoying relatively comfortable fasts during December/January. At the time I was at university and spent most of the time sleeping, woke up at 4pm and broke my fast a few minutes later. Now, the fasts have more than doubled in length and sleep is no longer an option.

Looking back at the origins of Islam and fasting, it's maybe significant to recognise that it was a religion revealed in the Middle East - in Saudi Arabia. Looking at the times for sunrise and sunset times in Mecca and one can see how little variation there is over the course of a standard (non-lunar) year. In December, the gap is approximately 12 hours and in August the gap is about 14 hours, with only a 2 hours or so variation across the year. Here in the UK, the variation is much greater, 10 hours in December and 16 hours in August (18 hours in July).

It just doesn't seem fair. Perhaps the rules of the fast need to be looked at. Islam was brought to a region where the fasting time was stable and maybe we should follow that. Of course as Islam has spread all over the world, people have needed to adapt with the country or region that they live in, but surely it is not a good idea to have muslims fast for so long when our brothers and sisters in the Middle-East are "enjoying" relatively shorter times.

If you think I'm being silly, what about our brothers and sisters who live in Scandanavia? In the northern regions of Scandanavia it is daylight for six months and darkness for the other six months. The rulings seem to vary, but from what I have read it seems to be the general consensus to follow the fasting times of the nearest country with actual sunsets and sunrises. That's not much of a relief as during the daylight months the nearest country will have upto 20 hours of daylight but during the night months, the nearest country will have only a couple of hours of daylight - a huge fluctuation.

In this country as Ramadhan enter July/June over the next few years, the fasting times will get longer. As a doctor I seriously question the health implications of fasting for such a long time. People will obviously want to complete the fasts for the blessings and rewards it brings, but at a cost to their health. Is that a good idea and is that something God would want? And it won't be just the elderly or unhealthy who will be affected. So, instead, how about just a fasting timetable that follows Mecca for everyone, all over the world? 12-14 hours all year round - seems fair to me. What do you think?

Whilst we're on this topic, by extension perhaps we should apply a similarly fair policy to other rules in Islam which perhaps haven't stood the test of time. The shortening of prayers is a classic rule which is often taken advantage of; in Islam, we are allowed to shorten the afternoon and evening prayers if we have travelled over 14 miles in one direction after crossing our home town border.

This ruling was introduced when travelling was a great undertaking at the time of the Prophet in Saudi Arabia. To ease the burden, Muslims we're allowed to shorten their prayers. The travelling rule also applies to fasting, you don't fast when your are travelling, again to ease the burden. Nowadays, travelling is not such a great undertaking - I travel 90 miles on a daily basis just to go to work and back - and so the shortening of prayers is just a time-saver and nothing else, (by the way, I pray the full length prayers at work as it's a regular place that I visit, so the same rules don't apply). Perhaps, this ruling needs to be looked out, it can either be abolished or modified according to difficulty. Of course there will still be people in the world for whom travelling is difficult, but for others particularly in the Western world it isn't such a problem.

However, if the ruling exists, then we should at least stick to it and follow it properly. People will conveniently follow the shortened prayer rule, but not the no-fasting rule when travelling. The shortening prayers saves us time, the no fasting rule causes more inconvenience as it means we have to make up the fast at a later date. As a result people tend to pick and choose what rule to follow and it is something that I have been guilty of in the past. Whilst the rules exist, we should follow them all and not pick and choose at our convenience.

Finally, another one maybe worth looking at are prayer times. Who has decided that Fajr prayer time is 1-1.5 hours before sunrise? Why is the time for Isha up to midnight only? I don't think there was such an accurate concept of time at the time of the Prophet. Surely Fajr should be just before the point of sunrise and the time for Isha should be up until the time for Fajr, just as Asr can be read up to the time for Maghrib? Actually, I'm probably nit-picking here, but for the purpose of this blog, I thought I'd try and find a third rule to discuss before passing out from the hunger!

Like I said at the beginning, this is all meant for discussion only, I am not trying to claim that I know best and that these rules should be passed, but simply typing out a few suggestions. If you can, please comment on what you think.

Take care all,

Thoughts just flow, when do they have to make sense?

Fed up with Iran

noreply@blogger.com (2yyiam) — Fri, 21 Aug 2009 12:46:00 +0000

I am feeling very disillusioned right now. Iran has been getting a lot of press coverage in recent months with the general election and the events following the resutls and frankly I'm getting more and more fed-up with the stories that keep coming out. As one of only two Shia-majority and Shia-governed countries (I am not yet counting Iraq as a third), the values and ideals that the country represents does not go along with the values and ideals of Islam and more specifically Shia Islam.

Let's start with the general election and work our way from there. The election saw a supposedly landslide victory for President Ahmedinajad for a second term. The polls before the voting all indicated it would be a close affair, but Ahmedinajad supposedly won large majorities in both urban and rural towns and even in the towns of his main rivals. It was approved by the Supreme leader Ayatullah Khameni within 24 hours and everyone was meant to accept it as halal.

Clearly this did not go down well with the voters leading to large protests and demonstrations, something which the government found unacceptable. The security forces under orders from the government, employed heavy handed tactics to try and quell the protests leading to the deaths of, officially, 30 people, but perhaps as much as 250 people unofficially. 100's were also arrested and several are currently under trial for crimes against the regime.

As the trials got underway, allegations emerged that the arrested had suffered torture, abuse and even rape whilst held in prison. Many people mysteriously disappeared, whilst others are currently being held without charge. All in all it has been a very messy few months for Iran and the Iranian government.

All this has added to my growing disillusionment about Iran and it's activities. It upsets me to think that this is what a Shia government can do. I am probably being incredibly naive, but I just don't understand why it appears to be so wrong. Ayatullahs are meant to be highly educated, highly spiritual and highly regarded as leading religious authorities, but having political power just seems to change all that. How else can you explain what is going on, the atrocities that are occurring in Iran?

This leads me to ask one big question. What would the 12th Imam do? Right now, if he were the supreme leader of Iran, would it be different, would it be more humane, more correct? The answer has to be yes. As the Imam of our time, as someone who is infallible and closest to God, surely he would lead in a completely different way.

Would the Imam allow heavy handed tactics to deal with protesters leading to their deaths? Would the Imam allow the alleged abuse of prisoners? Would the Imam allow potentially rigged elections? Again, perhaps in my naivety, I can only answer 'no' to all these questions. And yet, if I can see that with my lack of religious knowledge and authority, how can someone as grand as an Ayatullah supposedly not see that?

Perhaps I am mistaken in placing such a great deal of faith in our Ayatullahs, in fact the more I think about it the more certain I become that I am indeed mistaken. That doesn't come as a relief, but just serves to depress me even more. Can it only take a mausoom, an infallible man to make the right choices and decisions? Are us mere humans simply not up to the task? Is having power and control in a government really that corrupting? The more I think about these questions, the more I think that the answer is 'yes'.

This realisation is probably the most depressing, the most upsetting. The one main Shia governed country in this world is a big mess. I realise that I am being terribly simplistic about this all. Trying to criticise and comment on an Ayatullah when I don't have even 0.001% of his knowledge and faith is not the right starting point, but looking from the outside, these recent events just add to the growing disillusionment. What are we meant to do?

Finally, just to add more damage to the faith we may have in Ayatullahs, you may have read of a new ruling passed by a Shia Ayatullah in Afghanistan which permits men to deny basic maintenance towards their wives (i.e. food, clothes, housing etc) if they are denied their sexual demands. This ruling is basically allowing marital rape. If an Ayatullah can permit that then what is the world coming to?

Take care all,

Thoughts just flow, when do they have to make sense?

PS. Ramadhan mubarak to all!

Abuse of the NHS

noreply@blogger.com (2yyiam) — Wed, 19 Aug 2009 11:52:00 +0000

I see the NHS has been coming under some scrutiny this past week or so, mainly from politicians in the US. This seems to be because Obama's administration is currently trying to pass through new health care reforms aimed at providing medical cover to the entire population and not just those who have private insurance. As the debates rage on, the NHS has been put up as an example of how to do it rightly and wrongly depending on what side of the argument you stand on.

Last week a Tory MEP, Daniel Hannan on US television, much to the delight of Republicans, labelled the NHS as a "60-year mistake" saying that "he wouldn't wish it on anyone." This has understandably and rightly led to criticism from various politicians including the Prime Minister and Health Secretary who has labelled Hannan's words as "unpatriotic" and as "an insult" to the 1.4million workers in the NHS - including me.

Am I insulted? No, not really. I don't agree with Hannan's opinions nor do I find them particularly helpful, but I am not insulted by them. Like all large organisations, especially government funded, the NHS is not perfect, it has some major flaws and issues which need improvement (in some cases drastic improvement), but as a form of health care I believe it is a far better service than what is available in the US.

Interestingly Hannan has previously made some suggestions about how to improve or adjust the NHS, but they have all been ignored and overshadowed by the comments he made in the US. Obviously taking things out of context and being attacked by opposing party politicians is standard fare these days so it's no surprise about the reaction Hannan as recieved in light of these comments, but it does highlight how sensitive a topic the NHS is and will remain to be.

The main issue with the NHS is it's role as a universal health care system for everyone. Everyone is entitled to free health care but the quality of care varies with each condition. Studies have shown how the NHS fares in dealing with certain conditions compared to other Western countries and it seems that it struggles to match the success of other countries. For example in Britian, males have a 51% 5-year cancer survival rate, compared to 57% in Finland and Switzerland. Similarly in care for patients with heart disease or strokes, the figures show that the NHS continues to lag behind our European neighbours.

However, looking at pure statistics ignores the main concept of the NHS - I feel that it is the universal aspect of the NHS which is it's main problem. No other country has a health care similar to the NHS - the idea of it being completely funded by the taxpayer for everyone is unique. I believe that this is the main cause of it's struggles and failures.

In my experience (of 5 long years), people's attitudes towards their health is derived from the NHS. Because care is free, people are more lax and carefree towards their health. The majority of patients I see are so dumb when it comes to their health. I'm not just talking about the un-educated or working class, I'm talking about lawyers, accountants, bankers (although maybe they're just generally dumb) and other professionals. They just appear to have no idea about what to do and what not to do about their general health. Today, the health costs are huge to look after people who have problems related to alcohol, drugs, smoking and diet and most of them do not care. The care is free so they'll carry on abusing themselves.

I have repeatedly asked patients about what they should be doing to improve their health and am repeatedly met with blank expressions, offering no suggestions. People are not interested. Instead of a doctor-patient relationship, it often feels like a parent-child or teacher-student relationship, although in this case the child/student doesn't seem to learn, they just carry on as before. Of course, I am generalising, but the impression that I have built with my experience is that of a population that is not all that bothered about their health. Is it any surprise then that our survival rates are so poor?

In other countries where there is a mixture of government funded and privately funded health care, the care is better. Perhaps it's because people care about themselves. Of course there will be patients who suffer from alcohol abuse, smoking etc, but I don't think it's as bad as it is here in the UK. I've mentioned this before, but offer something free and inevitably it will be abused. The NHS is being abused.

I've discussed the options of charging for health care before and I am not going to head down that path again, but there has to be some repercussions for not looking after yourself after you have been given the necessary and correct advice from your doctor or health professional. It is arguably the most infuriating aspect of my work - seeing patients repeatedly for the same problem mainly because they refuse to help themselves. They keep turning up expecting solutions, when the main solution is to improve themselves and change their practices.

I leave you with an example from this morning's surgery. I saw a 20 year old female who keeps presenting with recurrent abdominal pain for the past 5 months. She is overweight, has a poor diet, takes recreational drugs and is currently unemployed. She has never tried to modify her diet ("it's too difficult") nor has she undertaken any exercise ("I don't have the time"). On her notes are clear documentations of plans other doctors have suggested to her to try and improve her symptoms and she has barely followed any of them. Because health care is free, she has had investigations including an ultrasound scan and various blood tests, all of which have been normal and yet she keeps coming back expecting us to have a quick-fix for her that doesn't require her to make any serious or strenuous modifications. I am afraid it just doesn't work like that.

Before people complain that she probably has psychological issues and can't change herself even though she wants to etc. First of all in this case it isn't true, I've asked, secondly, if that was the case she would still be able to get the psychological help, but I doubt it would make any difference and finally, do you not think there would be a change in attitude if there was some sort of repercussion for not looking after herself, or for not taking the necessary advice? I think there would be.

In the end, many improvements are needed in the NHS, of that there is no doubt, but one of them is to place more onus and responsibility on the patients who the NHS serves. Stop placing all the blame on the NHS itself and perhaps start focusing on the people who continue to take advantage of it - the patients.

Take care all,
Thoughts just flow, when do they have to make sense?

The drugs don't work

noreply@blogger.com (2yyiam) — Thu, 13 Aug 2009 13:33:00 +0000

It never ceases to amaze me how much rubbish the media get away with on a daily basis - how much they blow things out of proportion. Actually, "amaze" is the wrong word, "irritate" is more appropriate. However thankfully it's an irritation that doesn't get on top of me as blowing things out of proportion seems to be the main occupation for a lot of journalists and I'd be pulling my hair out if I got irritated every single time.

King of "blowing things out of proportion" is arguably the the Daily Mail and today was no exception. The front page lead with the headline "Tamiflu turned my children into hallucinating, sobbing wrecks" accompanied by a picture of the journailist Richard Price and his family. I'm hoping most if not all of you know what Tamiflu is - the drug used in the management of swine flu.

Apparently, Price's children were prescribed the drug by an on-call GP after they rang NHS Direct seeking advice about their children who had developed a cough and high temperature. They subsequently went on to develop unfortunate side-effects from the drug leading Price to stop the treatment and claim:

"So what happened when we defied government advice and eschewed Tamiflu in favour of Calpol and cuddlies? Within 24 hours both of our children were completely recovered, save for those with runny noses"

Similarly on Monday, there was another article in the Daily Mail about how GMTV presenter Andrew Castle almost lost his daughter to the "swine flu 'danger' drug", when he revealed on TV the side effects of the drug prescribed to his daughter whilst interviewing health secretary Andy Burnham. The drug was apparently handed out at her daughter's school by the Health Protection Agency when a pupil was suspected of having swine flu. The side effects of the drug apparently caused severe breathing difficulties requiring Castle's daughter to be hospitalised for three days.

Before I launch into my main points about these articles, let me quickly describe my own experiences of dealing with swine flu and the prescription of Tamiflu. Before the launch of the National Pandemic Flu Service (0800 1 513 513) a couple of weeks ago, we were being inundated with phone calls from patients with symptoms ranging from runny nose to full blown fever and bodyaches. I was typically taking over 20 calls per day dealing with potential swine flu concerns. To date, I have prescribed Tamiflu a grand total of two times.

As GP's, we are getting weekly updates on the lastest treatment suggestions for swine flu - it has constantly changed, but one piece of advice has remained the same - the use of our clincial knowledge and skill as doctors. In all my phone calls I take a detailed history, ask about close contacts and for me the key is the temperature control. Remember, swine flu in a healthy person is like any other flu. It causes the same symptoms and should resolve in the same amount of time (5-7 days). The important feature is how good is the temperature control. If paracetamol/ibuprofen are controlling the temperature and patients are seeing an improvement then the patient can continue with the treatment without requiring further intervention.

On the two occasions I've prescribed Tamiflu, once has been on a GP's insistence for themselves despite my misgivings and on the second occasion for a person who suffered with other chronic health problems and I felt the Tamiflu could potentially limit the extent of the flu for at least a couple of days and it seemed to help. There are different guidelines for unhealthy people, patients who suffer with chronic illnesses which would make swine flu more damaging, but for this blog, I don't want to get into that since I am assuming that both Price's and Castle's children are otherwise normal, healthy kids.

Sometimes, when consulting with patients, they are not happy when I suggest Tamiflu is not necessary. At that stage, I discuss the risks and benefits of the drug and explain what it is for. So far, all patients have agreed they rather hold off the prescription and wait to see how their symptoms progress. This is why Price's article irritates me. He casually states that the on-call GP "was pretty certain they had [swine flu] and it was better to be safe than sorry,"

I'm sorry, but I struggle to believe that. No doctor (GP or otherwise) will prescribe medication without discussing the benefits and risks of the treatment. I cannot believe that the GP would not have explained all this to Price before recommending the treatment. If he didn't, then Price received sub-standard care which is an exception and not something to blame the government or NHS over. If he did, then Price is omitting information in an attempt to exaggerate his article.

Like all drugs, Tamiflu has side effects. A quick look in the BNF (British National Formulary) reveals the side-effects include: "nausea, vomiting, abdmonial pain, diarrhoea, headache, less commonly rash, visual disturbances and neuropsychiatric disorders in children." These all sound rather alarming but then have a quick read of the side effects of common antibiotics used to treat a variety of infection. For example, amoxicillin's (used for chest infections, tonsillitis, cystitis) side-effects include: "nausea, vomiting, diarrhoea, rashes." Or cefalexin (used for cystitis, pneumonia), which can cause "nausea, vomiting, diarrhoea, abdominal discomfort, rashes, headache, fever, liver damage, hallucinations, confusion, dizziness." All very similar and yet I don't remember reading a report about someone's outrage after suffering from side effects caused by common antibiotics and attacking the government and NHS for prescribing them in the first place.

Among the side-effects of Tamiflu, there is no mention of respiratory problems which is what Castle's daugther suffered with after starting the treatment. It is however, a symptom of swine flu and it's not clear from the article whether Castle's daughter was suffering from flu symptoms prior to starting Tamiflu or not. It seems disingenuous to attribute the symptoms to Tamiflu when there is no evidence that it causes the symptoms that presented. However, to be fair, there is too much information missing from this story and it needs further clarification.

As far as swine flu goes, it is a new strain of virus (H1N1) which usually causes flu symptoms just like other flu viruses in healthy people. It can be more dangerous in patients who are already unwell, and like other flu viruses, there will be occasions when it can cause a lot of damage. It has caused national concern because it appears to be a lot more contagious than other flu viruses but the consequences remain the same. Over 12,000 people die annually in the UK from the flu and so far (as of the end of July) there have been 41 deaths from swine flu related illnesses, the majority in patients who had other chronic illnesses as well.

I come back to my original point, I feel that it has been blown out of proportion by the media. The government and the NHS are doing there best to manage the spread of the virus and reports such as Price's are not helpful in the slightest. There will always be people who suffer from side-effects and to try and blame the NHS is not fair. When Price concludes that:

"Yet the sobbering fact is that today alone, the NHS will hand out Tamiflu to thousands of vulnerable little children who will go through needless suffering as a result of scaremongering about an illness which is no more dangerous than seasonal flu.

Take it from us: it really, truly, is not worth it"

Who does he think is responsible for the scaremongering? How about the Daily Mail for articles such as this, this and this? Maybe Price should've taken advice from the Daily Mail's own GP about the use of Tamiflu:

"Q: Is it better for me to fight swine flu naturally if I am otherwise healthy, or to take Tamiflu if offered?

A:All medications come with potential side effects so, if there is the possibility of treating an illness more conservatively and still making the same recovery, doctors always prefer to do that. If you are otherwise healthy, it appears that swine flu is a mild illness lasting for three to four days with no complications: therefore, many GPs have been advising patients not to take the Tamiflu. So far many of those with confirmed cases of H1N1 have opted out of taking the drug and made a normal recovery."

Take care all,

Thoughts just flow, when do they have to make sense?

The cost of not turning up

noreply@blogger.com (2yyiam) — Wed, 12 Aug 2009 13:03:00 +0000

There was a news story this morning highlighting the cost of missed appointments in the NHS. Apparently it cost the NHS approximately £650 million between 2007 and 2008 for missed appointments. For every person who failed to turn up for their appointment in hospital or general practice, it cost about £100.

Working in general practice, there is a fair share of missed appointments, on average 5-6 per week. Often no explanation is given and when the patient does turn up at a later date there never seems to be much bother about it. Is it really that surprising? Offer someone a free service and people will take advantage. It's no cost to the patient not to turn up, so if they can't, they won't. When I mention to my patients that they missed previous appointments, it's usually met with a shrug and mumbled excuse about how they couldn't get to the phone cause they dropped it in the toilet or something!

The NHS is attempting to address this by trying to setup a text/email service to remind patients about their appointments. In GP-land, different practices have different policies. For example, in my current practice, we tend to phone the patients who have made emergency appointments to make sure there hasn't been an adverse event preventing them from attending. For standard appointments, it is documented in the system and then for the doctor to discuss the missed appointment at the next consultation.

Although it may sound like I'm complaining about missed appointments, it's actually the opposite. I quite like the chance of free 10 minutes in the middle of my surgery - it's like a free gift. If it's busy it gives me the time to catch up, otherwise I get a 10 minute break to relax and get ready for the next patient. During my hospital time, it was even more valuable as all the clinics would overrun and missed appointments would seem like a blessing and allow valuable catch up time. There's mention of hospitals over-booking, but I hope they're careful about how much they overbook - if there's even 60-70% attendance then it will get chaotic.

There was no surprise to read that the worst offenders were young men in their early 20s. They obviously have better things to do. However, in my experience there doesn't seem to be any particular age group - across the board, people miss appointments without giving a reason.

I believe when it comes to missed appointments, there should be a more ruthless approach. A system needs to be developed where patients pay a fee for missing an appointment without at least 24 hour notification (allowing for certain emergency situations - having the plumber run late at home is not an emergency situation).

How you implement this fee is the difficult part. When it comes to health care - charging for the care of someones health is an extremely alien concept in this country. Refusing to see patients unless they pay their fee for missing a previous appointment won't work, especially if the patient has a serious medical problem. Asking the patients to pay out of their own goodwill won't work - patients don't have goodwill. Perhaps getting the patient to pay a deposit prior to the appointment, which is then returned if they attend could be an option. It will be fiddly to say the least and time-consuming, but if patients know there are repercussions for missing an appointment perhaps they won't miss as much.

Finally, whilst we're on the topic of charging, here's one report last month, which looked very interesting. Charging to see a GP? Don't worry, it's not something I support, access to health care should always be free in this country - after all, what are we paying taxes for? Interesting however to see a think-tank have the courage to display such ideas, don't see it taking off somehow. Can you imagine the political damage it would cause if it was backed by the Tories or the Labour party? They wouldn't survive.

Take care all,
Thoughts just flow, when do they have to make sense?

The long-awaited return

noreply@blogger.com (2yyiam) — Tue, 11 Aug 2009 13:13:00 +0000

It's the time of year when I find myself with a lot of spare time and after exhausting all other options I return to the blogging world. Admittedly this wasn't planned and neither is it something I particularly want to do but for some reason, yet again, I'm back for some random ramblings about anything and everything. Once again I find myself in the front of the keyboard with time to kill and thoughts to express so let's see how long this return lasts.

You'll be glad to know that my time as a GP Registrar is over - I have qualified as a fully-fledged GP. Finally let loose onto the general public without any supervision. The qualification brings with it a lot of uncertainty, for the first time since I qualified, I am officially self-employed and currently without a permenant position. As a result for the next few months I am a GP nomad (or locum) working here, there and everywhere. Selling my services for an hourly rate to any surgery that needs a doctor. Thankfully demand is high and as it stands I'm fully booked upto mid-November.

Although it has only been 5 days since I qualified and started working as a locum GP, already I am seeing the benefits and why some doctors remains locums for years. My job is pure service provision, I turn up and just see patients. No paperwork, no prescription signing, no letter signing, no home visits, no telephone calls, just a morning and an afternoon surgery for a total of 5hrs and my work is done. Without going into specifics, 5hrs a day earns me enough to want this locum gig going for as long as possible.

The plan is to eventually get a permenant job as a GP partner, ideally in a practice close to home. Until that opportunity arrives, I'm more than content to carry on as a locum, scouring the job ads in the various medical journals waiting for the right job to turn up. I've already had a couple of interviews for partnerships one near the place where I trained (i.e. miles from home) and the other slightly closer. Although on both occasions I got down to the final 2-3 candidates, I was unsuccessful. Still, good experience etc etc. Good to know that my CV is up to scratch and at least I'm getting the opportunity. What the locums have afforded me is the time to make the right choice as and when it arrives.

Other than that, life remains pretty much unspectacular. Not much has happened in the past 5 months or so since I last blogged. Yet again as I restart blogging, Ramadhan is around the corner. It was 2006 when I first started this blog and Ramadhan was about to start, then again last year when I returned it was the same thing again, and now the third time I'm back just before one of the most important months in the Islamic calendar. No doubt I'll be attempting to type about some religious topics which I hope will prove insightful.

So there we go, a brief introduction back into the blogging world and hopefully there will be a lot more to come. After all, my free time has increased further. Before people start moaning about the amount of time doctors waste, using me as an example, may I remind you all that I am no longer paid for the free time. As a locum GP I am paid an hourly rate for the work I do in the morning and afternoon, no more no less, so this is now a free of charge service I am providing for you readers. Isnt' that thoughtful? How faecious of me!

Take care all,

Thoughts just flow, when do they have to make sense?

Our search for knowledge

noreply@blogger.com (2yyiam) — Fri, 20 Mar 2009 14:43:00 +0000

"The one who seeks knowledge is like a warrior in the cause of religion for the way of Allah." (Imam Ali a.s.)

Do you have enough knowledge to call yourself a warrior for the way of Allah? No, nor do I. No doubt at one point or another we find ourselves motivated to learn, to seek knowledge by way of lectures and reading - more often then not this commonly occurs during the first 10 days of Muharrum but soon enough we find ourselves increasingly distracted and subsequently find it hard to fit in the time to make an effort to seriously learn, revise and spread our knowledge of Islam.

Our basic Islamic understanding tends to come from the education provided by our parents or perhaps the few years spent at the Saturday/Sunday madressa, but how much of that knowledge do we retain today, and how much more have we sought ourselves? The information we have learnt from a lecture or a book is only one step in increasing our knowledge. Studies have shown that knowledge can only stay fresh in the human mind for a short period of 24hrs after which it needs to be revised in order for it to be retained. After listening to lectures, ask me what I learnt the next day and the information is limited.

Either out of laziness or naivety, we don't tend to enhance what we have learnt from lectures with further revision. I often think that when the time comes, I'll be able to seek the knowledge from various books or knowledgeable friends, but rarely make the effort to search for knowledge out of choice. It is important to know about the basic Islamic beliefs. I'm sure like me you find yourself in debates with Sunni's or non-Muslims and often come unstuck when your are unable to identify a viewpoint they have as incorrect. You know it's wrong, but can't back it up. The historical fact or quranic verse or narration of that particular event is missing from your mind and you end up looking foolish.

For us Shias it's even more important. There are several topics that are controversial for Sunnis and it's important to be able to talk about them with the correct information. I've previously touched upon temporary marriage and dissimulation and there are other topics which seem to be unique to the Shias although backed up by the Quran and Ahl-Bayt, and often cause great difficulty for us simply because we don't have the knowledge to back ourselves.

Islamic law and jurisprudence is arguably the most difficult simply because of the level of detail that is needed to have a proper understanding. However, even if we stick to the basics, how much knowledge do we have? Do we know what invalidates our prayers, what breaks our ablution, what needs to be performed after certain events? It is not good enough to simply argue that our intentions are pure and therefore God will accept our mistakes or lapses. When we have the ability to learn and clarify our practices, then there can be no excuse for being lazy - shaitan thrives on this laziness and lures us into a false sense of security.

I remember a hadith as a child (I don't have the authentic source unfortunately) where a man dreams about the shaitan. He sees him in a room lining up some equipment - a rope, a pipe, some string, a tree trunk etc. He asks him what is he doing. The shaitan replies that he's preparing his tools for distracting people during their prayers. Some people's faith and concentration is so strong that only a push with the tree trunk can distract them, for others a rope is sufficient to distract them and others, a piece of string. The man asks what he needs in order to distract the Prophet, the shaitan says that no power on Earth can distract the Prophet during his namaaz. The man confident about his namaaz having learnt it from the Prophet, asked the shaitan what he used to distract him. The shaitan put all his equipment away and said for you I don't need any of this, just a pull on my little finger is enough to distract you.

Ever since I've heard this hadith, I've always thought is shaitan using only his little finger to distract me? Sometimes it is so easy to get distracted. To strengthen our concentration we need more knowledge of what namaaz means and how important it is. We can't just say that our intention was pure, we need to constantly strive to improve our concentration levels at all times. Maybe then the shaitan will need to use something stronger to distract us - we can safely say that he won't give up - but our struggle to defy him can get stronger with more knowledge.

Having identified what we need to do, what is the best way to achieve it? Starting from scratch would be the best bet. Identifying the basics of Islam - the wajab and haram acts and then checking how much of it do we actually know. There are plentiful sources online such as Al-Islam.org and Madressa.net, both have excellent resources of knowledge, easily navigated and easy to read.

After exploring the basics, reading books which go into more depth will make more sense. Al-Islam.org has a vast amount of lectures and literature composed by a variety of scholars, our Imams and the Holy Prophet. There are also quite a few resources for watching lectures online such as ShiaTV.net and AIMIslam.org which again are a useful source of knowledge and information.

Armed with this ever increasing knowledge will not only increase our faith and beliefs and thus bring us closer to God, but also allow us to engage in debate and discussion with confidence and a certain level of authoritativeness. Obviously people will always try to catch us out, but having more and more information can only help. If you get a chance and inshallah have the motivation, check out the above sites and see what you make of it all. I particularly recommend the fact sheets of Shi'ism as a starting point, indeed many of you might recognise them from my blogs which have been based on them in the past and no doubt I'll be referring to them again in the future at some stage.

Before wrapping up, I want to congratulate Liverpool for the sumptuous thrashing of Manchester United last week and then commiserate as once again they face Chelsea in the quarter-final of the Champions League - it's going to be tense once again and I always hate the tension that surrounds these games, being a supporter is not that much fun.

Lastly, the new series of The Apprentice starts next Wednesday. It's always been entertaining for one thing - how dumb the candidates are. No matter what their background, some of the things they try in their tasks are just so inane, you wonder how Sir Alan could hire any of them. Should be entertaining.

Take care all,

Thoughts just flow, when do they have to make sense?

Mind draws a _____

noreply@blogger.com (2yyiam) — Fri, 13 Mar 2009 13:43:00 +0000

I've been sat staring at the screen for the last 15minutes thinking of something to blog about and my mind is completely blank. How sad. It's just been one of those typical mundane weeks where nothing much has really happened. Patients come and go, most are well and don't need my help - it has been a boring week to say the least. What follows now is some random chatter about nothing, so if you're reading then you've probably had a boring week as well.

Actually to start things off, I did have an interesting patient present last week in my surgery. A young Irish lady came complaining of multiple mouth sores/ulcers. Nothing interesting about that you may say, but then as part of my general health screening I asked about her job (as stress can be a cause for mouth ulcers) and she revealed that she was a fire-eater! I don't know how many fire-eaters you have met but she was my first one. As part of her act, she had to hold large quantities of liquid paraffin in her mouth and then spit it out on a naked flame to get a fire-eating effect. She works in the entertainment industry (unsurprisingly) and was part of an event group which organised shows and displays for corporate businesses. Her group appeared on Dragon's Den last year and were signed up by James Caan.

As I had a bit of time to spare before my next patient, I asked her about her experiences of James Caan. You may know that Caan was actually born as Nazim Khan to muslim parents in Pakistan. He changed his name when he saw the actor James Caan in The Godfather because he liked the spelling of 'Caan', plus, no doubt, he wanted a name that wouldn't sound like a muslim! Anyway, the patient described him as a bit of sleaze, always slightly drunk and hitting on the ladies at various parties. She then went on to say that during Ramadan whilst she was fasting, he was happily eating and drinking.

Pause for a moment and read that last sentence again. She was fasting? Immediately I interrupted her (going against all GP principles) to double check what she had just said. Indeed she was muslim, and had converted (re-verted) several years ago whilst living in Egypt. She was married to a son of a sheikh and converted after reading the Quran looking for answers about life. She spoke fluent Arabic andhad previously worn hijab but was currently reflecting on her experiences before hoping to resume the hijab once again. Rather enlightening to say the least. A fire-eating Irish muslim - surely one of a kind!

Anyway, back to the boring stuff. Liverpool's title challenge has lasted longer than most years this season and this weekend sees them face the might of Manchester United at Old Trafford. They need a win to have any chance of challenging for the title. Already 7 points behind, to fall 10 points behind with defeat would spell the end of their challenge this year and would mean that Man Utd would match the record 18 titles that Liverpool have won in their history. I started supporting Liverpool properly in 1994 and at that point Man Utd had won only 8 titles. Fast-forward 15 years and whilst Liverpool haven't budged from 18, Man Utd are about to catch up unless something can be done starting from this weekend.

It's ridiculous the amount of criticism Liverpool get on an almost daily basis for not being good enough to maintain a challenge. Everyone ignores the simple fact that Man Utd simply have far more resources because they have been able to spend a lot more money than Liverpool. At a quick glance, Man Utd have at least 5 players worth over £20 million, (not including Ronaldo) whilst Liverpool have only one (Torres). With that in mind, it's impressive that Liverpool were able to maintain a strong challenge for as long as they did this year.

Moving on briefly to mention 24. The show continues its resurgence with Day 7 this year. It has been a true return to form and I've forgotten about the drab that was Day 6 back in 2007. The last few episodes have been especially good. If you've never watched it, I truly urge you to go out and buy Day 1 NOW! I'm not going to talk about it any further until the season finishes as I don't want to spoil anything until it has completed.

I should conclude now, as I'm sure if you've persevered and read on to this point, you'll be grateful for the finish as well. I leave you with a YouTube clip of Michael McIntyre Live at The Apollo just to cheer you up after that boring read.

Take care all,
Thoughts just flow, when do they have to make sense?

Temporary marriage and Dissimulation

noreply@blogger.com (2yyiam) — Fri, 06 Mar 2009 13:34:00 +0000

I received a rather disturbing YouTube link to a video by Watford Man. The clip is by a American born Sunni 'scholar' criticising Shia's and Shia beliefs. Normally, this would not cause any concern, there have been many before and there are sure to be many after that will criticise Shias. However, what made this video stand out was the person speaking. "Sheikh" Yasir Qadhi was born and educated in America and then completed further Islamic studies in Saudi Arabia. He is a prominent speaker on the Islam Channel and Peace TV. Rather than the usual Arab nutjobs who rant and rave against Shias, his presentations tend to be calm, reflected and researched with Shia sources - making it sound very convincing. Have a listen, see what you think and then I'll attempt to discuss some of the points he raises.

He recently visited the UK for a Global Peace and Unity event hosted by the Islam Channel and had some Labour politicians as guests. Along with his views about Shias, he has also expressed derogatory opinions about the Jews and the Holocaust - so at least we're not his only targets - and so to have him at a Peace event is rather worrying.

Dealing with the issues he raises in the above clip, he picks on the most often used topics to criticise Shias - namely Muta (Temporary Marriage) and Taqqiyah (Dissimulation). Both of these concepts, he claims, are practiced by Shias and both are against the teachings of God and the Holy Prophet. To support his claims he quotes from Usl-al-Kafi, a collection of sayings from the 6th Holy Imam.

If I get into these two topics in depth, I could be here for hours. However, what I will attempt to do is discuss the two topics using the Quran and also touch upon the history of these practices and then hopefully you can decide how accurate his claims are. As always, the best place to start is the Quran. The concept of Muta revolves around one main verse in the Quran:

"(...Except the forbidden women) the rest are lawful unto you to seek them with gifts from your property (i.e., dowry), provided that you desire protection (from sin), not fornication. So for whatever you have had of pleasure (Istamta'tum) with them by the contract, give unto them their appointed wages as a duty. And there is no sin for you in what you both agree (in extending the contract) after fulfilling the (first) duty. Lo! Allah is ever Knower, Wise." (Surah 4, Verse 24)

The word 'marriage' is specifically not mentioned in this verse, it is instead the word 'istamatatum' which translates to muta (temporary marriage). It was a practice that was allowed during the time of the Prophet and according to many Sunni books was later prohibited by the second caliph, Umar. Referring to the main Sunni book of hadith - Sahih Bukhari, we find a narration stating: "The Verse of Muta was revealed in Allah's Book, so we performed it with Allah's Apostle, and nothing was revealed in Qur'an to make it illegal, nor did the Prophet prohibit it till he died. But the man (who regarded it illegal) just expressed what his own mind suggested." (Sahih Bukhari, Book 60 - Prophetic commentary on the Quran - Hadith #43). The man mentioned was Umar the second caliph.

Furthermore, in Sahih Muslim, the claim that Umar banned the act of Muta is confirmed in the following hadith: "Abu Nadra reported: While I was in the company of Jabir b. Abdullah, a person came to him and said that Ibn 'Abbas and Ibn Zubair differed on the two types of Mut'as (Tamattu' of Hajj 1846 and Tamattu' with women), whereupon Jabir said: We used to do these two during the lifetime of Allah's Messenger (may peace be upon him). Umar then forbade us to do them, and so we did not revert to them." (Sahih Muslim, Book 8 - Book of Marriage - Hadith #3250) So, with the aid of Sunni sources, not mentioned by the "Sheikh", it seems as if Muta is allowed as according to the Quran, practiced during the time of the Prophet and was subsequently forbidden by the second Caliph. As a Muslim, I think it's important to follow the Prophet rather than the second Caliph, don't you?

Having tried to prove the authenticity of Muta, obviously it is a topic that raises much debate because of what it means. I don't want to get into the rights and wrongs of Muta. It was introduced at a time when fornication and prostitution was rife, it was used at a time when men went to war and would be separated from their wives for long periods. Like any other rule or act, it is open to abuse. By all means criticise those who abuse the laws of Islam, but to abuse the act when it is clearly allowed by God and his Prophet is wrong.

Moving on to Taqqiyah and the act of dissimulation - i.e. to hide one's true faith in the face of provocation and risk of life, let me begin again by referring to the Quran:

"Any one who, after accepting faith in Allah, utters Unbelief,- except under compulsion, his heart remaining firm in Faith - but such as open their breast to Unbelief, on them is Wrath from Allah, and theirs will be a dreadful penalty." (Surah 16, Verse 106)
"A believer, a man from among the people of Pharaoh, who had concealed his faith, said: "Will ye slay a man because he says, 'My Lord is Allah'? (Surah 40, Verse 28)
"When Moses came back to his people, angry and grieved, he said: "Evil it is that ye have done in my place in my absence: did ye make haste to bring on the judgment of your Lord?" He put down the tablets, seized his brother by (the hair of) his head, and dragged him to him. Aaron said: "Son of my mother! the people did indeed reckon me as naught, and went near to slaying me! Make not the enemies rejoice over my misfortune, nor count thou me amongst the people of sin." (Surah 7, Verse 150)

The above three verses all go some way to explaining the concept of taqiyyah. The first verse states that taqiyyah is permissible only in the times of need, in the second verse a believer was forced to conceal his faith at the time of the Pharaoh for fear of prosecution and lastly even a Prophet of God had to engage in taqiyyah in order to save his own life. Infact, the Holy Prophet himself had to engage in taqiyyah during the first 3 yrs of the revelation to prevent Islam being obliterated at the very beginning.

The concept of taqiyyah is clearly supported by the Quran and one that is engaged by Muslims at times of persecution. It doesn't mean that we have become liars and cannot be trusted. Qadhi goes on to quote Usul-al-Kafi and the remark from our 6th Holy Imam: ""Nine tenths of religion is Taqiyyah (dissimulation), hence one who does not dissimulate has no religion." (Al-Kafi, Volume 9). From this he has concluded that 90% of the Shia faith is based on lies. Typical Sunni course of action, taking one quote completely out of context.

Ignoring the fact that the Qadhi himself ignores the Quran, let's discuss the above quote. This statement was first made at a time when true Muslims were under severe prosecution. The rulers of the Arab world at the time were extremely corrupt and keen to abolish Islam altogether. To prevent the risk of death and punishment, many Muslims had to engage in taqiyyah. This is supported by Sahih Bukhari: "Anas said, "I do not find (now-a-days) things as they were (practiced) at the time of the Prophet." Somebody said "The prayer (is as it was.)" Anas said, "Have you not done in the prayer what you have done? Narrated Az-Zuhri that he visited Anas bin Malik at Damascus and found him weeping and asked him why he was weeping. He replied, "I do not know anything which I used to know during the life-time of Allah's Apostle except this prayer which is being lost (not offered as it should be)." (Book 10 - Times of the prayers - Hadith#507)

The above hadith testifies that the practices of the Holy Prophet had been changed and even the namaaz was being altered. During this time, where were the true Muslims? If they weren't raising their voice, they remained in hiding to save themselves. When the 6th Holy Imam states that 90% of the religion is taqiyyah, then that is because 90% of the religion being practiced by the rulers was corrupt and not the true religion of Islam. Anyone who wasn't engaging in taqiyyah, but was instead following the rules of the caliphs at that time was not practising true Islam.

More importantly, fast-forwarding to today and post 9/11, Muslims throughout the world are being prosecuted and victimised. In the face of such aggravation what are we meant to do? In some situations people have no choice but to hide their true beliefs. To interpret taqiyyah as a form of lying and not telling the truth as Qadhi accuses Shias of is plain wrong and again extremely convenient for his style of preaching.

I've attempted to touch the surface of these two vast topics. I feel that using the Quran, as the main source would be a good starting point and also provide some clarification about the two practices. There is much more detail to go into about these topics and I finish with some links for further reading if any of you are interested about it.

Muta
Taqqiyah

Take care all,
Thoughts just flow, when do they have to make sense?

Tiredness is killing V

noreply@blogger.com (2yyiam) — Fri, 27 Feb 2009 13:47:00 +0000

Friday is not a good day to blog I have decided. I'm just too tired - man I sound like a broken record. The weeks efforts takes its toll on me so from next week I'm going to pick another day to blog instead. In the meantime, not wanting to disappoint my many readers (all five of them), I might as well type about something before the weekend.

First of all, I passed my exams! Boy, what a relief, I have never been stressed out for results before in my life (except perhaps my driving test), but there was real pressure on these results - approximately £1400 worth of pressure to be precise, so to pass was a big, big relief. I can now qualify as a GP this August inshallah - who knows, you may suffer at my hands one day in the near future.

I'm sure many, if not all of you have been following the Oscars earlier this week and the remarkable success of Slumdog Millionaire - a rag to riches story of a boy from the Mumbai slums, explaining through a series of flashbacks, how he came to know the answers to the questions in the gameshow (Who Want's To Be A Millionaire?) whilst growing up in the slums.

I watched the film last week and although entertaining, I'm not sure what all the fuss is about. I've seen far better Bollywood films over the years, but because this was a British film made in India with Indians, suddenly it became this huge phenomenon. The actor, Dev Patel is from Harrow and can barely disguise his British accent and Anil Kaoor (the show's host), was the third choice behind Bollywood icons Amitabh Bachchan and Shahrukh Khan - although I bet they regret turning it down now.

Amusingly, have a look at Amitabh Bachchan's blog to see how much the films success seems to irritate him. In his latest blogs this week he's pasted several newspaper clippings all having a go at the film - jealous perhaps? He continues to argue that he is simply inviting debate, but interestingly all the views are negative. Never mind Big B.

Alongside the awards for Best Picture and Best Film was the award of two Oscars for A.R. Rahman for Best Song and Best Score. It was great to seem him perform both songs from the film in the Kodak theatre in front of all the Hollywood superstars. However, the music was not his best work, but again, because it's a British film, it got the recognition that no Bollywood film could get on the international stage. All in all a remarkable success story.

With that, I think I'll give up, I'm too tired to type further. I think I'll quit and grab a nap before my afternoon surgery which starts in one hours time.

Take care all,
Thoughts just flow, when do they have to make sense?

What is the point?

noreply@blogger.com (2yyiam) — Fri, 20 Feb 2009 13:28:00 +0000

As always I find myself on a Friday afternoon absolutely shattered. Having a baby is not as easy as I first thought. I think my wife and I had been riding the confidence and excitement wave for the first 3 months, but now things have taken a turn for the worse. My daughter seemingly never wants to settle down. She is forever waking up in the middle of the night, demanding some attention so that she can get some sleep and it's taking its toll.

Last night, for example, she woke both of us up at 4.30am crying her head off. She would not settle until she had a feed and then would only stop crying if she lay between us in bed. At this point we were both half asleep but instead of sleeping, she decided that now would be a good time to start playing, kicking and making noise - she was wide awake! Naturally being the one who has to go to work in the morning I tried to go back to sleep but I just couldn't. The end result meant that I didn't get to sleep at least until 5.30am and I am experiencing the "thrill of feeling tired!"

Anyway, moving on. In the months I've been away from blogging, the months of Muharrum and Safar have just completed in the Islamic Calendar. I have already blogged awhile back about the importance and significance of Muharrum here, here and here, so I'm not about to repeat myself but nonetheless it will always be a very religious and spiritual time for all Shias across the globe.

During these months, as I attend majalises and continue to gain further knowledge about Islam, the Quran, the Prophet and the Imams I always try to make sure that this Muharrum is more fruitful than the last and that the motivation remains for longer after its conclusion. The basic aim is to keep the motivation going through to Safar and then extending towards Ramadan when I get the next injection of motivation.

To help, I like to employ discussion about a variety of topics with my family and friends. I'm extremely lucky in that I have a group of friends all of similar age, with kids etc who are all Shia and all motivated to explore Islam. One such discussion I had was particularly interesting and I wanted to share it on the blog (don't worry, everyone will remain anonymous).

What is your opinion on the meaning of life? Why are we here? I've often thought what is the point of it all? Why did God create us to lead the life that we do? If you think about it from a very pessimistic/negative point of view you can get caught into thinking that our existence is pretty rudimentary. God has created us on this Earth in order to judge us. Everything we do will be judged as right or wrong and then if we are deemed worthy we will be rewarded by being sent to heaven, otherwise the punishment is hell. Would it not be easier if we didn't exist at all? Why go through all this for such reward whilst at the same time running the risk of severe punishment.

These questions led one person to comment that knowing what they know about God, Day of Judgement, heaven and hell etc, they would rather not be human. Why not be an animal or a plant who doesn't have the same 'burdens of life' instead? Another person went further to say why exist at all? They felt it would be better had they not existed at all because then they wouldn't have to face any of this trail of life. An interesting thought, although incredibly flawed because the person could only have that viewpoint because they existed in the first place. However, it got me thinking that hypothetically if I had a choice, would I want to exist? If say, God had me in heaven and showed me the trials and tribulations of mankind, would I want to join it and face those trials?

As we explored this further, we came to realise that this opinion stems from our understanding on the meaning of life. Are we here simply to achieve the reward of heaven or does our reason for existence lie deeper than that? The answer is the latter. God did not create us as a hobby, he did not place us on this Earth simply to blindly follow him so that we can be rewarded and sent to heaven. Our creation serves a much more important purpose.

The one quality we possess that defines us from all of Gods' creations is 'free will.' Us (and jinns) have the ability to make our own decisions with no outside force from God, shaitan or anyone else. We have the ability to do whatever we want, we have to ability to choose to worship God. Our purpose on this Earth quite clearly is too worship God out of our own volition, God puts in clearly in the Quran: "I created the jinn and humankind only that they might worship Me." (Surah 51, Verse 56). This ability to choose is what separates us and elevates us beyond all of God's creations, even the Angels, as they do not have this choice.

God takes our purpose further when he states: "Say: Lo! my worship and my sacrifice and my living and my dying are for Allah, Lord of the Worlds." (Surah 6, Verse 162). It is clear that we have been created to worship God. We're not here to achieve heaven or avoid hell, we have a greater purpose than that. If we think purely about heaven or hell then we are missing the point. Heaven or hell is our reward/punishment depending on how we go about our worship of God.

An analogy would be to compare it to our career. We study for a qualification in order to achieve a successful career. It's not the other way around. We cannot aim for a career without the relevant qualifications. Similarly, we can't just think that we're here to try to get to heaven and forget to worship God. By worshipping God properly we have a chance of achieving a place in heaven.

By worshipping God, it means we are compelled to follow his commands, his Prophets and his Imams. The worship determines our type of life. It is not good enough to just say we worship but then do nothing to qualify that worship. Every action we take as to reflect on our worship, we must constantly be striving to seek God's pleasure and that is what the trial is all about. We are here to be tested for our worship of God. Being possessed with free will ensures that we have that ability to choose and hence when we choose the right worship and follow God as prescribed by him our reward will inshallah be greater.

Thus, we should not become too preoccupied with the punishment in hell or the rewards of heaven. Instead we should focus our energies in elevating ourselves spiritually and following the legal-moral-ethical guidelines of Islam with certitude and conviction and voluntary submit to God because He is worthy of our submission.

I often feel that atheists are who they are because they're lazy. They can't bring themselves to follow God and his commands and therefore deny his existence. I'm sure that many of them know that God does exist, but purely can't be bothered to acknowledge it because it would mean too much work for them. I'm sure God will 'reward' them appropriately for there laziness.

So, to wrap things up, our purpose on this Earth, our creation on this Earth is for us to worship God. Nothing more, nothing less. If you still have doubts about the point of existing, or harbor secrets desires of being a tree or a bird, I leave you with the words of our first Holy Imam: "O God, I do not worship You out of fear of the hell-fire because this would be the worship of a slave. Nor do I worship You out of desire for the pleasures of paradise because this would be the worship of a merchant. Rather I worship You because You are worthy of worship."

Take care all,
Thoughts just flow, when do they have to make sense?

Change of perceptions

noreply@blogger.com (2yyiam) — Fri, 13 Feb 2009 09:15:00 +0000

As promised I am back. Who knows whose reading, but frankly I don't care. It's good to back typing, good to be back to the blogging world. Since I last posted over two months ago, a lot has happened and I've made a startling discovery - GP life can be hard! Shocking, I know, but also true - I've experienced it first hand.

Before you get all cynical on me allow me to explain. When I last blogged in December I stated the reason for the pause in blogging was due to my study commitments, however, during the time off my day-to-day work has been extraordinarily busy. This all came about due to a change in practice. Until October my experience of GP-life was cozy to say the least. I was working in a sleepy rural town filled with the "worried well," patients who had too much time on their hands and would often come with problems that were trivial and often non-existant. It was mainly an exercise in reassurance.

However, since October I've seen the (dark) light. My trainer has been off sick since August last year and as a result it was rightly felt that I should switch practices as my training was suffering. My new practice has been the complete opposite. I've been working at a urban, town centre practice which has been absolutely manic.

In the past I have been critical of GP workloads and how they don't really do that much, but that was based purely on my experiences of working in a quiet GP practice. Now I have seen the other side of the coin. Since October my GP work has been busy to say the least. My morning surgery starts at 9am and the schedules appointments finish at 11.30am. However, extra appointments made on the day ensure that I finish at 12.30pm. I then have at least two home visits and after that have to go through a ream of blood results and hospital letters and I finish the morning surgery by 1.30pm. The afternoon surgery starts at 3pm, scheduled to finish at 5pm, but invariably by the time I leave it is nearer to 6pm.

And it doesn't stop there. A lot of the patients have serious health problems and suffer with a variety of chronic diseases, sometimes more than one which require a lot of help and intervention, so inevitably the appointments run over the allocated 10 minutes. It doesn't help when the majority of the patient population are from the poorer end of the social class, meaning a lot of the time they don't have clue about how ill they really are - "the unworried ill."All in all it has been the complete opposite to my experiences in the quiet rural practice.

On top of all that, the workload has been increased further with my continuing use of the ePortfolio and revision for my nMRCGP exams (the results of which I await at the end of the month). It's amazing to see the range of workloads across different practices and different GPs. In my previous practice the GPs would enjoy a leisurely break at the end of the morning surgery, often go home to have lunch with their families and then return refreshed for the afternoon session. At the new practice, it seems the GPs just about have enough time for lunch. But the significant thing out of all of this is that both types of GPs are paid around the same amount - in fact the GPs in my previous rural practice probably earn more as they also dispense drugs which brings in additional income.

So where has this left me? It's been a complete eye-opener. From being critical of GPs, I now find myself at the opposite end - a GP defender! Having experienced life as a busy GP, I no longer will be joining the GP-bashing brigade. The more important question is what type of GP do I want to be in the future? I find myself in a bit of a confused state. I'm sure most of you will expect me to claim that the rural GP is the life for me, but I'm not sure. This new practice has been busy, but along with that it has actually been interesting. I'm not just dealing with the bog-standard "coughs and colds," but also actual medical problems that require my intervention to improve patients quality of life. I'm managing long-term chronic conditions and seeing progress in a patients life and it seems to be surprisingly motivating. Could it be that I'm beginning to appreciate what it means to be a doctor?!

I'm not sure at the moment where this leaves me. This month I have changed practices once again as the busy practice was a temporary solution whilst we had hopes that my original trainer would be returning. As that is not the case, I have been allocated another trainer in a different practice. This practice is actually spread across four different sites and seems to offer a cross between a rural and an urban type patient population. This sounds ideal to me and will probably help decide where I want to be in the future once I qualify inshallah.

Interestingly, during the first meeting with my new trainer, we had the usual "getting to know each other" meeting. In the past, I've been frank and honest and said that medicine wasn't the most interesting thing in my life and I didn't enjoy my work, but it was something I was good at. Although this time I explained all that once again, I actually suggested that perhaps that perception was changing, following my recent experiences in a busy practice. I'll keep you all posted as this new sense of appreciation develops in the next few months!

Take care all,
Thoughts just flow, when do they have to make sense?

Goodbye for now II...

noreply@blogger.com (2yyiam) — Wed, 03 Dec 2008 11:39:00 +0000

I knew this time would come. As you can tell, the blogs have dried up recently and although I've been keen to type, I just haven't had the time. This ePortfolio and nMRCGP is taking up a lot of my time. I think I better put a pause on the blog for the time being. I have exams at the end of January/beginning of February, so until then I'm going to take a break from the blogging. Inshallah, provided I pass the exams I'll be back to my blogging best sometime in February.

In the meantime if anyone would like to type a blog of their own for this site then please get in touch through the comments section and I'll be glad to post their blog at any time.

So, until February this is me officially signing out.

Take care all,
Thoughts just flow, when do they have to make sense?

Jack's back

noreply@blogger.com (2yyiam) — Mon, 24 Nov 2008 15:54:00 +0000

Finally tonight after over 18 months, Jack Bauer makes a much welcome, much awaited, much overdue return to our screens for a 2-hour special 24 TV-movie tonight; 24:Redemption. The movie acts as a setup for season 7 which will return in January, 2 years after season 6 started. The delay was due to the writer's strike which crippled Hollywood earlier this year with 24 being the biggest casualty. Thankfully the wait is over: Jack's back.

You may remember in my last blogging stint, I typed at length about the brilliance of 24 and Jack Bauer here and here as I welcomed the start of season 6. That was a big disappointment. Us 24 fans are used to the plot holes, the ridiculous CTU politics or the miraculous abilities of Jack Bauer but season 6 was just a big disappointment, especially following on from the critically acclaimed season 5 (with Logan et al). We last left Jack staring into the distance standing on top of a cliff having said goodbye to his true love Audrey Raines. That was 18 months ago. It's been quite a wait.

The movie, filmed in Africa, is set in a fictional country, Sangala where Jack has gone to seek solace and to just get away from it all. Obviously, trouble follows Jack wherever he goes, regardless of the country and it's not long before things get out of hand. Simultaneously, back in Washington D.C. the new female President (blatantly cast by the producers because they thought Hiliary Clinton was going to be running) is being inaugurated and having to deal with the same crisis in Sangala.

Hopefully the 18 month break means the writers have had plenty of time to make sure the story lines and plots develop properly and we don't have any jumps or twists that make no sense. After the disappointment of season 6 and the long gap between that and season 7, I simply can't wait for the return of our favourite anti-hero - Jack Bauer. Thanks to Sky's affiliation with FOX, UK viewers will be able to watch the movie tonight on Sky 1 at 10pm. Even if you haven't watched 24 before, watch the movie to introduce yourself to Jack Bauer, you don't need any back history to be able to understand what's going on, and hopefully the movie will wet your appetite - there's still plenty of time to watch seasons 1-6 before season 7 starts in January. In fact I envy those who haven't watched 24 and are able to watch 6 seasons back-to-back, I'm definitely going to do that one day.

Before I finish, I just want to say thanks to the person who left a comment on my previous post, providing a link for the list of 100 blog topics - there were certainly a few headings which I will be discussing in due course.

Let me know what you think of the 24 movie tonight. Remember, you don't have to be a die-hard fan. Just watch the movie as an introduction into 24 - I won't be surprised if you're left wanting more.

Take care all,
Thoughts just flow, when do they have to make sense?

Random ramblings for the century post

noreply@blogger.com (2yyiam) — Wed, 19 Nov 2008 08:49:00 +0000

A milestone has been reached today with this being my 100th post on this blog. Technically not all 100 posts have been by me, but nevertheless, still a significant achievement. As a celebration I think I'm gonna have random ramble, as no specific topic comes to mind today.

The credit crunch disaster continues to show no signs of abating. Interest rates have now fallen to 3%. I took out a mortgage only 18 months ago and was strongly advised to take a fixed-rate mortgage - someone was either having a laugh or was totally clueless about the impending crunch. It seems likely to be the latter, which leads me to ask how were people so clueless about the situation and not have any contingency plans? The interest rate cut smacks of desperation, further supported by reports that the rate will need to be cut further in the coming months - seems all a bit "too little, too late."

Along with that has been the recent coverage of tax-cuts in an attempt to stimulate the economy and get people spending money again. The retail market has taken a big hit, with everyone tightening their purses, spending shoppers have been on the decline. I recently visited the new Westfield shopping centre in London and although it was filled with loads of people, what was noticeable was how short the queues were for paying in the shops. I think many people were there to admire the new store and window shop, rather than actually spend large amounts of money. I include myself in this, as we just used the various vouchers we already had and spent very little cash.

A side-effect of the credit crunch has seen consumer spending increase in the entertainment industry, mainly the cinemas and TV subscriptions. How else can one explain the remarkable box-office success of the new James Bond movie: Quantum Of Solace, which is currently topping both the US and the UK box-office and has already made over $321 million worldwide? It's not even that good - with action scene after action scene and a story that's too complicated to follow, it was like a Jason Bourne movie! There was none of the typical humour, wit and gadgets that make a Bond movie. He didn't even say "the names Bond..., James Bond," surely that should be a guarantee in all Bond movies!

Whilst I'm rambling about movies, I recently saw the Bollywood movie Dostana, and whilst the idea of a couple pretending to be gay in a Hollywood movie would not be something I want to watch, because it was a topic being dealt with in a Bollywood movie it became interesting. It was absolutely hilarious! Go see it now.

Along with the movie industry, there has also been a increase in the number of subscribers to Sky TV with the company announcing a 25% increase in profits this year. People are staying at home more and therefore looking for more in-house entertainment. What better than a new subscription to Sky Sports or Sky Movies or even Sky HD?

Moving away from all the credit crunch talk, how about an update on all things medical? I must say it has been a gentle re-introduction to work after my 3 weeks off in earlier this month. As always I continue to jump through hoops for my ePortfolio and have recently forked out over £1300 for one exam next year (the CSA), but I don't want to bore you with those particular details. As for patient contact, pretty uneventful thus far. I did see one patient who suffered from an extremely rare syndrome that I'd never heard of before - Klippel Trenaunay syndrome, let's just leave it at that - you can click on the link and read all about it if you're interested!

I've sat staring at the screen trying to think of something interesting to type and can't come up with anything. Not a good way to celebrate the 100th posting! I think I better give-up for today. How about someone come up with some topics for me to blog about? I guess that will be difficult as it would require you to leave a comment, and no-one likes doing that it seems. Don't worry, the 101st post is going to be much better - a certain Jack Bauer will be returning...

Take care all,
Thoughts just flow, when do they have to make sense?

Method of prayer

noreply@blogger.com (2yyiam) — Fri, 14 Nov 2008 09:30:00 +0000

Another week goes by as we approach the end of 2008. Yet again, another year of my life has flown by in a flash. I look at my baby and think that she didn't even exist at the beginning of the year and now here she is in front of me, increasing my level of responsibility dramatically, how time flies.

This week saw the world commemorate Armistice Day - the end of the first world war 90 years ago on November the 11th. For a definition of futility, look no further than World War I. It took place from 1914-1918 and saw the loss of millions upon millions of men all for little to no gain whatsoever. The military tactics of trench warfare saw millions of soldiers sent "over the top" to their deaths. The tactic seemed to be to send as many people as possible and hope that the sheer numbers would lead to victory. In 1995 I visited the battlefields of Somme, Ypres and Verdun on a school trip, and to this day I vividly remember the rows of trenches and rows upon rows of unnamed tombstones - a complete exercise of futility, and World War II wasn't much better either.

On to bigger and better things. One of the five pillars of Islam is the act of prayer - to pray to God at prescribed times during the day, to remember him and ask him for help. It is the mainstay of Islam and a provision for all Muslims to seek help directly from God. All religions prescribe some form of prayer and Islam is no different.

Unfortunately divisions in Islam, namely the Shia and Sunni sects has led to divisions in the conduct of most practices and the act of prayer is no exception. All Muslims believe in the five daily mandatory prayers and they also agree that these five prayers have set times in which they must be performed.

The first difference arises from whether the prayers can be combined or whether they need to be kept separate. Shia's believe that the afternoon prayers (Zuhr and Asr) and the evening prayer (Maghrib and Isha) can be combined at any time. The four different schools of Sunnism believe differently. Some schools believe prayer can only be combined during travel or periods of danger, other schools believe they cannot be combined at all. For the correct answer, let's start by looking at the Quran. It states: "Establish regular prayers at the Sun's decline till the darkness of the night, and the recital of the Quran in the morning prayer; for the recital of the dawn is Witnessed." (Surah 17, Verse 78). In this verse, three prayer times are mentioned, so that is the first indication of three separate times for prayer, not five. From that, it is sensible to ask what did the Prophet do? Look no further than Sahih Muslim:

"Ibn 'Abbas reported: The Messenger of Allah (may peace be upon him) observed the noon and afternoon prayers together, and the sunset and Isha' prayers together without being in a state of fear or in a state of journey." (Book 4, Chapter 100, Hadith 1515)

And why did the Prophet do this?

"I said to Ibn Abbas: What prompted him to do that? He said: So that his prophet's Ummah should not be put to (unnecessary) hardship." (Book 4, Chapter 100, Hadith 1516)

The next debate is over the method of prayer. All Shias place their forehead on a natural substance when bowing in sajdah, often a piece of rock. Sunnis place their forehead directly on the carpet/rug/mat and then claim that Shias worship the rock. Again, what did the Prophet do? In another famous Sunni book, Sahih Bukhari it narrates hadith which state:

"The Messenger of Allah performed prayer and I (one of the wives of the Holy Prophet) lay opposite to him while I was in menses. Sometimes his clothes touched me when he prostrated, and he used to prostrate on khumra (a piece of rock or dirt)." (Volume 1, Book 6, Hadith 321)

Also, the Prophet is quoted as saying:

"...the earth has been made pure and a place of prostration for me, so whenever the time of prayer comes for any one of you, he should pray wherever he is..." (Volume 1, Book 7, Hadith 323)

Lastly, when Shias stand in prayer, they do so with their arms by their sides. Sunnis can't seem to make up their minds. Some do the same as Shias, others stand with their arms folded, with some folding above the abdomen and other over the waist. Some with the left arm over the right and vicer-versa.

Unfortunately, I have been unable to find reliable sources to settle this particular discussion either way, perhaps you know of some. However, with the application of good sense, the answer in my mind is clear. All Shias pray with the arms by their sides. On the other hand, four different schools of Sunnism have four different methods of standing in prayer. If the schools can't agree on a relatively simple task, then I think I'll stick to my method.

Having briefly discussed the difference in the method of prayer, I hope I have been able to clarify some of the myths of Shia prayer and also explain why we do what we do, backed up with Sunni sources only. I will finish rather abruptly now as I am going home to my daughter - looks good just typing it!

Take care all,
Thoughts just flow, when do they have to make sense?

Guess who's back IV

noreply@blogger.com (2yyiam) — Mon, 10 Nov 2008 14:13:00 +0000

As you can see I've been away for quite a while, almost a month, but I have a very good excuse! My wife gave birth to a beautiful baby girl on the 19th of October and I have just returned to work after 3 weeks of paternity/annual leave spending time relaxing with my wife and baby (along with plenty of sessions playing the new Pro Evolution 2009 - much to my wife's disdain, but boys will be boys). It's true what they say, having a baby does change your life. Suddenly everything has become about her. A baby who doesn't even respond to us has become the most important thing in our life.

Over the past three weeks numerous family and friends have been visiting, all wanting a cuddle with the baby, receiving a lot of presents and so far it has been really fun and enjoyable. Everything else seems to have taken a backseat. Arguments, concerns, distractions, all have dissolved into nothing and all the focus is on their new grand-daughter, niece, cousin, etc. Along with the attention comes all the advice. What's difficult is deciphering what's important and what isn't. Some of the advice is useful, other stuff is almost pure superstition. Overall, so far, it has been an amazing experience and it was a wrench to get up and come to work this morning.

While I've been away a lot has happened in the world. Most significant was the recent victory by a certain Barack Obama in the US presidential elections. The Americans aren't so stupid after all. However, the optimism has to be tempered somewhat be recent events following his victory. First was the appointment of Rahm Emanuel as his chief-of-staff. A man who is as pro-Israeli as they come - he even volunteered to serve in the Israeli army during the Gulf War in 1991. His appointment led his father to comment: "Obviously he will influence the president to be pro-Israel. Why wouldn't he be? What is he, an Arab? He's not going to clean the floors of the White House." Great! Just what we need.

Secondly was the response Obama gave when asked about the unprecedented congratulatory message he received from his Iranian counterpart (Ahmedinajad): "Iran's development of a nuclear weapon I believe is unacceptable. We have to mount an international effort to prevent that from happening." Never mind the fact that the chief of the International Atomic Energy Agency (a UN led watchdog) clearly stated that "...the Islamic Republic is still lacking the key components to produce an atomic weapon. They do not have even the nuclear material, the raw unenriched uranium to develop one nuclear weapon if they decide to do so." The President has already seemingly decided that Iran is making a nuclear weapon regardless of the evidence. Ominous signs already, we'll have to wait and see how this plays out.

What else has been happening? Oh yes, how could I forgot Liverpool continuing their fine start to the season, joint top of the Premiership and never have I been this optimistic that they may continue to stay there and challenge for the rest of the season. The optimism breeds from a great victory over Chelsea at Stamford Bridge. Their first defeat at home for over four years - I wasn't even married the last time a team beat Chelsea in the Premier League.

With my return to work comes the bad news of exams for my MRCGP around the corner in January/February. The next few months are going to be very busy with my surgeries, tutorials, ePortfolio and studying for my exams. As a result, it is going to be difficult to maintain this blog on a regular basis. Instead, I will strive to blog at least once a week and hope other will contribute and that you all will continue to read albeit at less regular intervals. For now, it's sad to be back at work, and I am missing my daughter!

Take care all,
Thoughts just flow, when do they have to make sense?

The perfect consultation

noreply@blogger.com (2yyiam) — Wed, 15 Oct 2008 09:19:00 +0000

During my GP Registrar year, I am constantly getting assessed to determine whether I am progressing well with the skill of GP consultation. Out of all the medical specialties, General Practice requires a unique set of skills for consulting patients - skills that take time to develop and maintain. I previously blogged about various consultation models that we have been taught and how I adapt them for my consultations. The assessments are a way of making sure that we continue to develop our skills, continuing to perfect the art of consultation.

To achieve this, the Royal College of General Practitioners (RCGP) has set-up two main methods of assessment. The first is called a Clinical Observation Tool assessment (COT). This particular assessment requires me to either film my consultations (with the patients consent of course) and to then review them with my trainer, or to have joint surgeries with my trainer watching as I consult. The other assessment is the Clinical Skills Assessment (CSA) exam which involves 13 consultations with actors/actresses to be done in 10 minutes and each is assessed by an examiner. If it sounds tough, that's cause it is!

Assessing my consultation always feels a bit fake. Whenever I video my consultations, there's always an element of acting or over exaggeration in my consultations. I know what needs to be done to achieve the marks, so I always end up putting it on a little bit. I make sure I ask the key questions that I am expected to ask, regardless of their relevance. It's expected that for all consultations GPs should ask a few questions all the time and it all revolves around the patients I.C.E. (Ideas, Concerns & Expectations). So, when all my videos have me asking about what the patient thinks is wrong, what are their concerns, how the problem is affecting them and what expectations they have. To be fair, in most cases these questions are very important, and the more I video myself, the more I find myself doing it without the video. However, for some cases it is not relevant at all and it always feels a bit fake.

The most difficult aspect of videoing my consultations is making sure I cover everything within 10 minutes. I can almost see myself go through a mental checklist as I consult to make sure I ask all the right questions and sometimes my management of the patients problem suffers. I worry so much about asking the right question and covering the right areas, the important part - the medical part, providing a diagnosis or treatment gets forgotten. There have been times when I've gone through the problem, performed the relevant examination (which by the way, are off camera) and then got to the actual doctor part of the consultation and found myself struggling simply because I've been spending too much time on what has gone before, trying to achieve the perfect consultation.

It's irritating that I am being asked to spend so much time focusing on the consultation skills aspect that at times I'm having to think harder than before just to do the medical part of the consultation which is what I've been trained for. I understand the importance of achieving a good consultation, but as these assessments continue to develop and the RCGP continues to place more and more emphasis on it, I wonder if the medical aspect of patient care will begin to suffer?

To be fair, the RCGP place a lot of importance on us continuing to show that we keep up to date with our medical knowledge. We have regular tutorials and have to show evidence of our own private study on a regular basis on our ePortfolio, but the GP consultation is definitely the most important part of my medical training without doubt.

The hardest part of my consultations is getting the time down to 10 minutes, especially for the CSA examination. The consultation then will stop dead on 10 minutes, if anything is left, then that's just tough luck. Yesterday I had a COT assessment on a patient which lasted 14 minutes. My trainer and I discussed how it could have been shortened and we both struggled to come up with any answers. The problem that I was presented with required the 14 minutes and I was even rushing at the end to try and speed the process, but even my trainer agreed that it would be near impossible to get it down to 10 minutes. So, no answers and not good if I get a similar presentation in the CSA. The patient yesterday was a particularly slow talker, and perhaps the actor/actress would talk faster in the CSA. Maybe I wouldn't need to perform such a thorough examination and have the findings given to me. Perhaps that would be the only way I could cut down on my time for the consultation.

Obviously, these assessments are necessary. They are in place to ensure we develop or GP consultation skill properly, to get ready for the big bag world of General Practice at the end of it. I just hope that my medical knowledge or application of that knowledge remains appropriate and that, for the CSA at least, I am able to consult within the 10 minutes properly - the emphasis seems to be on the consultation models and not necessarily on actual medical knowledge. Don't worry, there is also a theory exam as well.

With that all said and done, I sign off for today and the rest of the week most likely. Got too many COTs to do and too little time to do it in! Next time you see a GP, is he/she more concerned about getting the consultation right, or getting you right?

Take care all,
Thoughts just flow, when do they have to make sense?

Credit crunching to disaster

noreply@blogger.com (2yyiam) — Mon, 13 Oct 2008 08:46:00 +0000

Almost two weeks without a blog. How have you survived? Extremely well by the looks of it as the hit count has barely moved in that time. A belated Eid Mubarak to everyone, this year I celebrated on 2nd of October and took off the 1st and 3rd for good measure. Last week was extremely busy, so busy that I was unable to blog.

I would like to put it down as a rarity but the signs are ominous - the GP Registrar year is going to be tough and I will have to cut down on the frequency of this blog as a result. Apart from the my surgeries, I'm having to spend a lot of time with my ePortfolio and tutorials in preparation for various assessments, and it is all taking up a lot of time. Take last Thursday for example: I had a 2 hr tutorial in the morning, followed by a video consultation assessment, then a lunchtime lecture, followed by an afternoon surgery and assessment. All in all I had 30 minutes for myself - it was like being back at hospital again, not good. With recent developments in mind, I'll be looking to blog at least once a week and try to do more as and when time allows.

First things first, in response to a comment left on my last blog by "Anonymous" (I think I know who it is - can you even pronounce anonymous?), yet again there was a report about how GPs are overpaid and under worked (blah, blah, blah) and to be quite honest, I am getting fed-up of having to defend GPs and whether they deserve or don't deserve their earnings etc. This time I would like to end this particular discussion with the words of Professor Steve Field, chairman of the Royal College of General Practitioners and leave it at that:

"The quality of care provided for patients should always be our main consideration and this demonstrates how GPs have stepped up to the plate to deliver improvements. Robust evidence shows that the QOF has been a success and that it has made a major contribution to raising standards by setting a universal measure of quality for patients, wherever they live. We refute any accusations that the targets are too easy.

The role of the GP is very different even from that of five years ago - we are caring for an ageing population, patients are presenting with complex and multiple conditions and we are providing many services in primary care that were previously carried out in secondary care. GPs are proving every day that they are up to this challenge, although we do acknowledge that PCTS have often lacked the will and capacity to develop local services in partnership with GPs.

The QOF is also helping GPs to shift the emphasis to health promotion and preventing illness in patients, rather than just patching up people when they're ill. By identifying those at risk early enough, we are having a dramatic effect in helping people change their lifestyles and improve their health through earlier access to treatment and specially targeted interventions such as smoking cessation - all of which can only benefit the NHS in the long run."

Moving on, and while I've been away, the so-called "credit crunch" has seemingly turned into a "credit disaster" with banks crashing across the world, the stock market falling and a global economic meltdown in the horizon being predicted. However, what does it all mean for us as individuals? How and when will the banking crisis effect us? For the answers I turned to Watford Man, a man who knows something about anything and everything, and as usual he didn't disappoint.

Since the last recession in the late 1980's, early 1990's, the economy in the UK has enjoyed a massive boom. A steady growth has seen people make loads of money, house prices have grown, consumer spending has increased and unemployment levels have decreased. Everyone was apparently in a win-win situation. Banks were de-regulated, which meant that chief executives and chairmen of British banks were allowed to do what they wanted with peoples investments, savings and pensions. Loans and mortgages were being handed out at record levels, seemingly to anyone, regardless of their credit rating.

In the US, subprime mortgages (mortgages valued at over 5 times peoples income, or in some cases up to 125% of the value of the property) were being handed out in their thousands. Regardless of whether people could actually afford the re-payments, they were able to become homeowners. "Everyone should be a homeowner," became a mantra for the US government. The companies that handed out subprime mortgages would then sell this debt onto bigger and more powerful companies at a certain rate, who would then sell to even more powerful companies and banks.

Everyone in the chain was making money, so all seemed well. Banks were coming up with their own mathematical formulas to justify their investments, and the risks got bigger and bigger. De-regulation meant that there was seemingly no accountability for their actions, as long as they continued to make money, everyone remained happy.

In the UK, as the interest rate began to increase from 2004, slowly but surely, more and more people began to struggle to repay their monthly mortgage payments. This was brought into sharp focus with the collapse and government takeover of Northern Rock last year. It had accumulated too much bad debt and was no longer able to afford charges to cover the debt with a drastic slump in profits. The collapse was the first warning sign for what was to follow.

In the US the situation is even worse. Banks and financial companies have offered thousands of subprime mortgages piling on bad debt on top of bad debt. Companies have sold these debts on to other large investors who have paid over the top for the debt, mainly because it was a US company meaning the investment should be safe! As more and more people have defaulted on their repayments, it has turned into a international crisis. The banks can no longer afford the debts they own and risk collapse and the government has to use taxpayers money to bail them out.

What the bad debt means is that everything is heading for a big bust. Unaffordable mortgages have led to a fall in house prices. Lack of spare cash has led to a downturn in consumer spending. Companies are having to lay of staff so that they can continue to run and pay off their debt and the recession looms closer and closer. The collapse of the economy will have an effect on all aspects of life. Larger number of unemplyed people means more disaffection, which will see an increase in social benefit claims and crime, putting more and more pressure on the welfare state.

The crisis means that banks no longer trust each other and refuse to lend money to each other, unless at extremely extortionate rates, and therefore a cut in the national interest rates will have no difference. For example, if my house is now worth less then what I paid (which is the likely situation at present), when I come to re-mortgage it, I won't be able to because of the drop in value. What will happen instead is that I will be asked to pay more to cover for the drop - and that is a real possibility if the situation remains as it is and worsens as is being predicted across the globe. The situation is even worse for pension owners or child trust fund owners, as their money has probably been used in bad investment and there is every possibility that they have been left with nothing.

The scary part of this crisis, is that no-one is safe. During the boom period, banks invested in each other across the world, it wasn't just limited to UK banks dealing with UK banks, or US banks working with US companies. Banks from the Middle East, China and other nations have all invested heavily and the whole global economy is at risk. I've said in the past that the banks should be allowed to collapse, but it doesn't seem a good idea if all the banks collapse on mass, leaving only a few to leave our savings with - we'll be sent back to the Medieval age and having to wheel and deal for our earnings and savings!

After such a large boom, a huge bust was inevitable. What is shocking is that it wasn't foreseen for so long. Until the banks trust each other again, the situtation won't change and that is where the national governments get involved. The UK government has just announced a £37 billion bailout of taxpayer cash into RBS, Lloyds TSB and HBOS. We, the taxpayers, will own upto 60% of RBS and 40% of Lloyds TSB/HBOS. The banks are being nationalised and the government will have a direct influence on how they are run.

This is just the beginning of the attempt to stage a recovery. It will be useless unless the whole world gets on board, which is why Gordon Brown recently met with 15 European leaders in an attempt to unify and sort out the financial crisis. All in all, even with my basic understanding, there are bleak times ahead and a situation that we will have to endure for the foreseeable future. In the meantime, hopefully the chief executives and chairmen of all these failing banks will be held to account for the recklessness and lack of foresight - but the chances are they will resign with big payouts without repercussion - doesn't seem fair.

What is most depressing as Watford Man pointed out last night, is that our generation will suffer the most. As someone who has recently started earning and developed a career, I won't enjoy the boom of the late 1990's, early 2000's for quite some time. Unfortunately, we missed out and now have to pay for the mistakes of the generation before us. Hopefully, the situation will remain cyclical and after the bust, things will improve once again and we'll be in a position to reap the benefits. Until then we have no choice but to grin and bear it and see how it all plays out.

Take care all,
Thoughts just flow, when do they have to make sense?

(i)L(l)iteral ignorance

noreply@blogger.com (2yyiam) — Tue, 30 Sep 2008 09:36:00 +0000

No teaching today which means you guys get a bonus blog from me. How exciting! Actually, although it may not be exciting, what I want to discuss today is certainly interesting. The muslim world is divided on a lot of things, and one of the differences I want to talk about today is to do with the Holy Prophet.

There is a debate going on that concerns the abilities of the Prophet, namely to do with his literacy skills. Certain Muslims, rightly or wrongly, suggest that the Prophet was illiterate, that he was unable to read and write. For some, it is not seen as a criticism, but rather as more proof of the miracle of the Holy Prophet in revealing the Holy Quran and also the message of Islam. For others (namely Wahabbis), it is a way to belittle the Prophet and attempt to reduce his status to that of a common man. Wahabbis would like us to believe that the Prophet was a normal man, whose mission was to bring the Holy Quran and that was it. Some even refer to him as a normal postman. Describing him as illiterate is just another way of downplaying his status.

For Shias, the belief is quite different. We believe that he was in no way illiterate and today I would like to attempt to explain why, using some reliable sources and also a very important tool (not necessarily utilised by others), common sense. Unfortunately, this has become a hot topic of debate because the information available is rather sparse, but a good starting point would the Holy Quran.

When muslims debate whether the Prophet was illiterate, they often quote the following verses:

"And ordain for us good in this world's life and the hereafter, for surely we turn to Thee. He said: (As for) My chastisement, I will afflict with it whom I please, and My mercy encompasses all things; so I will ordain it (specially) for those who guard (against evil) and pay the poor-rate, and those who believe in Our communications. Those who follow the Messenger Prophet, the Ummi, whom they find written down with them in the Taurat and the Injeel (who) enjoins them good and forbids them evil, and makes lawful to them the good things and makes unlawful to them impure things, and removes from them their burden and the shackles which were upon them; so (as for) those who believe in him and honor him and help him, and follow the light which has been sent down with him, these it is that are the successful." (Surah 7, Verses 156-157)

The key word in the above verse is Ummi. Scholars have translated this to mean either "unlettered" or "illiterate" and this is where the confusion seems to arise. Which translation makes more sense? If we take the first meaning, then describing the Prophet as unlettered would mean that he was not formally educated or schooled, which is true, all his knowledge came direct from God and therefore that translation would make sense. If we use the second translation, then it suggests that he was unable to read and write, but does that make sense?

Further tafsir of these verses reveals that Ummi was a term used to describe the Arabs, as they were often illiterate and uneducated. Hence, perhaps God was defining the Prophet as an Arab, which he was. Ummis also refers to the people of Mecca - the Ummul-Qura and God goes on to state that: "It is He who raised among the ummies a messenger from amongst them, who recites His signs to them, reforms them and teaches them the book and the wisdom." (Surah 62, Verse 2). The Prophet was a Meccan, but it is absurd to think that Allah sent an illiterate to teach the illiterates.

Continuing to use the Quran, God clearly states why he sent the Holy Prophet: "And We have not sent you but as a mercy to the worlds." (Surah 21, Verse 107) He was sent for all of mankind. Also, in the Quran, when God talks about Prophet Isa (a.s.) he mentions that Isa was able to speak from the cradle, when he was just a baby: "He said: Surely I am a servant of Allah; He has given me the Book and made me a prophet." (Surah 19, Verse 30) So, God describes a Prophet who was able to speak from the cradle as a baby, and then for the Prophet who has been sent for all of mankind, to suggest that he unable to read or write is surely a mistake. And lastly, the first verse revealed to the Prophet on the night of Qadr was "Read in the name of your Lord Who created." (Surah 96, Verse 1). Why did God ask the Prophet to read, if he was unable to?

Moving from the Quran and onto events that occured during the Prophet's life, there is the well documented event (Sahih Muslim, Book 13, Hadith 4016) that occured near the time of the Prophet's death. He requested a pen and paper from Umar as he wished to write his last will. Umar denied him that request, but nonetheless, why would the Prophet ask for a pen and paper if he was unable to write?

Furthermore, there is another incident which took place in the Prophet's life as quoted by Ibn Ishaq in the book "The Life of Muhammed: Translation of Ibn Ishaq's Sirat Rasulallah." In it he describes a letter exchange between the Holy Prophet and a man named Musaylima bin Habib who was claiming to be a Prophet of God:

"MUSAYLIMA'S LETTER AND THE APOSTLE'S ANSWER THERETO

Musaylima had written to the apostle (Prophet Muhammad):
>From Musaylima the apostle of God to Muhammad the apostle of God. Peace upon you. I have been made partner with you in authority. To us belongs half the land and to Quraysh half, but Quraysh are a hostile people...

Then he (Prophet Muhammad) wrote to Musaylima:
>From Muhammad the apostle of God to Musaylima the liar. Peace be upon him who follows the guidance. The earth is God's. He lets whom He will of His creatures (to) inherit it and the result is to the pious...

This was at the end of the year 10 (after Hijra). There were other instances in the history of early Islam where Prophet Muhammad sent many letters to Kings and other heads of state, inviting them to embrace God's religion. The only plausible conclusion is that he realized the importance of written communication, as God has taught in the earliest revelation. Ibn Ishaq's chronicle on this issue provides a historical evidence to support the fact that Muhammad was indeed a literate prophet."

The above extract confirms that the Prophet engaged in writing and reading in order to spread the message of Islam. Finally, putting on the hat of common sense, is it not nonsensical to think that the Prophet was illiterate? He was sent by God to spread the religion of Islam throughout the world, he was sent to a region rife with problems, including illiteracy, therefore does it make sense that God sent an illiterate Prophet to teach illiterate people? Also, the Prophet was a successful businessman and tradesman, dealing with the finances and wealth of his first wife, Bibi Khadija (a.s.). In order to do so, would he not need to be able to read and write?

For many Muslims, the Prophet's illiteracy is used as a tool to hail his miracle of the Holy Quran even more, but that is not necessary. The Quran is the greatest miracle for mankind and doesn't need any surrounding intervention to make it bigger. For those who claim the Prophet was illiterate in an attempt to belittle him, they are surely mistaken. The Holy Prophet was sent for all of mankind, he was not simply a postman sent to deliver the Quran. Without him there is no Islam. Who else is there to explain the teachings and meanings of the Quran and Islam? I hope this blog has addressed the issue over the Prophets alleged illiteracy although I am sure many people will disagree, if any of you are reading, then please leave a comment and we can discuss this topic further.

Take care all,
Thoughts just flow, when do they have to make sense?

Sincerity

noreply@blogger.com (2yyiam) — Mon, 29 Sep 2008 08:33:00 +0000

What a hectic morning so far, not helped by the fact that I got to work late. I was stuck behind a tractor on my way to work for over 30 minutes. So annoying. We are now in the final straight, with 3 days left of fasting before Eid (hopefully, as I have a day off booked) on Thursday. As always, there will be big debate over whether Eid will be on Wednesday, Thursday or even Friday (for some people), but this year I am going to follow the Greenwich Royal Observatory who clearly state that the new moon will be visible on the night of the 1st of October, and therefore Eid will be on the 2nd of October.

With this being the last Monday in Ramadan, I conclude my series of religious topics I've been discussing every Monday since Ramadan began, with a blog about Sincerity. Our intentions reflect our practices and actions. Whatever we do, from the mundane to the complex, God's judgement is based on our intentions, our niyyat. Sincerity is a combination, starting with our intentions, leading to our actions and then perseverance of the correct and halal way of life.

The ultimate in sincerity is to achieve a status whereby our actions are dedicated totally to God and reflect his will and command. God states in the Quran "Now, surely, sincere obedience is due to Allah (alone)..." (Surah 39, Verse 3). Our intentions are the building blocks for achieving this status. Everything we do is judged by our intentions. Seemingly good acts can be meaningless if our intentions are not pure and incorrect acts or mistakes can be overlooked by God if our intentions were pure.

I often find that our intentions get lost when dealing with certain actions or thoughts. For example, take the whole debate about when the 1st of Ramadan is, or when Eid is at the end of Ramadan. Everyone seems to get hung up about which Ayatullah to follow, what mosque to follow and as a result the Muslim community ends up divided. If previously it's been difficult to get Shias and Sunnis to agree on a date, now even the Shia community is divided with Shias following different Ayatullahs who have different rulings. However, if we come back to our intention, then it should be simpler.

Even though the Ayatullahs have different rulings, they all agree that their rules should not cause division within the community, but that is often ignored. However, if we focus on the sincerity of the decision, it should be simpler. Surely, everyone can agree to have the event of Eid on the same day in order to ensure that the community is united in celebration and we all get to enjoy Eid at the same time, on the same day. Whatever doubts there maybe about the moon sightings and various rulings, if we all have the same intention then it shouldn't matter as much as it does. I'm obviously not suggesting that we be careless and pick any random day (as the Saudis seem to do), but with the best intentions and common sense, we should be able to agree on one day for Eid and one day for the start of Ramadan. The way it's currently going, we'll soon be commemorating 10th of Muharrum on different days.

Our actions are derived from our intentions and it is how we then conduct ourselves that determines how close we grow towards God. Perseverance in action, is more difficult than the act itself. Sincerity is subsequent to action. This means a good deed without bragging, without showing-off is the better course of action. For example, if one performs a good deed in secret, he/she will receive reward from God, if he/she then declares this good deed, the level of reward decreases to that of an open good deed and if he/she starts to brag about this deed then the reward is cancelled and he/she may be punished for showing off. Once the intention is established, it needs to be maintained throughout.

It is the sincere intention and pure purpose that determines the perfection or lack thereof of our worship towards God. Struggling to get rid of self-love or pride or ego has to be a continuous process to ensure that our intentions are dedicated towards God. Performing acts of worship or in fact any act, for any other reason, takes us away from that purpose. Acts for the pleasure of others or ourselves can be classified as shirk, and that would be a true meaning of the word - not how the Shias are accused of shirk by associating others with God - and is something that needs constant work. Of course there will be acts which make us feel good, make us feel proud, but if these feelings get in the way of seeking God's blessings and reward then the acts have a negative affect on us.

The constant struggle to drive out love for worldly pleasures is what will draw us closer to God and help achieve total sincerity. Vigilance is constantly required because Shaitan is always close by to try and influence our acts. Remaining sincere at all times means resisting the temptations offered by Shaitan and continuing to focus on gaining God's pleasure. Modify our behaviour step-by-step - get rid of ego and pride in our actions stage by stage and inshallah the sincerity will follow. Our intentions may always be right, be pure but to be sincere means getting rid of any distracting thoughts. When God talks to mankind in the Quran, he asks the people who are righteous to "Say. Surely my prayer and my sacrifice and my life and my death are (all) for Allah, the Lord of the worlds." (Surah 6, Verse 162)

Take care all,
Thoughts just flow, when do they have to make sense?

Random chatter II

noreply@blogger.com (2yyiam) — Fri, 26 Sep 2008 08:29:00 +0000

All in all it has been a busy week. Started the week by commemorating the death of our first Holy Imam, then had the amaals of Shab-e-Qadr and to top it all off, I've actually been busy at work! Yesterday I had a meeting with my educational supervisor and we went through a video consultation of myself. It is so weird seeing myself consult patients - almost cringe worthy, although I must add I am rather good - I can put on a good act for the camera.

Being the end of the week and also the last Friday of Ramadan, I don't have much time to blog today before Juma prayers which I have to get to shortly. Just enough time to reflect on the current affairs of the week. The week started with a great tragedy in Pakistan. The Marriot hotel in Islamabad was attacked by a suicide bomber carrying 600kg of explosives in a truck. The devastation caused can be seen here, and resulted in over 50 deaths and counting.

It seems that no week goes by without some report of a suicide attack somewhere in the Middle East or South Asia. It begs the question, how easy is it to recruit a suicide bomber? How are people being so brainwashed that they agree to kill themselves? How do agents of Al-Qaeda or the Taleban convince people it is all in the name of Islam? The people who do the recruiting are not stupid and yet they seem to think that such violent attacks and causing the death of innocent people will lead to reward in the hereafter. All I can say is that God clearly states in the Quran that "...whoever slays a soul, unless it be for manslaughter or for mischief in the land, it is as though he slew all men; and whoever keeps it alive, it is as though he kept alive all men." (Surah 5, Verse 32).

Moving on from such tragic events, to something less traumatising. The Labour Party conference this week saw Gordon Brown attempt to stage a recovery for his premiership with a convincing speech discussing how he is going to deal with the various issues facing this country. At the end of the day it comes down to a simple question, who is the least worse option in running the country? Tony Blair won a 3rd successive term in power back in 2005, mainly because the quality of his opponents in the Tory and Lib Dem party were so poor and the same will apply again. This time, it appears that the public are turning against the Labour Party and the Tories will surely benefit. David Cameron must be loving it, he hasn't had to come up with any amazing policy breakthroughs or tax promises, he's just sat back and watch Labour implode. Too little, too late Mr. Brown.

Lastly, the credit crunch shows no signs of abating. This week, President Bush has been trying to convince Congress to cough up $700 billion in an attempt to save the banks who are at threat from going under in the US. A few years ago, when the banks were successful, making huge amounts of money, many chief executives, managers and whoever were making large bonuses on the back of it. At the time, do you remember receiving a letter from your bank, congratulating themselves for the success and rewarding you with a cash donation? I don't. So now that they are in trouble due to their own excesses, why are we, the taxpayers, being asked to foot the bill of recovery? They dug their own grave, now they should suffer the consequences. Obviously, I cannot claim to even begin to understand the complicated world that is the finance sector, but it just doesn't seem fair. If we didn't enjoy the bonuses, why are we being forced to help now. I await someone to explain it to me.

That concludes my brief discussion about the week just gone. The comments seemed to have dried up this week. No-one has yet commented on what personality type they are - c'mon readers leave a comment or two please!

Take care all,
Thoughts just flow, when do they have to make sense?

What's your personality type?

noreply@blogger.com (2yyiam) — Thu, 25 Sep 2008 07:49:00 +0000

Apologies to my numerous readers for not typing anything yesterday. I had to endure a GP Registrar Training Day at a posh conference centre in Chesham on Tuesday and then had a day off to recover yesterday (actually, it was because I was up late reading aamals for Shab-e-Qadr). The training day has all the usual touchy-feely, I love being a GP stuff in the morning and then the rather important discussion about the various assessments I'll be having during the next year, including a clinical skills exam. The day included a posh 3-course lunch, but I was fasting - good-timing as always.

Part of the day was spent talking about personalities of GPs. We were made to take the Myers-Briggs Type Indicator assessment. A psychometric questionnaire designed to measure psychological preferences in how people percieve the world and make decisions. If that sounds confusing, it's because it is.

The questionnaire was a series of silly psychological questions about what you prefer in certain situations - are you outgoing or introverted, are you easy to get to know or difficult, are you the life of the party or just there to make up the numbers, etc, etc. The aim of the questionnaire is to define four contrasting traits to come up with a full definition of your personal character. The four types divided into Extraversion vs. Introversion, Sensing vs. iNtuition, Thinking vs. Feeling and Judging vs. Perceiving.

The questionnaire would give a result of four letters, one from each type, to describe what are the dominant traits in an individual. It doesn't mean that you display none of the opposing type, but just that the opposing type is less dominant. It means that the particular trait is what one goes to without thinking, whereas the opposing trait requires effort and thought. Putting it practically, fold your arms right now... now fold them the other way and notice how you need to put some thought and effort into it and also how uncomfortable it feels. The same logic applies to these personality types.

For those of you who know me, guess what four letter combination I had. I'll give you a clue - according to my four-letter combination I am "a hands-on learners who lives in the moment, seeking the best in life, wanting to share it with my friends. I am open to situations, able to improvise to bring about desired results. We are active people who want to solve their problems rather than simply discuss them." Anyone agree? Anyone know the four-letter combination? Answers in the comment section please.

What is the point of all this? Actually I don't know. I didn't learn anything new about myself. If I had been told what the four types were, before doing the questionnaire and then before being led through a detailed description of each, I probably would have picked the same four letter combination that my questionnaire revealed. Before I finish, a quick description of the four types:

Extraversion describes people who draw energy from action: they tend to act, then reflect, then act further. For Introversion, it is the opposite, they become less energised as they act: they prefer to reflect, then act, then reflect again. Extraverts are action-orientated, whereas introverts are thought-orientated.
Sensing and iNtution are information gathering functions. Those who prefer Sensing, trust information that is tangible and concrete, they distrust hunches or "gut instincts." Those who prefer iNtuition, trust information that is more abstract or theoretical, they trust their "gut instincts."
Thinking and Feeling are decision making functions, used to make rational decisions, based on the data received from the information gathering functions (see above). Those who prefer Feeling, base their decisions by associating or empathising with the situation, weighing the situation and considering the needs of the people involved. Thinkers decide things from a more detached setpoint: measured by what seems rational, logical and consistent.
The last pair identifies people who have a preference for using either the Judging function (Thinking or Feeling) or the Percieving function (Sensing or iNtuition) when related to the outside world. To avoid the growing confusion, putting this as simply as possible, if you are a Judging person, then your Thinking or Feeling is dominant and if you are a Percieving person, then your Sensing or iNtuition is more dominant. If you are a TJ the world appears more logical, if you are a FJ, you are more empathetic. If you are a SP, the world appears concrete and for NP, the world is more abstract. Judging types prefer to have matters settled, whereas Percieving types prefer to keep decisions open.

The four letter combine to describe your dominant functions. The dominant function (E or I) is supported by the secondary (auxillary) function (S or N) and then the tertiary function (opposite to the auxillary function). The least conscious function is always the opposite of the dominant function. For example, if you are an ESTJ, it means Extraverted function is dominant, and is also a Judging function (because of the J preference). The dominant function is ET (extraverted thinking) and the auxillary funcion is Sensing, which is also a Perceiving function. The tertiary funcition is opposite to the auxillary function, therefore iNtuition. Lastly, the least conscious function is the opposite preference and attitude to the dominant, IF (introverted feeling)

So, after spending enough time confusing you, it is time for deciding which four-letter combination you think you are. Once you have the four letter combo (starting with E or I, then S or N, then T or F and lastly J, or P) have a look here to see what personality type you are and whether you agree and then have a look here to see which celebrity is the same as you. If you're still interested, please let me know your types in the comments section.

Take care all,
Thoughts just flow, when do they have to make sense?