‘Tis the Season of Heated Conversations: Stuffing, Sides, and Strong Opinions

Disagreement is nothing new, but how you respond this Christmas is down to you…

It’s festive time once again, and many of our On-Call community who have been granted time off by the rota gods will be making journeys back home to see friends and family.

If there’s one experience that we can all relate to more than counting down the minutes on a Friday on-call, it’s the round-table conversations at Christmas. Santa clearly didn’t get the memo that some topics should stay parked at the dinner table.

Generational divides are real. The prevailing narratives and opinions of our parents’ and grandparents’ eras were shaped by the cultural and socio-economic realities of their time, just as ours are today. For instance, while older generations may reminisce about the golden age of the NHS in the 1960s (when the service had just 66,000 hospital beds compared to over 162,000 today), younger generations might lament perceived underfunding.

Mix in a few glasses of mulled wine, and you’ve got the perfect recipe for a festive House of Commons-style bust-up, complete with fiery speeches and no Speaker of the House to shout, Order! Order!

Of course, the NHS – the great leveller – has a way of sneaking onto every family’s holiday agenda. After all, a YouGov poll in 2023 suggested it’s the institution that 94% of Britons say they’re proud of. Yet, it’s also the subject of deep frustration, as nearly 8 million people in England are currently waiting for treatment.

For those of us in the profession, the topic can feel personal. Strike action, pay disputes, and the spectre of burnout – with a recent BMA survey revealing that 50% of junior doctors in the UK are considering leaving the NHS – are all hot-button issues.

In an ideal world, these discussions would be an opportunity for meaningful dialogue. When we’re young, we wish for world peace. But as we get older, we realise that a world where competing ideologies keep each other in check is probably the best we can hope for. Yet, family debates often go off the rails for several reasons.

Psychologists have found that people are less charitable in arguments with close relatives – a phenomenon partly driven by emotional proximity and long-standing dynamics. Add to this the fact that humans are naturally prone to confirmation bias, the tendency to favour information that supports pre-existing beliefs, and the outcome is predictable.

Alain de Botton notes that our families (most of them anyway) aren’t uniquely damaged; we just know them too well. Unlike the exciting stranger, they’ve had the misfortune of sticking around long enough for us to discover their entire catalogue of quirks and shortcomings - a true downside of being the incumbent. So what matters, as doctors, is how we interpret the failings that we all have.

Let’s be honest—it’s a bit optimistic to think we’ll change anyone’s worldview over Christmas dinner. So, focus on the roast potatoes, savour your hard-earned day off the Christmas rota, and don’t let politics sneak in and steal the holiday cheer.

If It’s Not Written, It Didn’t Happen

The quality of patient conversations is on life support. Our obsession with documenting every sneeze and sigh makes real conversations feel like background noise. In medicine, if it’s not documented, it didn’t happen—so we cram notes with “just in case” scenarios that rival action novels.

Safety netting is the worst offender: predicting every complication as if we’re medical psychics. This relentless documentation doesn’t just steal time; it steals focus. Instead of connecting with patients, we’re stuck feeding the insatiable monster of medical records.

If we keep this up, records will grow longer than our lunch breaks, and fear will outweigh care. Patient care is about talking, not just typing

Should Face-to-Face GP Appointments Be Mandatory?

The evidence on the risks of virtual consultations is missing— here’s why it matters.

A new petition has landed at the desk of Number 10 after 100,000 signatures were gathered, calling for mandatory face-to-face GP appointments. It follows the tragic case of 33-year-old Laura Barlow, who passed away after being misdiagnosed with endometriosis. Her husband believes a face-to-face consultation would have helped the GP recognise the severity of her pain.

Since COVID, many of us have jumped on the virtual consultation bandwagon. A systematic review of 30 studies involving over 5 million participants suggests that virtual care is just as effective for certain outcomes, including depression, anxiety, smoking cessation, and alcohol misuse. For these cases, virtual appointments can provide the same standard of care as face-to-face consultations. Additionally, they also help reduce waiting times and lower costs for patients.

However, a recent call from Imperial College, published in the Journal of Medical Internet Research, highlights the need for more data on the clinical safety of virtual visits. So it’s worth asking ourselves: what do we miss out on when patients aren’t sitting in front of us?

The obvious answer lies in clinical skills. While technology has blessed us with “The Donut of Truth” (a.k.a. the CT scanner) and fancy blood tests, clinical acumen remains indispensable. You can’t hear a murmur through a screen, examine an abdomen, or peer into someone’s eye. Proponents of virtual care argue that if an exam is warranted based on history, the patient can always be called in. In this model, virtual consultations serve as a form of triage. Fair enough—but how well does this system work day-to-day? That’s a question we still lack data to answer.

But there may be a deeper, more foundational issue. As seen in Laura Barlow’s case, her husband believed that a face-to-face consultation would have allowed the GP to pick up on her non-verbal cues—body language, posture, and the subtle signs we rely on to make a diagnosis.

Research backs this up: a 2007 study from Bridgewater State University found that extroverts express themselves more authentically in face-to-face interactions compared to online ones. Non-verbal communication plays a critical role in the doctor-patient relationship, and it’s hard to replicate that through a screen.

There’s no denying that virtual appointments have their place, especially in a system as strained as the NHS. But over-reliance on them, while convenient, risks overlooking the nuances of patient care that only come from being in the same room.

“Christmas is around the corner and if you want to crush an anaesthetist’s soul then the only option is a yellow name tag with '“Cannulation service” as the job title.”

“When are we going to raise the question of whether the rise of medications like Ozempic will kill the speciality of bariatrics”

“I had to shadow a receptionist during my GP placement in med school :/”

“An M&S sandwich got me thinking about the benefits of obesity in each speciality. For example, as a rad, visceral fat is my friend. There’s nothing nicer than opening up a CTAP and seeing each organ and loop of the bowel separated from its neighbour by a few cm of fat. These people almost certainly get more accurate CT reports.”

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At which stage do you think we are most prone to falling at the ‘humble hurdle’ due to a bit of arrogance?

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Statistics can be tricky, and Berkson's paradox is a good example. Here’s an analogy to explain:

If we look at a population who have had bike accidents and ended up in an intensive care ward, those who wore helmets are less likely to survive than those who didn’t.

To land in the ICU with a helmet, your crash was likely catastrophic. Meanwhile, less severe crashes where helmets saved lives don’t make it to the ICU at all. This skews the data—because we’re only looking at ICU patients, not all bike accidents.

In reality, helmets still save lives. The bias comes from focusing on a specific subset of outcomes, not the full picture. It’s a reminder that stats can be tricky… but they’re no match for common sense.