Monthly Archives: January 2011

The politics of identity: Gender, TV and the internet

This week in my time machine I have been mostly travelling to 1973. Oh no, hang on, that’s just Sky Sports. Phew, because in 1973 I looked like this:

If I have to turn back the clock, I’d rather go back to 1998 and start again from there.

 Anyway, the mystery that is Andy Gray. Frankly it’s a mystery why a man with so few talents that are so well hidden; who has seen better days and was pug ugly even back then, and who has all the personally redeeming features of a UKIP member, feels qualified to comment on the looks and abilities of an attractive, intelligent young woman who was doing a damn fine job and who understands the off-side rule to boot. Any more sackings like that and who knows I might regain my faith in human nature. OK, let’s not go that far, but don’t let the door hit your arse on the way out, Andy, love. Normally I would be kinder to someone standing up to the Murdoch empire but I have no time for someone whose first thought about a new team member isn’t ‘Can she do the job?’ but ‘Is she eye candy?’ Oh, and if you really want someone to attach a microphone to your dick, I recommend that they use a bulldog clip.

 It’s been a week when I have pondered things about identity and sex difference. I can create an entire identity on here and put pictures of myself up but for all any of you know I might be a 58 year-old male software engineer living in Crawley who’s never been near a horse or a bike but who has a talent for trawling the internet and making shit up. Actually that’s not quite true, excuse me whilst I wave to my mum <Waves>. On the internet I can be whoever I want to be, or at least whoever I can convince other internet users that I am. Real life is trickier. My primary identity, the feature of which I’m most aware in my daily life is that I am a woman, closely followed by the fact that I’m a redhead. Obviously I’m not thinking about these things all the time, but when builders start singing O Solé Mio to me and calling me a spicy meatball, I tend to be acutely aware of the genders of everyone involved in the interaction.

 Channel 4 has a new show, a sort of spoof current affairs programme, called 10 O’ Clock Live. It features 3 men and a lady. Charlie Brooker—funny writer, TV presenter. David Mitchell—comic actor, does panel shows. Jimmy Carr—does stand up, irritates me to the point of violence. And Lauren Laverne. Token blonde woman. Why this uneven mix of the genders? This has been discussed on Christina Martin’s blog and I can understand the choice of Laverne who is intelligent and funny. But why not a female comic in the place of Carr? Well actually you could replace Carr with a pot plant and not reduce the comic effect but that wouldn’t realign the gender imbalance very effectively. This line up seems to bring home one point—men are funny, women are blonde. So are men funnier than women?

 Well no, obviously. Both genders are quite capable of being funny, just as they are both capable of being so dull that I start trying to see if I’ve got split ends in my hair and wonder if I can sort of hack them out one by one, using only nail scissors. But what of the accusation that men make jokes about life in general, whilst female comedians can only joke about being women. It’s all makeup and periods and how your first boyfriend had, oh hi mum, didn’t see you there.

Personally, if I realise that the line up for HIGNFY is an all male one I no longer bother watching. I get tired of the back-slapping, self-satisfied, 30-minute smugfest that is the  general result. I see the humour as male but I think we’ve become so used to seeing life in general from a male perspective that we no longer realise that it is a male perspective. The problem is that the baseline from which we judge humour is gendered, but that gender has become invisible because it is so predominant we see it as normal. We see men on TV, men are funny, so we reason that that’s what it is to be funny. So when a woman makes a joke we see it as different from this norm and different in a way that is gendered. Female humour is often, though not always, rather more self-deprecating. We move through the world in a slightly different way. Female humour is often about not feeling cocksure, what with not actually having a cock.

To give you a more detailed example—Rhod Gilbert trying to buy a duvet.  I find this quite funny, up to a point. The delivery makes it funny, even if he is using that peculiar comedy genre known as ‘Perhaps if I just shout a lot they’ll laugh’. But the content is more dubious. Essentially he’s just being rude to a female shop assistant who is trying to do her job, including seeming to think it’s funny to punch someone. Yes, I know he made it up and it’s funny, right. Not really, no. It’s just violent. Second, it’s only really funny if you are so spectacularly stupid that you can’t work out that a duvet needs to be thicker in winter than in summer what with it being a bit colder at that time of year. Frankly I don’t think you need to be a domestic goddess or lacking in Y chromosomes to work that one out. But make no doubt about it, that Gilbert sketch is about a man being unable to cope within what is traditionally a female sphere. It’s comedy about being a bloke and is as male as any of Jo Brand’s 1980s comedy was female.

I think men probably do not realise the extent to which as a woman, you are almost always aware of your gender, and how often you have to disguise your looks. Of course I’m generalising here—this disguise is something women tend to do more often than men, but it’s not an absolute rule. But how many men can say that they have deliberately dressed to make themselves less attractive because they know that they will be judged on their attractiveness rather than their ability? I know that I have done this—big baggy jumpers, loose trousers, flat shoes, make sure people cannot see what you look like as a woman because then they might judge you as a person rather than as a female. I know that many other women of my acquaintance have done this. And how many men find themselves thinking, on a warm spring day as they unzip a jacket, ‘I’ll just wait a minute until I’m past this building site, don’t want to set them off’.

Of course on the internet, I do not have this problem. I can go into chatrooms and log on as the amorphous Captain Codswallop or the Brigadier Ballsache and either not state my sex, or claim that I am male. A female friend of mine does this although she had to stop going in one chat room because a heterosexual woman fell in love with her and started stalking her. On the internet you can only really judge me on my words. I can put forward opinions that are not my own, under an assumed name, and if they don’t work out, I just never go in that chat room again. I can be Ballsache one day and Codswallop the next. Heck, if I were a little more clever with my browser I could log on as both and have a conversation with myself. I can be what and who I want.

 I’m intrigued, when I post under a gender-neutral name, how often it is assumed that I am male. I don’t think this is sexism—I’ve known men who post on the internet be mistaken for being female. But when I take those tests to see if your thought patterns are more in line with typical female brains or with typical male brains I get told that I have a male brain. (I’ve often wondered whose it is and if perhaps I should give it back). Not only is it male, it’s extreme male. It’s so male that ‘normal’ men and women have more in common with each other than either of them have with me, apparently, which might explain quite a lot. Or nothing at all.

And yet in real life I get decidedly ratty if someone mistakes me for a man. Generally this only happens when I’m on my bike and travelling at speed since anyone actually looking and not in need of an optician wouldn’t make that mistake. I find it disheartening to say the least that anyone slim, fit and going fast on a bike is assumed to male plus the fact that, sorry guys, I find it rather insulting to be viewed as male in appearance. In this respect the athlete Caster Semenya is far more level-headed than I am, as she recently spoke out on Newsnight about the row over her gender, declaring that it didn’t really bother her. In July 2009 Semenya knocked more than seven seconds off her 800m personal best at the African Junior Championships setting a national record and the fastest time for women’s 800m that year. Accusations followed that she wasn’t quite female because of course a woman who’s good at something must be partly male.

My own sport—horse riding—is one of the few in which men and women compete on equal terms. Of course when I use this as an example of a sport in which women can beat men I get told it’s not really a sport. This is somewhat confusing. OK, it’s not confusing, it’s a clear example of how people will twist pretty much anything if it means they get to retain their prejudice. It is annoying though. For the record, that most pretty of equine sports, dressage, which looks like a lot of running around in circles, is military in origin, so it’s about as stereotypically male as you can get. You need an obedient horse if you are going into battle. It helps if you have one obedient enough to leap on command and scatter foot soldiers, or who will rear up and give your blows the force of a horse’s weight as well as your own. Eventing is also military in origin. The cross-country phase of advanced eventing is so dangerous it could be ranked as an extreme sport.

Perhaps one of the things that made me fall in love with horse riding so much is that when I am on a horse, I don’t have to worry that I will be judged for how I look or whether the jumper I am wearing is suitably baggy. I can’t be intimidated by what anyone says when I’m on the back of a 500kg animal. The Andy Grays of this world, who can make workplaces in particular and life in general so unpleasant and intimidating, melt into nothing when I am around horses. It’s one of the reasons they make the world seem right, when there’s often so much evidence that it is wrong.

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Saving Derby’s leg: A diary of a tendon injury, part 2

The vet outlined a 4-stage recovery plan for Derby, each stage to last around 6 weeks. Stage one was walk work in hand; stage two was walk work under saddle; stage three build in some trotting work; stage four, get back into the school and build up to ‘normal’ work. Stages one-three were all to take place on the roads. So we began walking him, in hand. I say ‘we’ because there were four of us on a rota. Oliver had pretty much read us the riot act on this one. No days off. Three times a day every day followed by ten minutes of cold hosing. And NO days off. Did I mention NO DAYS OFF. Also 3, THREE, count them, THREE times a day. So I drew up an Excel spreadsheet and marked off the dates and the columns, morning, lunchtime and afternoon and filled in the ones I could do, so that Clare could then organise her staff rotas around a tendon injury. Clare, myself and two of the women who worked for Clare commenced Operation Derby’s Leg. I don’t think I’m the only one who started to get a Proclaimers earworm and found myself muttering ‘And I would walk 500 miles and I would walk 500 more’ on a frequent basis. This wasn’t too bad when I was leading Derby, but it got me some strange looks in the supermarket.

He had to walk for 20 minutes each time and here was the snag. Derby doesn’t really get walking, not ridden or in hand. He’ll slop along, scuffing his hind feet. You can get after him and make him walk but he is incredibly good at gradually, millimetre by millimetre, taking shorter and shorter steps so that you find yourself shuffling up the lane wondering why a snail has just whizzed past. Chase him up too much and he can actually go backwards. In the school this is not a problem, there are all sorts of ways of keeping him interested so that he ends up walking well without realising it, but on the roads when you are not allowed to trot, there are few options.

In less troubled times, before the tendon injury

Add into this mix the fact that Derby likes to talk. He witters away to you when you are riding him. There’s an almost constant conversation going on, in that respect he’s very like a stallion or a purebred Arab, even though he’s actually an Anglo-Arab x Hanoverian gelding. But riding him you quickly learn to tune into his voice ‘No, not the bins, mind that, mind that bracken, dear god no, I don’t go near dock leaves you KNOW what happens with dock leaves, oh look, Sarah’s ponies are out up there. COW, COW ALERT COW IN HEDGE, oops, sparrow, didn’t see that there, hang about, car coming, let’s pull over’. (In all seriousness, I ride him on single track lanes, he knows we pull over for cars, he hears them before I do and pulls into the nearest passing place for them well before I’m aware of their approach. I’ve learned to listen carefully to him). If you fail to listen to this voice he has a tendency to buck to get your attention. Not a big buck, but if I’m out with another rider and we are talking about their horse, I’ve got around a minute before he does some kind of leap or buck to ensure the conversation turns back to him. Leading him in hand made this conversation difficult because there was no immediate physical contact, reducing my ability to hear his voice. So he would grab hold of my sleeve with his mouth and wave my arm around as we walked up the road. All four of us learned to wear thick sleeves, because telling him off for this would involve him leaping backwards and the conversation quickly became ‘Help, help, get the RSPCA on speed dial, she’s trying to beat me up. AGAIN’.

We timed ourselves walking. Ten minutes out, see how far you can get in ten minutes, turn around carefully, ten minutes back. We used the passing places on the lanes as markers and tried to get a little further with him each day to improve his walk. I was approaching exhaustion but there were no other options. He was my horse, my responsibility. I was lucky to have the dedicated help with him that I got but still it was tiring. Walking, in addition to my usual cycling, made me lose weight that frankly I did not have to lose. But Derby was getting sounder. The vet had told me that I could turn him away for 6 months but he warned that if I did that, the tendon was more likely to heal as lumpy scar tissue that would not be sufficiently strong and elastic, and less likely to heal as nice, neat bundles of fibre. Steady, frequent work for short periods was what he needed. And Derby seemed fine with it. After all he was working for an hour a day, even though he wasn’t being turned out. We had no choice but to walk him up a slight incline so that gave him even more work and even if he was a little excited the first time out, by the time he got to his afternoon walk he was generally calm.

After about 4 weeks of this the vet came to see him again. Derby led up sound in walk and a little unsound in trot although that may have been his laziness and my reluctance to chase up a horse who by that stage had not been turned out for almost 3 months. Because of the lack of soundness, Oliver advised us not to ride him for another week and then only to ride him in walk. Then he said ‘And don’t put ten ton Tess on him’. Clare and I looked at him slack-jawed. Neither of us weighs more than 9 stone and at that point, with all the walking, it was probably considerably less. We were the only ones who ever rode him because one of the many things he has quite firm opinions on is Who Is Allowed On My Back. We asked Oliver how often he would need to go out once he started to be ridden. ‘Oh twice a day, like he’s doing now, like I said before’. More slack-jawedness. ‘You said 3 times a day. Three, count them THREE’. Waving, fortunately, 3 fingers in the air. Exhaustion may have frayed my temper. Oliver shuffled. ‘I always say three times a day because if I say twice a day everyone ignores me and only takes them out once a day, if that. So I say three times. Don’t worry if you have been taking him out three times a day though. You could do it four times a day if you want to’. There wasn’t much room for any more slackening, just a sort of universal shout of ‘Day jobs, we have other things to do. It’s not all Operation Derby’s Leg you know, it just feels like it’.

Turns out that people generally don’t follow the vet’s advice to the letter. It would have been OK for Derby to have been walked twice a day and for him to have one day off a week. Oliver had just not taken into account our punctiliousness in following instructions. So a week later we switched Derby to one walk in hand per day, plus one ridden walk, plus cold hosing. He remained amazingly level-headed, I think because he had got into a routine and accepted it and because he was going out so often, even if his freedom was curtailed. I took to letting him graze in hand at particular points where it was suitable, because that gave him a little more natural behaviour and because it was the right kind of gentle exercise that he needed. All in all he seemed happy.

We had a few alarm calls however. Up until his tendon injury Derby had been very healthy and had never needed to see the vet in the five years I had had him. But one evening, as I was cold hosing his leg, he started to stamp on his off hind leg as if he were irritated. As I led him out of the wash box, he had problems putting weight on it. I called Clare over. We watched, horrified, as his leg started to swell. I got him back into his stable and the swelling continued. We couldn’t bandage it as restricting the swelling could well have done more harm. By the next day the entire leg was 2-3 times its usual size and his other two good legs were also up, although the damaged one was not. We had thought it might be a foot abscess but the rapid spread of the swelling indicated something else. Blood tests showed that he probably had a viral infection. He was evidently under the weather, although he was eating alright, and for several days we went back to walking him in hand but just gently for a few minutes each time to try to boost his circulation, nothing more.

Once the swelling had settled we started to bandage his legs although we met with more firm opinions about Not Wanting My Legs Bandaged Thank You Very Much. Bandage shredding is an expensive hobby. Fortunately Clare had an unwanted pair of neon pink stable bandages she had been given as a present. We reasoned that we were on a win-win situation with them. Either Derby would accept them and not take them off, which would be good for his legs, or he would shred them as he had so many other pairs in which case we could legitimately say to the present giver ‘We’re terribly sorry, Derby wrecked your present. It’s very odd, he never does things like that’. As it happened he made one attempt on the pink bandages and succeeded in pulling them up above his knees, so he looked like a 1980s Fame reject in neon-pink legwarmers.

Towards the end of November he had another scan. The tendon had all but healed –there was a slight roughening on one edge but that might have been normal for Derby. We were allowed to commence trot work, although much of the time Derby interpreted ‘trot’ as ‘leap really high. Oh look, she’s still on board. Bit higher. I know, let’s capriole’. In the end, I don’t think this did him much good, although I tried my best to keep him calm. As I will recount next week, in February disaster struck. I had thought that if the scan showed the tendon to be OK it would remain OK but sadly this was not the case and Derby developed a hole in the same tendon. The vet was to add another 6 months on to his recovery time.

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A Devonian take on the health reforms

An NHS business manager once told me, quite seriously, that the NHS should be run strictly along business lines. Given that this was slap bang in the middle of the 2008 banking crisis it seemed to me that she had not thought through this statement thoroughly. I briefly considered asking her which business model she had in mind, did she, for example, admire the way the Lehman brothers had managed their trade? What did she think of Taylorism? Fordism? A cottage industry model? How did she feel about the Peter Principle? What did she mean by ‘business model’? Was she linking this with capitalism? What did she think of Adam Smith’s theories on the division of labour? Thinking more widely, did she follow Herbert Spencer’s idea of the survival of the fittest and if so how did that fit in with the ideals of the NHS? However, at the time I was temping for £6.50 an hour whilst she was probably on about £35k per annum so it seemed more sensible to keep quiet and keep data inputting, even though looking at the data I was inputting I could think of at least 6 ways to save the NHS money, starting by sacking whoever had designed the inept survey from which the data had been drawn.

Let’s think for a moment about a type of business with which we are all familiar – supermarkets. Leave aside for now the vexed question of the ways in which many of them treat their suppliers. Since MPs of various hues often say that they want the NHS to be patient-centred, if we are going to use a business analogy, let’s examine this from the customer’s viewpoint. Towards the end of the month when my salary goes into my bank account, I might take a trip into Marks & Spencer’s or Waitrose. Feeling a bit flush, I’ll probably opt for something in the Finest/ Bestest/ Poshest/ Middle-class pretentious range. Give it a couple of days and I will have calmed down enough to head for Sainsbury’s. I’ll probably shop in there for most of the month, although whereas I’ll start with the Posh range I’ll end up grubbing around on the supermarket floor trying to wrench the last packet of 35 pence basics shortcakes from the back of the lowest shelf, because that’s the kind of woman I am. In the days just before the next pay packet I’ll be in the Co-op at around 7:45 pm, in the 15 minute gap between them bringing out the knockdown-price yellow stickers, and hungry hordes of underemployed, pissed off bargain hunters running away with all the reduced price bread rolls. In the midst of all of this there might be a trip or two to a large German discount supermarket to stock up on olive oil; loo roll; tins of tomatoes; cheap pasta and whatever cleaning products I suddenly think I need, whilst I try to avoid the middle section with all the shiny trinkets; illuminated house numbers; saucepan sets; lava lamps; gardening gloves; bird food; diving equipment and dehumidifiers because I don’t need that stuff and buying it will defeat the object of going into a cheap store in the first place.

Is this the business model I want for the NHS? No. In so many, many ways, no. Businesses which are badly run and which fail are allowed to go to the wall and I do not want parts of the NHS going to the wall. Neither do I want this kind of choice. I just want good quality treatment. I don’t want to think that somebody else is getting much better quality because they can afford it, whilst another person is getting an inferior product because that is all they can afford. Neither do I want more popular parts being given more funding for R&D whilst those less under the pressure of consumer demand are allowed to wither on the vine. So is there a way of reconciling a business model which depends on offering choice and variation, with the NHS which was built on the idea that it should be free at the point of access and equally available to all?

In announcing the reforms to the NHS this week, Cameron went to great pains to point out that he was not driven by ideology but instead was concerned only with saving lives. In essence the Tories (or perhaps the coalition, who can tell anymore?) want to streamline the NHS and give power back to the clinicians but I’m not sure that they have thought this through any more than my business manager had thought through her remark. Looking at this from the perspective of someone who has worked in a non-clinical capacity in primary care and is trained in the history of medicine, I would say that those who are unaware of their history are doomed to repeat it. And the Tories seem deliberately unaware of the NHS’s history. They plan to abolish the Primary Care Trusts and Strategic Health Authorities, placing the majority of decisions in the hands of GPs. But I think if you are going to do this you need to ask yourself where did the PCTs come from and what is it really like dealing with the NHS on a day-to-day basis?

The 1997 paper The New NHS set out the aims for Primary Care Groups. These were to bring ‘together GPs and community nurses in each area to work together to improve the health of local people’ and they would ‘be subject to clear accountability arrangements and performance standards’. They were to commission services and monitor performance. One paragraph is worth quoting in full:

5.18 For the first time in the history of the NHS all the primary care professionals, who do the majority of prescribing, treating and referring, will have control over how resources are best used to benefit patients. By cutting through the artificial barriers that have been erected between drug budgets, hospital referral budgets and emergency admission budgets the Government will give real choices about how GPs and community nurses deploy their cash. In this way Primary Care Groups will extend to all patients the benefits, but not the disadvantages, of fundholding. By virtue of their size and financial leverage, they will have far greater ability to shape local services around patients’ needs.

 PCGs became PCTs as attempts were made to place power back in the hands of the clinicians. So how did they end up growing so rapidly and why did they employ so many non-clinical staff, including business managers? There are many reasons and this would repay a full study, comparing the different PCTs with each other, analysing their growth, asking why smaller PCTs merged into larger groups. If we can understand this fully, then we can begin to understand why the NHS is in the shape that it is and the challenges which the proposed GP consortia will face.

So what about the 2010 paper? What does it promise that is different from PCTs? I, like many others, suspect the new GP consortia will start to look very like the old PCTs, and in fact will include many of the same staff, simply because this government has not taken the time to understand why those PCTs evolved or how the NHS works. I am not convinced that revolutions produce either permanent change or change for the better – in fact history is littered with examples of revolutions that have produced the new boss, same as the old boss.

According to Equity and Excellence: Liberating the NHS,  patients will ‘have more choice and control, helped by easy access to the information they need about the best GPs and hospitals. Patients will be in charge of making decisions about their care’. Why? I mean I like being in charge of deciding whether today is an Aldi day or if I would prefer Sainsburys. I like choosing digestives rather than shortbreads. But I don’t want to choose which hospital is best. I want them all to be good. And if they are not good, rather than being given the option to go elsewhere, I want the poorer hospitals to be improved. Otherwise what happens to those hospitals which patients do not choose? Are they branded as failing? Are they bought out by Tescos? Is this really the best use of funding? I don’t want to be in charge of making decisions about my care. I want to be involved, in the way that I was involved in making a choice about taking anti-depressants or not (not, in my case, my horse is fortunately the best anti-depressant I can find and my GP is wise enough to know this). But I don’t want to be in charge. In the back of an ambulance after an accident I don’t want a league table of hospitals presented to me followed by a surreal conversation in which paramedics say ‘well it looks like your leg will fall off, would you like to go to Derriford, they’re good with legs. Oh no, hang about, there’s a problem with your arm, would you like to go to the RD&E instead love?’

Apparently in the new NHS, sorry the New New NHS, there will be a focus on clinical outcomes. Health professionals will be empowered. ‘Doctors and nurses must be able to use their professional judgement about what is right for patients’. Well yes, that’s not exactly contentious. Just hold on a minute whilst I set my time machine for 1997, I’m sure I heard something similar before. The 2010 paper goes on ‘Healthcare will be run from the bottom up, with ownership and decision-making in the hands of professionals and patients’. Pardon. For starters my inner copy editor is annoyed by superfluous hyphens. Adjectives are hyphenated so ‘decision-making what’? Or just ‘decision making’. And anyway, what does this mean? Have you ever been in a hospital? What do you mean by saying that healthcare will be run from the bottom up and then saying it will be run by professionals? Why do you think professionals are at the bottom? And do you not realise that those professionals currently have their own hierarchies and trust me, you disturb them at your peril.

Go further and we have 4. c ‘patients will have choice of any provider’. Really? If I require out of hours care and I’m in Devon, can I really decide that actually I prefer OOH care in Dorset and demand that I get that? This is the problem with offering choice, in reality it may well be a choice of A. or, if you push for it and are really lucky, errm, how about A? There are some services that simply were not meant to be subject to market forces because their very nature and structure does not allow for this. We don’t really have choice with the railways either, since you cannot run two competing services on the same tracks and having two tracks in the same location makes no economic sense. The same is true of healthcare. If you want it to be equally available to all, then ensure that all of it is equally good.

According to 4d I can also, as a patient, rate the services I am getting. Now this worries me. It really, really worries me. Have you ever read online reviews of services? I have. People will review a CD and trash it because basically, it is not to their taste. They will review clothing and say they don’t like it because it was designed for someone tall and they are not tall. If you work in a complaints department within a healthcare organisation you will quickly realise why people complain. The complaints are diverse and whilst many are well thought out and reasonable, some are not. Try explaining to someone that a visit will be carried out according to clinical need, not their transport availability, and they will mark you down. Try explaining that disease is a process and no doctor would have been able to make an exact diagnosis of their very unusual condition early on and they will mark you down. As valuable as patient feedback can be, patients are not always best placed to decide what constitutes good care.

Moving on to 5. j. ‘Quality standards, developed by NICE will inform the commissioning of all NHS care and payment systems. Inspection will be against essential quality standards’. Now that sounds good, on first glance. However, I have a couple of issues. First, how do you really know that your provider is telling you the truth? Because in my experience you can set the standards and providers will give you a report telling you they meet those standards. Personally I would be inclined to check very carefully that that is indeed the case.

This ties into the second and more fundamental problem. Let’s say that a patient is seen by their GP. Their GP refers them into a hospital to see a specialist. The patient decides that the GP should have seen and diagnosed them earlier, that the wait in the hospital was unacceptable and that the specialist they saw in the hospital was uncaring. They decide they will complain about this to the NHS, because to them it is all just the NHS and if they make a complaint it should be to one body. Except that even now, it is not. Their GP is governed to some degree by the PCT, so a complaint about a GP needs to be addressed by them. The complaint about the waiting area and its lack of comfort needs to go to the hospital. Whereas the specialist is provided by a third organisation and a complaint against them needs to go to a social enterprise company. As far as I can work out, this government’s proposals will make this whole scenario worse, not better. The NHS will be more fractured, more diverse, and more confusing to any patient trying to negotiate it if the coalition persist in the idea that multiple providers are the answer.

I could go on. And on. I could spend all week going through this and explaining why I think it won’t work. But what it boils down to is this: If you really want to give power back to the clinicians, how about you ask them what kind of reforms they want? Or have you just realised that if you do that, they will turn you down, given the concerns already expressed by members of the British Medical Association? Why not draw breath and take a long, careful look at the NHS. Work in it for a while, or at the very least spend time talking to those people who do. If you must waffle on about using clinical evidence, then why not actually examine that properly before you just yell ‘Oh look, our rates for cancer survival are a bit pants, let’s have a revolution’. It may not mean that the whole NHS needs reform, again. It might just be that you need to work better with oncology services, or work out why cancers are not spotted earlier. Reforms in themselves do not bring about efficiency – indeed they often delay it.

In my experience the NHS is a behemoth but it is far from monolithic. It is a huge beast that has, like most large organisations, acquired a sort of institutional inertia where change is concerned. If we could turn the clock back 65 years we could relaunch the NHS but we have over 60 years of history as its structures have evolved, put down roots, taken on an almost organic form. Cameron’s changes appear to me to be far more about ideology than anything else, since they have only a very shaky evidential basis. The NHS needs consideration, some careful pruning. Reforms need to be based on evidence and undertaken with a greater understanding of how the various parts of the NHS work and how and why they have grown, otherwise in another 15 years time another government will disband the by then bloated consortia and again announce that clinicians need more power.

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Six of the best: Some of the stupidest things I have heard whilst cycling

And in at number 6 we have:

 6. “You should use your legs! Why don’t you people walk!”

I was tempted to place this higher up the list, such was its sheer idiocy. However, I am most interested in the oddity of remarks made by apparently otherwise sane people when faced with a cyclist. Whereas the individual who made this comment was clearly differently eccentric or, as one might say, utterly barking mad, in a way that verges on not being funny because I wondered if he might need serious help.

I was cycling up one of Devon’s steeper hills. To be honest I can’t have been doing much more than about 6mph when I saw ahead of me two pedestrians walking in the middle of the road. Now let’s be clear on this, it was a two-way street open to motorised traffic and bikes. I was in no way, shape or form disobeying the law or the Highway Code. I rang my bell to warn the pedestrians I was there, and carefully went around them, when I was greeted with the comment about using my legs.

Given that I had not in fact levitated up the hill like some new-fangled dalek I wasn’t quite sure what part of my anatomy this man thought I was using. I was careful, I had warned him I was there and he was, when all is said and done, walking in the middle of the road when there was a perfectly good pavement available. I’m all for pedestrians’ rights and do think that the roads should not be a no-go area for them but this really was as astonishingly rude as it was nonsensical.

5. “It’s not a great big cycle path you know”

Yes, yes it is. It is in fact a National Cycle Route. It has big blue signs along its length apprising you of this fact. It has different coloured tarmac. It has bollards separating it from the pavement. It has bloody great white bicycles painted along its length. It has done everything in its power to make you aware of its status short of jumping up and hitting you whilst yelling ‘Hello, hello, I’m a cycle path’ so why in the name of my blue-rinsed grandmother you haven’t noticed this fact is beyond me, given that you do not have a labrador with you, or a white stick.

4. “Well you could go on the pavement”

This really was one of my favourites. Given how often pedestrians will have a go at you for cycling on the pavement, even when you are clearly either on the road or on a cycle path, to be told to go on the pavement did leave me wondering which particular parallel universe I had wandered into and quite what substance or substances I had inadvertently consumed the night before. I was cycling on a cycle path next to a footpath. There was a young woman ahead with a small child (I would guess around 4 years old) and both were on the cycle path, with the child wandering around on its own. I warned her it was a cycle path because in my experience people do not always realise this and because I was worried that the child was at risk, given the speed of some of the cyclists who used the path.

Actually she was wrong about me being able to go on the pavement – she had every right to be on the cycle path, though she would have been better off on the pavement. If I had gone on the pavement I would have been in breach of the Highway Code and if an accident had occurred I would have been liable.

3. “You shouldn’t be cycling on there”

This one was in fact true, I should not have been cycling down that particular alleyway. Which is why I had dismounted and wheeled the bike down it, making the remark at best redundant and at worst indicative of reading a few too many Daily Mail articles about the horrific things that cyclists do.

2. “You shouldn’t be on the road”

This is more of a generic, all-purpose insult that drivers like to shout at both cyclists and horse riders which roughly translates as “I spent a lot of money on this car and for some reason think I should be allowed to go exactly where I want, when I want and at the speed I want totally unimpeded by any other individual”. Of course the reality is that they are often impeded but rather than shout at other car drivers, causing an existential crisis as the other driver is only doing what they are doing and they would therefore in effect be shouting at themselves, they shout at whoever else is around. Actually, buggalugs, I am here by right because it is a public right of way (the clue is in the name). You are here under licence and if you are going to be rude all the time frankly I think you are the one who shouldn’t be on the road. Another candidate for the “Jebus, who let you off the lead and could they please round you up again” award.

The same goes for that blindingly awful comment “The road conditions are so bad I cannot see you, it’s dangerous you shouldn’t be on the road”. Well I can see you and your half-ton of badly-operated rust bucket despite the fact that it is indeed widdling with rain. If you cannot see me then get off the road and go to an optician. You have just admitted that you are not fit to be out here because you cannot see and what on earth makes you think that your journey is more important than mine and therefore it is me that should stay at home, when I’m not the one risking other people’s lives.

But the winner has to be a driving instructor teaching a learner the art of the SMIDSY (sorry mate, I didn’t see you). So at the top:

1. “You were in her blind spot”

How? How in the name of blue buggery’s betsying nonsense can you be in someone’s blind spot when you are in front of them? What are you on? Did you take the same stuff that I took just before someone told me to cycle on the pavement? Are you seriously telling me that your learner has a blind spot 12 feet in front of her nose?

For the record I was on a roundabout, actually on the roundabout so I had right of way over traffic to my left trying to get onto the roundabout. It was a 20mph zone and since I was nearing the end of a 2 mile downhill stretch I was pretty much doing the speed limit and I was in primary position – middle of the lane, not in the kill zone, in my lane, going at the speed of the traffic. OK, going at the speed the traffic would have been going at if anyone took any notice of speed limits. The learner was in front of me trying to pull out of the exit just before the one I wanted to exit at and either at her own instigation or at that of her instructor she did the classic ‘ach, who cares, it’s only a cyclist’ and pulled onto the roundabout meaning I had to jam on the brakes. It’s something drivers do every day and it kills people. I will not have instructors teaching people to do this.

I followed her. It’s possible I may have shouted. A little bit. Sometimes I shout. I may have used a word relating to parts of the male anatomy followed by ‘brained’ and ‘moron’. So three words, the first word is often associated with dogs and the first two words alliterated nicely. I caught up with them at the next roundabout and asked what they were up to which was when the instructor claimed I had been in the learner’s blind spot.

Words failed me. OK, that’s not true. Polite words failed me. The rude ones were nice and reliably lined up and available to most people within a two-mile radius. Risky behaviour on my part? Possibly. But nowhere near as risky as seeing someone drive like that and not saying something to make them aware of their mistakes.

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Saving Derby’s leg: A diary of a tendon injury, part 1

It was a hot, sunny August afternoon in 2009 and I brought my horse out for a lesson, as I had on many weekends. I’m experienced enough to know that when you tack up any horse you check it over, almost without thinking, for any signs of injury. I’d seen none on Derby but he felt a little odd in walk. This is not unusual for him, he can be a bit idle and he knows that if I think he might be lame, I won’t push him as much and he’ll get away with being lazy. So sometimes he likes to pretend to be a bit lame. Moving him up to trot however everything felt horribly wrong. I called to (let’s call her) Clare, who owns and runs the yard I keep him on and who also teaches me. Clare quickly saw that he had tweaked a tendon and I cursed myself for not noticing the heat in his off fore whilst I was getting him ready.

At this stage there was little we could do. When a horse first injures its tendon you need to wait before you do anything, as the damage is ongoing and needs to settle before you can make any diagnosis or prognosis. We put him on box rest (i.e. kept him in his stable and did not turn him out in the field at all) for a week. Three times a day we hosed the leg with cold water for 20 minutes each time. The vet came and saw him briefly, told us to keep doing what we were doing, and said that he would return in a week to perform an ultrasound scan. At this stage, although Derby was lame, he was not in any particular discomfort when standing still and he seemed to rather enjoy his new routine. No work, and three times a day he had a captive audience as either  myself, Clare, or whoever else we could rope in, sat with him and poured cold water down his leg. Derby loves attention and having some captive pixie perched on a stool within reach of his inquiring nose was wonderful as far as he was concerned. If he ever had to list his hobbies, hair chewing would rank quite high.

For me, it was not a good week. Derby remained completely unperturbed as I tried to work out the implications of what was going on. A horse’s foreleg is a highly specialised structure. The large joint about half way down that we refer to as the knee is the anatomical equivalent of the human wrist. Below this there is no muscle in a horse’s leg—only bone, tendon and ligament lie beneath the skin. The tendon that Derby had injured was the superficial digital flexor, i.e. the tendon nearest the skin’s surface that flexed his foot. This tendon at times carries a horse weighing around 550kg at around 30 mph (greater speeds than that if Derby were a racehorse. Fortunately, although he sometimes disputes this fact, he actually isn’t). It runs down the back of the cannon bone, a bone equivalent to the metacarpals in your hand. But it does a much tougher job as a horse is essentially running around on its finger tips and they are large animals that run at high speeds. And where you have five metacarpal bones to take relatively lesser strain, the horse has one.

Tendon injuries are often very serious. As the vet was later to explain to me, the initial damage to a tendon often causes few problems. However, the body’s response to an injury is for blood to rush to the area to help heal it. The area then swells. This is not a problem if there is room for swelling. If you bash your leg, damage within the muscle will hurt but it will recover in time. However tendons are different. The tendon fibre is encased by a tendon sheath that gives strength and allows ease of movement but when a tendon is injured the sheath prevents swelling. So the injured tissue, unable to swell, breaks down further. It is this that causes the greatest damage. You can minimise this by cold hosing the leg, reducing the heat and swelling and encouraging new tissue growth, but by the time you find the injury the damage may already have been done. Prognosis varies—some horses will go on to race again or compete at the highest levels in other equestrian sports. Some will have their activities curtailed and may only be used for light hacking. Some may never be fit to be ridden again, leaving the owner wondering whether to keep the horse indefinitely in a field or whether to have it put down.

Without an ultrasound scan (USS) you cannot really tell what the situation is but there is no point in scanning until around 7-14 days after the initial injury so that the full extent of the damage can be assessed. So for a week owners must wait, wondering if their horse will be fine or if they must make one of the most heart-rending decisions of their lives. As I said, it was not a good week.

However, when (let’s call him) Oliver, the vet, came out to see Derby to scan him, things seemed to look up. I could not take time off work but Clare was there for the vet. The farrier trotted Derby up whilst the vet watched, and he was sound again. In fact he played with the farrier, speeding up and slowing down his trot as the farrier alternated between jogging and running, because he could, because he had been shut in his stable for a week and because he likes to play. Oliver said we were to ride him in walk only on the roads for four weeks, gradually building up the distance. Then we could introduce trot work and after two weeks of that we could start schooling him again. Whilst he was in walk work we were to keep cold hosing the leg 2-3 times each day. Oliver said there was no real need to scan the leg since all the heat and swelling were gone and since Derby was sound. It was great news, although as I was to realise over the course of the next year, getting a horse over a tendon injury is something of a roller coaster.

Horses have evolved over millions of years to run away from danger. They are herbivores and are preyed upon. Their teeth are adapted to eat grass. Their eyes are on the side of their skulls so that they have almost wrap around vision. The eyes are relatively high on the skull so that the horse can see more even whilst its head is down grazing. They have long legs to run faster, meaning they also have long necks to reach down to graze. They have large torsos to hold the large digestive systems needed to break down grass. At the first sign of danger, they run. All their senses are attuned to sense danger and they can go from a standstill to 40mph quicker than a racing car. True, over 40mph and the car has a bit of an advantage but this does not detract from the fact that all their instincts tell them to gallop off at the first sign of a problem. Now vets know this and yet they will persist in telling you that a horse that has been shut in a stable for a week, that has this itching, burning, unarguable desire to gallop, buck and play, must walk quietly for 60 minutes. It was an interesting few weeks persuading Derby that it was for his own good. He felt fine, the leg no longer hurt and he wanted to run and play.

It was worse when we started trotting. If he was allowed to trot, he seemed to reason, then he could canter for goodness sake. But walk and trot he must, and on hard level surfaces. Uneven ground can twist the leg, causing it more damage. Soft ground will pull and suck at the tendon, straining it rather than strengthening it. Only a few years ago the usual cure for a tendon injury was to turn a horse away in a field for 12 months, leaving nature to heal it. More drastically people would ‘fire’ the leg, using hot metal to scar and damage the leg reasoning that as the leg healed this extra damage so it would heal the tendon. The most recent thinking, Oliver explained to me, is that tendons need careful, controlled exercise on roads. All well and good, but Oliver didn’t have to translate this into language that Derby could understand, or sit the rather over-excited bucks and leaps of protest as I evidently didn’t explain it very well.

Nonetheless Derby seemed to progress. We kept cold hosing the leg and it remained cool to the touch. There was no heat or swelling as I increased the trot work, and Derby developed a new and exciting pace that I was to refer to as ‘leapy bucky things’. It was amazing how many of these he could string together although I tried my best to remain calm and keep him calm, for the sake of his leg. We started to take him back in the school, changing from the hard surface of the road to a softer, sand surface as the leg got stronger. At first all seemed well but one day in late September, around seven weeks after Derby had first gone lame, the leg started to swell again. It was not as bad as the first time and Clare and I hoped that it was just a tweak. Nonetheless we decided that he must have a USS to see what was going on.

That scan was not good. The tendon should consist of tightly bundled fibres lying smoothly next to each other. Instead the top 25% of Derby’s  tendon looked as if someone had taken a meat tenderiser to it. As I was to realise over the coming months, what is happening on the outside of a horse’s leg, the clinical signs, do not match up with what a scan will tell you. The instrument-based laboratory signs of an injury can give a very different picture. However, Oliver was relatively sanguine. He gave us a 6-month exercise plan, said that under no circumstances were we to turn Derby out but also said that there was a 70% chance that Derby would return to full work. At 16, middle-aged for a horse, his years told against him, but he had good short cannon bones meaning the tendons would be less weak. Whilst the injury was quite severe, the prognosis at that stage was good. I knew we had a long road ahead of us, but I had no inkling of quite how tough the winter of 2009/10 was going to be for me and my horse.

To be continued…

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A Devonian take on the news

I have disobeyed police orders. Orders which were given expressly for my own safety. And how have I achieved this? Why by venturing out on my own after dark. Admittedly it was 5pm and I was going to Sainsbury’s, but as far as I can gather from advice given by Avon and Somerset police, it is standard for women to stay in after dark rather than go out on their own. The fact that this has put every woman in the northern hemisphere on a 14 hour a day curfew for around 6 months of the year does not seem to bother them.

 Joanna Yeates’ murder has not dominated the news to quite such an extent this week though there is still plenty of feverish speculation about what happened. I am mindful of the fact that at the heart of this is the tragic story of a young life cut brutally short. It’s just unfortunate that on the periphery, and at times vying for centre stage, is a missing ski sock, a pizza and a comic turn from the boys in blue the like of which I haven’t witnessed since I saw Much Ado About Nothing in the open air theatre at Regents Park and they made the 3 policeman all wear the same cape so that in effect one be-caped beast had 3 heads and 6 legs, and all 3 heads were made to sing in unison.

 Now don’t get me wrong. I know the police have to give out advice and I appreciate it. If it’s sensible advice that helps I particularly appreciate it. Since I’m the sort of person who carries a handbag with nothing in it as a foil to muggers whilst stuffing ten pound notes in my bra and doing irreparable damage to my credit card by carrying it around in my shoe I probably don’t need someone to tell me to be careful when opening the front door, but I applaud the effort. However, Avon and Somerset really did surpass themselves. To be clear, they said that lone women should avoid going out after dark on their own. There’s more here: http://www.mirror.co.uk/news/top-stories/2011/01/03/jo-yeates-murder-detective-warns-women-not-to-walk-alone-at-night-115875-22822796/ (Yes, I know it’s the Mirror. I like to read it from time to time to remind myself why I don’t read it more often). It just isn’t practical advice, not to anybody holding down a 9-5 job in winter. Actually not to anyone since insisting that women stay in after 4pm in the winter is basically idiotic.

 It’s not that I have a problem with advice to women in general, I have a problem with this piece of advice and I have a problem with the fact  that whilst men are more likely to be the victim of crimes, police do not seem to think they need to be given similar advice. Somewhere in here is a good topic for a masters student, if it hasn’t been done already. After a man is killed, do the police routinely say that men should not go out alone after dark? How do they tailor this advice? If they think there is a racial motivation, do they caution everyone of a particular race to stay in? No, not generally, and imagine the outcry if they did. My guess, and yes at the moment it is just a guess, is that we are so used to infantilising women, in a way that we do not infantilise other groups, that often we don’t even know we are doing it. The only group that I can think of that receive similar advice is the elderly and again I think the motivation is similar – taking care of a group whom we consider to be slightly less than capable of taking care of themselves.

There was much else besides in the news – much of it concerning floods in various parts of the world though let’s face it none of it was funny. (Well OK, I found the idea of a shark in the streets of Brisbane wryly amusing whilst realising that it was anything but for the more usual denizens of the city. Come to think of it, I don’t suppose the shark was having that much fun either). Thinking of toothy grins, Palin tripped herself up again, perhaps even more spectacularly than when she couldn’t work out which Korea was which. I sometimes find myself wondering if Palin isn’t actually a plant by the Democrats, in much the same way that I idly wonder if Widdecombe is actually Labour’s secret weapon.

 But to end the week back where we started on nonsense advice to women, I have to give a special mention to Kenneth Tong. For those of you who haven’t heard of him Tong is known (I can’t bring myself to write ‘famous’) for being wealthy, stupid, and on Big Brother, though I appreciate that might not narrow the field down too much for you. For those of you who haven’t come across it yet, Tong had a remarkable interview with Johann Hari which is available here: http://www.johannhari.com/2011/01 

Now Tong did some rather ill-advised tweeting in which he put forward the idea of ‘managed anorexia’ and argued that women should be a size zero and that being plus size made women ‘sub par’. I’m not really sure I should give the obnoxious little man any more attention than he has already had so I’ll keep this fairly brief. He said some frankly bizarre things about how it’s good to starve. He has been rounded on because much of what he said was downright dangerous. In amongst all his ranting gibberish he seemed to think that women should be a size zero to be successful and attract men.

By ‘size zero’ I’m assuming that Tong is referring to American sizing, although it is entirely possible that Tong himself doesn’t know to what he is referring. A US size zero is a UK size 4. I’m a UK size 8 so in order to get down to a UK size 4, I would have to lose 4” (10cm) off my hips and bust. Given that I’m already very slim, the only way I can think of to do this is just to cut my bum off. I’m not going to do this. Mainly because it would be very detrimental to my health but also because it’s my bum and I find it quite useful. These are my main reasons for having no desire whatsoever to change my shape. Trailing away in a very distant third place is the fact that I seriously doubt that I would become more attractive to the opposite sex were I to get rid of my arse.

 Frankly, I think women should completely ignore anything Tong might ever say. I know that even stopped clocks are right twice a day but I doubt he would ever manage those giddy heights of exactitude. By and large I wouldn’t take too much notice of Avon and Somerset police either although in fairness the advice they offer here http://www.avonandsomerset.police.uk/community_safety/crime_reduction/violent_crime/personal_safety/on_foot.aspx

makes a lot more sense than the things quoted more generally in the media. I suppose one could follow Tong’s advice and get down to a size zero, thereby enabling one to travel safely in the dark because, should anyone appear and look murderous, you could simply turn sideways and disappear. No, scratch that. I’m off to strike a blow for feminism by going out in the dark to get more food. I would hope that by 2011 we would have got further along than this, but sadly it seems not.

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How to survive on the UK’s roads: Top tips for cyclists

It can be tough out there on the UK’s roads if you opt for two wheels rather than four. For starters there’s the odd assumption that you haven’t chosen to travel like that but have had cycling foisted upon you because you can’t drive or are too poor for a car. The Brits might have a reputation for being terribly polite; queuing; whingeing; whingeing about queuing (whilst being polite to the people they should actually be complaining to); keeping a stiff upper lip, and enjoying cream teas, but put them in a little tin box on wheels next to a bike and they appear to lose any sense, intelligence and perspective they might ever have had.

Of course, they’re not all like that. Pedestrians, cyclists and car drivers are often one and the same person. and there are many perfectly polite and careful drivers out there. But you only need to encounter one loony with a Clarksonesque attitude to road safety and you, and your bike, will be at risk. So with that in mind, here are a few tips for surviving on the roads in the UK.

1. The micro-second you sit on a bike on the road you become invisible. This phenomenon has yet to be replicated in a laboratory but there is plenty of evidence for it in the real world. That said, should you commit the cardinal sin of cycling on the pavement (please, please don’t do this, don’t actually hand people the ammo) every car driver in a 50-mile radius will suddenly be aware of your presence.

2. Assume that anybody on, or even vaguely near the road is a potential hazard. Also assume that they aren’t actually looking at the road and may in fact be nigh on oblivious to it, despite operating a ton of fast-travelling metal along it. Bear in mind that even if they are looking, they might not actually be seeing and if they are seeing it’s quite likely to be the bus in front of you, not you, that they actually register. And on a related note:

3. It is better to assume that all car drivers are kamikaze; slipshod; think that they really can text and drive; think that it’s other people who cause accidents; cannot locate their indicators (steering wheel and lights are often a bit dubious too, although generally they can locate the car horn); have no sense of speed or distance; no concern for anybody else’s life; have all the road sense of a dead hedgehog; think that speed limits are either some kind of minimum target to be aimed for or that they are for other people because they themselves are so skilled they couldn’t possibly be meant to go that slowly. Of course very few of them exhibit all these characteristics, but given the number who exhibit at least one, it’s just safer for you to assume that most of them shouldn’t be allowed beyond their own front door and have only learned to walk upright at some point in the last week or two.

4. Invest in the best lights you can afford and carry a back up set as well. Any lights have an irritating habit of turning themselves on miraculously whilst in the depth of your pannier so that by the time you need to cycle home, they are blinking at you anaemically. You might also want to invest in some fluorescent clothing. The jury is out on this one – it does make you more visible but wearing it places the onus on you to be seen rather than on the drivers to keep an eye out. Also bear in mind that you can be dressed head to toe in fluorescent clothing and look as if you are the product of one of those genetically-modified luminous rabbits having had sex with a Christmas tree, but if they don’t look, they still won’t see you. Aliens have used me as a landing beacon before now and yet car drivers have stopped me to say that they can’t see me (yes, you’re right, there is a logic fail there).

5. Remember that a car driver’s time is of the essence. It is vital that they get to the back of a queue of traffic before you do. The fact that you will then sail past them and the queue, so that they almost took your leg off for nothing, is neither here nor there. Do not question them on the logic off this manoeuvre since they will not be able to answer. However, it has its roots in various problems. Many car drivers can only focus on one thing at a time. If they see you cycling ahead of them you might, if you are particularly lucky, become the focus of that attention. Unfortunately at this stage they are limited to the following thought process ‘Cyclist in front, cyclist go slow, must overtake cyclist’. They will not register the 3-mile tailback 20 yards away from them but will instead overtake you, even though it may entail both breaking the speed limit and endangering your life. In some quarters this has become known as the ‘overtakey brakey’. It is odd that car drivers who are convinced that they can multitask well enough to both drive and talk on their mobiles cannot focus on both the queue ahead of them and you but such is life.

6. On a related note, much of the problem is the average car driver’s inability to understand traffic flow. As far as a driver is concerned, the faster they are travelling, the faster they will get to their destination. They have not worked out that this logic only applies on empty roads and quite definitely does not apply when everybody else is also trying to go fast. Think about the different ways in which drivers and experienced cyclists approach roundabouts. Cyclists will assess the traffic as far ahead as possible and will adjust their speed expertly so they can fit in without interrupting traffic flow. Some drivers also manage this but the majority will simply drive up to the roundabout as quickly as possible, jam the brakes on at the last minute, then look, then think about pulling out, thereby disrupting the entire queue of traffic behind them. Generally they won’t signal on the roundabout, or anywhere else for that matter, holding up traffic flow even more. It is this lack of understanding of the relationship between average speed and maximum speed that prompts them to overtake you, even though you will simply sail past them shortly afterwards.

7. Have some answers handy for the petty abuse that may get shouted at you, in particular ‘you don’t pay road tax’. Just reply ‘I do on my Rolls Royce’ or ‘I pay tax on my car I’m just not stupid enough to drive it in this traffic’.‘ Big car, small dick’ is your basic, all purpose comeback. ‘It’s inversely proportional to engine size’ is also handy. If you’re female try ‘I don’t care how much you rev your engine, I’m NOT going to have sex with you’. (Ok, I’m all for equal ops, you can shout that if you’re male too). Alternatively, if time is short and their windows are tight shut, you might want to opt for the kind of hand signal that you can’t make whilst wearing mittens.

8. Be particularly careful when there are high-sided vehicles around – even if car drivers have managed somehow to see you despite your magic cloak of invisibility, they generally cannot see through vans and do not expect you to emerge from behind one.

9. Take particular care if you are moving alongside traffic, especially at junctions. Car drivers often see no need to indicate left and are more than capable of overtaking you, only to slam on the brakes and turn left across the top of you. Also be wary if the car in front of you slows down drastically for no apparent reason – check that the driver is not letting a car travelling in the opposite direction turn right in front of them. OK so it’s nice that they let traffic out, but few of them think to check their wing mirrors before doing so. In fact some of them may well just have overtaken you before slowing down but will have entirely forgotten your presence. This is known as the ‘out of sight, out of mind’, school of driving.

10. On trying to turn right, you may find that the driver behind you kindly slows down so that you can pull out and perform this manoeuvre. However be careful – there’s every reason to suspect that the driver behind that will have entirely failed to assess the situation adequately and will be sitting there thinking ‘why’s that idiot in front of me slowing down, best overtake him, the twunt’ and then will take you out in the process.

11. Never take any notice of any other road users’ signals (your own of course are faultless). They will happily pull out from the roadside whilst indicating the precise opposite. Also, ignore everybody else’s lane positioning. Being in the left of three lanes never stopped anyone from turning right.

12. Basically, treat car drivers as you would any other aggressive, territorial, predatory species locked into a confined space. They would probably all be happier if they left the car at home and cycled to work, they just haven’t realised it yet.

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