Answering a challenge for eligibility

Looking at your vulnerable side

Having a sit down to talk and have a conversation with people for professional services is quite an interesting thing, especially where an assessment is being made of whether the professional or assessor can help you. The day before, I had met with a prospective buddy/mentor, we decided to meet again when it seemed there was no point of agreement or meeting of minds.

It was in a conversation with my consultant some weeks ago that we agreed that on her referral, I could avail myself of counselling rather than request it on my own pre-empting.

I think I have convinced myself that I am quite articulate, I have a disciplined or call it measured way of talking about myself that exudes qualities of clarity of mind, understanding of issues, elaboration of detail, and building relatable narratives.

Making sense of the complexities

Interestingly, for the first time, I linked together a whole range of life events walking backwards from situation to Genesis, a framework that had developed in the many blogs I had written but never laid out in a string of unintended and yet natural chain of occurrences.

The questions I was asked were supposed to elicit concepts and ideas upon which a decision could be made to put me in line for engagement, but it got to the point where it was first opined that I might not need the service and hence, I needed to assert by whatever means why I felt they could be of help.

An analogy for counsel provision

I had never thought of it before, it was like I was given utterance to address the challenge as I spoke. I started with every journey has a road to a destination, the destination sometimes is what is required and nothing else. However, consider if on that journey, you were driving and then you had a diversion or probably you had a tyre puncture that meant you had to stop to change the tyre.

That interruption to your journey is worth considering in terms of delaying you getting to your destination, bringing some new experience into view, what you might have run over to cause the puncture, how to avoid such punctures, like navigating another route, being conscious of the related hazards, and how to have a better journey.

The focus has moved from the destination to the experience in the journey which is part of the tapestry of life itself. Surely, all that is significant. I think that analogy helped considerably, he nodded, acknowledged how useful the illustration was and I think he was a bit more convinced that there was scope for me to access services.

In what I thought would be just an hour of conversation, over 90 minutes went into the chat that I found myself running late for my welcoming stint at the cathedral. Meanwhile, there is a waiting list and maybe soon, I would be getting a call.

Opinion: Getting good medical outcomes is a fight to be heard - II

Up against the system

When I wrote last week that my NHS rating is a 6 on a scale of 0 – 10, a series of conversations with users of the service and most especially, my personal experience highlighted issues I have overlooked rather than pursued.

Blog - Opinion: Getting good medical outcomes is a fight to be heard - I

There are organisational inefficiencies that consequently impact the patient at the point of contact and the bureaucracy demands those who people the establishment that they need more time to address issues and where they do, they should be more attentive.

In some cases, those who choose to address ineffective processes that result in poor outcomes are deemed, termed, and labelled difficult and troublesome. The person's suffering is forgotten as the Hippocratic oath of service becomes a perfunctory recitation without heart or mind involved. The patient is a customer on a fast-moving conveyor belt to the exit than to wellness.

Organisational failings that fail us

In my other blog, I talked of when I had to relay my medical record to a doctor because my file was not available to check my notes for the consultation. It would appear, every patient that visited on that day, if they were not as clued in and read up on their condition would have received attention below par.

I have high praise for the department that has taken on my case for almost 8 years, but they are not perfect and not all the consultants I have met give due heed to the wider issues of who the person they are seeing is and I can understand their limitations. However, one has to question how with that knowledge of who was attending for the day the essential documentation was not provided to the consultants for review and understanding as they met their patients.

It might have been a one-off situation, but I have the feeling there is a rot that pervades the system that is seething and creeping almost unaware to those with the responsibility to ensure things work better for the desired outcomes of their patients.

Seeing but not perceiving

Then, it was the lassitude that greeted my need for treatment of a co-morbidity condition that they knew of for more than two years, but never sought to address until I challenged the thinking in the department. You could almost feel they were more ready to express sympathy after your demise in the knowledge you were one less problem to deal with than face the complexity of the person-problem conundrum.

When they advocated for the change of my drug regime for a new medication, the consultant inelegantly let slip that the decision was being made on a cost basis as my medication was still under patent protection. This was reinforced with a contrived neurological test as I did mention absences in thought that could be side effects on my memory, much of which I had compensated for as I noticed changes in how I remember things, especially in the short-term memory space.

The struggle of outlay over outcome

The new medication was a hellish 7-week experience that they were keen to fix me to after the second week which I thought was too short a period to understand its effects. I dare say, one of the side effects that was on a label you could tear off from the packaging included sudden death. Each day, I recorded every funny symptom from tingling in my extremities, to insomnia and nausea – those were the prominent ones.

I walked into the department with 42 pages of side effects recorded for each of the 42 days and demanded I be put back on my old medication that I had tolerated well for over 8 years. The year after this sordid experiment, there were generics of my medication available, and I have been on those since then.

Obviously, there is a cost to medical provision, and I cannot ignore the towering cost of the 12-week medication for treating the co-morbidity 7 years ago with new drugs for which I am grateful, but it is never comfortable to be in the hearing of cost rather comfort and outlay rather than outcomes.

Being there but not with me

It was my last consultation that inspired these blogs as my doctor’s notes created on the day of my visit or thereabouts get sent to both my GP and me. Now, after that consultation, I was given a survey to fill in about attending the consultation that day. After receiving the note, I would like to review my earlier commending comments.

This is for the simple reason that I discussed a number of issues with the consultant that should have superseded the talk we had 6 months ago. On review, there is little of what we discussed in the new note, I can also put it down to either the consultant being distracted or inattentive. That conclusion is easy to arrive at as when he said he had refilled my prescription, it was one of two medications that he prescribed, and I had to return the next day for the other medication.

The notes can be consequential

Doctor’s notes might hold no particular significance as a simple administrative process, but when one is engaging with the system and some decisions are predicated on what the doctor’s perspective is of you and your situation, there can be no room for error or variance between how you describe yourself and your doctor's observations. I can only wonder what it would take to rectify this without creating a crisis of confidence and trust within that team of medical personnel.

Indeed, I do make demands on the NHS for better outcomes which have much room for improvement, but there are only so many things you can overlook before you realise something radical is needed to ensure you do not become a mere conveyor belt statistic.

It is a fight to be heard and listened to, beyond which you hope that they would respond and act on the situation, with your interests to heart and in your favour.

Opinion: Getting good medical outcomes is a fight to be heard - I

Not operating at full potential

On a scale of 0 – 10, I would probably put the quality of the service I get by default from the National Health Service (NHS) at a 6. If I want better outcomes, I need to challenge the system and the process to do much more.

Comparing my experience with those of others who interact with me about their issues and challenges, I seem to be getting a much better deal than them in the responsiveness of the institutions and establishments and more particularly from the personnel that man the points of access I utilise.

General practice without practicals

I do have a GP, but I never met her even though I have been registered at the surgery for close to 8 years, the only times I visit are usually to get the annual flu jabs if I need anything else; it is impossible to get through on the phone and when you use their website, my most recent application took 10 days to get a response and that was to ask me to pay for a possible referral from the GP who was to call me in another 3 weeks.

Ah! The GP in whose docket I was, retired from the practice 18 months ago, and it was when the surgery contacted in the response that I found out who my new assigned GP was. My main engagement with the NHS is actually elsewhere, my GP just gets informed of and updated on the observations and recommendations.

It is my body first

As I have had to fight for better personal outcomes in pain management, suggested treatments, and delayed intervention both in the Netherlands and the UK, the lessons I have learned personally and from others reviewing issues with healthcare delivery can be useful to others.

One key point I always make is, “It is my body first, before it is your guinea pig.” That was what I told a team of consultants and an insistent neurologist when after months of chemotherapy they wanted to perform a lumbar puncture, which I was not keen on. They relented.

At another time, the pain medication was insufficient, and I had to disabuse the notion that black people have a higher pain threshold and can endure much more suffering that the medical establishment defaults to think we are becoming junkies rather than people who need simple relief. Yes, after the consultant expressed some bafflement, he did increase the dosage of my Fentanyl patch and the pain considerably subsided. I was grateful for it. It is documented research that there is racial bias in pain management for black people. [NIH: Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites]

Be forthright without fear

I lived with a diagnosed condition for more than 3 years that presented a co-morbidity, and each time I went for my biannual check-ups, it was noted but not dealt with. Everything with done around the periphery of it but not the essential action required. At one such consultation, I said to the consultant, I am very aware of my morbidity that you have observed and done nothing about for years, what do you intend to do about it as you all know it is getting worse.

I guess he was shocked by my forthrightness that within a month I was put on the latest medication and the condition was eradicated in less than 12 weeks. I have found I need to ask questions, seek satisfying answers, and deliberately go over a review of my test results to observe trends and mitigations to attain outcomes.

You cannot use the NHS from a stance of passive participation, you need to understand your condition fully, be knowledgeable and clued in on your medical notes as well as the medical personnel. There was one visit where my file was not available, when I finished, the doctor commended me for giving a detailed situation as good as a medical file. You need to read up and understand everything along with studying developments concerning your medical profile.

This might well help you

Anyone who needs access to the healthcare establishment, they should listen to the Reith Lectures delivered by Dr Atul Gawande on The Future of Medicine that covers topics like, Why Do Doctors Fail? and The Problem of Hubris, amongst others. I believe there are many tips and ideas you can gain about attaining the best outcomes in your engagements. [BBC: The Reith Lectures: Dr Atul Gawande - The Future of Medicine]

I started this blog to write about why I have not received some of the outcomes in service, attentiveness, or understanding of my requirements. Whilst some of that is covered in this blog, I feel I need to review how to write the second part of this topic.

Thought Picnic: Self-doubt, a teacher of humility

The humbling of the present

The unfortunate sacking of Kwasi Kwarteng, the erstwhile Chancellor of the Exchequer gave me something to ponder about my situation. I wrote in a tweet, “Sometimes, a dramatic humbling can be quite life-affirming, do not take every setback as the end of purpose, ambition, or prospect.”

The reason why I can relate is I was invited for an interview on Monday and just before we had the meeting, the agency called to say that the client had realised they had a budget shortfall and whether I would consider lobbing off about 40% from what we had agreed on Friday.

I politely declined as I reflected on the disrespectfulness and insult apart from the unprofessionalism that enabled that kind of feedback that should have been better relayed as the position had been filled by other personnel. You see a lot in 27 years of dealing with contract agencies, and then some.

Beyond the travails we see

Soon afterwards, I got a phone call from another agency offering the prospect of a re-engagement with a client I had worked with before. I was keen and so my details were put forward and they expressed an interest in offering an opportunity.

However, I was to attend an interview on Microsoft Teams scheduled for Friday and I had only hours before reserved to collect my new passport in Liverpool. I did not want to postpone the interview and so that meant planning to be in Liverpool to both attend the interview and collect my passport.

Meanwhile, I was also to give a presentation as part of the interview process with the choice from 5 topics that looked quite distinct yet from my experience were intricately interrelated. I found myself in a similar brain fog as I was 5 years ago, trying to decide which topic to present, though then I chose one and wrapped the considerations of the other 3 topics into how they relate with the one I chose.

In doubt and unsure

It would have been easy and lazy to rehash the old document, but I had to do better, and I gathered the material and began to construct the elements of my presentation. In my head, I had a good idea of what I wanted to say, but how to fit that into an acceptable presentation became a challenge.

For all the expertise and experience I do have, others probably do believe in my abilities more than I dare to believe I am. There are jobs I should apply for that reticence and doubt persuades me otherwise. My friends constantly urge me to step up, their perspective of me way ahead of my apparent insecurities.

My presentation almost became existential in its import, for it would have been the crux upon which the decision to hire me would have been based amongst other considerations. I found myself wondering how I could quite easily scupper my chances given what might be a golden opportunity. Then I would whisper to myself, that everything would be fine, take breathing exercises and try to calm myself down.

The trial of adequacy

My friends would suggest I am not lacking in confidence, I have my doubts about that assessment, and then maybe I am beating myself up too hard. My presentation was only about 75% finished by the time I went to bed, and I was so sleep-deprived thinking about how I had not closed the activity. Something was missing from giving the presentation the necessary feel of a proposal made to a C-suite executive.

A few ideas wandered into my mind overnight and on getting up, I showered and went for breakfast that I could hardly finish before giving Brian a call. My best friend had sent me a message of encouragement during the night too, which I acknowledged. I went for a walk to the River Mersey and returned to complete my presentation with just an hour left to the interview.

Things seemed to fall into place and with just about 20 minutes to spare, there was nothing more I could do about what I was about to present. Unsure and nervous, we began a discussion when I realised that my 9 slides of PowerPoint presentation were to be delivered in 10 minutes, there was no point panicking, I went for it with mannerisms and tics, all forgiven with the verdict that it was a good presentation.

Self-doubt, the measure of strength

This was something I would never have been able to pull off without the support of my friend, and my partner, they were constantly encouraging me even as it was increasingly difficult to believe them. Then I need to find the positive in my ordeal, maybe self-doubt is a good check on hubris too, it works for me even if it stresses me out too.

There is a humbling that teaches you the truth of your vulnerability not to strip you of agency but to equip you with the human need to seek support and encouragement to empower you through when your strength appears to fail.

It is like what Apostle Paul said in II Corinthians 1v9-11“Yes, we had the sentence of death in ourselves, that we should not trust in ourselves but in God who raises the dead, who delivered us from so great a death, and does deliver us; in whom we trust that He will still deliver us, you also helping together in prayer for us, that thanks may be given by many persons on our behalf for the gift granted to us through many.”

It speaks for itself, that our vulnerabilities or the humbling of the present only allows us to appreciate that we can do a lot more in the context of our humanity by relying on others.

Tested by many things

Just doing it

I decided not to beat myself up for the fact that July presented no prolific blogging activity even as I split the month between celebrating my partner’s birthday and holidaying, out of which I took the time for intensive study to do a Microsoft test.

After I did the AZ-900: Microsoft Azure Fundamentals entry-level test which I had been putting off for so long until early June, I began studying for the AZ-104: Microsoft Azure Administrator test, though this was not until I had completed all the course work on the Microsoft Learn website, even though I had handsomely passed the test. I did initially think I would finish that track before I travelled to Cape Town at the end of June.

Recovering self and purpose

Events and issues scuppered that plan, I lost my uncle, my contract was ending, and I was preparing for the trip to Cape Town to celebrate Brian’s birthday and spend the month together. The first few days left me slightly indisposed even as I discreetly planned for his birthday. Visiting Cape Town in the southern hemisphere’s winter might have me considering if I need the flu jab as we do take it for the winter in the northern hemisphere. Winter in Cape Town is like a mild spring to a summer day in Manchester, they are closer to the tropics than we are.

After his birthday, we did a few things, and moved accommodations and I found that I had some free time to do some study which required discipline and concentration as there was a lot of material to cover. Beyond the theory, there are the hands-on labs and then getting used to doing requisite tasks towards achieving goals or requirements borne out of typical case studies.

As I learnt and understood much more, I believed I had gained enough confidence, maybe folly to book the AZ-104 test in cape Town, a few days before my return to the UK. The more I thought I had covered everything, there was much more to do. A YouTube video signified the test in its current format with its current syllabus would change on the 28^th of July. I was now running against the clock to get it done.

Upset to messed up

I found some practice tests and subscribed to an annual membership of Whizlabs, this exposed some areas of serious weakness in my grasp of the concepts and the detail, that needed urgent addressing if I had any hope of scraping through the test. Progress in gaining the requisite understanding of the weak areas was slow.

The test was booked for Tuesday, the 26^th of July at the Prometric office in Cape Town, I checked in the shared workspace and was working towards taking the test at noon, when at 9:38 AM, I received an email from Prometric Vue, the test provider that they could not offer the test and I had to reschedule. Their scheduling system lagged the reality of what they intended, as I spent the next hour with an agent trying to sort it out. In the end, I had the test cancelled and booked a new test date for the next day at another Prometric test centre of the 4 in Cape Town.

The morning’s nonsense left me a bit messed up, I did a walk from the shared workspace home and back to clear my head before I could pore over the material towards the test the next day. Meanwhile, my Whizlabs profile got corrupted that I could not review test attempts and it was not working on my Android devices at all. Thankfully, the CEO contacted me to connect on LinkedIn and that gave me access to the technical team to provide a temporary account whilst they fixed the issue.

Facing up to it

On Wednesday morning, I had a niggling thought that I was about to undertake the test with the barest minimum grasp of the material. Yet, the truth is I had put in over 4 weeks of work along with my experience, and my confidence was taking a hit as Brian assured me that I will do well. At the test centre, I was met with both nonchalance and officialdom, both of which I put down to getting what you pay for in a different kind of setting. The test costs $55 in South Africa, £113 in the United Kingdom, and $165 in the United States. It would appear South Africa has the lowest cost, as most other African domains pay $80.

I was stripped of everything including my walking cane I had to ask if I would have been allowed to use a wheelchair. Then short of being patted down, I was asked to upturn my sleeves to see if I had secreted away cheat sheets of something. Heck! I have been doing vendor certifications since 1994 and this was the first time I was so violated. I surmised, it came with the territory and calmly went into the test room to begin the test some 15 minutes ahead of schedule.

Tested by the test

I did not get a hang of the interface when I was presented from the first question with case studies. I could click on the case study body and requirements but did not realise I had to click on the Question box at the top to return context to what I was to answer. I was close to panicking mode. When I eventually worked out how to do things, I had two case studies, with 9 questions and 32 minutes gone out of 90, with 45 questions to do.

Halfway through I scared myself into thinking I had already failed the test. With 10 minutes left, I had 12 questions to do, they were point-and-click multiple choice questions that I got done with 2 minutes to spare. I marked one question for review, answered that and could not wait to end my ordeal that when presented with the 54 questions to individually comment on each, I passed on the opportunity and closed the test.

The relief of passing

My heart beating at rates it should never reach, the test result came up and I had passed, not glowingly, one section required work, others were rated at average understanding and one at the level of very good. I would not deceive myself into thinking having passed by the skin of my teeth, I was through, I am going to study the material fully again and this would be necessary for the next stage AZ-305: Designing Microsoft Azure Infrastructure Solutions for the Microsoft Azure Solutions Architect Expert certification.

However, after this, I did give myself the time to do other things, especially with Brian and time to myself. There is a good feeling and sense of achievement, the quest to challenge oneself to ascertain, validate, and certify the knowledge and expertise one has gained. I suppose that is the pleasure one has in the work one does.

Embrace the mistakes and learn

 Breaking out of perfect

Attending an interview that became the impetus for an almost 13-year sojourn in The Netherlands, I was asked a question about a scenario I had never encountered in all the environments I had ever worked in before. I had no answer to what the interviewer must have thought would be the dealbreaker of suitability to fill in the role.

Having answered all other questions, I was asked if I had any comments, and I took the opportunity to seek an answer to the question that stomped me before returning home to research what it was all about. I concluded to myself that the reason I had never encountered that issue was that the environments in which I had worked were almost too perfect and where no problems arose, there was no challenge to normalcy or quest for any resolution.

Problems and practice are necessary

In my professional life, there is a lot of documentation about how to design, setup, and implement features and products, but what do you do when things do not work as required or expected? That is where knowledge and experience are created, the art of troubleshooting is honed in the hard craft of practice and research, seeking out where things might have deviated from the norm and reviewing experiences of others in the field to augment, enhance, and improve your knowledge and expertise towards becoming a subject matter expert.

That aspect of practice and discovery is all too necessary along with the inevitable mistakes that dot a life of determination, adventure, application, daring, and accomplishment. We all know we are not perfect, but we are always getting better, the more time and effort we put into understanding how things work and consequently why they fail to work as intended.

Face the fear of failure

Yet, this does not just apply to the narrow area of the use of technology but any useful endeavour. As a conversation with Brian, the other way gave birth to some conceptual thinking about the fear of making mistakes. The strains of what I said turned into what might be a saying, a note to myself and to anyone else with whom it might resonate.

“If you don't make mistakes, you can't correct them, you don't learn from them and you have no practice necessary to perfect your craft. The fear of making mistakes ultimately robs you however close or remote, of the possibility of genius. Mistakes help you become the best.” Now, go and do that thing you were afraid to do because of your fear of failure or embarrassment.

Thought Picnic: We lose when we have none to question us

Who can speak to you?

I think of this a lot, the danger of primacy, the curse of being at the pinnacle of power and authority with a court, courtiers, or acolytes who pledge fealty and extraordinarily little truthfulness and honestly.

More and more, I realise than a man needs to be answerable to another man, it behoves us to surround ourselves with people who can challenge us, question our motives, withstand our opinions and persuade us of alternatives in direction and decision. At the very least, if we are not to be dissuaded, we should be able to defend our positions with conviction, courage, and truth.

No place is lonelier than to be where you are out of the reach of checks and balances. Where reality is bent to your will and none that see you can say what needs to be said to bring a sense of reflection and ground one in the incontrovertible essences of existence, that power is transient, life is not immortal, and deeds with their consequences are rarely forgotten.

Honest counsel is more than gold

Through history into the present day, you wonder what better decisions to change the course of history might have been visited if kings and queens long gone were better advised, generals and leaders did not rule with terror and an iron fist that even the truth was trammelled and out of reach in their counsel and counselling, if my own father was subject to the scrutiny of some of decisions and actions.

Yes, these thoughts occupy my mind when it comes to myself, the things I have done that with better insight and advice with counsel, direction and mentoring might have saved me from the foolishness and stupidity of my ways. Yes, much as it can be bruising, I desire friends and partners that will be honest and unrelenting in their engagement to make a better person. I will deploy my wiles and caprices, but they can and do put a mirror up before me that I can see myself clearly.

Seek to listen to glisten

We would normally say, we are our own greatest critic, that is good, but have people around you who can critique rather than criticise, who can appreciate with all its caveats, yet not excoriate. We need iron to sharpen iron, the forge to heat the iron, the anvil to shape the iron, none of which in its processing is easy work, but the result is a fine tool or instrument for the task in hand.

I know I have such friends; I ensure that my ears are not clogged with earwax so I can hear and listen, understand and comprehend, working towards a better representation of myself. I hope also that I am equipped, courageous, able and persuaded to offer the same to help my friends be the best they can ever be, either in giving them the assurance they need or the persuasion that is required.