What"s your experience of vaginal mesh implants?

More than 800 women are suing the NHS and the manufacturers of vaginal mesh implants after suffering serious complications.

Some women reported that the implants – used to treat incontinence after childbirth or pelvic organ prolapse, where the womb or bladder bulge against the walls of the vagina – had cut into their vaginas. One woman said she was left in so much pain that she considered suicide. Others have been left unable to walk or have sex, according to the BBC.

The medical regulator has said that the best current evidence supports the continued use of mesh implants to resolve health conditions that could themselves cause serious distress to patients.

If you’ve received vaginal mesh implants, we’d like you to share your experiences with us. You can fill in the form – anonymously, if you prefer – and we’ll use a selection of responses in our reporting.

Your responses are secure as the form is encrypted and only the Guardian has access to your contributions. We will do our best to keep you anonymous.

What"s your experience of vaginal mesh implants?

Social care staff, what is your experience of working with the NHS?

Integration between health and social care has long been touted as an answer to the gargantuan problems faced by both sectors.

But now a scathing report by the National Audit Office (pdf) has revealed that integration is not working and that barriers preventing it remain intact. In a piece about the report, Richard Vize, former editor of the Health Service Journal, wrote: “The failure to break down these barriers leads to the crazy situation where health and care staff can only succeed in working more closely together if they fight the very system that employs them.”

Health and social care leaders regularly debate how integration could – and should – work. We want to know what those on the ground think about the obstacles to closer working with the NHS and how they can be overcome.

Are you a social care professional with experience of working with the NHS? Do you feel the current set-up is conducive to working together? Do you have any experiences that highlight how things are not working? What are relationships between health and social care professionals like?

We also want to hear success stories. Do you work in an area of the country where integration is working well? Tell us about it.

To share your thoughts and experiences, please fill in the form below. A selection of responses will be used in our reporting. You may remain anonymous if you wish.

Social care staff, what is your experience of working with the NHS?

What is your experience of working with child mental health services?

The health secretary, Jeremy Hunt, has described children and adolescent mental health services (Camhs) as the “biggest single area of weakness in NHS provision”.

Hunt told the Health Service Journal that too many families were being let down because of what he described as “big problems” in the capacity of services to support and treat children earlier in their lives.

Healthcare professionals are also painfully aware of the issues facing Camhs. Those working in and with the service admit failing to provide adequate care because of time pressures, a lack of staff and a shortage of beds. Teachers and social care professionals also feel the effects.

We want to hear from healthcare professionals, both those working in Camhs and in other areas of the health service, about what the situation is really like. What challenges are you faced with? How does it have an effect on you personally?

We’d also like to hear from teachers, social workers and any other professionals who have dealings with children or adolescents with mental health problems and/or with services. How is your job affected? Does it take a toll on you?

You can remain anonymous. If you prefer, you can email sarah.johnson@theguardian.com with your thoughts.

What is your experience of working with child mental health services?

What"s your experience of mental health in the workplace? – share your stories

A new study suggests more than three quarters of workers aged 16 to 64 have experienced symptoms of poor mental health, and nearly two thirds of those with mental health problems believe work was a contributing factor.

Many of the 20,000 employees surveyed by the charity Business in the Community employees found their employers lacked awareness, training and responsiveness to mental health issues. More than half said their employers took no action when they disclosed their symptoms of poor mental health.

We’d like to hear from you about your experiences of mental health in the workplace. Do you feel able to discuss mental health in your workplace? Have you had a positive or negative experience when you have discussed your mental health? Are you an employer who has experience of building a workplace culture that supports good mental health?

You can share your views by filling in the form below – completely anonymously if you would prefer. We’ll be putting together an article highlighting your views to coincide with World Mental Health Day on Monday 10 October 2016.

What"s your experience of mental health in the workplace? – share your stories

Doctors lack experience and expertise in treating transgender patients, study says

Doctors and therapists are struggling to give transgender patients the best medical care because of a lack of expertise and experience, according to a new study from Appalachian State University in North Carolina.

The study, published this month in Sage, examined interviews with healthcare workers around the country, finding that medical providers are facing “vast amounts” of uncertainty when treating trans patients. Current guidelines carry little scientific evidence to show they work, writes the author, and the medical community’s narrow definition of what it means to be trans only exacerbates the issue.

“My research begins by asking what happens when there is no scientific evidence and little clinical experience to base medical decisions,” said the report’s author stef shuster (whose legal name is written in lowercase letters), an assistant professor of sociology at Appalachian State University. “This particular feature of trans medicine introduces the potential for providers to bring bias or limited knowledge into their work with trans people.”

Transgender is the umbrella term used to describe people who don’t identify with their biological, or so-called “assigned” sex. According to the American Psychological Association, a person who is trans has an “internal sense” of being a man or a woman, or something outside of these categories.

Often, trans people will seek to change their physical appearance and biology to resemble the identified gender, known as sex or gender reassignment surgery. It’s not a straightforward process, and generally requires multiple meetings with both doctors and therapists. Transgender medicine covers both physical care, such as estrogen or testosterone hormone therapy, as well as mental healthcare, to help a trans person transition both physically and socially.

When determining whether a person is a candidate for medical treatment, doctors, therapists and other health professionals typically use a set of clinical guidelines created by the World Professional Association for Transgender Health (WPATH), a nonprofit that promotes transgender healthcare. The guidelines lay out a series of steps, starting with one or more visits with a therapist, who decides whether sex reassignment surgery is the correct course of treatment.

If the therapist concludes that the person is indeed transgender, the trans person is sent to a doctor to receive treatment such as hormone therapy or surgery, including reshaping the breasts or the genitals to resemble the identified gender.

The process has many challenges, according to the study. The fact that a trans person’s fate is placed entirely in a therapist’s hands is morally questionable and controversial, writes shuster. Transgender medicine has also been built around the idea that to transition means to switch from male to female or vice versa. But that’s changing, shuster says.

“More recently, trans people’s understandings of their selves and bodies have become more fluid, and ‘cross’-gender transitioning is not always the ultimate goal,” writes shuster, who asked to be identified with the pronoun “they” rather than “he” or “she”. “The nuance in gender identification that trans people bring to the clinic exacerbates providers’ uncertainty.”

The study interviewed 23 doctors and psychologists who have chosen to work in transgender medicine. Many had entered the field because they personally knew someone who had trouble finding a provider to treat them. Only two of the participants worked exclusively with trans people, while just one identified as transgender.

According to the study, uncertainty about how best to treat a trans patient was something that was regularly experienced by all of the respondents. To cope with this uncertainty, providers used current guidelines to help inform their decisions.

The study found that some providers closely followed guidelines, while others were more flexible and interpreted them on a case-by-case basis.

Those new to the profession and those with a decade or more experience tended to be more rigid, expecting trans people to be “100% certain” about their desire to undergo sex reassignment surgery. One reason for this, writes shuster, is that more experienced providers may be slower to accept changing notions of what it means to be trans, while those new to their profession lacked the experience to confidently chart their own course.

One respondent named Sarah, a therapist in private practice, said she closely followed guidelines to ensure a patient didn’t come to regret their decision to transition later on.

“I can’t have you wake up on a surgeon’s table and say, ‘Who are you and what are you doing to my body?’ That has happened,” she said. “So I am really good about wanting to be holistic with people, and saying, please just let me be your therapist.”

This absolute power to decide the course of another person’s future made some of the participants uncomfortable. Alexis, a social worker, said although she has refused to okay some people for sex reassignment surgery, the double standards in transgender medicine versus other areas of medicine doesn’t always sit right with her.

“It is a tough function to fulfill,” Alexis said. “In all other areas of mental health practice, I don’t really have to give permission to people to do things.”

The idea that a trans person has to be absolutely certain about their desire to transition doesn’t take into account the complicated and oftentimes changing nature of gender identity, writes shuster. For instance, some people might start hormone therapy but decide months later that the treatment isn’t right for them.

“Trans people are allowed little room to explore their identities on their own terms,” writes shuster.

It also gets more complicated when people identify as “gender fluid” rather than explicitly male or female. One participant, Brandon, a psychologist at a university clinic, said it’s much easier for a therapist to make a decision when the boundaries are clear and a person wants to transition from male to female or vice versa.

“In the land of non-binary gender folks, you have to wade through waves and waves of ambiguity,” he said. “You have to build way more of a relationship with the person and establish a whole lot more trust.”

Respondents that took a more flexible approach to the guidelines said they weighed up what was more harmful: to treat someone even when it isn’t clear they are ready for medical treatment, or to not treat someone at all.

“It seems far less harmful to give someone hormones long term and take some risk that it might kill them, where maybe before they were suicidal,” said Anna, a family practitioner at a community clinic. “It is not for me to say to any given person, ‘Well you are not quite suicidal so I don’t think it is worth the risk.’”

Shuster describes gender as a “socially-ascribed category” that cannot be simplified or standardized. More research is needed in the area of transgender medicine, shuster says, especially from the perspective of the medical community. Shuster also urges doctors and therapists to be less dogmatic and allow trans patients to have more ownership in the process.

“From a trans patient perspective, healthcare encounters might feel easier to negotiate if providers stopped emphasizing this narrow definition of ‘transgender’,” shuster says. “And opened up more dialogue for their trans patients to describe how they understand their own identities and bodies.”

Doctors lack experience and expertise in treating transgender patients, study says

Experience: my attempt to go 21 days without a whinge ended up taking six months | Michael Dawson

Sunday 24 July 8.43am. In the midst of the US presidential election, news breaks that WikiLeaks plans to release 20,000 hacked Democratic Party emails that will likely damage Hillary Clinton’s chances, and enhance Donald Trump’s. I read the relevant passage aloud to my wife, before adding my own searing commentary: “I would’ve thought Assange and Co would have the intelligence to realise …” I suddenly pause.

A ripple of panic pulses through me. Am I complaining?

Over the past five months that question is one that has developed the ability to paralyse me. Why? Because I’m in the throes of what has turned out to be an epic challenge. I am trying to go 21 days without complaining. A self-imposed abstinence from grumbling of any kind: no slander of public figures, no whining about the weather. Nothing.

It’s an exercise that I first heard of while listening to a podcast by Tim Ferriss, the productivity expert and quasi self-help guru. Ferriss in turn discovered it after it was popularised by a new age pastor from Kansas City by the name of Will Bowen. And while I identify neither as a member of the self-help set nor the god squad, I was instantly fascinated by the mission.

The rules are ostensibly simple: put an elastic band on one wrist. Every time you complain, switch it over to the other wrist. Repeat, until the band has remained on one wrist for three weeks.

The simplicity is compelling, but the moment you start it becomes awfully complex. It turns out that “Am I complaining?” can be a very hard question to answer, because what is a complaint? There’s obviously the dictionary definition: an expression of discontent about a person or state of affairs, something like that. But in practise it gets murky. Consider the following three phrases.

1. “It’s cold.”


2. “Damn it’s cold.”


3. “Damn this cold.”

I think we could all agree that (1) is probably not a complaint. Assuming the weather is actually cold, it’s just a statement of fact. And we could reach a similar consensus that (3) definitely is a complaint. But what about (2)? What about (1) said in a slightly whiny tone of voice? What if someone else says (3) and you agree with them?

Or how about this: “I would’ve thought Assange and Co would have the intelligence to realise that a Trump government will not be good for people like him.” Is that a complaint, a pointed observation, or merely the expression of a dashed expectation?

On that particular Sunday morning, I decide it is not a complaint. I turn the page and leave the worn-out hair elastic clinging to my left wrist.

Monday 25 July 11.19am. The following day I meet my wife for coffee. As we approach the cafe, I spot a former colleague waiting at the counter. Let’s call him Gary. I’m not a fan of Gary’s. I mean, I wish him no specific harm. He’s not a bad person – he just has an awful sense of humour. Dad jokes and cries of “Taxi!” when a glass breaks are the cornerstones of his comedic oeuvre. Now I’ll have to endure some of it and, worse, my sweet wife will be subjected to it. For a moment I forget myself. As I spot The Gazmeister I let out a big sigh and two words slither out after it: “This idiot.”

That sentence isn’t even a sentence. It doesn’t have a verb. But the moment I utter it, I know the truth. It’s a complaint. I change the elastic band over and brace myself for some punny pleasantries. It stings, because at that point I was into my fourth consecutive day without complaint. And in five long months of trying, the longest I have gone is six days.

Not complaining is really, really hard. Until you try to stop, you’ve no idea how often you do it. It’s not a question of whether you’re an inherently positive person or a negative one. Complaint is a pivotal part of all conversation – it can be used for good as well as evil. A lot of the time, we complain as a way to connect. A shared moan is a time-honoured technique for relating to a co-worker, fellow traveller or life partner. Who hasn’t felt the warm rush of catharsis that occurs when you discover that someone else hates that thing you hate? Bellyaching is bonding.

So it’s wrong to say that complaints are wholly negative. In fact, some can be extremely positive. In a certain light, you could even view the whole of human progress as the result of complaints. Complaints about slow horses, or polio. Complaints about apartheid, or gender inequality.

We need complaints, and we need negativity. But for me at least, this challenge is not about disputing that fact. Nor is it about worshipping at the altar of positivity. The reality is you can perform some verbal gymnastics that allow you to express negative sentiments without complaining. “This traffic sucks” can become “I would love it if this traffic would clear.”

But in order to do that you’ll need to pause and really think about your choice of words. This is where the challenge becomes fascinating, because you start to realise how little thought we give to what comes out of our gob. The words just tumble out, like goods being looted from a supermarket. By focusing the mind on complaints, you employ someone to work the checkout. And why is that of any benefit? Well, it becomes a sprawling and highly effective exercise in mindfulness.

Mindfulness, in case you missed it, is approaching the status of full-blown fad – pretty impressive for something that is a few millennia old. One description is that it’s the practice of being present in any given moment. If that smells a bit too much like smouldering sandalwood for your liking, try “being aware of what you’re doing and what’s happening around you”.

Buddhists long ago observed what they call the “monkey mind”, the idea that the mind is inherently a bit restless and fidgety. If you don’t give it a clear task, it will either keep a running commentary, or wander off on tangents. Your head becomes filled with an endless, meandering chatter – a din that has been blamed for everything from anxiety to insomnia. The solution, say the Buddhists, is to give the monkey a job. It could be watching your breath come and go (meditation), or it could be keeping a keen eye on what you’re doing (mindfulness).

The claimed benefits are as varied as they are numerous: improved focus, anger management, treatment of depression, lower blood pressure, stress relief, general wellbeing. It’s a laundry list of advantages that has seen mindfulness teachings adopted by everyone from captains of industry to captains of football teams. All sorts are trying to experience the benefits of silencing their simian. There are countless ways to do it, but I’ve found one of the best ways to shut him up is to have him monitor your moaning.

27 July. Mid-morning a colleague and I travel to a meeting in his 2006 Toyota, a vehicle he calls Sonia Kluger, after the Australian media personality. I ask him how he feels now that his people mover has become associated with calls to ban Muslim immigration. He says there’s not much he can do about it. But our conversation has taken a turn, and we make some very pointed observations about Isis and the state of the world. I come dangerously close to complaining, but stop just short.

It’s not until later that evening that things fall apart. Over dinner a family member tells us she’s recently discovered that her former boss underpaid her entitlements. The business is no longer trading, so she’s unlikely to see the money owed. I simply can’t participate in the conversation without making negative comments about the person in question. It occurs to me that if I have any chance of making it to 21 days, I’ll need to recognise these situations immediately, and turn mute.

It’s that recognition that is the hard part though. That’s what makes it so different from other abstinences. When someone breaks their commitment to Dry July, they do so consciously. I’d imagine very few people get halfway through a beer and suddenly remember that they’re meant to be off the sauce. But that is exactly how it is with complaints. By the time you realise a gripe is in the vicinity, it’s usually too late.

5 August. Seven days and counting, a new record. I call the bank about two errors it has made, and manage to correct both without complaining. Instead, I simply state that I “can’t understand” why these things occurred when I was led to believe they would not occur. Sure I sound like a robot, but who cares? I’ve completed a task with a high degree of difficulty. If not complaining were figure skating, the bank call would be equivalent to a triple axel. I might not have shown much grace through the air, but I stuck the landing.

12 August. It’s at this point that I could veer off on a tangent about the general level of whingeing in the world. I could note that social media has amplified gripes about everything from overpriced avocados to sluggish Wi-Fi. I could write about how millennials are profuse whingers, surpassed only by non-millennials when you get them on to the topic of those wretched millennials. I could do all that, but I won’t. That would be a meta-whinge, and I’m 14 days without complaint. I’m into the home stretch and I’m not about to slip up now.

19 August. I took on whining, and I won. Were there some 50/50 calls that went in my favour? You bet there were. But when it’s all said (or weirdly bottled up) and done, I achieved my objective. Thrust into all manner of less-than-stellar scenarios, I summoned the strength to stifle my disapproval. I came, I saw, I concurred. Not only that, I did it at a time when the Pokémon GO frenzy was at its peak.

So how do I feel? Well, unsurprisingly, there’s not some powerful benefit that is unlocked on the 21st day. Rather there is an accumulation. I definitely think my focus has improved, along with general calmness. But perhaps the most noticeable benefit is a greater sense of control. You might think your level of control is just fine as it is – I certainly did – but it can be much better. If you try to stop complaining you’ll see what I mean.

Turning off autopilot is hard to do, and you’ll find those muscles that steer the plane have atrophied. But if you pump them up for a few weeks, the flight becomes more interesting and engaging.

How do I feel? Can’t complain.

Experience: my attempt to go 21 days without a whinge ended up taking six months | Michael Dawson

Third of teenage girls in England experience depression and anxiety

Depression and anxiety have risen among teenage girls in England, with more than a third reporting symptoms of distress, although the rates are stable among teenage boys, according to a major survey of 14-year-olds carried out for the Department for Education.

Among the girls, 37% reported feeling unhappy, worthless or unable to concentrate, more than twice the percentage of boys reporting such feelings, a rise since a study in 2005, which was described by the researchers as “an important and significant trend”. The figure for the girls had risen by nearly four percentage points since 2005, while the figure for boys, 15%, had fallen slightly.

The rise was pronounced in young people living in single-parent households or with stepfamilies, and those with a long-standing illness or disability affecting their education. Poor sleeping patterns, including sleeping for less than the recommended amount, were reported among many of those reporting other problems, and will be followed up in later reports.

A spokesman for the Department for Education said the mental health of the young was a priority area.

“Children’s mental health is a priority for this government and we know that intervening early can have a lasting impact,” he said. “We are putting a record £1.4bn into transforming the dedicated mental health support available to young people across the country and are working to strengthen the links between schools and mental health services.

“We are also driving forward innovations to improve prevention and early support, by investing £1.5m on peer-support networks in schools so children feel empowered to help one another.”

There was some good news in the report, which found that the teenagers were more serious than their predecessors, less likely to be play truant, more convinced of the importance of hard work, and “markedly” less prone to risky behaviour including smoking, drinking and drug-taking. In 2005, 30% admitted to drinking alcohol, but this had fallen to 12%. Reported drug-taking was also down, and truancy had fallen from 21% to 11%. There was a sharp fall – from 23% in 2005 to 16% in 2014 – in teenagers reporting that their parents had kept them out of school for reasons other than illness.

The situation outlined in the report, based on in-depth interviews with thousands of teenagers in year 10 in England, was described by Marjorie Wallace, chief executive of the mental health charity Sane, as “a slow-growing epidemic”.

Wallace told The Times that her charity had been contacted by worried school heads. “There definitely does seem to be something happening – it’s a slow- growing epidemic,” she said. “Over the period covered by the report we have seen a very disturbing change in admissions to hospital for self-harm in under-16s that have gone up by 52%.”

The report found the problems were more marked among both girls and boys of parents educated to degree level, which the researchers said could be partly due to peer pressure and pushy parents. There had also been “a small but statistically significant” worsening in young people’s belief that they could influence their own destinies – more marked in households where at least one parent was out of work.

The researchers – who will continue to follow up the group of teenagers interviewed – said there appeared to be less stress, possibly because of lower expectations, among those from more disadvantaged social backgrounds.

“There may be some ways in which having lower social status may be associated with lower levels of expectation for school success and lower levels of associated pressure. Another possible explanation is that young people from disadvantaged backgrounds may be more resilient in the face of [stress factors] associated with a more challenging economic and school environment.”

Third of teenage girls in England experience depression and anxiety

Bullying in the NHS – what"s your experience?

Bullying has long been a serious problem in the NHS.

Nearly a quarter (24%) of healthcare professionals working in the health service who responded to a 2014 staff survey said they had been bullied or harassed in the workplace.

Robert Francis’s 2010 report into the Mid Staffordshire hospital scandal said staff were reluctant to come forward with concerns about poor care because they were scared. Witnesses described “an endemic culture of bullying”, and the report provides graphic examples of the victimisation of those who did raise concerns.

Bullying also leaves its mark on employees’ physical and mental health and costs employers sick pay and turnover. It is also bad for patient care. Staff are less likely to raise concerns and admit mistakes if there is a culture of blame and bullying.

We want to hear about your experiences of bullying in the NHS. Have you been victim to it, or seen a colleague be bullied? What impact did it have on you and those around you? How does your trust handle it?

We want to hear from all roles within the health service – nurses, managers, doctors, administration assistants, allied health professionals, paramedics etc. Please take our survey and tell us what the situation is for you. If you’d like to get in touch to tell your story, please email sarah.johnson@theguardian.com.

Results will be published in the Guardian.

Bullying in the NHS – what"s your experience?

Large number of young people experience sex problems, study finds

Large numbers of young people experience sexual problems such as pain or anxiety during sex, the inability to climax and finding intercourse difficult, a study has found.

A third (33.8%) of sexually active teenagers and young men aged 16-21 and 44.4% of sexually active young women the same age experienced at least one problem, which lasted for at least three months, with their ability to enjoy sex in the past year, according to the research.

Related: Less sex please, we’re millennials – study

Experts say the results, from the latest National Survey of Sexual Attitudes and Lifestyles (Natsal-3) study of sexual health in Britain, show that young people need help with their “sexual function” as much as advice on avoiding sexually transmitted infection or unintended pregnancy. They experience problems almost as much as older people, it emerged.

For women, the most common problem was difficulty in reaching climax, which 21.3% of female participants said they experienced. The next most common problems were: lacking enjoyment in sex (9.8%), feeling physical pain as a result of sex (9%), an uncomfortably dry vagina (8.5%), feeling anxious during sex (8%) and no excitement or arousal (8%).

Among men, the biggest difficulty was reaching a climax too quickly, which 13.2% had experienced. Smaller numbers reported difficulty in reaching a climax (8.3%), difficulty getting or keeping an erection (7.8%), lacking enjoyment in sex (5.4%) and feeling anxious (4.8%).

The Natsal surveys, the funders of which include the Medical Research Council and the Department of Health, are seen as the most in-depth portraits of sexual behaviour in Britain. This latest edition has been carried out by academics from the London School of Hygiene and Tropical Medicine (LSHTM), University College London and NatCen Social Research. Natsal-3 is based on 1,875 sexually active and 517 sexually inactive men and women aged between 16 and 21.

“Our findings show that distressing sexual problems are not only experienced by older people in Britain”, said Dr Kirstin Mitchell, the lead author of the study. “They are in fact relatively common in early adulthood as well.

“If we want to improve sexual wellbeing in the UK population, we need to reach people as they start their sex lives, otherwise a lack of knowledge, anxiety or shame might progress into lifelong sexual difficulties that can be damaging to sexual enjoyment and relationships,” she added.

Among the sexually active, 9.1% of young men and 13.4% of young women said that they had felt distressed about a sexual problem that had troubled them for at least three months.

Natsal-3 found some significant differences between men and women in the sexual problems they encountered. Far more women (9.8%) than men (5.4%) lacked enjoyment in sex, felt anxious during sex (8% compared with 4.8% of men) and experienced no excitement or arousal during sex (8% compared with 3.2% of men).

Related: Sex: the myths debunked

The same stark gender divide was also apparent in those who professed no interest in having sex. One in five (22%) of women said they lacked interest, while far fewer men – 10.5% – said the same.

Young people are very unlikely to seek professional help for their problem. Although 36.3% of women and 26% of men said they had sought help, this was usually from family, friends, the media or the internet. Just 4% of young men and 8% of young women had turned to an expert such as a GP, psychiatrist or sexual health professional about their sex life.

Prof Kaye Wellings of LSHTM, a co-author, said: “UK sex education is often silent on issues of sexual satisfaction, but these are clearly important to young people and should be addressed. Sex education could do much more to debunk myths about sex, discuss pleasure and promote gender equality in relationships.”

Large number of young people experience sex problems, study finds

Experience: I was stung by one of the deadliest creatures on Earth

I moved to Sydney, Australia, after finishing my master’s degree at Nottingham University. I was winging it: I just turned up with a suitcase. I got a couple of jobs, in internet marketing and as a private tutor, and met an Australian woman, Chloe. About a year after I arrived, I was off work on a beautiful summer’s day and fancied some peace and quiet, away from all the tourists who flock to Bondi. Chloe had told me about Gordons Bay, a small, secluded beach nearby, and I was looking forward to listening to music, reading and relaxing.

There was hardly anybody there and I settled on some large rocks to sunbathe. It was postcard perfect: serene, azure sky and a calm, green sea. It was the hottest part of the day and, after reading for a while, I decided to cool off and jumped into the water. It was warm and I remember feeling happy. I swam away from the rocks and kicked back to float, looking at the sky. That’s when the pain struck.

My first thought was that a shark had taken my right leg. I didn’t know what was happening, but I knew I was in danger. I expected to see my blood billowing around me in the water, but there was nothing. This magnified my panic; I didn’t know what was causing the pain or which direction to swim to avoid it.

My heart was racing and every one of my muscles tensed, then went into spasm. I was in blinding pain all over. I lost the ability to speak or think. My internal voice had stopped. I could barely breathe. I believed I was going to die.

I tried to swim, but felt very tired. I thought that if I went to sleep, it would all be easier when I woke up. But I went into autopilot and somehow managed to get myself to the rocks. There were thin red lines across my right shin that looked as if they’d been drawn with a pen.

A scuba diver ran over. He said he’d seen box jellyfish in the area. I wouldn’t have been able to see them in the water. I didn’t know then that they are one of the deadliest creatures on Earth. Their tentacles pump venom into the skin that attacks blood cells and can lead to cardiac arrest. He told me I’d been stung by one and needed to get to hospital immediately.

All my conscious decision-making facilities had left me, and I wasn’t able to process what he said. I walked away. He called after me, but my only instinct was to get home. The next thing I knew, I was in my apartment with a bag of peas on my leg.

I still don’t understand the sequence of events. I lay down, and for an eternity I didn’t move. I didn’t feel like I’d been awake or asleep. I couldn’t think of what to do or how to communicate. I was a prisoner in my own body.

Related: Experience: IVF gave me a heart attack

After a day or two, the poison began subsiding. My foot had swollen massively – my little toe was the size of a big toe. Those thin red lines had started corroding, and the poison had eaten away at my skin, revealing the muscle and bone underneath. It looked as if someone had taken a jagged axe and tried to chop off my foot. I managed to call Chloe and show her. The next thing I knew, we were on our way to hospital.

The doctor asked why I hadn’t come in sooner. I tried to explain. I asked if there was anything he could do, but he said the toxins had gone through my system: there was nothing they could do except clean the wound. He told me I was lucky the jellyfish had stung me on my leg; if it had been on my chest, I would not have made it.

I left Australia pretty quickly after that. I have a scar, still walk with a limp and have pain in my hip. I wonder about the long-term effect on my brain and body as a result of the toxins, but there’s very little data on this. I think my delay in getting treatment was down to the shock.

Chloe and I are still friends, although the relationship didn’t work out. I now run a startup in Silicon Valley. Sometimes I think about setting up a box jellyfish survivors’ group – Indigenous Australians say that you inhabit the power of any animal that stings you. That makes us pretty indestructible.

• As told to Sophie Haydock

Do you have an experience to share? Email experience@theguardian.com

Experience: I was stung by one of the deadliest creatures on Earth

EU working time rules a "mistake" that prevents junior medics obtaining adequate experience, says top surgeon

He has now written a guide about his career as a neurosurgeon, entitled Do No Harm, and earlier this yr disclosed he had made the decision to retire from the NHS soon after management banned him from sporting his wristwatch.

When asked no matter whether younger doctors had been offered sufficient expertise in coaching right now, Mr Marsh informed an audience said: “No, they’re not.

“It is a fear. What is indicates is the new generation of young consultants are a lot less skilled.

“At the minute I’m fairly positive junior medical professionals are not working enough. The European operating time directive is a blunder.”

He additional: “The difficulty is now my students face is that they operate 48 hours a week and are significantly, significantly much less experienced than I was at their stage.

“They don’t have continuity of care, they don’t comply with individuals via in the way we used to. I believe that’s all very undesirable.

“But they invest the entire night on the phone. My juniors are used as a brain scan reporting services for the whole location, so they get no sleep at all.

“Most of their time is spent handing out very simple health-related advice to quite inexperienced casualty physicians.”

Mr Marsh, who plans to continue educating around the globe when he retires, stated he also believed physicians improved in their later career, gaining empathy and insight into the patients’ own maladies as they aged.

“I like to think they’re like a good red wine,” he added. “They get far better with age.”

His memoir, Do No Harm: Tales of Daily life, Death and Brain Surgery, is out now.

EU working time rules a "mistake" that prevents junior medics obtaining adequate experience, says top surgeon

Bettering The Healthcare Patient Experience: Why Hospitals Consulting Hospitals Doesn"t Function

The way I see it, healthcare is hospitality with healing: a combination of two positives. Or it is healing with hospitality.  The emphasis one particular way or the other probably does in fact matter, and ought to be selected based on the patient, the ailment, and other factors, but either way, I see healing and hospitality the two as positives. [A hat tip here to Brad Black of HUMANeX Ventures.]

Considering that we can all agree that clinical outcomes (the healing portion of the equation) matter, I’ll leave that aside right now and talk about hospitality, the client knowledge side of the equation. 1 of the ideal factors to do to enhance the patient expertise is to contemplate the globe your oysterbed of inspiration: to open your considering to incorporate models outside as nicely as within of healthcare.

The issue of hospitals benchmarking hospitals

An obstacle to improving patient fulfillment in healthcare is the industry’s insular nature, which can make the status quo self-reinforcing.  In other phrases, healthcare providers and institutions compare themselves to each and every other – to the hospital in the following town, the surgeon in the up coming O.R. – and benchmark their buyer services accordingly. And to do so is to set the bar in the wrong location.

It’s not as if individuals cease becoming buyers – clients – when they place on a hospital gown. And it’s not as if their loved ones surrender their identities as businesspeople, twitterers, Facebook end users, both, when they enter your institution. So, it’s time to benchmark healthcare buyer service towards the best across all services-intensive industries, because that’s what your patients and their loved ones will do.

Every single patient’s interaction with healthcare is judged in portion on the basis of expectations set by the best organizations in retail, foodservice, the hospitality market, economic companies, and other places where specialist gamers have made a science and an artwork of consumer services.

…but nurses are not waiters, medical professionals aren’t baristas

Now, I do not want to overstate the situation.  I know consultants who consider such factors to an intense: I’ve run into (and competed with) consultants who make it sound like staying at the Ritz-Carlton and staying at a local community hospital need to be equivalent. Or that ordering a latte at Starbucks and getting an outpatient process are in concept more are less the same.

And I argue back at them with the fantastic words a nurse sent to me recently: “Healthcare is a calling, and we really don’t deal with it like functioning in quick food if we had wished to be waitresses, we would be functioning as waitresses–and we’re not.” I think that is absolutely correct, and that the analogy to other services-intensive industries is also strained by the reality that your patient did not, all things getting equal, select to “check in” with you both. Healthcare is enforced hospitality. Involuntary hospitality.  Which can make factors a bit, or more than a bit, different.

But there’s so considerably to be realized from the strong, examined practices of organizations across many industries — and these do include Starbucks and Ritz-Carlton, in spite of my disclaimer over.  Here are five concepts that will get you started.

1. Objective vs. Function 

You can only create a basis for wonderful patient service if you operate to make sure, from the initial day of orientation onward, that every single employee understands what her underlying function is in your organization. An worker has each a function—his day-to-day job responsibilities—and a function: the reason why the occupation exists.

For instance, ‘‘To develop effective health-related outcomes and hospitable human experiences for our patients” is a goal.   “To adjust linens” is a function. A appropriately trained and managed employee will know to—and will be empowered to—stop modifying linens if generating effective medical outcomes or being hospitable needs a diverse action at the moment. And afterward, management will celebrate her for her purpose-driven determination, not scolded for currently being a number of brief in the amount of linens transformed.

two. Very first issues initial: Resolve your service beginnings and endings

Due to the fact of how human memory works, the initial and final things in any list are the ones most very easily remembered. (You can go through the psychological literature on this, or demonstrate it to oneself with a checklist of things and a bunch of your close friends.)  In the buyer encounter, the exact same principle holds true: The first and last moments of a client interaction are what a customer is likely to hold in memory as everlasting “snapshots” that signify the whole event for them in memory.

This means it can be difficult to recover the goodwill of a patient or household member whose initial impression is:

• A front-desk staff member’s irritation at becoming “interrupted”–even for that telltale half-2nd.

• Spending a prolonged, tense time discovering a parking space (and when she does, the space he finds is a 6 minute stroll to the front door—and he’s on crutches).

• Signage in the developing that is puzzling (after he finally does control to hobble the 6 minutes to the front door).

 As far as goodbyes: Your goodbye wants to be much better than just a chilly invoice sent by means of the mail by your billing service. (Why do veterinarians universally follow up to see how Rover is carrying out but doctors rather hardly ever do the exact same with their human patients? It could make all the distinction.)

three. Fantastic buyer services—real hospitality—is ideal delivered on the schedule of the buyer. Strive to provide services on patient-centered timetable, not just a schedule that transpires to be handy for your institution.

For instance:

• Avoid  unnecessarily lengthy waits for/batching of lab final results to be distributed this practice is disrespectful and even cruel.

•  Consider the innovations now accessible that let a patient much more manage than does the (sadistic) tradition of forcing them to wait in the dark for an eventual response to their get in touch with light.

• Search at the Cleveland Clinic exact same day appointment model. (Here’s my article discussing this in detail.)  Do you actually need to have to surrender your patients-in-a-hurry to a chain drugstore clinic — or is it achievable you could reorganize your own operations to see them right away?

When reviewing your standards and approaches in the region of timely, patient-centered scheduling, usually preserve in mind that expectations of velocity have transformed: Your sufferers are not as patient as they utilized to be.  Today’s sufferers and their households live in a planet the place Android units and iPhones, laptops and iPads, can connect them – quickly! – to vetted suggestions from the Mayo Clinic. Exactly where Amazon.com can get them a book of expert guidance quickly in electronic form, or within eleven hrs in hardcover. So to believe you can get back to individuals with info at the identical sluggish tempo at which you have constantly responded is not going to cut it. Patients don’t want you to shoot from the hip, but they need to be kept informed. Regularly and speedily.

4. Cues to quality matter: You’re a skilled professional, but that lipstick on your teeth tells me otherwise  

Do not assume your patients to be nonjudgmental just because they’re at a disadvantage and in some distress. Lipstick on your teeth implies incompetence in a healthcare setting the identical as it does in the outside planet although I myself sympathize that you just pulled a double, your patient won’t.

Numerous cues to top quality are associated to poor use of language, and nonverbal snubs, such as hospital employees staying away from eye get in touch with with civilians in the hospital, and acting like they are “other.”  (Speaking of which: Personnel want to recognize that great consumer support is their task from the time they get on the residence to the time they depart the residence the damaging cues a person “not however on duty” or “just off duty” can convey although traveling from the automobile down the hall to his station, or from his station down the hall back to his vehicle, can ruin all the effort his colleagues have invested.)

Bettering The Healthcare Patient Experience: Why Hospitals Consulting Hospitals Doesn"t Function

Recovering addicts: tell us about your experience with heroin addiction

Philip Seymour Hoffman’s death Sunday, which authorities think was a result of a heroin overdose, shocked his close friends and followers, many of whom publicly wondered: “How could this have happened?” – but in accordance to a latest review, heroin use is increasing more common in the US, and recovering from the potentially lethal drug remains extremely challenging.

A recent survey by the federal Substance Abuse and Mental Well being Solutions Administration discovered that the use of heroin jumped 102% among 2002 and 2012. In 2012, about 669,000 men and women reported utilizing heroin at some point in the 12 months. Roughly 467,000 of people were deemed heroin-dependent – far more than double the number in 2002. The heroin epidemic has turn out to be so pervasive, that Vermont Governor Peter Shumlin, invested his whole 34-minute State of the State address this yr discussing a “full-blown heroin crisis.”

Recovery is achievable, but extremely hard. Hoffman had been clean for 23 many years ahead of he relapsed, and his encounter is not uncommon.

“Someone with opiate addiction, they are doing pushups their entire lives,” Dr Drew Pinsky advised HLN Monday. “And they need to function on it all the time. And even operating on it, there is a large probability of relapse.”

With so significantly consideration being centered on heroin addiction, we want to hear from individuals who have skilled it firsthand.

• In a recent piece in the Atlantic, Jeff Deeny, a recovering addict wrote that Hoffman’s death reminded him to continue to be vigilant in maintaining [his] psychological well being. How do substantial profile overdoses, like Hoffman’s and Glee’s Corey Monteith impact you?
  
  


• What do you make of the fact that Hoffman was 23 many years clean and then went back to medication? Can you make clear the pull of addiction to an audience who may well not otherwise comprehend its electrical power?
  
  


• Last but not least, if you had 1 piece of guidance for current addicts taking into consideration recovery, what would it be?
  
  

Submit your answers below and we’ll featured selected responses on the Guardian. Please speak to Ruth Spencer with any queries. For all responses published, the Guardian will only publish your initial name. Your electronic mail tackle will remain personal.

Studying on mobile? Click here

Recovering addicts: tell us about your experience with heroin addiction

Virtual actuality theatre puts first-hand experience of brain harm centre stage

In 2007, Jane Gauntlett was preparing for a job in theatre when she was violently mugged and fell into a coma for 3 weeks. She suffered a traumatic brain damage (TBI), the lengthy phrase legacy of which includes epileptic seizures and brief phrase memory and communication difficulties.

“When I woke from the coma I had no notion how serious the damage was. I was adamant that I was to become a freelance theatre producer,” says Gauntlett, who had completed the Royal Court Theatre’s Youthful Writers Programme even though doing work previously for mental well being charities. At first, she stayed on track, gaining encounter with interactive theatre makers at Battersea Arts Centre and making demonstrates in Edinburgh, London and Margate.

However, work was disrupted by epilepsy. Worse than the seizures themselves was the alarmed reaction of colleagues, and this was compounded by the humiliation of not being in a position to remember and talk as freely as she as soon as had in the course of the inventive approach.

Daily life will in no way be the same 

The very first step toward accepting her lifestyle post-damage was to volunteer as a mentor for youthful folks with related concerns. She worked to facilitate understanding in between people she mentored and these who could in no way relate to the daily knowledge of TBI, which can be frustrating and scary. People whose injuries leave no physical trace face the biggest challenge, given that their difficulties are so effortless for other folks to overlook. Gauntlett says the young folks had to accept that existence would in no way be the very same because “communication with families, friends and strangers was frequently challenging.”

It was this imperative for empathy in between people with and with no brain injuries that gave Gauntlett her route back into theatre. But to achieve her goal, she had to look past the spacial and relational conventions of functionality. The outcome was a piece called In My Shoes which lacks anything a single may recognise as actors or an audience and is also non-website distinct. In fact, the immersive and single-consumer knowledge relies mainly on technological innovation.

Daily life becomes theatre with the help of technology

The piece recreates the producer’s own disorientating knowledge of waking up in Slough right after a seizure, with no notion how she received there. The audience – or rather the a single person encountering the display – is put “into Gauntlett’s shoes by wearing Vuzix 920 Eyewear, wrap-all around video glasses, and earbuds connected to an iPod Touch which deprive them of their personal, familiar senses. Virtual reality takes more than and is augmented more by the manipulation of touch, taste and smell, even though exactly what transpires should probably be saved for the efficiency itself.

“We have our eyes peeled for technology that will improve our experiences – we want to keep up to date,” says Gauntlett. “In My Sneakers experiments with substitute strategies of communication. My aim is to place audiences as near to becoming in the sneakers of a stranger as I can, I use virtual actuality computer software, touch, taste, sound &amp smell to make it as real to lifestyle as attainable.”

The achievement of the 1st incarnation – reactions run the gamut of emotion but are by no means underwhelmed – led to the evolution of the piece. Gauntlett formed a collective called Sublime and Ridiculous, to share the perform of exploring a assortment of complicated, delicate or controversial subjective realities. They have so far put hundreds of inclined participants into the shoes of a folks with post-traumatic pressure disorder, bi-polar disorder and stroke, as nicely as these of a paramedic and a trans-gender person. They have strategies to adapt the piece and its technology to investigate the perspectives of an astronaut, a politician, a dominatrix and a murderer.

Though Gauntlett had no prior knowledge in the discipline, engineering is now integral to her function: “I am fascinated by how rapidly factors are evolving and have my eyes peeled for new inventions. In My Footwear is an ever-expanding collection of audio and audio-visual experiences and I am keen to expand it, and for it to evolve utilizing cutting edge technologies as it gets to be available.”

Different versions of My Shoes have been carried out by the Sublime and Ridiculous collective in New York and London. Photograph: Amy Hart

Technological innovation is part of theatre’s long term

In spite of this kind of a unique genesis and manufacturing, she is quick to stage out that the symbiosis of theatre and tech is frequent in contemporary functionality. “Interactive theatre plays a big part in the fringe scene,” she says, even though elsewhere, engineering is employed to deepen knowing in other distinct contexts: “Large tech Kabuki theatre in Japan uses transportable monitors [for the audience to study] subtitles in order to better understand an artform that is frequently hard to comprehend.”

As effectively as illuminating intensely private experiences, Gauntlett hopes this kind of advances will lead to more international collaboration and theatre that is accessible to a lot broader demographics. Nevertheless, she says: “I don’t feel theatre’s survival and relevance depends on embracing technological advances.” The point is there is space for every thing, and technological innovation-driven theatre will acquire momentum as technological innovation turns into ever a lot more integral to people’s day-to-day lives.

Such innovation, she says, “is at times frowned upon by critics. However, if the operate is excellent it should not matter.”

Sublime and Ridiculous will carry out In My Shoes at Battersea Arts Centre, London on eight February 2014, as component of Freshly Scratched

Virtual actuality theatre puts first-hand experience of brain harm centre stage