Old Lad

I’ve just been to a funeral. It reminded me of how much rituals play in our lives. And as I get older I find some rituals reassuring and helpful. When you are younger of course rituals can seem exasperating and pointless – its the urgency of youth to get things done. There are long standing traditional rituals in life – Births, Marriages and Death – which are a focus for these major events. Although in the case of marriage and death these are changing with the decline in religion, the use of varying venues for weddings and unconventional funerals.

I was a child in the 1950s and life was marked by daily rituals. Monday was wash day – no automatic washing machines then – and was labour intensive. Tuesday was Drying and ironing day. Wednesday was cleaning downstairs (we were posh, we had a vacuum cleaner) and Thursday was “Doing the bedrooms”. Friday was the day the Co-op travelling shop called and my Mum being hospitable would provide a cup of tea for the driver. And so the weeks rolled on but the ritualistic nature of all this meant that I had no problem knowing what day it was! Sunday of course was the ritual of the Sunday Dinner!

The interesting thing about rituals though is that if a routine changes a person can feel unsettled. For example every morning when I shave I always start on the Right side of my face. Occasionally for a bit of bravado I have started on the left side, but it just doesn’t feel right! There is a ritualistic order in showering and drying which means of course that you can do it while thinking of something else. Rituals can become very negative things if they form part of an Obsessive Compulsive Disorder and can pose quite a challenge to the sufferer and their immediate family. And rituals are often a feature of an autistic spectrum disorder.

Medicine and medical practice is full of rituals. The majority of them do have a value although their true value is not often recognised. When I qualified in 1971 hand washing before and after examining somebody was the expected thing. Indeed when I started as a GP doing home visits (remember those)it was often the case that I would be offered a clean towel and use of the bathroom for hand washing. Its significant that with the rise in hospital acquired infections we have had to reinforce the ritual of hand washing. One of the rituals in the medical consultation that is often being debunked by modern practice is the physical examination of a patient. It is probably true that a good medical history and listening to the patient’s story will give the diagnosis in 90% of cases. Similarly the use of the stethoscope will often not reveal anything of note. But my view of practice is that this physical “laying on of hands” is an important part of the job. Just before I retired I was a member of medical tribunals hearing appeals against a decision not to award disability benefits. The job often entailed looking through a person’s medical records and very often no physical examination was recorded. And conversations with people who are dissatisfied with a visit to the doctor express frustration – “The doctor didn’t examine me – I was just sent for a scan”. Which reinforces my view that the ritual of examination is therapeutic and probably instils confidence in the doctor’s advice.

So next time you are pottering about just take a moment to think about rituals you may have. Are they a benefit or a hindrance?