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Posts by Beth Routledge

Of Course There Are Still Exams

Yes, of course I recommend sitting nine hours worth of exam in a room with no crosswind on the most humid two days of the year; why do you ask?

Last week on Tuesday evening, I told the collected Internet that I was knocking off and going for a run and an early night — “this is going to go however it goes now”, I said. I’m sure the Internet was relieved. I had been using my last little bit of annual leave to study for the exam I was about to take, and while stuck in front of my laptop I had been intermittently making fun of the more ridiculous of my practice questions for the benefit of Twitter.

For example.

The correct answer suggested that I have the power to quarantine dogs in Uruguay. By the power vested in me by the medical receiving page.

The correct answer suggested that I have the authority to quarantine dogs in Uruguay. By the power vested in me by the medical receiving page.

In the middle of all this, a friend who is not a doctor confessed himself to be curious as to why I was still being obliged to sit exams. The short version of the answer and to put it in a broader context is that for the time being this is just what I do as CPD. The longer answer is that medicine, after medical school, always requires some form of specialist qualification, which is what this is, and then sometimes, later, a subspecialist qualification too. I’m sitting my membership exams for the Royal College of Physicians, with what I did last week being the second of three parts. You may remember that I’ve moaned and mumbled about this sort of thing before, and that was Part 1. If I wanted to be a surgeon or a paediatrician or a GP, for instance, they all have their own college and so their own kind of exam.

A few people had warned me that I would feel as if I’d been hit on the head with a hammer, afterwards.

There are 270 questions split into three papers that are spread over nine hours across a day and a half. The questions all have a wee story, which is called a stem, normally about twice the length of that story about the Uruguayan dog, and then five options, of which a single option is “best”, to be selected and changed and then changed back using a 2B pencil and an inadequate eraser. My question paper, which they don’t mark, thank God, is full of circles, arrows, sums, and manic scribbles. A bit of sensible reasoning through of logic, a lot of notes-to-self, and the odd piece of exam-induced snark: “prob talking to an obstetrician before I do anything with the 38 wk pregnant woman tbh”.

You would think that this would all be old hat. It is a broadly similar format to Part 1 — the stories are slightly longer and the material is more clinically relevant, more about my actual job, although slanted heavily towards the weird and wonderful, and less about my ability to remember specific trinucleotide repeats on specific chromosomes, but generally familiar territory. And it’s not like I did Part 1 just the one time.

Except: in Part 1, you don’t have to come back the next day.

At the end of the second paper and a rudimentary debriefing over dinner (“I don’t even know where I’d start. Did you know what a rupture of thingummy of the sinus of Valsalva is? Are those prawns?”), I took myself off for a swim where I got to cool down (have I mentioned that it was hot?) and do nothing more complicated than count laps and ponder whether it would be appropriate to sit the third paper in the pool.

Back in on Thursday morning, and by the two hundred and sixty ninth question my eyes had crossed and even the invigilators looked like they were flagging. After a day and a half of mostly sitting in a chair, I was exactly as knackered as I would have been if I’d done four days of medical receiving. But, except maybe the candidates, nobody in that exam had anything as mundane as a troponin negative chest pain.

It’s done, anyway, and now I’ve got a few weeks grace before I’ll know how it really went.

The lessons learned from the experience are:

  1. If you can, don’t sit an exam in the two days of the year when humidity comes to Glasgow.
  2. I have rarely felt more ancient than the morning after, when, having spent my week sitting a postgraduate exam, I had a work experience kid in clinic who was waiting for the results of his Highers.
  3. Don’t forget to cuidado con el perro.

Letting Streams Of Living Justice Flow Down Upon The Earth

The General Convention of the Episcopal Church of the United States begins on Thursday morning — their equivalent of the General Synod that I was at a couple of weeks ago and that I’ve spent much of the couple of weeks since mulling over.

In the liturgy that I’ve witnessed, in the music that I’ve heard, in a trip to Edinburgh Pride this past weekend with fellow Episcopalians. A spark of optimism is there that burns brighter than it did before. It says that we can do this, and that we can do it while still all doing that most simple and complex thing of loving each other.

As part of their business over the next nine days the Episcopal Church of the United States will be considering an amendment to Canon I.18, which is their marriage Canon. The proposed changes are mainly based in the removal of doctrinal statements, and in that sense are similar to those which the Scottish Episcopal Church has just agreed to consider.

In my mulling over of the business that was done here in Scotland, I am still struck by the atmosphere of constructivity and generosity that I experienced in those three days in Edinburgh. At the time, I was struck by how hard people were willing to work to ensure that a satisfactory process was embarked upon. I was struck by the determination of people on all sides of the conversation to look for a compromise and an answer that we could all live with. I was moved then and am still by the willingness of people to be vulnerable, to talk about their lack of certainty, to lay their lives and their journeys bare, to show us all the deepest corners of their faith.

We in the Scottish Episcopal Church credit ourselves with having birthed the Episcopal Church of the USA when we consecrated Samuel Seabury in 1784 against the wishes of the Church of England.

It is my prayer for our sisters and brothers in the United States that they encounter as much love in their General Convention as we did in Edinburgh, and that Scotland will once again have lit for them a beacon of hope.

General Synod 2015: Going Forward In Diversity

Tonight, at the service of Evening Prayer with which we close each day’s business at Synod, I found myself in tears.

Not the tears that I wept at General Synod last year, when I had to make an escape from the building to have a few moments of quiet with a friend in my anger and my frustration. No, I said to those who came to me when worship was over. No, these are the good kind, these are the tears of joy. The weeping that I do today is the weeping of Easter Sunday.

The motion put to Synod before lunch today was whether we wished to proceed to debate the options for potential change to Canon 31, which is the canon the deals with how we marry people in the Church.

Section 1 of Canon 31 states that:

The Doctrine of this Church is that Marriage is a physical, spiritual, and mystical union of one man and one woman, created by their mutual consent of heart, mind, and will thereto, and is a holy and lifelong estate instituted of God.

Having decided that we did want to vote on some form of change to that Canon, the options we were choosing between were as is written here.

74% of Synod voted for Option A as their first preference. We have asked the Committee on Canons to prepare canonical material removing Section 1 in its entirety from Canon 31. If that passes through subsequent Synodical procedures, the result will be that Canon Law in the Scottish Episcopal Church is silent on the doctrinal nature of marriage and that our doctrinal understanding reverts to that which is found in the liturgies of the Church.

And to save you looking it up: The liturgies of this Church as they already exist allow for many possible understandings of marriage, including that which is between two people of the same gender.

I voted for Option A. I dithered, and I considered voting for Option C (altering “one man and one woman” so that it instead read “two persons”) which would have produced something that I could have joyfully lived with. I chose instead to put it as my second preference.

Because it isn’t just about me, is it?

It used to be about me. This conversation used to be a conversation that was being had only amongst people like me and people who agreed with us. But if anything has become clear over the last two days, it has been that this is now a conversation that is being had by the whole Church, willingly and intelligently and diversely and overflowing with love.

That has been a wonderful thing to witness.

And so I voted for the option that I think allows us to go forward together, loving one another in our diversity and our difference and our disagreement. I think that that is the kind of Church that we are, and it is the kind of Church that I want us to be.

Now, the work is not done.

To change Canon Law as has been requested in principle by General Synod today will require two years worth of procedures. The canonical material which has been requested will be brought for first reading at General Synod 2016, requiring a simple majority. If passed, that will go to the Diocesan Synods of 2017 for further discussion before being brought for second reading to General Synod 2017 where in order to pass and to actually become Canon Law it will require a two thirds majority from each of the House of Laity, the House of Clergy, and the House of Bishops.

No, the work is not nearly done.

But the things that have happened today have been good things, marvellous things, things that if you had asked me two years ago I would have said that I didn’t know if they would ever happen at all.

And as the words of Psalm 40 were read, I wept for joy and for gladness:

I waited patiently for God
and God bent down to hear me.
God lifted me from a murky pit
and set me firmly on a rock
where I can stand confidently.

God put a new song on my lips,
a song of praise to my Maker;
many will look on in wonder
and put their trust in God.

Countless are your wonders, O God;
in goodness you have no equal.
We would proclaim all your works
were they not too many to number.

General Synod 2015: Sit Rep on Day 1

I am in Edinburgh, where the General Synod of the Scottish Episcopal Church has reached the close of business for Day 1.

There is a significant amount of business to be conducted in this Synod, and a lot of it is about marriage and about Canon 31. The motions that came on Thursday were largely procedural in nature, relating to whether Synod wished to adopt the process that had been suggested by the Faith and Order Board. It required a two thirds majority of Synod voting in one House.

The motion passed with the following amendments as I understand them:

  • A procedural motion will be taken following the substantive debate as to whether Synod should move to a vote on it (and, by implication, whether Synod is of a mind to have any change to the Canon)
  • If so moved, the vote will be by what has been described as single transferable vote, rather than by the allocation of points as had been suggested originally by the Faith and Order Board.
  • If so moved, the vote will be on Options A / C / E as writ in the Synod Papers (1 / 3 / 5 in the linked blog post). There will then be a separate motion as to whether a conscience clause should be added.

A further amendment was proposed, suggesting a further option for the ballot that Canon 31, Section 1 should be maintained in its present form and that a conscience clause should be added allowing individual ministers to solemnise marriages between individuals of the same sex. That amendment did not achieve a majority of Synod and so that option has not been added to the ballot: it is my view that that was a right and proper decision by Synod, as it would not have been an option that could not possibly have resulted in a competent Canon but instead might have led to the Church having a Canon Law that contradicted itself.

Now, that is all procedure. It is all preamble. It is not yet the substance of the thing, but it seems to me that it has been significant nonetheless and that Synod has had important conversations amongst itself today and done work that it was necessary to do. It seems to me particularly important that Synod did not choose to merely follow along with the process presented to it or indeed merely to vote down the whole thing, but chose to do that hard work that it felt was needed to make that process better. I think — or hope, at least — that that represents a willingness to engage.

Tomorrow, we move to substance.

There is a vote before lunch on whether we go on to debate. If we do vote for that debate, that will take place after lunch on the canonical options as listed, and, if it is agreed to move to a vote, a vote on those options by ballot. If voted on, we will then be able to choose whether to ask the Faith and Order Board to instruct the Committee on Canons to prepare canonical material for first reading in 2016 in line with that vote. The final piece of business tomorrow will be to discuss whether the Committee on Canons should prepare a new Canon which if agreed to would enable the registration of civil partnerships in the Scottish Episcopal Church — it is worth noting that that piece of business is not contingent on anything that has gone before it.

There is a live audio stream available on the Provincial website for anyone who wishes to follow along at home, and the public gallery at St Paul’s and St George’s where we are meeting is open to the public for all debates.

The Doctor That Glasgow Built

This past weekend was the (mostly) completion of the closing down of five of the hospitals in this city and their transfer to a new hospital in South Glasgow that so far as I can tell mostly contains furlongs of corridors.

I exaggerate, I suppose. I’ve been in the new place just enough to have decided big and confusing, and I don’t work there really although doubtless I will at some point. I expect eventually I’ll adjust, and I expect eventually everyone will stop wandering around like a crossbreed between frightened rabbits and lost sheep. There is no question that the buildings that have closed are no longer fit for purpose, and have become increasingly even less fit for purpose over the past ten years as apathy and not-here-for-much-longer have set in.

But the days and nights I’ve spent in them are ones that have been the making of me as a doctor so far, and sentiment is a powerful thing.

Screen Shot 2015-06-08 at 16.26.33

If I could take a single memory from the old hospitals, it would be of standing at this window as one of the worst nights I’ve ever had finally ended; when, inexplicably and unexpectedly, the sun came up and everyone lived.

Marriage and the General Synod

Next week, the General Synod of the Scottish Episcopal Church meets in Edinburgh to do its annual business. A significant chunk of our agenda this year is to talk about marriage: what we believe about it, what we say about it, and what steps (if any) we as a Church want to take to recognise the lives and loves of couples who happen to be of the same sex.

It is my view that we should be recognising those lives and loves in precisely the same way as we recognise those of couples within the Church who happen to be of opposite sexes – and it is not only my view. The most profound social change in the last decade has not been the rewriting of old laws and the enacting of new ones. It has been the basic truth that society no longer thinks I am being radical when I say that in life and law and linguistics there should be no difference between gay couples and straight couples.

But it is the truth and beauty of the Scottish Episcopal Church that we are not all of the same view, and that we are not all required to share a single view. It is right and proper that we have this conversation and that the matter is given due process in accordance with the procedures of the Church.

It is proposed that the Synodical debate this year will be based on six options drawn up by the Faith and Order Board for changing Canon 31, or a separate option for no change.

For avoidance of doubt, Section 1 of Canon 31 states:

The Doctrine of this Church is that Marriage is a physical, spiritual, and mystical union of one man and one woman, created by their mutual consent of heart, mind, and will thereto, and is a holy and lifelong estate instituted of God.

Also for the avoidance of doubt, Clause 1 was written into Canon Law for the express purpose of clarifying the Church’s position on the then newly enacted divorce laws.

The options laid out by the Faith and Order Board are:

  1. Removal of Section 1
  2. Removal of Section 1, with the addition of a conscience clause stating that no cleric is obliged to solemnise a marriage against their conscience.
  3. Alteration of Section 1 to render it non-gender specific, e.g. by replacing “one man and one woman” with “two persons”.
  4. Alteration of Section 1 as in (3), with the addition of a conscience clause.
  5. Alteration of Section 1 to include two expressions of marriage, i.e. to state that there are two expressions of marriage in the Scottish Episcopal Church: one between a man and a woman and one between two persons of either gender.
  6. Alteration of Section 1 as in (5), with the addition of a conscience clause.

We are told that in order to debate these options, a two-thirds majority of voting members will need to agree to do so. If the Synod agrees to the debate, the Faith and Order Board ask that the subsequent voting be conducted by a ballot and we are told that that voting mechanism will also need to be agreed to by a two-thirds majority of voting members.

I think that it needs to be understood that the requirement for one at this stage in the conversation means that Episcopalians who happen to be lesbian, gay, bisexual, and transgender are being required to meet a higher standard just to get in the door. I am not scared of the requirement, but it must be distinctly understood that to require it at this point is not just.

The proposal for the voting mechanism is that representatives will be asked to give six points to their most preferred option, and five points to their second most preferred option, and so on. After the points are added together, Synod will be declared to have expressed a preference and will then be asked to vote on whether the Committee on Canons should be asked to prepare canonical material relating to that preference. That vote requires a simple majority of 51%, not voting in houses. The canonical material would be presented to the General Synod of 2016 for first reading.

The agenda and papers for General Synod 2015 have been made available on the Provincial website. The relevant points are the motions themselves on pages 1-10, and the process paper from the Faith and Order Board  on pages 46-50. The Doctrine Committee have produced a paper on the theology of marriage, which is also available on the Provincial website and which I believe is intended to inform the debate.

In addition to the material on same-sex marriage, the Faith and Order Board have proposed a separate motion relating to whether the Scottish Episcopal Church wishes to undertake the registration of civil partnerships. There is an ongoing discussion about this on Kelvin’s blog, which is worth reading and joining in with. I have not been able to answer his question and I’m not convinced anyone knows the answer, including those who proposed the motion. I am against that motion, and I think it must be clear in everyone’s mind before we get to Synod that this should not be a question of either/or — I do not believe we are looking for religious civil partnerships, and as I said some weeks ago we are certainly not looking for them as a consolation prize.

I urge members of Synod to read and digest the material that is in the Synod papers — there is a lot of it. I also urge people within the Church who are not on Synod to read the material — if you have an opinion on this, talk to your clergy or your lay representative or any member of Synod and make your views known.

If I Were Prime Minister

Good morning, Mr Cameron.

Paracetamol? Coffee?

The campaign is over and the post-election knees up is over and the weekend is over. It is Monday morning. It is the start of the next five years of your life. It is time to go back to work and get on with the business of governing the country, including the nearly two thirds of us who voted for someone else.

Oh, that’s right. I didn’t vote for you and I loathe everything you stand for, but you are apparently my Prime Minister too.

So with that in mind, let me offer you some unsolicited advice on what my priorities would be if I were in my first hundred days of a new Parliament.

  • Set out a timetable for electoral reform. I would start by abolishing the House of Lords and setting a date for a referendum on PR.
  • Secure the future of the National Health Service. I would tell the public that the NHS is incredibly expensive for government and is delivered absolutely free of charge to the public, and that that is the way it is and the way it should always be. I would tell them what an absolute privilege it is to live in a country where our highest economic priority is to look after the sick. I would reverse the steps that have already been taken towards privatisation, completely and unreservedly. I would put control of decisions about the NHS back into the hands of healthcare professionals and patients. I would fire Jeremy Hunt.
  • Repeal the Health and Social Care Act 2012. 
  • Disestablish the Church of England. 
  • Raise the minimum wage to the living wage.
  • Reshape the funding of higher education. Specifically, I would abolish tuition fees and student loans and I would reintroduce student grants. I would pay for this by introducing a graduate tax of 10% on any income over £21,000.
  • Have a different conversation about immigration. In the last year, every mainstream politician in England who has talked about immigration has framed it as a problem. I still don’t know why. I think we would get a lot further if we stopped blindly accepting that it is a problem, and started talking about the positive effects that immigration has had on the UK.
  • Reform taxes. I would close tax loopholes on big business, I would actively seek to prosecute and recover funds from those who have evaded tax, I would abolish the non-domiciliary tax status, and I would raise the top tax bracket by 2% on the richest 1%. Just for starters.
  • Start the process of nuclear disarmament. I would commit to completing the process during the life of this government.
  • Recommend to Her Majesty the Queen that the 49,000 men who were convicted under historic anti-gay laws are immediately given pardons and full apologies.

I have more, but that’ll do you for now.

Best wishes,

A Socialist Liberal
(for whom you now work)

Fifteen Hours To Change The World

And so it is that every once in a while we all get one day to say what we really think.

This is not simply an opportunity, but a right and a privilege and a responsibility for our own futures, for the lives of our fellow men and women, and for the world we will leave to those who come after us.

Vote for a better world. Vote for a braver world. Vote for a more compassionate world. 

Vote because today you get to decide what matters most to you.

Vote to say something about healthcare, about education, about war and peace, about social justice, about the economy, about our place in the ever growing and ever shrinking world, about transport and the environment, about the kind of people you want us to be and the kind of society you want to be part of building.

And above all, don’t squander your vote to apathy, or to cynicism, or to staying home.


Separate Is Not Equal

Today, members of the General Synod of the Scottish Episcopal Church were sent a paper on “the theology of marriage as currently articulated through the Canons and Liturgy of the Scottish Episcopal Church, and exploring whether there is a case for change based on tradition, scripture, and reason”.

This has been sent out in advance of the bulk of the Synod papers, and we have been asked to devote some time to reading and digesting it in preparation for what is suggested will be substantive debates at Synod in June. It clearly represents an enormous amount of work by the Doctrine Committee, and they are to be praised for their commitment to it. I believe it has the potential to be a very useful document, both in framing and informing such debate. The purpose of this document is not to take a position, but to outline all the positions and the arguments for and against them. It starts by suggesting cases for no change and for change to Canon 31 (which it calls Options A and B, and, recognising that those arguments tend to be in direct opposition to one another, lays them out as far as possible in parallel. At the end, it suggests a case for what it calls an Option C, which represents the argument to allow recognition and blessing of same-sex partnerships but not to allow them to be called marriage.

It is this last part that is my concern.

And let me be very clear: I am not criticising the Doctrine Committee for fulfilling their stated purpose and outlining all possible options. I do not think that this option was dreamed up by the Committee; I think that it represents a position that exists and has been thought of already by many people and was always going to be proposed in one form or another.

As an option that has now been articulated and put out there into the world, I think it is important that we talk about it.

Because let me also be very clear: Option C is not a real option.

In an effort to be clear about their meaning, the Doctrine Committee explain that what this suggests is ‘a rite equivalent to marriage for same-sex partnerships but called something else’. Again, this is not language peculiar to the Doctrine Committee; it is an explanation that I have heard in synods and committees and Cascade Conversations for the last three years from well-meaning people who have never read Animal Farm.

In the world before civil partnerships, Option C was something that we might have grabbed with both hands. In a world where I had never campaigned for marriage equality, I would have said that this was the best we would get and more than I had ever dared hope for. I know now that that is not true. The world has changed, and will keep on changing. I live now a country where marriage is just marriage, where equal means equal, and where I know that we can believe in and fight for better.

During the House of Commons debate on marriage equality in England and Wales, in a speech that will go down alongside Martin Luther King in the history of great human rights speeches, David Lammy said, “Separate but equal is a fraud. Separate but equal is the language that tried to push Rosa Parks to the back of the bus. […] It is an excerpt from the phrasebook of the segregationists and the racists. It is the same statement, the same ideas, and the same delusion that we borrowed in this country to say that women could vote — but not until they were 30. […] It entrenched who we were, who our friends could be, and what our lives could become. This was not ‘separate but equal’ but separate and discriminated, separate and oppressed, separate and browbeaten, separate and subjugated. Separate is not equal, so let us be rid of it.”

If an Option C is passed by the Scottish Episcopal Church, it will achieve something that is not fair or just or right and that pleases no one. Option C will alienate couples who are married out there in the world and are… what, when they walk through the doors of a church? Option C will not guarantee an end to homophobic and separatist policies such as the ones enumerated in the Bishops’ Guidelines in December. Option C will stall the fight for real equality as we live through a decade or more where people like me will be expected to sit down and shut up because we will be thought to have won. Option C is something people will expect me to say thank you for.


The lie of separate but equal is one that sustained apartheid in South Africa and segregation in America. It is a lie that today allows a political campaign to flourish in Britain through the language of hate, and that in the Church aims to make us all believe that the struggle for gender equality in Lambeth Palace has been won and is over when nothing could be further from the truth. It is the language used by those who believe that men are better than women, that black people are inferior to white people, and that gay people are deserving of less than straight people, but who do not have the guts to say any of it out loud in a world that knows how wrong they are. It is a lie that has no place in a civilised society, and it is one that I will never vote for.

The Further Adventures of My Ridiculous Accent

He got up to leave, thanking me for seeing him and brushing off my apologies about the wait.

He said: “And before I go, Doctor, whereabouts in Northern Ireland is that lovely accent of yours from?”

“Newcastle upon Tyne,” said I, with a straight face.

He frowned. “I don’t think I’ve heard of it,” he admitted. “Where is that in relation to Belfast?”

“Far side of the Irish Sea,” I said. “The one next to Hadrian’s Wall.”