Those who argue that most patients are uninterested in choice such as doctors

Those who argue that most patients are uninterested in choice, such as doctors at the recent British Medical Association conference in Llandudno, and that all they want is a good local hospital where they can rely on prompt, high-quality service are missing the point – or at least half of it.It may well be true that what people want when they fall ill is a high-quality, local service they can rely on. Coping with a nation of Victor Meldrews will be a tall order for the NHS.Imagine your local GP’s surgery crammed with people demanding to be sent to the best place for hips or hearts or hernias, only to find that several hundred have got there first and the waiting list stretches from here to next Christmas.Imagine outpatients filled with people demanding to see surgeon x or doctor y, only to be told that their favourite medic has been seconded to the fast-track centre down the road and is now performing cataract ops three at a time.Don’t get me wrong – I am in favour of more choice in the NHS. And not just for the old, but for all of us.I am not convinced that the politicians who advocate choice – from all parts of the political spectrum – have thought this through. Old people are routinely offered poorer treatment than the young, but the worse outcome is blamed on their age.The first imperative for those wishing to be a healthy hundred, therefore, is to be informed, stay in command and be thoroughly obstreperous in refusing to be fobbed off with second-rate medical care.But this command, which has always been true, will become doubly so in the new consumer-led NHS.

Determined old bats are also less prone to medical ageism, blatant examples of which are to be found in the NHS. As my brother-in-law proposed a toast to absent friends at the gathering last weekend, his mother fired back, a steely glint in her one good eye: “Why should we? They could have been here.” Tolerance and resignation are not virtues in their household.All the evidence shows that wilful people, who insist on staying in control of their own lives, live longer than the more compliant “sweet old folk” who make the good patients favoured by doctors and nurses.People in control of their lives stay healthy and live longer than those who allow themselves to be buffeted by events. Never less than a dozen different items on the plate – it is a matter of motherly pride.They are an impressive couple and you do not need to spend long in their company to learn how they have survived. Last weekend, I attended my father-in-law’s 94th birthday and, without delving into family grief, it is fair to say that in a long and productive life he has not been backward in expressing his needs.He is ministered to by my mother-in-law, aged 89, who still produces roast dinners with all the trimmings for her family. Those who shout the loudest get first choice and the rest can go hang.
It is an excellent prescription for a long life. It is the inevitable consequence of the new focus on choice in the NHS. Cantankerous That is what we are all set to become.

They found that in times of war and employment booms, scientists pronounced adolescents as being “capable and adult-like” but during peacetime and economic downturn they characterised them as “psychologically incapacitated and slow to develop”.We may have got it right this time around, but its worth considering whether our simultaneous demonising and infantilising of adolescents tells us more about our society’s need for good consumers than it does about the true nature of our children.. Teenagers go to bed and get up later because that is what their body clocks are telling them to do. A society that requires them to turn up at school at 8am or 9am in the morning may be a recipe for mass teenage sleep deprivation.However, these brain scans studies fit into a wider social picture, as shown in a review of scientific theories of teen behaviour conducted by researchers at University of Wisconsin in 1987. One of the less appreciated effects of the rise in sex hormones is the effect it has on the rhythm of the sleep hormone melatonin. Without fully developed neuronal brakes, why put off the pleasures of sex, drugs or risk taking?Even the business of endless lazing in bed turns out to have a biological basis.

The hormonal rush increases its levels and so feelings of pleasure become more intense. But in the new model, while hormones provide the engine, the problems arise because the wiring for the control systems is still not in place Take the feel-good brain chemical dopamine. Sex hormones, the usual culprits responsible for teenage bad behaviour in the past, still play a major role. The apparently wilful refusal to solve simple organisational problems – how to book cheaper train seats for a trip as well as getting clothes for the weekend party – doesn’t look quite so hopeless either. One of the brain parts that doesn’t completely connect till later is the corpus callosum – the bridge that links the two halves of the brain – which is involved in creativity and problem solving.The ability to ignore obvious risks – from smoking to unsafe sex – begins to make more sense, too.