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Archive for January, 2014

Medicine as Meditation Practice

Posted in from the consulting room, from the dark room, from the living room, health, life, personal growth, photography, psychology on January 21, 2014| Leave a Comment »

mitsudomo

So, I was told this week I was the most calm person someone had ever met, and asked how did I manage that?

This isn’t the first time. Not by a long way. So the truth is there is something about who I am which allows me to emit a sense of calm. When I was a young hospital doctor (25 years old) and in charge of a Cardiac Arrest Team, the other team members would commonly say that once I arrived on the scene, everyone felt their anxiety level dropped and everyone felt more calm. I never understood how that happened, because my heart would be banging away in my chest and I would feel that bucket loads of adrenaline were storming around my body. But somehow, what I emitted was calm.

However, what occurred to me in response to the question this time was, I’ve learned that calm and ease occur more naturally when we focus on the present. I sometimes say to people that suffering occurs in the gap between fantasy and reality, by which I mean, when we are wishing how things were, instead of experiencing how they are, then we suffer…..regrets, relived hurts, anxieties or fears. The way I practice, and have practiced now for many, many years (this is the year I turn 60), is to fully focus on the person who is consulting me right now. Whether it is for 90 minutes, 20 minutes, or, when I was a GP, only 10 minutes, that piece of time is always fully for this person who is with me. I will listen attentively, engage with them fully, and be completely present. My mind doesn’t wander off to the patient before, or the one about to come next. But whenever that person leaves the room, I let go. And the next patient walks in, and again, I’m fully present with this new person.

What struck me as I thought about that was “what a great meditation practice!” “what great mindfulness practice!” Repeatedly, gently, returning to the present. So maybe that is at least one of the reasons I still absolutely love daily clinical practice. If I’m ever feeling not so great, then a busy clinic gives me a lift. If I’m feeling a bit weary, then the clinic boosts my energy.

I owe a debt of gratitude to my patients over all these years. See what a lot of good they’ve done me!

(And I’m sure it’s a two way benefit. I’m told that all the time.)

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Plant neurobiology

Posted in from the living room, from the viewing room, science, video on January 20, 2014| 1 Comment »

Oh, this is fascinating! We tend to think of plants as pretty static creatures, despite the fact that every large plant was a tiny seedling once upon a time. They move. They move a lot…..but slowly.

Time lapse photography reveals just how much a plant moves. I’m sure you’ve seen many such videos, but click through the link below and watch this one because this one reveals the plant’s neurobiology, its intelligence, and its ability to interact with, and respond to, other plants.

Seriously, I don’t think you will ever have seen something quite like this. You won’t look at plants the same way again!

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The A – Z of Becoming. C for Choose

Posted in from the dark room, from the living room, life, personal growth, photography on January 19, 2014| 4 Comments »

In the A to Z of Becoming, the third verb is C, for “choose”

path

 

Choose….hmmm, what will I write about choosing? I’ve got a few ideas rattling round my brain, so I’m going to share several of them, and then YOU can choose which inspire you most, or which you want to explore further for yourself.

The first thing I thought about was “choice theory” – the work of William Glasser. I like Glasser’s emphasis on how we create our own experience of reality through the choices we make. I like how he rejects the “external control theory” which suggests we are just puppets or automatons having our buttons pushed. I like his holistic approach to psychology, and, most of all I like his emphasis on verbs.

Secondly, I thought of how empowering it is to move your brain from default reactive mode, to response mode, and how a crucial step in developing that skill is to consciously, mindfully make choices. In reactive mode, we are pretty much on autopilot, blindly following the scripts of others, and it can feel like that. It can feel like we are the trapped victims of circumstances, of society, of others’ choices. Developing response mode, creates that little gap (see “getting neutral“) which allows us to become more conscious of what is happening, and, thereby, to take the opportunity to choose which response we want to make.

Thirdly, I thought of “Amor Fati”, the ancient teaching to “love your Fate”, which is actually advice to fully accept and enjoy the reality of the present, rather than suffering through wishing things weren’t the way they are (see the “suffering gap”)

Fourthly, I thought of choosing a path (like in the photo above which I took in a garden in Japan), and of how every path takes a different route, even if it leads to the same destination. I saw a TV programme during the holidays in December where a regular rambler walked from the West to the East of Scotland up in the far North. He came across countless old drovers paths (where the cattlemen would drive their cattle from the Highlands down to the markets in the South), and shepherd’s paths, and the paths the crofters would take to go from one croft to another, and the hiking routes, and…..well, you get the idea……the wild, open, sparsely populated areas of Scotland are criss-crossed by a myriad of paths, so when you want to walk from one coast to another, you have plenty of choices. Each of those choices will bring its own experiences and its own discoveries.

Fifthly, I thought of how sometimes I deliberately choose to walk down a different road, or to visit a different cafe, or to catch a different train, just to wake myself up and keep me aware that today is indeed a unique and amazing day.

Does any of this inspire you?

Which of these five explorations of choosing appeals to you most?

Which will you choose today?

 

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Resilience and the need for diversity

Posted in from the consulting room, health on January 18, 2014| Leave a Comment »

The Resilience Alliance give this description of resilience, using forests as an example of a complex adaptive system which exhibit resilience.

Natural systems are inherently resilient but just as their capacity to cope with disturbance can be degraded, so can it be enhanced. The key to resilience in social-ecological systems is diversity. Biodiversity plays a crucial role by providing functional redundancy. For example, in a grassland ecosystem, several different species will commonly perform nitrogen fixation, but each species may respond differently to climatic events, thus ensuring that even though some species may be lost, the process of nitrogen fixation within the grassland ecosystem will continue. Similarly, when the management of a resource is shared by a diverse group of stakeholders (e.g., local resource users, research scientists, community members with traditional knowledge, government representatives, etc.), decision-making is better informed and more options exist for testing policies.Active adaptive management whereby management actions are designed as experiments encourages learning and novelty, thus increasing resilience in social-ecological systems.

The main point made here is the importance of diversity. They mention “socio-ecological” systems, but in fact organisations can also be considered as complex systems. This is one of the ways we are going wrong with the way we deliver health are these days. Due to the vast diversity of human beings, and the reality that large organisations behave as complex systems, we need diversity in our organisations and in our practices.

There just is no one size fits all when it comes to health care and a health service managed by protocols, rules and tight controls, will ultimately fail.

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Half a brain…..

Posted in from the consulting room, from the viewing room, health, neuroscience, video on January 17, 2014| 3 Comments »

Take 20 minutes to watch this brilliant TED talk by Iain McGilchrist.

 

I agree with everything he says in this, but I was especially struck by his mention of the gene which codes for eyes. It’s the same gene which codes for a fly’s eye, a frog’s eye and a human eye. What makes the difference? The context of the other cells in the separate creatures. We are not just our genes, and our genes only express themselves in the contexts of the cells in which they exist.

I also really like what he says towards the end of the talk about protocols and the practice of medicine. How on earth can a protocol devised by a committee somewhere tell a doctor how to treat this particular, unique, individual patient today? It’s nonsense.

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Subject/object, inside/outside….of what?

Posted in from the consulting room, from the dark room, from the living room, health, life, perception, philosophy, photography on January 16, 2014| Leave a Comment »

Rain lenses

 

Look carefully at these raindrops and see what you can see within them.

There are all kinds of theories about reality and how we experience it, but in this Age of Modernity, the object, what’s “outside”, what can be measured, what is “physical” has gained almost a monopoly over what is accepted as “real”.

What a patient’s tests or scans show are believed to represent what’s really wrong or right. What a patient reports, relates or describes of their experience – their symptoms, their personal narrative, is often dismissed by researchers as anecdote, or by clinicians as unimportant – “I’m happy to tell you your results are all normal” (“now go away and stop bothering me with your complaints!”). Somehow the lived experience of reality has become less relevant than the measurement of reality. The object trumps the subject.

Yet that objective, physical reality can only be experienced by, can only be measured by, the human subject.

So, in this dialectic, is there some way to grasp reality, to know what is REAL?

I’m not about to solve this one here, but one way of approaching this which appeals to me a lot, is to ask the question “what are these the two poles of?” “Inside and outside of what?” Or to put it another way……If the subject and the object are two sides of the coin, what’s the coin?

Is it the continuous process of becoming which we see everywhere in the universe? Is it the vital force, the Life force, the universal spirit from which all form emerges?

Can we take a perspective on reality which sees BOTH the inside and the outside as valid and important?

That’s why I don’t accept the proposed duality of mind and body, and any understanding of a patient is incomplete without exploring both.

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Time like a river, or time like a tree?

Posted in from the dark room, from the living room, life, perception, personal growth, photography on January 15, 2014| 1 Comment »

waterfall

Is time linear? Is it like this waterfall? Does the future rush towards us, the present pour past us in a constant stream, and the past disappear into the far distance carrying the our daily experiences off into the vast oceans of memory?

Or is it more like a tree?

zen garden

Does time accumulate, like the growing sapwood just under the bark, laying down this year’s experiences on top of last years, each and every ring layered over the previous ones?

The forest becoming

Does the present grow out of the past which doesn’t disappear, but which perpetually lies beneath us, our daily experiences emerging from, growing from, all that has occurred before?

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Health in health care

Posted in from the consulting room, health on January 14, 2014| 5 Comments »

Steven Charlap tells the story of the failure of his MDPrevent business which he had to close down last month. It’s an honest and thought provoking reflective piece. His idea was to have a medical practice which focused on health instead of disease, which advised patients and supported them in making lifestyle changes instead of prescribing for them. It didn’t work out. For a number of reasons……he didn’t get enough referrals from other health care providers, had many problems with health insurance companies, and, he says, the patients weren’t really up for it.

Based on our review of the credible research, our model mostly excluded dietary supplements and multivitamins because the science mostly did not support their use. When it came to pharmaceuticals, we didn’t rush to prescribe if there were a non-drug alternative. This approach was a turn-off to many patients who expected a prescription or emphatically clung to beliefs in supplements. And the no-cost, no-deductible, no co-payment provisions in Medicare’s preventive benefits may have had an adverse effect on people’s sense of its value. How much would you appreciate something that has no cost to you? For many patients, it seemed easier to take supplements than to be more attentive to food labels and exercise habits.

I have a lot of sympathy for this doctor. I think the present system of health care is not about health, and is not sustainable. I’m not so sure about the emphasis on prevention however…..let me explain – to prevent something has a negative tone for me, and I think health is a positive attribute. I prefer a focus on positively creating health, rather than negatively trying to prevent, or avoid disease.

His conclusion is particularly striking –

Patients loved my practice because I was willing to spend up to two full hours with them, most of it not reimbursed by insurance. The extra time often meant successfully making a diagnosis that had eluded other doctors for many years. It takes a very long time to get a thorough history and do a good exam and almost no time to prescribe a medication for a presumed illness. I chose the former. Insurance pays for the latter. Unfortunately, we still have a healthcare system that makes money by treating disease, rather than by preventing it.

and that last sentence is the real indictment in this story “we still have a healthcare system that makes money by treating disease, rather than by preventing it.”

What do you think? Do you think we need health care which helps people to create health? Would you like a service like that?

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Getting neutral

Posted in from the consulting room, health, life, personal growth on January 13, 2014| 2 Comments »

Mostly we react, but its better when we respond.

What’s the difference?

Reacting is automatic and rapid. Somebody presses one of our buttons and BUZZ out comes the response – anger, indignation, anxiety, hurt, sadness…..you name it. One of the problems with this reaction mode is that we get the feeling other people are constantly pulling all our strings.

It would be great if we felt more in the driving seat, wouldn’t it? To do that, we need to practice responding instead of reacting. What happens in response mode is that somebody presses one of our buttons, we notice it and think, ‘oh, there’s that button getting pressed again’, then in the short pause, we get to choose. What am I going to do about it?

It’s a bit like when the telephone rings. You don’t HAVE to answer it. You have a choice. The experience of exercising that choice, in fact, even the experience of having time to choose, is hugely empowering.

Here’s a simple little technique which lets you begin to change from reactive mode to responsive mode. It’s called “getting neutral” by the “Heartmath” people.

First deliberately move your attention to your heart area. Say, for example, you are speaking to someone on the phone, maybe someone who repeatedly winds you up. They hit one of your buttons but instead of automatically reacting, you say ‘hold on a moment’, put your hand over the receiver, turn your attention to your heart area, and now, take three deep, diaphragmatic breaths. One, two, three. Now return to the conversation.

This is called ‘getting neutral’ because its like when you are driving a car and the brakes fail. You can slip the gear into neutral, breaking the connection between the engine and the car’s wheels, stopping it from speeding out of control.

I’ve taught this method to people who experience panic attacks. Instead of spinning out of control, they turn their attention to their heart area, take three diaphragmatic breaths, and the panic stops.

It might not work every time, but one of the great things about it, apart from its simplicity and easiness, is that it gets more powerful and useful the more it is practised.

 

 

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The A – Z of Becoming. B for Breathe

Posted in from the living room, health, life, personal growth on January 12, 2014| 2 Comments »

In the A to Z of Becoming, the second verb is “breathe”.

You might think, ‘well that’s easy, I do that all the time!’ But I don’t mean automatic, unaware breathing. I mean the kind of breathing we choose to do.

Think of these two different kinds of breathing – primarily using the muscles of your chest, or primarily using your diaphragm. It’s this latter form of breathing which I’m going to focus on this week. Diaphragmatic breaths tend to slower, deeper and fuller than the more automatic chest muscle form. These deeper, fuller breaths change the balance of oxygen, and carbon dioxide in our lungs, and so affects the balance of chemicals in the blood. This has far ranging effects on your body, and your mind.

Here are two simple suggestions.

First, awareness of the breath. At any moment, in any place, turn your attention to your breathing. Without trying to change anything, see if you can just notice how you are breathing. How fast is your breathing? How regular? How deep?

Secondly, take three diaphragmatic breaths. Fill your lungs by breathing in as much as you can breathe in. Now breathe out, slowly, evenly, and as completely as you can. Once you have completed this out breath, breathe in again, again completely filling your lungs. Breathe out, slowly, evenly and completely a second time. And now do the same again a third time, once more filling your lungs to the top, and slowly, evenly breathing out to empty them.

Notice how you feel. How does your body feel? How does your mind feel?

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