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Archive for May, 2024

What’s the problem? Immigration or integration?

Posted in Uncategorized, tagged , , , , on May 26, 2024| 1 Comment »

I find it pretty depressing how immigration is presented as a problem in so many countries. It seems every far right political group on the planet wants to build walls around their own country and keep any foreigners out. Why? Because people who aren’t born in the country where they now live are a problem to be solved?

Personally, as an immigrant myself, I think everyone who live in the same street, the same village, town, or city, the same country even, should be treated equally. I’m not a problem because of my genealogy or my genes. We are all inhabitants, we who live together, sharing the same roads, the same shops, the same activities. I prefer the concept of “inhabitant” or “resident” over that of “citizen” if, by the latter term, we mean people who have passed whatever administrative and/or economic rules a country applies to people who weren’t born in that particular part of the world.

In fact, more than anything geographical, I feel I am a member of the human race, and a unique expression of Life, just like all the other human beings who I share this planet with, just like all the other astonishing forms of life I share this planet with.

I don’t think immigration is a problem to be solved. The problem to be solved is “integration”. Here’s the definition of integration I work with – “the creation of mutually beneficial bonds between diverse and well differentiated parts”. In other words, how do I live with my fellow “residents”, fellow “inhabitants”, fellow “citizens” in the part of the planet which I call home?

When we don’t create healthy, positive, creative, and caring bonds between each other, we all suffer. We humans have always moved around the Earth, and we always will. Yet, most people who live in a particular part of the world would prefer to stay there – it’s war, violence, and utter poverty that drives out those who would rather stay.

I think we should put our energies and our resources into living well together – that would include treating people in the same place equally no matter where they were born, actively helping immigrants to integrate by teaching them the language, customs and laws of the country, and encouraging their full participation in society. And we need to develop mutually beneficial, caring, creative relationships between countries, instead of hostility, hatred, fear, competition and violence.

We humans are superbly adaptive creatures and we’ve evolved to be able to inhabit almost every corner of this little planet. But we’re going to have to adapt better if we all want to survive….or at least, if we want our grandchildren and their grandchildren to survive. We’ll do that through integration – by the creation of mutually beneficial bonds between ourselves and others.

So, I reject the dominant narrative that immigration is a problem, and I say, loud and clear, that what we should address and “solve” rather, is integration – integration in our streets, our villages, our cities, our countries, and our planet.

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Holistic

Posted in Uncategorized, tagged , , , , on May 18, 2024| Leave a Comment »

All my working life I practised Medicine as holistically as I could. I never made sense to me to split a human being into parts, particularly into a “mental” part and a “body” part. I was trained to practice holistically, even if my teachers rarely used that word. They taught me to listen to a person’s story, to listen with empathy and without judgement, in order to understand their illness, to make a good diagnosis and to plan what investigations and treatments should be considered. We started with the person, and drilled down to clarify what was happening in certain systems or parts, with the help of investigations.

This way of working emphasised that every single human being was unique, and that there were no one size fits all treatments. It taught us to remain ever alert, to follow up patients ourselves and to adjust our diagnoses, treatments and prognoses, as life continued to flow.

But was it holistic enough?

My chronic doubt, which, I confess, has grown over the years, was that it wasn’t. The reason for saying that is that whilst I knew everyone lived within a complex, layered web of relationships and environments, my interventions were almost exclusively individualistic.

But I know that our health is affected by traumas, by relationships, by work, by poverty, by housing, by pollution.

The Covid pandemic made all that clearer than ever, but still, we went for an individualised approach, focusing on vaccinations and personal hygiene. But we saw that the vulnerabilities and problems lay in insecure employment, poverty, racism, overcrowded and inadequate housing etc.

Sometimes I buy the idea that we can all be healthier if we exercise enough, eat a balanced nutritious diet, and manage our emotions, but then I see children in Gaza, people picking through the rubble of their houses in Ukraine, whole towns swept away in historic floods, and I realise, this individualistic holism just isn’t enough.

Let me clarify – I’m not knocking holistic medical practice – it’s far superior to reductionist, materialist, industrialised models. But we need to be much more aware of the circumstances of our lives, and, in particular, of the shared circumstances of our lives. If we can’t do anything about climate change, plastic pollution of the oceans, chemical pollution of the soil, the waterways and air; if we can’d do anything about poverty, social exclusion, hatred and prejudice; then we’re going to be fire fighting, and applying bandaids, when we could be creating a better world for all of us to live in.

How do we do that?

Ah, that’s the big question, and it’s not an easy one to answer. But we have to start somewhere, and awareness might be a good place to start. We need to talk to each other, to express our desire for more justice, more care, more understanding of how we all share this one, massively connected world.

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Paying attention

Posted in Uncategorized, tagged , , , , on May 14, 2024| 1 Comment »

I’ve read that we live in an attention economy. Marketers, producers, companies and individuals are all competing for our attention. They pay the social media companies to promote themselves to us using attention grabbing, and attention holding tools and techniques. “Influencers” can only influence if they attract attention, so they do whatever they need to do in order to achieve that goal.

I was pretty shocked on a recent trip to Milan to discover how “instagrammable” has become a major force. Certain buildings, certain viewpoints, or “attractions” were surrounded by dozens of, mostly young female, photographers, either taking pictures of themselves in front of whatever it was that had become “instagrammable”, or having someone else take their portraits there. Some even used portable reflectors, to “get the light right”, and had changes of clothing to model. I joked that my wife and I, standing in front of the Duomo, were the only people in the crowd actually facing the building. Most were trying to make it more beautiful, or more interesting, by putting it in the background, and themselves in the foreground.

That’s not a new phenomenon. A few years ago on a visit to the Alhambra in Grenada, I was surprised to find that most people who were taking photos of the amazing art and architecture, were only doings so by putting themselves into the foreground of each frame.

But attention is important. It’s how we see and experience the world we live in, and it influences our moment to moment moods, thoughts, and actions.

Ellen Langer, who studies “mindfulness”, describes it, simply as, “actively noticing things”.

I love that.

This “heroes not zombies” blog is all about living a more mindful life, and, I believe, that requires two things, both created out of attention. The first is, “noticing”, or as Ellen Langer says, “actively noticing”. When we pay attention, when we set out with an intention to notice – to notice the world around us, to notice others, to notice our thoughts and feelings – then we move into a more active, more conscious mode of existence. We reduce the chances of blindly following the influences and powers of others who try to shape our lives. The second is, to pay “loving attention”. I think whatever we pay attention gets magnified. If we focus on problems, we fill our lives with problems. If we focus on joys, of moments of awe and wonder, then we fill our lives with amazement and delight. But when we pay attention from a loving position – from a position of care, of empathy, of genuine interest, and love – then our attention changes, not only our own lives for the better, that of others…..whether they be other people, animals, plants, the environment, or the planet.

So, I’m all for paying attention – do it actively and do it lovingly – not mindlessly.

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Informed consent

Posted in Uncategorized, tagged , , , , on May 1, 2024| 2 Comments »

“Informed consent” is a fundamental principle of good, ethical, medical practice. In the UK, the General Medical Council has specific guidance about informed consent in its guide to shared decision making, which begins –

This guidance explains that the exchange of information between doctor and patient is essential to good decision making. Serious harm can result if patients are not listened to, or if they are not given the information they need – and time and support to understand it – so they can make informed decisions about their care.

They specify what information should be shared –

You must give patients the information they want or need to make a decision.

This will usually include:

  1. diagnosis and prognosis
  2. uncertainties about the diagnosis or prognosis, including options for further investigation*
  3. options for treating or managing the condition, including the option to take no action
  4. the nature of each option, what would be involved, and the desired outcome
  5. the potential benefits, risks of harm, uncertainties about and likelihood of success for each option, including the option to take no action.
    By ‘harm’ we mean any potential negative outcome, including a side effect or complication.*

When did you last receive a treatment from a doctor? Before you received it, did they gain your “informed consent”?

In my personal experience, informed consent before surgery has always been present, but over the years the information given has improved considerably. When I saw a urologist last year he offered me different options for treatment, discussed the potential benefits and harms, and included a discussion about the option of doing nothing. He then gave me a pack of literature to read and insisted I didn’t decide which treatment to take until I’d read the information and reflected on it before my next appointment with him.

That’s not my experience when it comes to drugs. I have never been given options, nor had the potential benefits and harms discussed, before receiving a prescription, and, in fact, I’m not sure I’ve ever heard of any patient who hasn’t shared exactly that same experience. It’s far more likely that a doctor will write a prescription, and say, take this and come back and see me in x days/weeks. Once the patient picks up the drug from the Pharmacy, inside the pack is an information sheet, which is usually a longer piece of paper than you’d find anywhere else, but where there is a lot of information about what the drug is, the precautions you should take, potential side effects and harms, and exactly how to take it. I’ve never seen any “other options” described on such an information sheet (unlike the information pack I was given before surgery).

I just don’t think this is good enough.

It’s not good practice, as defined by the GMC, and it doesn’t fit with the “Evidence Based Medicine” approach, and it certainly doesn’t meet with the constantly repeated claim to provide “person centred” or “patient centred” Medicine.

If you are a prescriber, maybe you will say, but this just isn’t feasible. There isn’t sufficient time available in each consultation to obtain “informed consent”. I think there are ways to address that. Firstly, there should be enough time, and if there isn’t, then the system is not working. Consultations which are routinely too brief to make a good diagnosis and obtain informed consent are inadequate, and fail to meet the standards of good practice. Secondly, if surgeons can produce comprehensive information about their procedures and the potential benefits and harms, then so can physicians and generalists. Thirdly, as the GMC points out, informed consent is a dialogue and not a single event. Continuity of care has a wealth of benefits, and one of them is enabling an ongoing dialogue between doctor and patient. Many clinics are not designed to facilitate continuity of care, but they could be if we all agreed it was important.

I just don’t think it’s good enough in this day and age to have a doctor write a prescription and say “take this”, without giving any information about potential benefits, harms or other treatment options. And without facilitating a discussion/dialogue with the patient to obtain truly “informed consent”.

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