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Archive for the ‘from the consulting room’ Category

bandanaEvery day in the UK, we hear stories of ambulances waiting in queues at hospitals. Patients waiting hours to receive attention. Patients waiting hours on trolleys in hospital corridors.

What’s the problem?

Much of the media coverage focuses on the “demand”, by which they mean the sheer numbers of people coming to hospital for health care.

Let me return to the issue of demand in a minute, but let’s start with waiting times. Let’s set targets aside for a moment as well, because targets can be arbitrary and unhelpful.

Why are there queues of ambulances at hospitals?

Part of the answer is there aren’t enough doctors and nurses to attend to the patients’ needs.

There aren’t enough, because if there were, they would be able to devote all the time necessary to each patient but there wouldn’t be a huge queue.

Part of the answer is the staff can’t move patients through from A&E for inpatient care because there aren’t enough inpatient beds.

There aren’t enough inpatient beds.

There are more patients needing inpatient care than there are beds to put them in.

Beds aren’t enough.

Once a patient is in a bed, they need to be cared for….by staff to keep the ward clean, staff to make food for them and feed them, staff to care for their daily needs and staff to manage their diseases and get them well enough again to go home.

So can we fix that first?

  • Increase the numbers of beds available in the NHS to cater for the needs of sick people.
  • Increase the numbers of NHS staff to the level where there are enough of them to meet the needs of sick people.

Wasn’t that the whole point of the NHS in the first place?

To meet the needs of the sick in society.

Let’s turn to demand.

It’s going up.

And there’s absolutely not a shred of evidence to suggest it’s going to do anything other than continue to go up.

The proportions of the population over 60, over 70, over 80, and, yes, over 90 are all rising. All the evidence shows that older people have greater health needs. The demographics of the country tell us that demand will increase.

Life expectancy might be going up, but disease isn’t going down. There are more people suffering from a chronic illness every year. There are more people suffering from two or more chronic illnesses every year. This is what doctors are referring to when they talk about increases in “complex problems and needs”.

All those patients waiting on trolleys for a hospital bed have been assessed as needing the complex care of a hospital to cater for their complex needs.

Not all those patients already in the hospital need the complex care of the hospital. Some of them are elderly, and/or disabled people who are not able to look after themselves at home. They need to be looked after somewhere else.

Here’s the next item on the list.

There are not enough places available in care facilities which are not hospitals.

Places in care facilities, (nursing homes, residential homes etc), need sufficient numbers of trained and support staff to provide the care for their residents. We don’t have enough care facilities.

Let’s think about another aspect of demand. Time and again we hear that many people pitch up at A&E because they can’t get to see their local GP. They are told they have to wait several days, or even weeks, for an appointment so they go to the local hospital instead – with problems which could be, and should be, managed by GPs in the community.

Why can’t people get to see a GP in a more timely manner?

There aren’t enough GPs.

There never have been.

The scourge of General Practice is not having enough time to treat each patient as well as the doctors would like to. Were five minute appointments ever adequate? Are ten minute appointments adequate? Do they give the patient enough time to say what they want to say? Do they give the doctor enough time to listen, to examine, to diagnose, to offer treatment, to give the patient enough information to give informed consent to the treatment, to allow enough time to discuss options and alternatives?

You’ll have a hard time finding someone who can answer yes to that.

There aren’t enough GPs.

And there aren’t enough staff in the GPs’ teams either.

A healthier society

The biggest delusion suffered by those who created the NHS was that the NHS would make the population so much more healthy that eventually demand for it would shrink. That’s never happened. And it’s not likely to happen.

Health care isn’t the biggest contributor to the health of the population.

We need to address the causes of illness if we want to reduce demand. The causes of illness are primarily social, economic and environmental.

  • We need to tackle the isolation of people in our society.
  • We need to tackle poverty.
  • We need to tackle the constant stress of the “precariat” – all those without secure incomes, those on zero hour contracts, short term contracts, those employed for insufficient hours at insufficient levels of pay to meet their daily needs.
  • We need to tackle the food industry, from farming methods, to factory production of foodstuffs, to marketing and sales of food.
  • We need to tackle the chemical industry, to reduce the amount of CO2 in the atmosphere, the amount of plastic in the sea, the number of chemicals found in the blood of every newborn child, the number of chemicals found in drinking water, the number of chemicals in every household.
  • We need to tackle inequality which is rising fast and has been shown time and time again to inflict pain and suffering on millions.
  • We need to tackle conflict, to be able to direct resources towards healthy lives instead of war.
  • We need to tackle our political systems which leave so many feeling disempowered and forgotten. Democracy might be a great idea. Maybe we should try it. Not the pretend democracy of a vote every few years for someone to work in government, but real, relevant, responsive democracy which increases the engagement and autonomy of citizens.
  • We need to find different ways to live together.
  • We also need to tackle the Pharmaceutical industry. That industry which doesn’t exist to produce cures, but profits. There isn’t a drug on the market which increases health. At the very best a drug will support the body’s natural systems of repair and recovery. At worst drugs diminish symptoms without making any impact on the underlying disease.

We need a different philosophy of health care, one focused on health not taking drugs.

That’s an awful lot. Daunting perhaps. But are there better answers?

In summary

This is a toe in the water. There is no way to cover the complexity and extent of the issues in one short article. But can we make a start?

  1. We need more hospital beds, more care facilities, more GPs, more doctors, more nurses and more support and care staff.
  2. At the same time, we need to tackle the causes of the increase in demand – the social, economic and environmental causes.

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I see this sort of thing a lot when I look at old buildings in either France or Spain. This one is in Segovia.

What’s the first thing you notice?

The window?

Or the window in an arch?

See, when I look at something like this I really get to wondering….how did this come about? Did the original builders build a nice big entrance way, two verticals and a horizontal? Building a frame like a picture frame for an entrance? Maybe not….well, maybe not exactly anyway, because it looks like exactly the same bricks have been used to make the archway and some of the bricks seem to run between the two frames….the square frame and the arched frame. So maybe the original builders built an arched entrance and surrounded the arch with a frame?

But then it looks like somebody decided not to have an entrance there after all and filled in the space.

Then somebody else thought, hey, wait a minute, I’d like a window here and put in the window….but did they fit bars around the window at the same time?

So, has this window, this barred window, emerged over many years from a wall which was built in the space formed by an arched doorway?

And what was the thinking behind each of those steps in the development?

Make an entrance, an attractive, obvious entrance…..then block it up…..then make a window, but not one for letting that much light in, and certainly not one somebody might climb into, or out of…..was that, is that, a problem around here? People climbing in and out of windows?

Bear with me here but because I worked as a doctor for almost forty years this image sparks my thinking about patients and the problems they talked about in the consulting room. They’d bring the equivalent of this window….let’s say they’d talk about a pain (instead of a pane….ha! ha! sorry!)…..and I’d ask about the pain, asking them to describe it….its features, its characteristics, its exact location, what surrounded it, or accompanied it……and then I’d want to know how it arose. Tell me when it wasn’t there. What was there before it? What was happening when it began? And so, gradually, what a first glance might be a simple symptom turned into a unique, never before told, story…..and that’s where I began to understand what the problem might be.

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I’ve noticed there is a phase of consciousness between sleep and waking up, a kind of half-asleep/not-quite-awake phase. It’s different from being asleep and it’s different from being awake. Maybe it’s a time of surfacing which sways between those two distinct states. Whatever it is the other morning, in that phase, I became aware of a number of different things “coming to my mind”….an image, a memory, an idea, a bit of a conversation, some things on a list to remember to do….it was really quite a mixture. At about the same moment I became aware of the feeling that I wasn’t in control of any of this. Whatever images, words, thoughts, ideas, memories there were, it was if they just appeared, or as if they were flowing by and I was just noticing them.

It got me to wondering where the contents of the mind come from, how many there are, and how, probably, the ones we notice are just the tips of an iceberg.

I remembered a number of occasions when I’ve stood on a bridge (like the one in the photo above) and looked down at the water as it flows towards, beneath or away from me.

This experience of noticing the contents of the mind flowing past reminded me of those times.

Sometimes what would catch my attention from the bridge would be movement. Like the flow of the water over the rocks, or leaves on the trees in the banks of the river blowing in the wind, or birds darting down to catch an insect or even a fish, or even a fish swimming in the water. Movement catches our attention. Change catches our attention. Something appears….like a branch or some leaves tumbling over the rocks to be carried away by the river. We notice that.

Sometimes my attention would be broad rather than narrow. I wouldn’t zoom in on any particular element but just gaze upstream and take in the whole scene. Seeing the general colours, the shapes of the rocks and the falling water, the patches of turbulent white and the still, dark pools…all at once.

Meditation is a bit like that. You sit and watch to see what turns up, then, after just noticing it, you choose not to interact with it, or hold on to it, but just notice it floating on by. Images pop up and then disappear, a thought half forms and then unravels, a memory emerges and then fades……

And it’s not always rushing and tumbling either. Sometimes what comes to the fore does so quite slowly and gently….

I thought of a number of bridges I’d stood on. The ones over the waterfalls, the ones of the gently flowing rivers, the ones over the big city rivers, the ones over little ponds in Japanese gardens. Each one was a vantage point. Each one allowed me to take a few minutes to stand and gaze and notice and to turn my attention towards something, then let my focus drift over to something else. Never getting stuck, never staying the same, always bringing something different, something new…….

It’s a nice metaphor for the interaction between the conscious and unconscious regions of our minds.

But, wait. I’ve got more big questions now.

Where is the bridge?

Who is the me, the observer, who is standing there watching the flow of mental content?

Where is the mental content coming from and where is it going to?

Strange how hard it is to pin down this idea of the “self”. Two things pop into my mind right now…….Mary Midgley, the philosopher, who tackles the idea that the self doesn’t exist at all…it’s an illusion….in her book, “Are you an illusion?”, where she asks the question – if the self is an illusion, who is it who is having this illusion? And Dan Seigel, who in “Mindsight” and other books, defines the mind as “an embodied, inter-relational, process of regulation of energy and information flow”.

And something else pops up now…my training in TM. Sitting, repeating the mantra, noticing words, thoughts, ideas, images and memories bubbling up and just gently returning to the mantra, letting them all flow on by.

Well, one thing at least is pretty clear to me. The origins of all this mental content are multiple. Sometimes they are a response to an external stimulus, a sound, a light, noticing something. Sometimes they emerge from memory, from imagination, or from whatever area of the mind we use for gnawing away at things….problems, worries, things to do, things we want to say. But wherever they come from, I really don’t think we have much control over that flow. What we can do is to notice, to become aware. Then we can begin to choose where to direct our attention and decide how which ones we want to follow and which we want to let go off.

 

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Richard Louv once coined the expressing “Nature Deficit Disorder”, arising from not spending enough time in Nature and proposed a treatment – “Vitamin N” – a dose of Nature. In Japanese research there have been discoveries showing positive chemical changes in the human body in relation to the immune system and a settling of inflammation when practising “forest bathing”, which consists of spending some time in a forest.

I like those ideas and so, last week, on a sunny day, we took a trip into the Limousin, found a nice forest, and had a walk.

Do you do that from time to time? I thoroughly recommend it. I mean, who really cares about the biochemical markers of immunity and inflammation when spending a bit of a day amongst the trees is just such a treat anyway? But it’s good to know the benefits are so deep.

Le Monde group has just launched a new publication entitled “Sens et Santé” – I like how French words often have several meanings all at once – “Sens” can mean “sense” or “meaning” but also “direction” (“santé” is health). One of the larger, beautifully illustrated articles in the inaugural issue focuses on “forest bathing”, describing how you can take time to become aware of the sounds, the sights, the smells, the feel of the trunks of the trees, and even, if you are so disposed, to spend a little time meditating.

Of course, I wouldn’t go without my camera, but that’s just my personally favourite way of raising my level of awareness. I notice more when I have a camera in my hand and an intention to take photos.

Look at this particular tree. I posted about a strange shaped tree a few months back, wondering what had happened in its life to bring about its peculiar shape. Well, here’s another one to stop me in my tracks and get me wondering….what on earth happened here?

And immediately another thought pops up – what resilience! What an incredible power to overcome what looks like it could have been a fatal event, to grow again, not just a new trunk, but six of them! Wow! There’s an inspiration!

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Last November I was invited to address the Faculty of Homeopathy at their Congress in Belfast. I prepared a talk entitled “Images of Health. Pictures and stories” based around some of my own photographs and covering the key principles of health which guided me through my career as a doctor.

Here’s the video of that talk. I hope you enjoy it, find it interesting, or even inspiring. (by the way, if Google pops up any ads along the bottom of the video, just click the “x” box to make them go away 😉 )

I wrote a book to accompany this talk. It’s called “Escape to Reality” and I’ve published it (so far) only as a Kindle e-book. You can find it on Amazon.

 

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red-veg

Peter Brabeck-Letmathe, the outgoing chairman of Nestlé’s intention is for Nestlé to develop food scientifically – synthetic food which will be better than “natural food”. He rejects the notion that food grown in the ground is best for us. He says

Nature is not good to human beings. Nature would kill human beings. The reason why homo sapiens have become what we are is because we learned to overcome nature.

What do you think when you read this?

Is “Nature not good to human beings”? Does Nature seek to “kill human beings”?

I was pretty astonished at this claim because I think human beings are part of Nature, not something outside of “it”. If we want to learn what’s good for us my own feeling is that we should look to the rest of Nature. As Idriss Aberkane says of “biomimicry”, Nature is a library, a source of knowledge, not a source of repository of fuel to burn.

So where does this idea that Nature is trying to kill us come from?

Well, as chance would have it I read an interview with the French philosopher, Michel Onfray, at the weekend, and he mentioned the definition of life given by Bichat, the physiologist

Life is the sum of the forces which resist death

That’s an interesting definition of life – life is resistance. Is death constantly attacking life? I think that’s a pretty miserable and negative understanding of life. But I think it might come from the notion of entropy. You know about entropy? Entropy is “the gradual decline into disorder”. The second law of thermodynamics states “entropy always increases over time”. You can probably see how this observation can lead you to think that we are only alive as long as we resist death, disorder, and decline. But is that enough to lead you to conclude that Nature is trying to kill us?

It seems to me that this entropic force in the universe is only one of the major forces at play. What Thomas Berry referred to as “wildness” is another way of thinking about this force. It’s the chaotic force. If this was all there was, or if this was the dominant force, what would the universe look like? Would there be stars? Would there be galaxies of stars moving together? Would stars have planets? Would there be any complex living organisms? How could there be? There is a second force. One Thomas Berry calls “discipline”. It’s the ordering principle, the structuring principle, which contains, limits and holds together. But what if that was the only force in the universe? What would the universe look like then? Would it be any more than a dense ball of energy? Would it be expanding? Would it show diversity? Or would whatever existed by “more of the same”?

I think there is a third force at work in this universe, because it seems to me, without it, there is a tendency for the first two forces to cancel each other out, or for there to be a significant tendency towards either chaos or uniformity.

That third force is creativity. The creative force is a force of integration – it integrates the two forces of wildness and discipline to produce astonishing levels of complexity. Look at the history of the universe. Is it a history of endless decline and degeneration, or one of stasis and constriction? Or is it a story of ever increasing complexity and diversity?

It’s this latter, isn’t it? The universe is on a course of increasing complexity. We humans, with our bodies, our brains and our consciousness, are the most complex phenomena the universe has produced so far. But we haven’t been about for very long.

cosmic_calendar

(the cosmic calendar)

The universe is on a course of increasing diversity. Not just the rich diversity of species and life forms on planet Earth, but in the diversity of unique human beings. Not one of us ever repeated. No single experience of a whole life ever duplicated.

So is Nature a threat to us? Or is Nature a manifestation of the creative force of the universe?

I’m opting for the latter view. And I’m going to continue to enjoy the fruits of that rich creative diversity, just like you see in my photo at the start of this post. I won’t be swapping “real food” for synthesised, chemically “enhanced” stuff any time soon!

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two

In the Spring of 1784, Armand Marie Jacques de Chastenet, marquis of Puységur, discovered that Victor Race, one of the peasants who worked on the marquis’ land, had pneumonia. The marquis had become interested in the work of Mesmer and “animal magnetism” so decided to see if he could help Victor back to health using this new method.

Victor fell into a trance and began to speak. But to the astonishment of his master, he didn’t speak in his usual patois, but in perfect learned French instead. Not only that but he talked about subjects that an illiterate peasant couldn’t have known about.

What happened next is even more astonishing. The marquis and Victor became a therapeutic couple. The marquis would ask an ill person about their symptoms….he’d “take the history of the patient”, and, in trance, Victor would pronounce the diagnosis and prescribe treatments.

Neither of these men were able to carry out the acts of healing by themselves, but together, they could.

This was one of the first recorded episodes of “lay mediumship” in Western civilisation.

I think that’s a remarkable story and I know of other instances from within my own lifetime where such astonishing collaborations occurred.

But even setting aside the somewhat “supernatural” aspect of these tales, isn’t there something like this going on in every therapeutic act? Isn’t every therapeutic act a collaboration between the patient and the therapist. Without each other they can’t achieve healing, but together, they have the chance to become something unique and greater than either of them. Together they can gain a greater understanding, and together they can find answers they couldn’t find alone.

I think we forget that in modern medicine, thinking that the doctor can do it all by him, or her, self. Thinking that one person has all the answers, ready made, so to speak.

There can be some of the most astonishing examples of magic happening when two people form a bond and work together for a common purpose.

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