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Archive for the ‘from the consulting room’ Category

alone

When I worked at what’s now called the NHS Centre for Integrative Care in Glasgow, every patient attending for the first time had a sixty minute appointment. 60 minutes doesn’t seem a lot in the context of a life time but to receive a whole hour of undivided, focused, non-judgemental attention feels like a gift.

My colleagues and I would frequently have patients tell us “You’re the first doctor to have actually listened to me.” I don’t think that feedback ever lost its power to shock. How did so many people get so far into the health care service and not have the experience of being listened to?

We all need to be heard. We all have the right to be heard. All of us.

The recent EU Referendum in the UK, and its political fall-out has made it even clearer to me that, politically, we are not being heard. There is a disenchantment with politics and politicians across the so called democratic world. Maybe one of the reasons for that is that our democracies are not enabling people to be heard.

In the UK there is a whole chamber of government, the House of Lords, which is 100% unelected. There is nothing democratic about it. Nobody voted for them and they aren’t accountable to the electorate.

The electoral processes based on simple majorities lead to government after government which does not represent the majority of the electorate. In the recent referendum 52% of those who voted, voted Leave and 48% voted to Remain. About 30% of the electorate didn’t vote. The 52% of the 70% are heard (on this question). The rest of the population are ignored. Parliamentary elections are like that too.

Is handing power to the largest minority the way to ensure that most people in the country are heard?

How can it be?

Most people don’t have the experience of being heard and, in consequence, don’t feel the elected governments represent them.

There’s an additional problem and that is that politics, as currently practised, is about power, not consensus. Those minorities who are elected believe they have the power to act according to their own beliefs and values. They act to exert power over others. If politics was about creating consensus, rather than wielding power over others, it would be an entirely different kind of politics. It would be more democratic. More people would have the experience of being heard.

Being heard isn’t enough.

We need to be cared about too.

Whilst it’s a good thing to listen to someone, to give them the time and attention to enable them to tell their unique story, it’s not enough. The response to that story, the doctors’ responses, the politicians’ responses, need to show that they give a damn. They need to show that the individual human being matters.

If we don’t have a system based on the principle that every one of us is unique and valuable then we get what we’ve got – politics, economics, education, health care, as if people don’t matter.

Isn’t it within the capacity of we human beings to create something better? What would the world look like if we did?

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really

Karol Sikora, a well-known “cancer doctor”, just said this

It doesn’t make much difference whether you are one of the people who get cured or not

He was talking about cancer care in “the NHS” (as a Scot, it bugs me every time when people refer to “the NHS”, as if there only was one). I suspect he was saying things in a controversial way to promote his new book, but this particular sentence really caught my attention.

He’s referring to how organisations and systems can be managed to work “efficiently”, and I think this probably applies to most health care systems around the world. We’ve developed a way of delivering health care as if individual patients don’t matter. Protocols are created based on the statistics from research into the experiences of groups of patients. I’ve even heard a young doctor say they were told that if a patient takes an evidence based drug and it doesn’t work, then either they haven’t taken the drug or they are lying. These are the kinds of things which happen when doctors take their eye off the ball.

When we base health care on management systems designed for industries which produce physical objects to sell, then, it seems, statistics become king.

It doesn’t make much difference whether you are one of the people who get cured or not

Really?

In what way does it not make much difference? To the individual it makes all the difference in the world. To the doctor? Shouldn’t it matter if this individual gets cured or not? Isn’t that an irreducible fundamental of all medical codes of behaviour? It’s always this patient, this very patient I am dealing with right now who has the right to the best possible care I can provide.

I struggled a bit to find a photo to go with this post then stumbled across this one of a sculpture I saw recently in a garden. It seems to capture that sense of caring for the individual. And it seems the character’s hair is standing on end. Maybe the little bird just told him what Karol Sikora had said!

We can’t accept this way of delivering health care, can we?

This story also made me think of those pretty pointless statistics you can see every day on billboards at railway stations, telling you what percentage of trains arrived on time this week. Should we deliver health care by aiming at percentages of patients properly cared for? Or should we deliver health care by always, I mean always, giving the very best care and attention to every single patient in every single interaction?

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niche

I happened across this little snail in a tree the other day. It immediately caught my attention and got me thinking.

Look at it…..

Doesn’t it look a perfect fit for that space? Doesn’t it look like it fills the space it’s living in quite completely? Doesn’t it look like it’s adapted well to where it’s found to live?

So what about you?

Hans Georg Gadamer, in his “Enigma of Health”, discusses ideas of health and refers to the concept of “fitness” – but not just the fitness of an athlete – the overall concept of “fitness” – when something is just right, when it just fits well. There is something in that idea which speaks to us of health. When we are in the groove, in the flow, in harmony….when everything falls into place……

What would you say about the fitness of your life? How well do you fit your life? How well does your life fit you?

Then I thought about how this snail seems somehow to be living fully or completely within its niche. And I wonder what you’d say about that?

We all live with certain boundaries, limits, “the hand we have been dealt”, influences from Nature and nurture, from the past and from the future, which set the parameters of our potential lives. Aren’t those parameters immense? Aren’t they almost infinite? But do we stretch ourselves out to fill our available life-space as well as we can? There’s something there about flourishing I think. Not just growing and developing, or being “the best you can be”, but of constantly expanding, flexibly adapting, to manifest ourselves, to express our uniqueness in our own vast life-space.

Adaptation. That’s such a good word. I find some people use it in a negative way as if adapting is about compromise and being less than you could be, but I don’t see it that way. Adaptation is how we grow, how we develop, how we live. Adaptation is how all of Life emerges and flourishes. I think we can get caught up in military and/or capitalist metaphors too much, thinking about the world in terms of competition, territory, power, and aggression. But actually, although all those things do exist, seeing the world that way often goes hand in hand with ignoring the co-operation, collaboration, compassion and kindness which also exists.

And when it comes to adaptation, there’s a lot to be said for negotiating your life-space, rather than killing for it!

If integration can be defined as the creation of mutually beneficial bonds between well differentiated parts, then adaptation becomes a process of a living in a way which maximises the abilities of you and I to explore and inhabit our personal, unique, life-spaces.

 

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last leaf

There’s a growing body of evidence that using your brain is good for your brain. Who’d have thought it?!

There’s also a growing body of evidence that what is good for your brain is good for you. The old mind-body duality is breaking down in the light of neuroscientific findings about the connections between the brain, the rest of the nervous system, and the rest of the body.

Using your brain is one of the key themes of this blog. I believe it’s just too easy to drift through life in zombie mode, influenced by others, manipulated by others, controlled by others. And yet, I also believe it very, very possible to make our own choices, to become “self-directed”, conscious creators of our own, unique stories and, hence, lives.

One of the most commonly promoted ways to use our brains is “mindfulness“. A sort of clumsy word which describes a certain state of awareness.

You can practice “mindfulness” by learning certain meditation techniques, and/or, you can do what Ellen Langer says, and “seek novelty”. 

I find that choosing to be aware, stoking the natural curiosity for the day, seeking “l’émerveillement du quotidien” is one of the easiest, and most delightful ways, to achieve this – this is the main way I try to be “mindful”.

There are two related techniques which help me to live this way. They both date way back thousands of years but both work just as well here and now.

Here are two photos to illustrate the techniques.

The first one is the one at the start of this post. It’s “the last leaf”. There’s a mulberry tree in my garden here in France and this is my second season of raking up and gathering the leaves as they fall. The first year I arrived here I wasn’t prepared for this phenomenon. This tree really sheds a LOT of leaves. I confess, I found that clearing up the leaves was a bit of a burden. But this year? This second season for me? I’ve loved it. Pretty much every other day I’d take the rake and gather up the leaves into huge canvas bags and every other week I’d make a trip to the “déchetterie” (“the tip”, we’d say in English). I enjoyed taking my time, rummaging through the different shapes, sizes and colours of the leaves. I enjoyed seeing the green grass again once the leaves were gathered, but quickly, of course, the grass would recreate a “wabi sabi” appearance with just two or three newly fallen leaves adding interest and attracting attention.

As more and more of the tree shed its leaves I decided I’d like to photograph the “last leaf”. That’s my first image in this post. And that’s the first technique – “live today as if this is the last” – that’s not as morbid as it first sounds…..due to the constancy of change, every day is unique, and the truth is, you will never have a chance to live this day, exactly like this, ever again. So it might be a good idea to savour it. To notice what you can, to hear what you can hear, touch what you can touch, smell what you can smell, take your time to taste and savour the food you are eating.

Because this will be your last opportunity to do so.

Here’s the next image –

first leaf

We have twin birch trees in this garden, and when the wind blows in the autumn, they shed, not only leaves, but lots of small twigs and branches. Yep, most of these head to the “déchetterie” too, but Hilary picked some up, finding their shapes pleasing and used a couple as a table decoration. There was a little water in the bottom of one of the vases she used, and look what happened! A few days later, there was a new leaf!

So, here’s the second image, “the first leaf”, and the second technique, “live today as if it’s the first”.

That’s true too. Due to the uniqueness of every day, of every experience, of every moment, whatever you encounter today, you encounter for the first time. Sometimes that’s not so obvious. Our habits and our routines deaden our awareness and we become oblivious to the small changes which can make a big difference.

You have never lived this very day before. So why not approach it with the sense of wonder, curiosity and amazement which you did so naturally as a child? (This is “l’émerveillement du quotidien” – the wonder of the every day)

I mean look at that little twig! It’s grown a leaf! A perfect, bright green, little leaf! Isn’t that amazing? I wondered a wee while ago about how difficult it was to know whether a seed was dead or alive, but I didn’t wonder about these (apparently discarded) twigs. They were dead as far as I knew. But add a little water, and, hey presto! Life magically emerges!

If you don’t stumble across something new, something for the first time, today, you’re just not looking.

So, there you go, two photos, two ancient techniques, “last and first”, and a step in the right direction from “zombie to hero“!

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lunch in paris

I wonder how many people are thinking about food at this time of year? Lots, I expect!

As a doctor, I was often asked for a “diet sheet” but I never had such a thing. I thought that just as every patient was a unique individual so there was no standard diet which everyone should follow. We’d have a chat about food and I’d suggest a good start would be to become aware of what the person was eating and noting any specific effects they experienced. For example, I found that if I ate a sandwich at lunch time, my energy would drop within the next hour or so. It was better to have soup, or salad, or sushi. In fact, I found that after sushi I’d experience a rapid boost in energy and alertness. I don’t expect everyone would have the same experience.

So the first part of my advice about food would be to keep an eating journal for a couple of weeks, noting what you eat and drink, and also noting anything you experience in terms of energy, mood, alertness, any physical symptoms etc. In other words see if you can learn for yourself what the effects are of different food and drink.

The second part, though, was something I read about a number of years ago in a French magazine. It was that food has a place in our lives which is far greater than nutrients or food groups. It’s not all about carbohydrates, omega 3, or dairy products, for example. What’s also important is where we eat, and who we eat with. In other words, the contexts (physical and social) of eating are important. It’s really quite a different experience to eat a sandwich at your desk, than to enjoy a “croque monsieur” on a Parisian street corner! (see the photo above).

Seriously, give some thought not only to the foods you are eating, but to how eating fits into your life. I have a hunch that the more you enjoy the experience of your meal, the more you’ll find what you’ve eaten is good for you!

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cad

I’m a strong advocate of individual health care.

What I mean by that is that I am wary of health care delivered on the basis of statistics and generalities.

It was not my experience as a General Practitioner that I always knew best. I might try my best every day, but every day there would be patients whose blood pressure had not come under control, whose infections had not cleared up, whose pain was not relieved. So every day I had to modify my decisions and change them to better suit the individuals who came to see me.

Health care practiced on the front line makes you wary of generalisations. You quickly realise you can’t apply the same treatments to everyone with the same conditions.

I think there are three main, rational, real life reasons underpinning that experience.

Firstly, every individual is unique. Not only are no two individuals the same biologically, but every individual has their own history, their own influences, potentials and predispositions. Added to that every individual has their own beliefs, values, preferences and priorities.

Secondly, life is an emergent phenomenon, and so, so is health. There is no such thing as simple cause and effect in Nature. No intervention produces predictable outcomes in all circumstances.

Thirdly, life is not a series of discrete events. There is a lot of talk in health care about outcomes, but what are outcomes? Life is a process. What happens today is influenced by what happened yesterday and what might be possible tomorrow, and all of that will change every single day.

In my view, the health care choices for each individual are best left to the doctor and patient together in their ongoing relationship, not decided by politicians, insurance companies, managers or drug companies.

 

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DSCN4747

Look at this tree. Those aren’t leaves, they’re birds! Hundreds of them, thousands maybe.

I’ve never seen such a large flock of birds near me before. Maybe you haven’t either. What do you think your response would be? Would you think of Alfred Hitchcock?

Not me!

I didn’t think of that for a moment.

I was fascinated, entranced, drawn outside with phone and camera to do my best to record something of this phenomenon.

Here’s what I put together from my short video clips and some photos.

Later, while reading Montaigne, I read

He who fears he will suffer, already suffers from his fear.

It got me thinking about the stance we take towards the world, about our default attitude. Because isn’t there so much fear around? In fact, it seems to me that fear is often used deliberately as a weapon of control.

What’s the greatest fear?

Some say it’s the fear of death. That this “existential fear” is the foundation of all other fears. For example, as a comedian I heard once said “I don’t have a fear of flying. I have a fear of crashing!” People who fear the dark, fear what dangers might be hidden in the darkness. People who fear dogs, fear that the dogs will attack them. People who fear illnesses, fear suffering and death.

Montaigne says if you spend your life fearing suffering, you’ll be suffering throughout your life. Yet so much of the health advice offered to people is based on trying to avoid death (the greatest fear).

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If fear is our default, we don’t just suffer, we live in a shrinking world, fearing difference, the “other” and change.

What’s the alternative?

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Dread one day at a time??!!

Nope.

The great thing about alternatives to fear is that there are so many of them.

There’s courage. Courage is the determination to go ahead even when you are feeling fear. That’s something I’ve been practising since coming to live in France. When you start to live in another country with a different language, not only are customs and habits different but at first you’ve no idea how to ask the simplest things. So a trip to a post office, or the local Mairie, or the garage can be quite intimidating. Until you summon up your courage, and just go. And, in my experience here, each and every time I discover there has been absolutely nothing to be afraid of. People are friendly and they want to help. (Then next time you go the fear has diminished, or even gone away entirely)

There’s wonder. Wonder and curiosity. That’s the response I had when I saw all the birds. That’s the attitude I hope to take into every day – l’émerveillement du quotidien.

There’s love. Love comes with a desire to make connections and with an intention to care, or at very least, not to harm – and that applies in relation to plants and animals as much as to other human beings. How often does it seem to be that when your intention is a loving one, that you meet the same response? When I was a GP, my partners and I built a new clinic and the reception was an open one – no glass or metal barriers between the patients and the staff. We were warned that we’d be vulnerable to being attacked. It never happened. Not even remotely.

Fear closes.

It closes us off from the world and from life.

The opposite is whatever opens – courage, wonder, curiosity, love…..add your own favourites at the end of this sentence!

I prefer the opposites for what they bring in themselves, but I resist fear for another reason. I don’t want to be controlled. Heroes not zombies anyone?

 

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