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Archive for the ‘health’ Category

present.jpg, originally uploaded by bobsee.

Here’s a slide I made for one of the talks I give to medical students and doctors. I use this diagram during consultations with patients sometimes too.
Imagine that from the left to right here is your life line – the day you’re born on the far left and the day you’re going to die on the far right. We all know our left hand dates but none of us know our right hand ones! Let’s assume we are currently about half way along (I know, I know, but “middle age” seems to stretch for longer periods the older you get!)
Everything from the day you were born until now is in the past. It exists in our memories. Everything from now until you are going to die is the future. It exists in our imaginations.
If you spend most of your time thinking about and talking about the past, or most of the time worrying about what might happen in the future, the one place where you are not spending your time is – THE PRESENT.
So, if the past or the future is troubling you and consuming your thoughts and your energy, then draw your attention into the present from time to time. The more you do so, the less you’ll be spending time, attention and effort in your memories or in your imagination. You’ll be living NOW, experiencing life as it is actually happening.

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….that might seem like a strange and obvious statement, but the reality is that health is experienced by individuals which is why we need a health service which is patient centred, taking a holistic focus to understand the differences between people as well as their similarities (what diseases they have). However, the other side of the partnership in healing is the health care professional – doctors, nurses and other professionals. There’s a strange distortion of “Evidence Based Medicine” which seeks to reduce the whole of health care to numbers, as if people don’t matter. We see this in the way that randomised controlled trials are conducted using methods which explicitly seek to exclude the individual people effects – you never see any mention in a research paper of who the individual health care professionals were who actually interacted with the nameless and faceless patients in the trial. It’s as if we can only rely on studies which exclude the effects and contexts of human beings. This has always struck me as strange.

In any GP partnership, patients quickly suss out which doctor is good for which approach. Those who want to be given time to talk about their problems seek out the doctor who listens. Those who want antibiotics seek out the one who is best known for prescribing them without lectures…….and so on.

Doctors are not clones. They are individuals too. In good health care each of us needs to find a doctor we can connect with, one who is on our wavelength. Yes, we want a surgeon, a physician, a GP who has good up to date technical knowledge and skill. That’s a given. But we need more than that. We need a good human relationship with him or her.

So, I wholeheartedly endorse Dr Everington of the BMA today who says

Doctors feel under attack, the government wants to turn everything into something that has just a monetary value. Vocation, dedication and lifetime commitment to patients and the NHS has little value in this new world – we are just financial commodities.

There’s a process going on in the NHS known as “Agenda for Change“. It’s central tenet seems to be that every job in the NHS can be described according to the knowledge and skills required to do that job, every person can have their knowledge and skill level assessed, then anyone with the requisite level for a particular job can do that job. The actual human beings become dispensible and interchangeable. The whole process is demoralising for thousands of NHS staff. People matter. Personal, individual qualities and characteristics matter. Two different people doing the same job will interact with people differently. In health care this matters. In a factory making widgets it maybe doesn’t. But GP surgeries and hospitals are not factories and people are not widgets.

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Interesting article on ScienceDaily today about a physicist postulating the existence of non-particles. It’s one of those mind-bending thoughts that physicists are so good at – maybe not everything is made of particles? Maybe there’s something else? “Non-particles”?

The line that really caught my attention was this –

a theorist who restricts their imagination to merely the likely possibilities probably isn’t trying hard enough.

I totally agree. This is true in life as well as physics. If you only think about the kinds of things you’ve already thought about you’re either stuck in a loop or you’re restricting your view.

The area of clinical practice in which I work is Homeopathic Medicine – as a doctor in the National Health Service, in Scotland’s only NHS Homeopathic Hospital. Some people ridicule homeopathy because they say there is “no plausible mechanism” to explain how it can work. But two thirds of the patients we see at the Homeopathic Hospital have already failed to have their pain, wheeze, depression, whatever, relieved by the best “Evidence based” treatments, but get relief after treatment with homeopathic medicines. It might be hard to accept that a treatment we can’t explain can have a useful place within the Health Service but the daily reality is that it does. So, I say to other doctors or “scientists” who dismiss this form of treatment, learn from the physicists…..

Try harder, imagine the unlikely as well as the likely.

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A study published in The Archives of Internal Medicine looked at how doctors greet their patients. In particular they studied how often doctors used the patient’s name and how often they greeted the patient with a handshake. They claimed to show that most patients wanted to be greeted by name and with a handshake and that many times doctors failed to use the patient’s name. However, the statistics on the handshaking are fascinating –

Seventy-eight percent of patients surveyed wanted a doctor to shake their hands, while 18 percent did not. In the taped sessions, doctors and patients shook hands 83 percent of the time.

Read that carefully. 78% of patients said they wanted the doctor to shake their hands. 83% of time the doctor shook the patients hand. What does this mean? That doctors are shaking patients’ hands too readily? That more patients get their hands shaken than wish to do so? Funnily enough, there’s no comment about this strange anomaly.

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Here’s a quote from The Conqueror by Jan Kjaerstad

Supposing one were a conqueror – what would one win? The world? A little peace of mind? A name? Immortality? Oneself? Power? Women? There were times in Jonas Wergeland’s life when he felt there was only one thing worth striving for: health. To be fit and well.

What do you think? Do you agree with Jonas? What do YOU think is worth striving for?

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A BMJ-published study from the Scottish Physical Activity Research Collaboration has focussed not on the fact that walking 30 minutes every day will significantly reduce your chances of suffering from several diseases (potentially halving heart disease risk for example) but on how to motivate people to act on this advice.

What would it take for YOU to change your habits and walk for 30 minutes every day?  The answer is interesting –

Our findings are consistent with (but certainly not proof of) an assumption that different types of people may respond to different approaches, tailored to their psychological characteristics or life circumstances. In other words, one size may not fit all and various approaches should be offered: some people may respond best to personal advice from their doctor, others may prefer the private feedback from a device such as a pedometer, others (perhaps those in a more advantaged socioeconomic position) may benefit from interventions delivered through the internet, others may benefit from the social support of a walking group, and others may increase their walking in response to prompts about reducing their car use on environmental grounds.

In other words, what works for one person doesn’t work for another and if we want to help people we need to both actually communicate with them to find out a bit more about them, and then tailor our advice to best suit the individual.

This kind of study gives me hope. For too long Medicine has focussed on disease and then tried to treat every patient with the same disease in the same way, but we are beginning to see the glimmers of the New Medicine which focusses on the individual and tailors the treatments according to the individual’s uniqueness.

This is a move from Zombie Medicine (unthinking, treat everyone the same) to Hero Medicine (thinking, holistic and individualised)

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A three year study of treatment for “acute promyelocytic leukemia” adding arsenic into the mix has shown that doing this can increase the survival rates significantly.
What really struck me in this story though was this comment by the Reuters journalist

Arsenic has been used as a traditional therapy in China for more than 2,000 years, but its use in the United States is still rather novel.

Why is that? What is it about the tendency to certainty in Western thinking? I suppose we have a long history of believing we are right and that our ways are best. We live in a chaotic world where chance events change people’s lives forever every single day. When it comes down to the individual all the so-called certainty of our statistics-focussed view of the world is of little use. When I meet a patient with disease X, I have no way of telling whether or not they will CERTAINLY respond to the same treatment as other patients with the same disease, nor of knowing EXACTLY what will lie ahead for them. But as human beings we can’t cope with total chaos, and complete uncertainty. We need to have some idea of what’s happening in our lives and some idea of how things MAY turn out with particular choices we make. That’s just how we are. We need to juggle our knowledge of uncertainty and unpredictability of the particular with our knowledge of probability gained from the general. The problems arise once we turn those probabilities into certainties.
There was an interesting line of dialogue in CSI the other night – one character, a forensic scientist, said “I am confused”, and her boss replied “Good. That’s the best place for a scientist to be”. He was SO right. Well, not that scientists should always be confused but a scientist who stops doubting, stops looking and stops thinking.
Wouldn’t it be a good thing for us to look outside of our little boxes and see what phenomena are actually already well-observed (just by other people in other places – people who think differently from “us”)

I’m a homeopathic doctor and homeopathic arsenic was the very first remedy I had success with. Whether or not you believe in homeopathy, one thing a study of the subject brings is a greatly increased knowledge of substances used medicinally in different cultures over the centuries. It’s well known to homeopathic doctors that arsenic has traditionally been used to increase stamina and staying power (in fact, it was used to do just that in racing horses until it was made illegal!)  It’s also well known to us that arsenic is a commonly indicated homeopathic palliative treatment in cancer.

I wish we could replace the arrogant know-it-all and I-know-best in scientists and doctors with an attitude of lifelong curiosity and wonder.

What do you think? How would you change the education of scientists and doctors to increase open-mindedness, creative thinking and foster a spirit of humble, endless curiosity?

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Janssen LP have created goggles and a headset that give the wearer the experience of having hallucinations. There are two scenarios to choose from – riding on a bus where people appear and disappear randomly and birds of prey claw at the windows, and going to pharmacy where the pharmacist gives you poison instead of pills and other customers stare at you in disgust.

They’ve used these goggles to train social workers, policemen and others who might have to deal with mentally ill people and have apparently shown that after the training the workers understand mental illness better – learning through virtual empathy!

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I was taught at medical school that the way to make a diagnosis (that is to understand what’s wrong with a patient) was to listen carefully to them (take a history) and examine them thoroughly. Only if the diagnosis remained obscure at this point would we subject the patient to any investigations. Sadly, there has been an increasing reliance on technology to the point where many doctors seem to be losing the ability to diagnose on the basis of listening and looking. A study from the University of Winsconin has shown another problem with this.

The researchers studied patients with acute appendicitis. They compared what happened to those who went straight to surgery after the diagnosis had been made clinically, and those who first went via a scanner room to have a CT investigation to make the diagnosis. Those who went via the scanner (two thirds of all the patients!) took longer to have their operation done than those who went direct to theatre (only a third of them). The scanner group had twice the rate of burst appendix (perforation) and twice the number of post-op complications.

Moral of the story? Don’t rely on machines as a routine way to make a diagnosis.

We need to make sure medical students and doctors know how to look and listen and make good diagnoses without relying on technology.

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We have a real tendency to divide up our experience of the world, put the pieces into separate boxes and label them. Brian Broom talks about this in his excellent book, “Meaning-full Disease“. He says we discriminate, categorise and judge. It’s kind of how we make sense of the world. The human body is remarkable and is endowed with an incredible amount of sensory equipment to detect the world we live it – we sense light and colour, sounds, smells, textures and so on. In fact, our sensory systems are under constant bombardment. If we didn’t discriminate we wouldn’t be able to make sense of it all. We can only deal with so much at a time. We are pattern-seeking creatures, constantly trying to recognise and make sense of the sights, smells and sounds that surround us. Of course, we lose something in this process of discriminating. We ignore most of the signals coming our way and only pay attention to the ones that most interest us. As I said in an earlier post, “we are what we pay attention to“. If we want to grow, if we want to develop and change and not be stuck in deep ruts, then we need to shift our attention, to deliberately try to break our attention-habits and notice what else is in the world. I am a doctor specialising in homeopathic medicine. This is a method which is based on noticing difference. When a patient tells me their story, I don’t want to know just what symptoms they have in common with other patients I’ve known (so I can make a diagnosis), but I want to notice what is different, what makes this person unique. Picking out patterns is a good skill, but we just have to be wary that we don’t always only see the same old patterns. We also categorise everything. We love labels. Often a so-called diagnosis is nothing more than a label. I saw a little boy recently who had an itchy bottom. His mum said the paediatrician had diagnosed the problem as “pruritis ani”. That’s a latin label. You know what it means in English? Yep, “itchy bottom”. So how helpful is that label? Labels, categorising sadly tend to limit our vision. Once we place something in a box we tend to stop being aware of it, stop noticing how different it is from anything else in the same box. Finally, to judge those boxes, calling some “good” and some “bad”? I can’t remember who said it, but I remember once reading “Judgement stops thought”. How true. When we judge something and especially when we judge a person, we stop thinking, stop noticing and stop actually seeing.

Nothing stays the same. We are always constantly changing. We grow, we develop, we change. The processes of discriminating, categorising and judging create a false impression that the world is made up of fixed, separate things. It’s not true. Nothing exists except embedded in a web of connections, and nothing exists without changing. The world is not really so easy to pin down, and thank goodness for that. Life is dynamic. It flows, it moves and constantly changes. Too much pinning down, labelling and judging creates a false impression of a fixed, stagnant world. So, beware. Shift your attention, break your habits and try to see the connections between things, try to see how nothing just is anything, but instead how everything is in the process of developing and changing. Everything is becoming not being…….

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