Heroes Not Zombies

If you suffered from a heart attack or a stroke you’d probably be interested in trying to reduce your chances of a second one. So here is something which apparently achieves the following results –

35 per cent reduction in risk for cardiovascular death
14 per cent reduction in risk for new heart attacks
28 per cent reduction in risk for congestive heart failure
19 per cent reduction in risk for stroke

Pretty impressive huh?
So what is this wonderful treatment?

“A heart-healthy diet rich in fruits, vegetables and fish” , according to a big study conducted by researchers at McMaster University.

In the report about the study was a little passing comment – “At times, patients don’t think they need to follow a healthy diet since their medications have already lowered their blood pressure and cholesterol — that is wrong,” said Mahshid Dehghan, the study’s lead author and nutritionist at McMaster University’s Population Health Research Institute”
That is actually such an important point. How many people are suckered into the belief that as long as they take drugs they can forget about trying to live a healthier life?

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I use a three phase cycle when teaching medical students and doctors.
Phase one is the story.
Phase two, making sense of the story.
Phase three, a therapeutic action.
All doctors have been trained to start with the patient’s story. Sounds simple, and at one level it is, but what makes it complicated is that in every story there is an author and a reader. The patient is the author, and the doctor is a reader. But neither of these roles exist in isolation and the consultation in this phase is a process of co-creation. Both the patient and the doctor bring their stories into the room and, together, they co-author a new story.
Most of these narratives are very, very short stories. Typically less than ten minutes. I remember being very struck by a study which measured how long into a consultation before the doctor first interrupts the patient’s story – 18 seconds. In such short consultations the doctor is seeking to focus and direct the story right from the outset. He or she will decide which story lines to close off, and which to open up. The goal is to quickly move on to phases two and three.
What sense can I make of this patient’s story? Another way to think of this making sense phase is to see that it is about achieving an understanding. The doctor is trying to understand the patient, and the patient is trying to understand their experience. In fact the declared aim of medical undergraduate education is to teach doctors how to make a diagnosis (diagnosis means an understanding). Sadly, the biophysical model and short consultation approach to medicine means that diagnosis is reduced to discovering the presence or absence of a lesion. It’s not about understanding a person in the context of their life, nor about understanding their “illness” in a whole of life context.
The reduction of the understanding phase to the declaration of a clinical label which is then called a diagnosis sets the limits of the third phase – treatment.
The therapeutic interventions are intended to reduce or contain the diagnosed lesions. If no lesions are found, the intention becomes one of reducing the symptoms.
At every stage of this cycle there is a narrowing of vision, which reduces the story to a data set which will be judged as either normal or abnormal. Treatment is then either a surgical procedure or the prescription of drugs to try to alter the data.

What’s the alternative?
Broadening the focus at all stages.
Expand the story from a biophysical one to at least a biopsychosocial one and a story of a person replaces the story of a disorder.
Expand understanding from diagnosis of a lesion to understanding the emergence of an illness in the context of an individual’s life and a person can make sense of their experience.
Expand the interventions on offer beyond surgery and drugs to methods which increase vitality and resilience and a person can experience greater health.

Recommended reading –
Read Arthur Frank’s The Wounded Healer, Kleinman’s Illness Narratives or Cassell’s The Healer’s Art, to better understand the importance of narrative in the shift from biophysical to biopsychosocial.
Read Balint’s The Doctor, the patient and his Illness, Leader and Corfield’s Why do People Get Ill? Or Broom’s Meaning-full Disease to better understand the shift from a disease to an illness agenda.
Read Dan Siegel’s Mindsight, Doc Childre’s The Heartmath Solution or David Servan-Schreiber’s Healing without Freud or Prozac to understand the potential for interventions which don’t involve surgery or drugs.

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Four of my verbs in one day! Had a trip to Franschhoek – an amazing, French culture wine growing area in South Africa.
Took lots of photos like this one –

And used Photoforge 2 to create this image from it –

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It seems like there’s one story after another at the moment about vulnerable old people being neglected in hospitals, “care homes” and even in their own homes where home “carers” are failing to provide the “minimum standards of care” – even, according the most recent reports, to the extent that their are breaches of basic human rights.

It makes you wonder about the word “care”.

Within the health service and the “care” industry there’s been an increase in setting standards, developing procedures to record activities and the government’s response to this latest report is to talk of strengthening the inspection systems.

Is this the answer? To set higher “standards”, and to ratchet up the monitoring and inspection processes?

I don’t think so. It doesn’t seem to be enough. The missing link, is, I believe, a prioritisation of people.

What does it mean to be human? If we reduce a human being in any way, we start to lose the very essence of being human. A human being can neither be reduced to  an object to be acted on, nor a means of carrying out procedure without losing something. Every human being is unique and lives constantly with a subjective experience of reality. If we forget that we start to act towards each other as if others are objects.

What we need is to reclaim the values – that the most important thing is to care – to feel empathy towards, compassion towards the people – both the people in need of care, and those delivering it. We need to treat people as whole people, not as tasks to be carried out or completed.

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I was wondering the other day what makes the difference between a good day and a not so good day, or, frankly, a bad day?

It’s tempting to think its to do with external circumstances, like the weather, or with other people – what other people say or do. But I don’t think that’s a good explanation.

Maybe it’s to do with attitude or perception then? After all, some days the rain will seem to dampen your spirits. Some days the clouds seem to have been sent to rain on your parade. But other days, the rain will release the fresh, clean smell of grass. It will make the cobwebs in the bushes sparkle. You can turn your face towards the sky and feel invigorated by the rain drops falling on your skin. What makes the difference?

I got to thinking about verbs. Verbs? Yes, verbs. The words we use which describe what we are doing. Because we LIVE. That’s a verb. It’s something we do. How do I live? How do I do this living? Maybe my everyday verbs create my everyday experience? Maybe I DO, or, rather, CREATE, the quality of my everyday life? If that’s true then which verbs are important to me?

Here are the five verbs I figure are important in my life. The more of these I’m doing in a day, the better the day seems to me. Conversely, the less I’m doing these, the less satisfying the day feels.

I remember these verbs easily through the letters – CSEED.

C is for CREATING. I get creative restlessness. Do you get that? It’s a kind of agitation or a feeling of being unsettled. I can ease that feeling by creating. My favourite ways of creating are writing, photographing, or solving problems. I’m sure we all have our own ways to find our creativity.

S is for SHARING. I’m not a loner. I like to be in communication with others and to share experiences with others. I like people and it feels good when I’m sharing some of my day with others.

E is for ENJOYING.  Who wants a life without fun or pleasure? There has to be some enjoyment for life to feel good.

E is also for EARNING. I need to earn to live my life. Maybe I won’t always need to be earning (hey, I might win the lottery!) but until then it’s important that I earn, and it contributes to my self worth.

D is for DISCOVERING. I am insatiably curious. I love to find things out, to learn, to develop new understandings and have new insights.

That’s my verbs. The more I’m creating, sharing, enjoying, earning and discovering in a day, the better the day feels to me.

You can do this for yourself. Ask yourself which verbs are important to you in your everyday life? Maybe they’ll be the same as mine, maybe they’ll be different. Feel free to share if you like……

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