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Posts Tagged ‘health’

Life and death and choices

Posted in from the consulting room, from the reading room, health, life, tagged , on November 21, 2012| 2 Comments »

There was an amazing story recently in the NY Times about a Greek man living in the US. He was diagnosed with lung cancer in his mid 60s and given the prognosis of 9 months to live. He decided that instead expensive treatments and a costly funeral in the US, he would return to his native Greek island of Ikaria.

He moved back in with his parents and went to bed to be cared for by his wife and mother. But he started to feel strong enough to go out so reconnected with childhood friends and re-established his Sunday trips to church.

As the months passed he felt strong enough to do some gardening (a common activity on the island) and planted vegetables thinking he might not live to enjoy them, but he would enjoy growing them. Not only did he live to enjoy them but with his regular routines now of plenty of sleep, regular walks up the hill, spending time in the garden and in the evenings with his friends at the bar, and his weekly visits to the church he began to feel well enough to tackle the old, neglected family vineyard.

Three and a half decades on he is now 97, producing 400 gallons of wine a year from his vineyard and seems to be cancer free.

What can we learn from this inspirational story? Well, the author of the story in the NY Times concludes this –

If you pay careful attention to the way Ikarians have lived their lives, it appears that a dozen subtly powerful, mutually enhancing and pervasive factors are at work. It’s easy to get enough rest if no one else wakes up early and the village goes dead during afternoon naptime. It helps that the cheapest, most accessible foods are also the most healthful — and that your ancestors have spent centuries developing ways to make them taste good. It’s hard to get through the day in Ikaria without walking up 20 hills. You’re not likely to ever feel the existential pain of not belonging or even the simple stress of arriving late. Your community makes sure you’ll always have something to eat, but peer pressure will get you to contribute something too. You’re going to grow a garden, because that’s what your parents did, and that’s what your neighbors are doing. You’re less likely to be a victim of crime because everyone at once is a busybody and feels as if he’s being watched. At day’s end, you’ll share a cup of the seasonal herbal tea with your neighbor because that’s what he’s serving. Several glasses of wine may follow the tea, but you’ll drink them in the company of good friends. On Sunday, you’ll attend church, and you’ll fast before Orthodox feast days. Even if you’re antisocial, you’ll never be entirely alone. Your neighbors will cajole you out of your house for the village festival to eat your portion of goat meat

 

Those are probably reasonable conclusions but what inspires me most about this this story is the series of simple, pragmatic choices this man made. He didn’t set off to “beat cancer”, or to find the elusive magical cure. No, what he did was chose, moment by moment, day by day, to live. He might have died in his bed within days of returning to Ikaria. He would have had the death he chose, if that were the case. But he was not at any point focused on trying to determine the detailed outcomes.

Here is what inspires me about this story – at each stage he was focused on how he would live today and at no point did he think how to escape death.

Read the whole article here.

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Stories and power

Posted in from the consulting room, health, narrative, tagged , , on October 28, 2012| 1 Comment »

The Scottish Storytelling Centre in Edinburgh hosted the International Storytelling Festival last week and I participated in a series of workshops entitled “Stories and Cures”. What a fantastic, stimulating, rich experience with a diverse range of nationalities and disciplines taking part. Right at the start of the week I heard something I’d never heard before.

Back in the 18th and early 19th centuries throughout Europe when a person wished to consult with a doctor, there was a practice of letter writing. Someone would write a letter to the doctor whose advised they wished to receive. The letters were typically the person’s story, in their own words, describing what they were experiencing and the contexts of those experiences. In other words, the letters weren’t just lists of symptoms, and certainly weren’t tables of figures or readings, but, rather, they were highly personal, unique life stories.

The doctor would then write back, commenting on parts of the person’s story and giving a range of advice , often touching on issues of morals, hygiene or spiritual life. This was the beginning of a conversation which might be followed up with further exchanges of letters and/or with meeting up for face to face consultations.

Joanna Geyer-Kordesch, whose research as a Professor of the History of Medicine was the basis for this series, has read hundreds of such letters in English, German and French.

I didn’t know such a practice had ever existed.

Just think for a moment how different this practice was from our current doctor-patient relationships.

First of all, the record of the person’s illness is now created and held by the doctor. The stories have been turned into case notes and typically it would be extremely difficult to gain any understanding of who the person is if you were to read these notes. Doctors notes (I don’t think they usually could be stretched to be considered as stories) are mainly lists of symptoms, physical findings and results of investigations, then diagnostic labels based on pathology. The advice recorded certainly isn’t in the form of a conversation or exchange with the patients. In fact advice is more likely to have been replaced by a list of drugs prescribed.

What are the consequences of this change?

There has been a shift in power – from the person to the doctor, or the institution. This shift in power is so great that the words recorded are much more likely to be the doctor’s words and his or her interpretations of the person’s experience, rather than any record at all of the story the person has told (it’s not like that where I work because we have a tradition of writing down the patient’s actual words as much as we can – however, it’s still the doctor making and holding the record, not the person whose life it is)

There has been a shift in focus – from the person to the pathology. As Eric Cassell so beautifully describes in his “The Healer’s Art”, and “The Nature of Suffering”, illness is what the person goes to the doctor with and disease is what he comes home with.

It seems to me we’ve lost sight of the human being in the process. By reducing someone to a mere physical body to measured and imaged, we have dehumanised Medicine. The PERSON has been lost. How do we get the PERSON back into the centre of the stage? How do we get the individual’s agenda back at the heart of the medical engagement? How do we regain the truth of the uniqueness of every single human being and move away from the mass production processes of reducing people to diseases, diseases to “managed”, rather that people to be healed?

A good starting place would be to enable people to tell their stories – in their words, in their order of priority, in their own style – to reveal not just their sensations and experiences, but also their choices, their values and their beliefs (and what about the creation of the record? How and where would you create the record of your illness and your healing?)

Maybe valuing each individual’s story would begin to let us re-humanise Medicine?

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Another kind of growth?

Posted in from the living room, life, tagged , , on October 24, 2008| 6 Comments »

The main news programme on the BBC tonight had the word RECESSION plastered behind the newsreaders for virtually the entire duration of the programme. Got me thinking about what on earth’s going on in our “global economy”. It seems the economic system we are all living with is designed around the concept of growth. Technically, a growth rate less than zero for two consecutive quarters is the official definition of a “recession”. Some of the items covered under this heading included fears of shop owners that people won’t buy so much this Christmas. But hold on a moment. Does this make sense? Can you really design a system that will work forever on the basis of consumption and production of more, more, more? We’ve already seen in recent weeks the consequences of a financial system geared around the mantra of making more and more money. In a finite world, does any of this make sense?

And what happens when human beings just keep consuming more and more? Oh sure, they grow all right – take a look at this map of the increasing levels of obesity in the USA – watch it spread across the whole continent like a contagion. This growth, this getting bigger, fatter, consuming more……this is health? This is a goal worth striving for? This is a system which will deliver good lives for the human race?

I don’t think so.

You see growth in a healthy way, growth in Nature isn’t about ever increasing consumption and accumulation. It’s about development. A healthy child grows into a healthy adult by maturing and developing. This involves learning, experience, acquiring skills, becoming resilient, adaptable and fit. That kind of growth is sustainable. That kind of growth is worth pursuing.

I don’t have the answers to this one, but it just strikes me that maybe we need an economic model which is based on a more natural and a more human concept of growth…….development, maturity and the fitness to be able to cope with what comes along. Not the current model based on greed, consumption and ever increasing production. The current model doesn’t work. It’s an illusion.

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Tackling chronic disease through trying to reduce the ageing process

Posted in health, tagged , on July 30, 2008| Leave a Comment »

There’s an interesting and thought-provoking article in the BMJ last week about health promotion and a call to tackle the ageing process.

The traditional medical approach to ameliorating modern chronic diseases has been to tackle them individually, as if they were independent of one another. This approach flows naturally from our experience with acute diseases, where patients seek medical care for one condition at a time. In fact, applying this same strategy to infectious diseases in the 20th century helped to deliver the first longevity revolution.4 Although some infectious diseases have chronic effects on health (such as malaria and HIV infection), and others remain difficult to treat (including tuberculosis and most viral diseases), public health efforts to combat these diseases have made it possible for people in today’s developed nations to live long enough to experience one or more of the degenerative and neoplastic diseases that are now the dominant causes of morbidity and death.

The phrase which really struck me here is the last one – “public health efforts to combat these diseases have made it possible for people in today’s developed nations to live long enough to experience one or more of the degenerative and neoplastic diseases that are now the dominant causes of morbidity and death.” Think about that for a moment. Yes, there have been great advances in human health and life-expectancy has increased dramatically (mainly due to the reduction in infant and child mortality), and, yes, the ability to effectively treat so many potentially fatal infections has played a significant role in improving human health. But what we have now is more people living long enough to experience a serious chronic disease. So what are we going to do about that? The authors argue this –

Medical research worldwide has already accomplished much, and is certain to achieve more in decades to come, but its effectiveness will become limited unless there is an increased shift to understanding how ageing affects health and vitality. Most medical research teams are oriented towards the analysis, prevention, or cure of single diseases, despite the fact that nearly all of the diseases and disorders experienced by middle aged and older people still show a near exponential increase in the final third of the life span. Now that comorbidity has become the rule rather than the exception, even if a “cure” was found for any of the major fatal diseases, it would have only a marginal effect on life expectancy and the overall length of healthy life

I would disagree a bit – in fact, I don’t think ageing is the issue, it’s health. I think we don’t so much need to understand how ageing affects health and vitality as to understand how health and vitality affect ageing! It’s true that so much of contemporary health care in focused on treating single diseases and disorders (in fact almost the entire evidence base of “evidence based medicine” is clinical trials conducted on individuals with single conditions), but it’s also true that “comorbidity has become the rule rather than the exception”. That’s such an important point to take on board. We will NOT have any significant further improvement on health and longevity by focusing on single conditions and diseases.

Instead, we need to focus on health and vitality. It’s well known that exercise and nutrition contribute enormously to both of these and some commentators on this article have made that point well.

What I take out of this article however is this – if we want to significantly improve health and longevity we need to focus on HEALTH not disease and we need to take the policy decisions to target health improvement if we are to reduce the burden of suffering and illness.

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