The Weekly Wellbeing Round-Up #23

Welcome to episode 23 of the weekly wellbeing round-up!  Some of you may have noticed an item or two in the news this week about the publication of the NHS’s vision for prevention, publicised by Matt Hancock the health secretary.  Plenty to chew over there and for this reason I will be devoting this week’s post to the subject, looking at the positives, the negatives and the unanswered questions – for patients and for doctors – from a pragmatic perspective.  Let’s jump straight into it!

Prevention is better than cure

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OK, so it’s a pretty obvious title for a government paper on the subject, but one that is clearly appropriate and hard to argue with.  The paper was published this week and you can read the full forty-one page document here, as well as Matt Hancock’s blog post on its publication here.  Just in case you don’t have the time or inclination to read all of that, I have summarised some of the key points and some of the issues that arise as a result.

The importance of prevention

Whilst it’s not necessary to spend a lot of time agreeing with motherhood and apple pie, there are a few points made that are worth reflecting on.  Firstly, how might we define prevention?  Here it is described as “about staying people stay healthy, happy and independent for as long as possible”.  Not a bad definition.  It is worth remembering that we can’t prevent everything (ageing and death being two obvious examples) and sometimes it might be more accurate to use the term “delayative” rather than “preventative” medicine.  However, it’s still very important as one key area is the number of years of life that we enjoy in good health… something we will touch on later.   It is pointed out in the document that we spend over ten times more money on treating disease rather than preventing it (£97 billion vs £8 billion).  This demonstrates that, whatever the rhetoric may have been, we clearly aren’t getting the balance right and it still needs to shift significantly.  If we do what we’ve always done, we should be entirely unsurprised when we get what we have always got.

Funding for prevention

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Much play is made of the increased funding for the NHS, an apparently rising amount up to £20.5 billion a year in five years’ time.  Clearly this is welcome.  The welcome should be a cautious one, however.  First of all we need to be sure that none of this is simply rebadged money.  Secondly, money absorbed into existing NHS deficits (e.g.  overspent clinical commissioning groups and hospital trusts) is not available to be spent and therefore not a real terms increase,  so we need to be clear about where it’s going.   Thirdly,  the big issue of funding for public health was not addressed by the health secretary when he was asked this question repeatedly on the Today program this week.  Public health funding provides services such as smoking cessation, weight management and sexual health clinics.  The budget has been slashed in the last few years.  There has not been an announcement yet about the budget for next year.  If this is further reduced (or in my view, not increased) then a lot of the rhetoric about funding will ring hollow.

Who is responsible for practising prevention?

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There are a lot of references to personal responsibility in the vision document.   Generally speaking, I’m a big fan of personal responsibility.  Ultimately we all make our own decisions about what we put in our mouths, how much we drink and whether we are physically active.  I really struggle when I talk to people about the risks they face to their long-term health and wellbeing and their response is either to shrug or to suggest that it’s up to the medical profession to sort it out for them.   That said, life is not a level playing field.  There is evidence of inequalities in society increasing rather than decreasing in some areas.   Many factors influence a person’s wellbeing and the majority of them are not directly related to physical health e.g. housing, employment, education and social networks.

One area that is highlighted is the aim to halve reduce childhood obesity by 2030.  In the UK we have one of the highest childhood obesity rates in Western Europe. Serious public policy is required here, not just telling kids and their parents to eat more fruit.  People worry about the nanny state and curbs on freedom, but the biggest advances to health have often been the result of large-scale public health interventions such as safe drinking water, vaccination and smoking bans.  I’m a massive fan of the nanny state.  We need cities safe for cycling, better public transport,  advertising bans and more tax on unhealthy foods and sugary drinks, mandatory calorie counts on menus, regulation of fast food shops on the high street and near schools, and increased input into the school curriculum.  We need the government to take responsibility for this as well as expecting local authorities to do their bit.  If this does not happen, then very little else will.

Social prescribing for prevention

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Social prescribing involves helping patients to improve their health, wellbeing and social welfare by connecting them to community and other third-party services – for example those run by a council, local charity or lifestyle and wellbeing service provider.  The vision document highlights the  important part that social prescribing has to play in prevention.  It is important to “change the mindset from condition management to health creation”.

Our clinical commissioning group has a strong social prescribing model which has received national recognition .  We have a team of  community navigators serving each of our local areas.   My practice patient participation group has just launched a social prescribing group that dovetails in with this service, offering weekly clinics for primary care team members to refer into where we feel that a person’s needs might be better met by this than by a medical practitioner (e.g.  to address loneliness and debt).   However, we need to ensure that we don’t see social prescribing as an option to compensate for lack of funding and support from central government and local authorities, relying on the good will and free time of individuals and charities.  If it works as a concept and in reality, it must be properly commissioned.

I was rather tickled to read this BBC news article which reports the health secretary advocating GP’s prescribing song playlists as well as medication.  I like the idea although I’m not sure that this is necessarily something that will ever make it into the core general medical services contract.  I’m also not sure that my sharing any of my playlists with my patients would be a kindness, but just in case you are interested, here are my apple music playlists for ambient music, jazz , electronic dance music and rock.  A little something for whatever suits your mood, I hope.

 

Technology for prevention

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Our secretary of state for health is very keen on his technology.  I was rather suspicious at the beginning of his tenure that a lot of statements were made about using apps to transform the NHS.  Don’t get me wrong – I’m proud to consider myself a bit of a geek and have always looked to use technology to help me work smarter and more efficiently – but it did raise the suspicion that this might be a message that all we need to do to save the NHS is to use our smartphones more.  Maybe this isn’t entirely fair as there is going to be an increase in funding, which I have already covered. Two particular aspects of using technology caught my eye in this document.

Predictive technology

The first aspect is use of a predictive technology to assess risk which is not just limited to a body system or a disease.  Bearing in mind my earlier comments about the determinants of wellbeing outside of health,  I think this is a really interesting idea and would be a considerable extension above and beyond current risk tools such as Qrisk2, which allow you to put in a postcode as part of calculating a person’s risk but nothing more than that.   How such a tool would be developed and demonstrated to be valid is another issue altogether but one that I look forward to learning more about.

Telehealth

Oh how we love our telehealth in the NHS.  The great solution to everything.  The thing that everyone of every age demands and desires.  The thing that will radically change the NHS.  The thing that has lots of evidence behind it…oh, wait.  No, it doesn’t.  As someone who used to be responsible for telehealth developments in our clinical commissioning group, may I take this opportunity to say just how weary and cynical I am about the whole thing?  It may augment NHS services if used in just the right group of people with just the right level of engagement.  It will be convenient for some patients.  However, an appointment with a doctor remains an appointment with a doctor and takes up the same amount of time as any other kind of appointment.  Next time you are at your doctor’s surgery,  try asking about the level of excitement they feel about now having to consider telehealth as well.  See?  Told you.

Prevention…what’s the point?

This is what it all comes down to.  We need to be clear about this.  We can’t stop people ageing or dying (despite NICE’s best efforts when it approves yet another drug with marginal gains for £20,000 per quality adjusted life year).  So what is it all about?  I was pleased to see that Matt Hancock states that the aim is for an extra five years of healthy independent life.   Assuming I have understood this correctly, this is a welcome emphasis on quality rather than quantity of life – something that we can all get behind.

That’s all from me for this week.  The weekly wellbeing round up will return.  Until next week, take care of yourself!

Dr Richard Pile

The Weekly Wellbeing Round-Up #20: a miracle cure!

Good morning and welcome to another edition of the Weekly Wellbeing Round-Up.  This week I thought I would get your monday morning off to a great start by offering you…a miracle cure.  The ultimate tonic with guaranteed improvement to your health and wellbeing.  It has  been shown to improve physical and mental health and cognition as well as reducing the risk of cancer, heart disease, diabetes and other long-term conditions.  It works as well as if not better than many drugs and unlike drugs there are no side effects as long as it is taken in the appropriate dose.  Best of all, it’s free and available to every person on the planet.  You don’t need a prescription from a doctor, and you don’t need any special training or expensive kit.  You can start treating yourself with this wonder drug whenever and wherever you like.   I am, of course, referring to the medicine of movement: physical activity.  People are, I hope, used to health professionals banging on endlessly about this.  I thought it was worth reminding ourselves why  this is such an important issue, before we explore the benefits of it and then take a pragmatic approach to moving more.

The bad news about physical activity

Let’s start with looking at the scale of the challenge that we face in terms of physical activity being a part of our daily lives.   Once upon a time, it was.  We were hunter-gatherers, often chasing our prey over long distances.  If we sat still, we perished.   Nowadays, our day-to-day existence is much more sedentary.   We have enjoyed the benefits of tremendous technological advances and the associated convenience, but there are also tremendous downsides that are gradually becoming more and more apparent. The nearest we get to hunting our food may be tapping our password into our device when doing our online food shop from the couch.   Being inactive has roughly the same health risks as smoking 15 cigarettes a day and the overall risk of mortality due to inactivity may be double that of obesity. .  This is worth thinking about for a minute:  most people would clearly not choose to take up smoking, but by default we risk choosing inactivity.  The irony of all of this is that by sitting still we still perish (sooner) but for now for entirely different reasons.

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I used to think, a long time ago, that by default we were probably active enough and that to stay healthy all people needed to do was to avoid eating too much unhealthy food.   I have come to the realisation that this is nowhere near enough.  The default, the baseline that we operate from in today’s world, is not just inadequate but actually toxic.   In 1949, 34% of all journeys travelled by a mechanical mode were by bicycle.  Nowadays it’s less than 2%.  The design of our homes and our cities, our patterns of working, our use of technology and all the associated infrastructure have all contributed unwittingly to the making us less physically active. The consequence of all of this is that almost half of adults over 65 years of age are inactive, and most working adults spend at least 5 hours of their day entirely sedentary.   To overcome this requires thought, planning and effort.

The good news about physical activity

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Before you sink into despondency,  there is good news.  These problems did not appear overnight with a bang.  A lot of it has been incremental.   The good news is therefore that we can take the same approach to addressing the balance.  Let’s leave aside the need to lobby government about how we build communities and transport links in future, how we make cities safe for cycling and encourage working lives that are more physically active.  These things are important but you and I can’t do anything about them right now, whereas there are other changes that you can start with today to help you and, if you are a medical professional, your patients.

My top tips for physical activity

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  1. Make the first few steps.  The really good news about becoming more physically active is that the greatest reduction in risk of cardiovascular disease (heart attacks, stroke and diabetes) occurs in those who go from being completely inactive to mildly active.   If you break into a sweat at the thought of breaking into a sweat and are put off by images in your head of lycra-clad latte-sipping gym bunnies in a spinning class or ex-military personnel with personality disorders barking instructions to groups of miserable looking people dragging mud-covered tractor tires across the park in the rain – never fear.  The journey of a thousand miles literally begins with a single step.  If you don’t do anything that gets your heart rate up at present, try starting with just 5 minutes a day of brisk walking round your garden or down the street and back.  All you need are shoes on your feet.   Public Health England have a nice app which you can download onto your smartphone called Active 10.   You can get it for iOS devices from the app store, or for android devices from Google Play.
  2. Make it rational, routine and relevant.  For us to face the challenges of inactivity individually and collectively, it’s only going to work if physical activity becomes a simple, meaningful and sustainable part of our lives.   If a gym subscription works for you because you will feel motivated by parting with your hard-earned cash, you like the idea of being able to work out in all weathers and at any time of day, or you just like sitting in the cafe and chatting afterwards, then great.   If you have a dog, make the walks a bit longer and for part of each walk push yourself a bit harder to get your heart rate up.   If you don’t have a dog, think about getting one.  They provide people with company, keep their owners fitter than non-dog walkers, and encourage socialisation.  I love chatting with other dog walkers when I’m out and about.   If your job involves walking, whether it be commuting or delivering the post, use the opportunity to do likewise.  Try getting off the bus, tube or train a stop or two earlier.   Use the stairs at work rather than the lift.  Consider getting a standing desk.  You could suggest standing or walking meetings when appropriate – just think how much quicker they would go without people distracted by their laptops and phones!  T4YactPmS1KcJ4xRvSwLCA
  3. Make a plan.  I posted about this a few weeks ago.  Whatever you do, plan how it’s going to happen.  In my personal experience, if I don’t make a plan then nothing changes.  Once you have a regular slot and you’ve done it often enough then it becomes a habit and so more likely to stick. mdHKUVBWR9yqCTjy2IjpKQ
  4. Make it social.  Behaviour change is more likely to occur if it is socialised.  Taking part in physical activity with others is beneficial for a number of reasons.  Firstly most of us are social animals to one degree or another, so it’s a good way of connecting for our mental wellbeing.  Secondly, we are in effect making ourselves accountable to others or even allowing them to be our “referee”.  Your friend/spouse/cycling club/fellow dog walkers will encourage and check up on you.   If you aren’t sure what you would like to do, check out what information is available from your local council, community centre, library or GP surgery.  QMt5W8BPQq2F68v5UBFttg5. Make it pleasurable.  Pick something that you enjoy.  Don’t think of it as “exercise”, which sounds like something you have been told to do and probably won’t enjoy.  Instead think of it as something that gives you pleasure, makes you feel good and helps you connect with others.  Just getting out of the house and enjoying some fresh air and daylight is good for your wellbeing.  Two of my most favourite things are going for a bike ride on a sunday morning with my friend Al and taking my dog Prince for walk in the afternoon.The fact that the my sunday morning bike ride includes breakfast and a cuppa and that my afternoon walk involves a pint in my local is not a coincidence and a great example of “temptation bundling” – having a reward which is associated with a specific activity.

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Real life examples of the benefits of physical activity

I thought I would finish with two stories from this week.  The first was from a patient that I reviewed as part of teaching our medical students about mental health.  They had seen one of my colleagues previously with a longstanding history of depression.  They were physically inactive and presenting with a lot of physical symptoms which were really manifestations of how they felt in themselves.   They had been consulting about these physical symptoms frequently and eventually were persuaded by my colleague that the root cause of their symptoms was their depression.  They were encouraged to start being more physically active.  When I reviewed them with our medical students, they were transformed.   I asked them what they felt the reason was for the improvement and they told me that they had started to walk every day for half an hour, either in the park or up and down in their garden.  Their mood was better.  They had more energy, were sleeping better and were much less bothered by the occasional aches and pains that previously had preoccupied them.  They also had a much better understanding of how their mood might influence physical symptoms as a result.

The other story I really enjoyed listening to this week was that of Vassos Alexander, sports presenter, formerly of Radio 5 Live and now Virgin radio.   He was interviewed by Dr Rangan Chatterjee in Episode 31 of the Feel Better Live More podcast.  He described himself as being overweight, unfit and a smoker in his early 30’s.  He decided he wanted to make some changes.  He decided to go for a run.  His first run lasted just a few minutes.  He describes being out of breath and having to pretend to some of his neighbours that he had just finished a run, to avoid embarrassment.  Vassos didn’t give up, however.   To cut a long story short,  in 2017 he completed the Spartathlon, an endurance event run over 153 miles.  His enthusiasm for running, it’s benefits and his encouraging other people just to get out there and do something is infectious.  Well worth a listen.

We’re almost done.  I wanted to finish off with something to challenge and encourage you, your family,  friends or patients.  There is a great video available on YouTube called “Twenty three and a half hours“.  It’s got a fantastic punch line at the end and is well worth 5 minutes of your time.

That’s it for this week.  I hope that you have found this week’s wellbeing round-up helpful.  As ever, I would appreciate your feedback and you sharing it with others if you have enjoyed it.  You can subscribe to the blog to automatically receive email updates in future.  Until next week, take care of yourselves!

Dr Richard Pile.

 

 

The Weekly Wellbeing Round-Up #19: mental wellbeing.

The more observant of you may have noticed that this week (October 10th) it was World Mental Health day.  In recognition of this, the round-up this week has a mental health focus.  I will be highlighting how this affects people of all ages, the issues raised for the NHS including the mental health of those that work within it, and how we can take simple steps to help ourselves and others.

Global Mental Health Summit.  This was attended by 50 countries on World Mental Health day this week.  The Prime minister announced the appointment of a minister for Suicide Prevention and pledged extra investment in this area including additional funding for the Samaritans.  More details on this in a report from the BBC here.   The article highlighted some contact details for mental health charities which I have listed below:

  • The Samaritans are open 24 hours a day. Call 116 123 or email jo@samaritans.org
  • The Campaign Against Living Miserably (CALM) offers support to men. Call 0800 58 58 58 between 17:00 and 00:00 everyday or visit their web chat page here
  • Papyrus helps people under 35. Call 0800 068 41 41 – Monday to Friday 10am to 10pm, weekends 2pm to 10pm, bank holidays 2pm to 5pm – or text 07786 209697
  • Childline is available for children and young people under 19. Call 0800 1111 – the number will not show up on your bill
  • The Silver Line helps older people. Call 0800 4 70 80 90

Young people’s mental health

Loneliness

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When talking about suicide, this is inevitably and appropriately an area of concern for us.  Social isolation and loneliness shorten our lives, being equated to smoking 10-15 cigarettes a day in terms of the impact on our health.  When we think of the lonely groups in society, we often think of the elderly.  However, children and young people are the group who report being the most affected by loneliness.   Such people might appear to have a wide circle of friends and to be connected by social media but it just demonstrates the truth that you can still feel lonely even if you are not considered alone.

Tracy Crouch is the first minister for loneliness, and gave this interview to the BBC about the need to address this issue.  It’s clearly not an easy one.  The government may not be able to make friends for us, but we do need action at every level ranging from decisions about how we plan and develop our society and infrastructure, right down to individual day-to-day interactions.  When I consult with anyone who is anxious or low in mood, I will always ask about what their connections are with other people and encourage them to seek them out or develop them further.  We are ultimately social animals.  People do better with real life, face to face interactions when they are struggling.

Cannabis use

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Living in an affluent commuter town, you might be forgiven for thinking that there’s no big deal when it comes to casual drug use, particularly amongst the middle classes.  It tends to get lost in the general debate about legalisation but the reality is that there are serious consequences for mental health, particularly that of young people.  This article in the American Journal of Psychiatry highlights the dangers of cannabis use and its impact upon cognitive skills, memory and behaviour.  The effects were greater than those of alcohol, and appeared to be longer term.  Take home message for me?  That we need to be very careful as adults, particularly if we are parents, as to the messages that young people get from us.  Adult brains may not in the same vulnerable state as theirs are.

Child and Adolescent Mental Health Services (CAMHS)

As a GP I know many colleagues who work to provide CAMHS in their localities, and do their best in very difficult circumstances with limited budgets and increasing demands.  This article reports a 26% rise in referrals into such services nationally.   When faced with inadequate resources, services inevitably look at their referral thresholds and it is reported that a similar percentage of referrals are rejected, saying they do not meet the criteria.   This could be because of genuinely increasing rates of mental health problems and also a result of  increasing awareness of the signs of potential mental health problems due to health campaigns in this area.  I don’t have an easy solution for this, but one of the things I recommend is that as parents and professionals we have some knowledge of the options available to us as well as the traditional CAMHS route, which not every young person will need.  These might be third sector or voluntary organisations.  In my locality we recommend Kooth, which offers many different ways for young people to access support.   Suicide awareness and mental health first aid training for young people and adults alike is very important.  In St Albans we have the OLLIE foundation which is a charity doing excellent work in this area.

Ask Twice

One of the messages on World Mental Health day was “ask twice”.  People often say that they are fine when asked the first time.  We’ve all done it over our first cup of tea of the day at work.  Sometimes it feels as if you are obliged to say that you’re fine, as it might throw a spanner in the works and feel a bit awkward if you tell people how you are really feeling!  However, my view on this is that anyone who asks “how are you?” should both expect and be prepared to respond to whatever comes back.  If you sense that your friend, family member or colleague may not be feeling fine, ask them again.   The point is well made by this short video.

Mental health support for NHS workers

Staying with work, NHS chief Simon Stevens announced recently that there would be an expansion in the mental health service for doctors.  It already exists for GP’s and extra funding will be put into making it more widely available.  Clearly this is welcome and has been beneficial for the doctors that have used it so far.  However, if we are to practice preventative medicine when it comes to NHS workers’ health in the same way that we would like to with our patients, we must consider the underlying reasons why there is an increasing mental health burden.   I hope that the secretary of state for health and his colleagues will be considering underlying issues like workforce capacity and conditions as well as proper funding for services.  If not, it will simply be a sticking plaster that will fall off sooner or later.

Mediterranean diet…helpful for reducing depression?

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It was recently reported that there may be an association between the Mediterranean diet and reduced odds of depression.  Now we all know that association is not the same as causation, but I think this is encouraging enough both to look into more deeply in terms of research, and to try for ourselves in the meantime.  After all, it isn’t complicated or necessarily expensive to do and has none of the risks associated with taking antidepressants.  Here is a simple diagram to remind us of the key components of a mediterranean diet:

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That’s it from me this week.  The weekly well being round-up will return.  Probably next week! Until then,  take care of yourself.

Dr Richard Pile

 

 

 

The Weekly Wellbeing Round-Up #18: a weekend of wellbeing in Valencia.

When I was a medical student our favourite lecturer was Dr Andy Sparrow. Not because of his subject (which was anatomy) but because at random points throughout his slides he would show us pictures of his holidays – a bit of light relief in the midst of gruesome detail.

I am currently at around 30,000 feet as I write this blog post , returning from a weekend in Valencia with my friends. We are all part of a GP learning set and this was the group’s 19th annual trip. It’s been a great weekend in a fantastic city that I will definitely return to.

During our time away we each prepare a topic to discuss. We do these throughout the weekend, combining continuing professional development with eating, moving, (some) sleeping and plenty of relaxing. My topic this year was Lifestyle Medicine and Wellbeing. I shared my journey thus far and how learning about the importance of this has transformed how I feel about my job and purpose. We discussed models of wellbeing including the four pillars that I have already mentioned.  I had recommended to the group that we try to all read Dr Rangan Chatterjee’s Four Pillar Plan before the trip. We also added another pillar: connection. So for this week’s blog I hope you will indulge me as I share some of our experience how it relates to wellbeing for real life. With a few holiday snaps thrown in.

Eat

One of the pleasures of the trip is finding nice places to eat good food. We like to go on local recommendation, backed up by Trip Advisor. The highlight for me this year was a day spent on a farm learning how to make proper valencian paella and sangria. It was of course terribly gruelling but we did end up with a certificate which I will show to my appraiser next year. Learning about the origin of the dish and what the correct ingredients are (apparently if there’s sea food or chorizo in it then it’s not paella, just rice with things in it) was interesting but the best part was how paella is served up and eaten. First of all everyone makes a point of thanking the cook (whether it tastes good or not!) and then everyone sits round the table with a spoon (not a fork) and eats from their segment of the paella dish. If you want a bit in someone else’s segment you negotiate for it. You can put bits you don’t want in the centre for anyone to take. And you never, ever turn the dish round to take something you want, not unless you enjoy getting stabbed in the hand with a fork by one of your neighbours.

Connect

What struck me is how important this is for a key pillar of wellbeing: connection. The food is cooked from local, seasonal ingredients. The meal is communal. Everyone shows their gratitude. Food is shared together over what will doubtless be good conversation, helped perhaps by a little sangria. It was a wonderful experience that our hosts were very happy to share with us, and send us away as paella ambassadors! Interestingly, the valencians consider paella to be a dish that you only eat at lunch, and as it can be quite heavy then they enjoy their siesta afterwards and tend to have a light evening meal around 10pm, often with tapas dishes. In Valencia, anyone eating paella for dinner is definitely a tourist.

Sleep

In the interests of full disclosure, sleep was a bit of a mixed bag. There is time-stamped photographic evidence on our WhatsApp group of some deep and meaningful discussions taking place in a bar in the early hours of friday morning. However, we were quite sensible for the other nights. What is always striking when going to Spain is the siesta. In his book Why We Sleep, Matt Walker explains how we naturally have a biphasic sleep pattern as humans (i.e. we do best if we sleep twice a day) and so to have a siesta is consistent with this. In the UK we have forced a monophasic sleep pattern on ourselves with a masochistic long working day…which results in less productivity, not more. When Greeks stopped their siesta at the height of the financial crisis, cardiovascular deaths increased significantly as a result. We also get a surge in these events when the clocks go forward and we lose an hour’s sleep every year. The EU will stop the twice yearly changing of the clocks in 2019. It will be interesting to see if population health benefits can be demonstrated. After Brexit (the only topic we banned for the whole weekend) the UK could be the control arm of this large-scale population experiment!

Move

Walking from cafe to bar to restaurant was, as you can imagine, absolutely exhausting. Somehow we managed. We did take in the sights as well, hitting 10,000 steps most days. There are beautiful museums, markets and churches in Valencia

Having to walk up and down four flights of stairs due to a broken lift was very helpful in this respect. We must write a note of thanks to the hotel. On our last morning I went for a run with my friend through the park that runs along a dry river bed in Valencia. It’s a lovely setting and despite being early it was practically rush hour with the locals in running clubs, walking dogs and riding their bikes…Valencia’s equivalent of Park Run. Running with someone who is a better runner than me really helped me go further and faster than I would normally. I made a point of thanking them for this through only slightly gritted teeth. Incidentally, did you know that Park Run is a global thing? Apparently some people do the Park Run Alphabet challenge finding cities all round the world where it takes place. It takes place in both Mile End and Milan. I suspect the starting letter and hosting Park Run are the only thing they have in common. There’s also a UK version.

Relax

We are not usually short on relaxation during one of our trips. The key idea that underpins very trip is the idea of “me time”…that as human beings we all need and deserve some me time. Our group is very fortunate in being able to do this for a whole weekend once a year. What was interesting is that sitting round the dinner table and talking about which pillars we find easier and which we need to work on, the commonest area for improvement was in relaxing. One of our group described their child had complaining to them that they couldn’t sit in their lap if there was a lap top already there.

It’s great to have an opportunity like this once a year, but probably more important, if you had to choose, to have five minutes every day. We talked about what we found relaxing: reading, listening to music, walking the dog, eating a meal as a family or watching our favourite TV show with them. We discussed practising mindfulness, being present and limiting screen time and I showed some of our group how to use Do Not Disturb and night-shift functions on their phones, before we finally turned in for the night.

By the time this post is published I will be at my desk in the surgery on a cold, busy monday morning. I will feel a bit sad that our trip is over for another year. However, I have got more CPD points for my appraisal, a new background photo on my desktop, more fond memories to add to the nineteen year collection, and a date already in the diary for next year.

Thank you for allowing me to share this with you. I hope that making it personal has been useful. Like James Bond, the weekly Wellbeing round-up will return. Until next week, take care of yourselves!

Dr Richard Pile