Wellbeing for Real Life: what is resilience and how do we build it?

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I was recently asked to write a module on resilience for clients of a healthy lifestyle service provider. We had previously put together modules on anxiety, depression and stress management. The feedback that we were getting from some team members delivering the modules was that they found the subjects rather complex and difficult to discuss and there was a risk of ending up focussing on the negative. We therefore decided to simplify the modules, fuse them together where appropriate, and to take a more positive tone discussing fitness rather than illness. As I put the module together I was reminded that teaching something is a great way of learning something , and so thought I would share what I have learnt in the hope that it is useful to you.

Let’s start with some questions people commonly ask. What is resilience? Do I have it? How do I know? Can I measure it? If I don’t have it, can I get it, or improve it? How can I help my kids to have it?

Defining resilience

A very basic definition of resilience is the ability of a substance or object to spring back into shape after trauma. To make it more human, we could describe it as the ability to cope with setbacks, or the ability to overcome difficult experiences and to be shaped positively by them. It might be described very simplistically as physical or mental strength or fitness.

Resilient people are not just born, they can be made

As my wife pointed out to me during the writing of this post, anyone who has had a few children can tell you that we are all in different places on the scale of natural resilience. It’s undeniable. However, where we end up is not inevitable. Nurture has at least as important a role as nature. I used to be a bit daunted by the people in the weights section at the gym, heavily muscled and confident specimens stalking around the equipment as if they owned the place, occasionally grabbing hold of some colossal bits of metal and wrestling them into submission before grunting and moving on to the next unsuspecting piece of apparatus. This was until I realised that they hadn’t become like this spontaneously but had developed themselves over time, with regular practice and commitment and maybe some pain. I’ve heard physios encouraging people to keep doing their exercises, advising them that they should be aiming to stretch their muscles and cause them to ache because that’s the only way they will ever strengthen them. When you exercise, you need to get your heart rate up for it to do you some good, which isn’t always comfortable.

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So it’s good news for all of us, particularly if we are feeling life’s challenges. The route to resilience is adversity – getting through it, and learning from it. Machine parts are tested before they leave the factory, to ensure they are strong enough. In the same way that a person who never makes a mistake never learns anything, you can’t be resilient if you have never suffered any setbacks. I’m not suggesting you go seeking adversity, or deliberately make decisions that are likely to have a bad outcome, but its ok and indeed necessary to endure traumas to build resilience. In the same way however that an athlete would prepare to compete, there are of course things that we can do to prepare ourselves for life’s challenges.

My top tips for developing resilience, based on my own life and what I have learnt from others, include:

  1. Self nurture. Sleeping well, being physically active and eating a healthy varied diet will mean that we are physically and mentally in as good a place as possible to take on whatever comes our way each day. Relaxation is an important part of this too, setting aside some regular time that is just for you. That could include reading, listening to music or meditating.
  2. Good connections. With friends, family and other people that you have a shared interest with. Prioritise the positive relationships with people that encourage and support you, and who you can do the same for. Put dates in the diary to make sure it happens, or it won’t. If you have kids, make sure that they have positive, nurturing relationships in their life. These could be with friends, teachers, relatives, health care practitioners and of course…parents! It can be vital to be able to ask others for help when we feel we don’t have the strength for ourselves.
  3. Positive action. Take a positive attitude towards your abilities and encourage yourself, especially in difficult situations. Be assertive and open in your relationships, whether personal or professional. Set goals in the short, medium and long term and make a plan for how you are going to achieve them, breaking it down day by day and moment by moment if need be.
  4. Develop new skills and hobbies. You could learn a new language or take up an instrument. This is good for your brain, encourages further social networking and helps with practising delayed gratification. This is particularly important for children who have been born into this era of instant gratification and rarely having to wait for anything for any significant length of time.
  5. Learn from challenges. Whether it’s a mistake that you made, or something beyond your control that happened, take time to reflect on how it made you feel and what you can learn from it or do differently next time. If you have kids, it’s important to let them make decisions and live with the consequences. Obviously you have to pick and choose depending on the stakes for their immediate health and wellbeing. Resist being a helicopter parent. It’s understandable but rubbish preparation for life and not in your child’s long term interests. If you wrap them up in cotton wool, they will just break later in life when you may not be around to support and encourage them. Better to let them make mistakes at a younger age and be stronger and wiser for it.
  6. Practice gratitude. This is such a simple and yet profound thing to do. I would be willing to bet that if you are reading this blog you have at least one thing in your life to feel grateful for, no matter how bad today or this week or month has been. You can start with the very basic stuff (like being born!), narrow it down a bit (like living in a democratic society in here in the UK where you are allowed to express and practice your beliefs) and then focus on the more personal and specific things you are thankful for like the place where you live, your friends and family…maybe even your job!

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I hope you have found some of these tips helpful. Remember – we should not and cannot avoid adversity in life. It’s the route to resilience and can make us stronger.

The Weekly Wellbeing Round-Up #21

Welcome back to the weekly wellbeing round-up!  After a few weeks of posts focusing on more specific topics like the miracle cure of physical activity and mental wellbeing, we are back to a good old-fashioned trawl through the week’s wellbeing news, digging out the most interesting, relevant and useful bits.   Let’s get stuck in…

Food

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Omega 3 and Oily Fish

A study in the BMJ this week found that there was an association between the intake of omega 3 polyunsaturated fatty acids (n3-PUFA’s)  from sea food and healthier ageing.  Healthier ageing was defined as the absence of disease and physical dysfunction.  Risk was reduced of unhealthy ageing by up to 25%.  Recommendations are made for further research into the possible causal mechanisms.  This reinforces the existing dietary recommendations already made by most doctors which is to eat oily fish at least twice a week.  I suspect that the benefits of n3-PUFA’s will apply to all age groups but it is easiest to demonstrate reduced risk in older patients who are, by definition, a higher risk group.

Oily fish include herring, salmon, sardines, trout, mackerel and pilchards.  Shellfish (mussels, oysters, squid, crab) and white fish (cod, haddock, plaice) are considered healthy but don’t contain the same amount of the n3-PUFA’s as the oily fish.

Organic Food and Cancer

Research published in JAMA Internal Medicine appears to suggest that eating organic food may be associated with a lower risk of lymphoma, a particular type of cancer.  However, there may be confounding factors such as lifestyle differences in people who choose organic food.   So in summary:   whilst it makes sense to try to minimise chemicals used in growing food that may cause inflammatory responses in our bodies, there is not yet a compelling case for switching to organic food on a large scale, at least in terms of reduced risk of cancer anyway.

Food supplements

 

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One of the questions my patients commonly ask me is  – should I take food supplements?  This was debated again in the press this week after the case of a man who ended up with liver failure after taking green tea supplements.   Here is a simple, fairly balanced BBC news article on the subject.  My advice on the subject is:

  1. Most people don’t need food supplements if they have a balanced diet (although I am in favour of children under five having safe doses of multivitamins and I recommend all pregnant women take folic acid)
  2. Getting nutrition from eating whole foods is more desirable than taking supplements
  3. Don’t make the mistake of assuming that if a little extra of something is good for you then a lot must be even better.  Check the recommended daily amount.
  4. Buy from reputable manufacturers

Wellbeing for Doctors

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There is a good article in the BMJ this week by Greta McLachlan about the importance of doctor’s wellbeing.  You can read it here.   She describes the challenge of burnout (faced by up to 50% of doctors) and the importance of doctors putting themselves first at times. After all, passengers on a plane are given the advice that they should put their own oxygen masks on first before attempting to help others.   The article contains some links for doctors to use if they are either struggling themselves or are aware of a colleague that is.   These are the  Practitioner Help Programme, the Sick Doctors’ Trust and the Doctors’ Support Network.

I recently read an article on the same subject, looking at what we can learn from the history of doctors’ working conditions.  I know I often find myself reminiscing with colleagues about the good old days.  On the one hand, there were undesirable aspects of a macho culture and the “it never did me any harm” mindset.  On the other hand, job satisfaction may have been higher because doctors had a sense of belonging as part of their “firm” and continuity of care and patient relationships were better.  We worked an on call rota as a team and were not fragmented by shift work.  To me, this is a reminder of the importance of purpose and meaningful work – not just the pay or the hours associated with it.   In this age of talk about lifestyle medicine and wellbeing, we must avoid putting the responsibility for doctors’ wellbeing entirely on their heads and consider carefully the system that they are being asked to work within.   Practising a bit of yoga and mindfulness at lunchtime may well be helpful but it shouldn’t be used to paint over the cracks of underlying system failure.

Lifestyle Medicine:  it’s a thing.

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In fresh and not entirely shocking news, this article in the BMJ reports the findings of a UK biobank cohort study into the risks of stroke and the role of both genetics and a healthy lifestyle.  It comes to the conclusion that just as genetics can significantly affect your risk of having a stroke, so adopting  a healthy lifestyle may significantly reduce it.  A healthy lifestyle was defined for the study as being physically active, not smoking, having a healthy diet and a BMI of < 30.  People are prescribing and taking their own lifestyle medicine and benefitting from it.

When I was training as a doctor, the only kind of medicine that we learnt about was the kind that was prescribed and came in bottles or packets.  Nowadays we hear more and more about lifestyle medicine.  There are two parts to lifestyle medicine of course – the information and advice that’s given to us , and our actual practice of it.   There is debate within the medical profession as to its value and place.  Whether you view lifestyle medicine as a relatively recent and increasingly important speciality,  an integral part of whatever speciality you practice, or just stating the bleedin’ obvious, it seems to be gaining more and more traction.  As a GP I find it bizarre that having been a doctor for over twenty years it is only in the last few years that I have really begun to understand it and do it properly…both for my sake and the sake of my patients.

This article on lifestyle medicine in this week’s BMJ is well worth a few minutes of your time.   It asks the question as to whether lifestyle medicine is a speciality or should be part of all medical practice, whether it is something to be practised by a few or should be done by everyone.  There is further information about the British Society of Lifestyle Medicine and the diploma that they offer.

From my own perspective, what I can say is that both preaching and practising lifestyle medicine (and in my opinion you have to do both to be credible) has improved my life both personally and professionally.  I was in danger of low-grade chronic burnout as I found myself increasingly frustrated and disillusioned by my experience of general practice and the relatively minor difference that I was able to make for most of my patients.  The medicine I was practising was often just a sticking plaster, an exercise in damage limitation and closing the stable door after yet another horse had bolted.  It was based on a pathological model of health.  Please don’t misunderstand:  this still has value.  Our patients with long-term conditions,  cancer and life limiting illnesses still need our compassion and care, technology and drugs.  However, lifestyle medicine is based on a salutogenic (positive and health-based) model.  It is optimistic, energising and life changing.  In this context, the relationship between a patient and their doctor as a powerful catalyst for change.  The challenge that we face in primary care should not be whether we “do” lifestyle medicine (many if not most GP’s already are, to varying degrees), but how we do it within the constraints of our current consultation model and contract framework.   The answer probably lies partially within and partially outside our current ways of working…but that’s a topic for discussion another week.

Podcast recommendations

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I thought would finish with a mention of some of the podcasts that I have particularly enjoyed and found helpful this week and are related to some of the topics in this week’s post.  For your aural delectation, I heartily recommend:

Feel Better Live More Episode 32:  The science of happiness with Dr Rangan Chatterjee and Meik Wiking

TED Radio Hour:  The meaning of work.

That’s it for this week’s wellbeing round-up.  I hope you have enjoyed it – if so, do share with your friends, colleagues and patients.  Your comments and feedback are really welcome.  They will help me make it as useful as possible in future.  Until next week, take care of yourself!

 

Dr Richard Pile

 

 

 

 

 

The Weekly Wellbeing Round-Up #15: making a plan to improve your wellbeing.

When I first became a GP, I decided that many of my patients who needed to make lifestyle changes also had undiagnosed conditions that resulted in problems with their understanding,  memory and planning processes.  There must be something wrong with them, so my reasoning went, because they left my consulting room chastened by me about their lifestyle choices,  concerned about their impending doom, and clearly intent on turning their lives around….but when I saw them again they hadn’t done anything.   In fact, some of them were even more unhealthy than before.   Some cases stood out, like the man who was still popping out for fag breaks in between ward rounds on the coronary care unit after he’d had his heart attack.  Or the elderly lady with furred up arteries in her legs who looked me straight in the eye and told me that she was more scared by the thought of life without cigarettes than she was by the below knee amputation that she was heading relentlessly towards.   Surely the only explanation was stupidity or a death wish?  Or so I thought.

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Years have gone by and I have learnt a lot about people, which is an inevitable and highly desirable side effect of working in primary care.  I have spent time talking these things through with patients.  I have read round the subject of behavioural psychology (I highly recommend Nudge, Inside the Nudge Unit, and Think Small for a good grounding in this area), met with people from the Nudge Unit (or Behavioural Insights team, to give them their proper name)  and spent time discussing these issues with psychologists and other colleagues.   At Thrive Tribe, we are working with the Centre for Behavioural Change to ensure that all our practitioners are appropriately skilled in this area to help their clients, offering a service that is more than just education about giving up smoking or losing weight.

For the purpose of today’s blog post, I am going to share with you a small but important part of what I have learnt over the years.  It’s not very clever or surprising.   Neither is it difficult.  Everyone can do it.  It’s about having a plan.

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Why do we need a plan?

Humans are not rational creatures.  We assume that because we have been well in the past we will be so in the future.  We cleverly avoid joining the dots with all that we know about what is likely to happen as we get older.  We know that there are theoretical risks of things happening, like heart attacks and cancer and road accidents, but we assume that somehow we as individuals are exempt from this risk,  unlike everybody else in the world around us.   I’m sure you can see the potential flaws in this reasoning.  When things unravel, they can unravel quickly.  Even when things are not yet seriously unravelling health-wise, people are often still aware of their wellbeing issues.  When people fail to make changes that are needed, it isn’t because they don’t know what to do.  It’s beause they either don’t know how to do it, or they do know how to but have no plan in place to make it happen.   I know that I would like to catch up with my brother for breakfast over the next few weeks.  I also know based on the endless games of message-tag we play that via text, facebook messenger, what’s app and email unless we actually make a plan, it will  never happen.   It’s better to have a plan.  It could be written on paper, or stored electronically – just as long as you can refer to it and review it whenever you need.

Do wellbeing plans work?

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Plans are not foolproof.  Otherwise we wouldn’t refer to the best-laid ones or talk what the road to hell is paved with.  They do, however, increase our chances of making and sustaining the changes that we want to.   There are various reasons for this.

Accepting the need to make changes

Firstly, making a plan to change means that we have generally (perhaps grudgingly!) accepted that there is a change that needs to be made.  Maybe you’ve been along to see your GP, practice nurse or health care assistant and a few issues have been raised that you concede might be worth a look at – that weight you’ve been meaning to lose for years, your need to quit smoking or reduce your drinking because of the effect it’s having on your health,  or perhaps your worries about getting a bit fitter as you move into middle age.

Being specific about the changes

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Vague plans are not much good.  “I will lose weight/eat fewer biscuits/do more exercise” might work for a small minority, but for more people it will never translate into anything.  Why? Because they have leapt straight to the desired outcome and are too vague.  We need to be clear about what we are going differently that will result in those outcomes.   Each step in the process needs to be considered, broken down into even smaller steps if required, to see how realistic it is and what needs to be done in what order.  A plan makes it easier to achieve than a one-off mental note to self or vague intention.

A plan makes us accountable for the changes

If we have a plan, it means that we are accountable.  Not just to ourselves, which helps a bit, but potentially to others, which significantly increases our chances of success. Letting other people know what you are doing and even asking one or more of them to be a referee and hold you accountable means you are more likely to follow through.

A plan helps us to measure success as well as failure

If we have been specific in terms of what we want to achieve, how we will achieve it and how we will measure our success, then this will help us by encouraging us when we achieve what we have planned (which increases the chances of making further changes and sustaining what we have already done) as well as maybe challenging us with the areas where it hasn’t quite worked out yet.   The plan can always be changed when we learn as we go.   Putting rewards into the plan for when we achieve each stage of success can be quite motivating as well.

My top tips for making your wellbeing plan

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  1. Make it for yourself and only if you really mean it.  Not to make your GP happy.  If you’re not ready to make changes, let them down gently as early as possible and perhaps keep an open mind for the next time you have a wellbeing conversation.
  2. Make it simple.  The more complicated it gets, the more likely you are not to achieve bits of it, which can be disheartening.  Better to have simple success and build on it.
  3. Make it specific.  Losing weight might be the overall desired outcome, but break it down into smaller chunks e.g. cycling or walking to work, cutting out snacks, shopping for and preparing more of your own meals, not eating after a certain time of day.
  4. Make it achievable.  If you are inactive at present and break into a sweat at the thought of breaking into a sweat,  don’t aim for 150 mins of exercise a week from the outset.  Start with 5-10 mins a day every other day.  If you want to learn about mindfulness, start with 5 minutes a day on your smartphone app or just spend the time reading a book or listening to music.  I know a lot of people who say “I tried that” by which they mean they gave it a go a couple of times and gave up because it was too difficult or not immediately rewarding.  Changes are more likely to be made if they are easy, accessible, social and timely.
  5. Make it rational.  Think about what changes you can implement that are compatible with every day life and easy to sustain.  It needn’t involve hours of your time every day or expensive kit, diet plans or gym memberships.  It could be walking more briskly to the shops or whilst out with your dog, taking the stairs at work or working in the garden.
  6. Make it measurable.  It might be weight lost, minutes of activity completed, amount of sleep you have obtained or personal goals achieved (e.g. taking part in a social activity with your friends or playing football with your children or grandchildren)
  7. Make yourself accountable.  Tell people what you are doing e.g. work colleagues, friends and family, social media groups.  Consider asking someone to be a referee who will check in with you regularly.  Some people might ask their spouse.  Some might prefer a friend or colleague depending on how much they enjoy being nagged!
  8.  Make it a work in progress.  Your objectives are likely to change over time.  You will succeed in some areas and maybe not others.  That might simply mean not giving up and then trying again, or it might mean learning from what has worked well and not so well, and coming up with a better plan for the future.

Wellbeing planning in the real world.

I thought I would finished with some real life examples.

  1. Last year, all the GP practices in my area took part in a local Cardiac Prehab scheme which I had designed with some of my colleagues for our CCG.  Part of the service included identifying patients at higher risk of having a heart attack, stroke or developing diabetes and inviting them to an educational event at their GP practice.  The evening included a presentation on wellbeing and finished with each patient signing up to their own personal wellbeing plan.   These plans were collected and scanned into each patient’s records.  When they were reviewed a few months later, the doctor or nurse they saw reviewed their plans with them and discussed what had worked well or not so well.  The majority of the patients I reviewed had achieved at least one of their intended outcomes and were really pleased to see how well they had done, which encouraged them further.  This year the scheme has been rolled out across our entire clinical commissioning group, with a patient population of over 600,000 people.
  2. Those of you that are kind/enlightened/fortunate enough (delete as applicable) to read my blog posts regularly will know that I talk a lot about Rangan Chatterjee’s Four Pillar Plan.  Inspired by this, I have started to develop a welbeing plan template for EMIS (our computer system) which is based on this.  I have shared it with my practice colleagues and am now using it to enter data into the patient’s record and give them a printed copy after our consultation, so they have something to remind them of what we have agreed and to document their progress. Rangan Chatterjee and Ayan Panja did an excellent presentation on Prescribing Lifestyle Medicine at last week’s Emis National User Group conference at which they showcased an early version of their own lifestyle medicine template which is currently in development and  which will no doubt be snazzier than mine when it’s finished!

And finally, my own personal wellbeing plan

It is only right, of course, that I practice what I preach.  For years I have meant to lose a bit of weight.  For years I have surveyed my profile in the mirror in the morning, disappointed in myself for not having achieved anything and disappointed in the Six-Pack Fairy for not having visited overnight as I had hoped.  So in the end, I made a plan.  This included eating a lower carb diet (specifically changes to what I make for breakfast, making salads for lunch and cutting back on biscuits), exercising more regularly (getting up early to walk before work, doing HIIT workouts when I didn’t have time to ride or run), and doing press-ups as strengthening exercises each morning).   I am also much better at getting enough sleep, although there is always room for improvement.  I told my wife about this as I knew full well she would remind me if/when I lost track.   The results?  I have lost just over half a stone without feeling that I am depriving myself.   I feel fitter and have more energy.  I still don’t have a six pack and have decided that I was probably born without one, so maybe I will leave that out of the next version of the plan.

That’s all for this week from me.  Weekly Wellbeing Round Up #10 will be out next week.

Please do make a comment on the blog if you have enjoyed it, if you feel it could be improved, or to suggest future topics for me to work on.  I want to make it as useful as possible for all of you.  Please feel free to share the blog with your friends/colleagues/pateints/family members and sign up to it to receive updates automatically if you haven’t already.

Until next week, take care of yourself!

Dr Richard Pile

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The Weekly Wellbeing Round-Up #3: My Weekend Wellbeing Clinic

How was your weekend?  Maybe like me on sunday afternoon you found yourself in a glorious alternative reality, as the match commentator stated that it was 5-0 to England.  At half time.   It doesn’t get much better than that!  My weekend had started less positively, as I found myself getting up (a little resentfully, if I’m honest) earlier than desired to go into work and do a three hour surgery.   I decided that for both my patients and I to get the most out of the surgery,  I would make a note of how many of the consultations were rooted in wellbeing and lifestyle issues, and to dig a little deeper with those patients to help them get the most out of the consultation.  After all, if I’m going to blog about wellbeing I need to make sure I’m practising what I preach, not just summarising the theory.  The results genuinely blew me away…so today’s blog contains the summarised highlights and learning points of my experience.  In case you’re worried about GDPR (that’s General Data Protection Regulations to those of you fortunate enough not to have to know this), there is no patient identifiable data contained in this blog. For those of you desperately disappointed that this isn’t the Weekly Wellbeing Round #3, I promise that it will be back next week!

So what did I learn?

  1. There’s a lot of it about.  Two third of the consultations were primarily about an underlying wellbeing or lifestyle issue.  I was expecting it to be high, but not that high!   Of those two thirds it was about a fifty fifty split between those that openly acknowledged this was the problem and those that either weren’t aware of it, or chose not to acknowledge it.
  2. It’s easy to take the path of least resistance with a prescription and do your patient a disservice.  At least two of the patients that I saw presented with one simple symptom, for which they were asking for a quick fix, usually a prescription.  One patient had a rash.  They just wanted some cream for it, having tried nothing at all so far.  I could have just prescribed steroids.  I’ll be honest – depending on how late I’m running and what sort of day I’m having, I have historically taken the easy way out, gained myself five minutes of catch up time and breathed a sigh of relief. However, the reason they had this rash was because of chronically swollen and inflamed legs, which in turn was due to their weight.   I did give them some cream, but only after we had spoken about their weight, what they felt about it, what they had previously tried in terms of weight loss etc.  They left not just with their prescription but with a weight management referral.  I could have spent time talking to them about a low carb diet but they gave me the very clear steer that they really wanted to be told what to eat and to be held accountable and would prefer a weight management programme.
  3. Social history is important, particularly occupation.  Doctors are taught to take a social history.  This is particularly pertinent in primary care.  However, as the years have gone by and the time pressures have increased, I find myself sometimes taking shortcuts.  That may well be okay in the case of minor illness and discussing blood results, but it’s an important part of the picture as a determinant of wellbeing.  Of the cases that I identified as related to wellbeing and lifestyle, half were at least partly occupation related.  They were either the primary cause of stress and multiple symptoms, or contributing significantly to the problems.   I may not be a career advisor, but what’s the point of repeatedly consulting for mental health issues, signing prescriptions and sick notes to address the symptoms, without challenging a person to consider addressing the cause?
  4. Ideas, concerns and expectations.  Oh how we love them.  Anyone who is a GP reading this will be familiar with these terms.  They are all about the importance of establishing a patient’s understanding, their fears and what they want to get out of the consultation.  Having been a GP for almost eighteen years now,  I sometimes end up feeling that all a lot of patients want is a referral for a fancy test or to see a specialist who will fix the problem that I can’t (or that they don’t believe I can).  What was really interesting about my wellbeing surgery experience was that my assumptions were often incorrrect.  When we began to explore the issues and the options for dealing with them, a significant number of the patients did not want a blood test, or a drug, or a referral.  They were actually very happy with advice about lifestyle medicine and even expressed relief that it was something they could be in control of.
  5. It’s okay to be honest and you don’t have to “fix it”.  The consultation that I found the most challenging was with a patient who was actually very up front about the reasons for their wellbeing concerns and clearly identified work and relationship issues that were causing them a lot of stress.  They had adopted some unhealthy coping mechanisms as a result and , in my opinion, their situation was clearly unsustainable in the long term without serious consequences for their health.  The problem for me was that they made it very clear they weren’t immediately planning on taking personal responsibility for the situation and making any of the vital changes that they needed to improve things.  They also made it very clear that that felt it was up to me to sort them out, and requested various medications to this end.  When I was younger and less experienced, I would have felt pressured into prescribing because it was the only thing that I could do.  It would have also made the consultation much shorter.  Now that I recognise this is actually not serving the patient well at all, I pushed back and (having checked they were safe from a mental health perspective) challenged them about expecting medical solutions to a problem that they should be dealing with themselves.   We agreed to a further consultation to discuss this some more and I also gave them our wellbeing team phone number so they have someone else to talk things through with.
  6. Wellbeing and lifestyle medicine is increasingly on the patient agenda.   A lot of patients are very well informed, even if they don’t have my obsessional podcast/blog reading habit.  Wellbeing is increasingly on the political agenda and in the media.   Some of the patients who identified lifestyle issues were already well on the way and we talked about a number of concepts and resources such as Public Health England’s Active Ten campaign and app, Dr Rangan Chatterjee’s excellent 4 Pillar plan,  the concepts of a low (or low-ish!) carb diet, time restricted eating and weight management programs.   It’s very rewarding to see people making changes and just to touch base with them occasionally or give them a gentle nudge here and there as they work their way through managing their own wellbeing.
  7. It does take a bit longer.  Case selection is key!   My clinic did finish on time, thanks to the one third of people who came with minor and easily addressible problems.  I’m not going to lie to you…to do this properly does take a little longer.  My belief is that if health professionals invest just a little extra time with the right people, the benefits in the long term will be significant.  A very small proportion of people genuinely have no insight and are not willing to take any responsibility for their own wellbeing and may not respond to this approach.   However, if a doctor would offer a double appointment to a patient with serious mental illness, a complex long term condition or a newly diagnosed cancer, why would we not do the same for someone who could make huge, lifelong gains in wellbeing as a result of a little extra time?  A GP can sometimes feel a bit of a lightweight if they book too many extra long appointments.  Patients may feel they are taking up too much of the doctor’s time with “minor” issues.  I would argue that of all the things we spend more time on, this is one of the most potentially beneficial areas for patients and health professionals alike.

I hope that you have found my sharing this helpful, whether you are a patient or a health professional.  Weekly Wellbeing Round Up service resumes next week

Until next week, look after yourself!

Dr Richard Pile