Self Responsibility 2
In the long run, we shape our lives, and we shape ourselves. The process never ends until we die. And the choices we make are ultimately our own responsibility.
When it comes to YOUR health and well-being, who is in the driving seat?
Are you in control of your health? Truly?
Things are changing in the world of medicine and one of them has huge implications for YOU as an individual or patient; more and more you are being silently nudged to take responsibility for your own health and well-being. See opposite.
My doctor has already started the process. I arrive with my symptoms and say I have no idea what they mean nor what their cause could be. (Actually I do but I want some validation and have learn not to go into the surgery and say, "I think I have .." Doctor seem not to like that opening remark. So I wait for my GP's first comment after "hello!" “And what would you like me to do about it?”
Well, I already know he will not entertain looking for causes, so that is a no no.
And since I do not know what options he can offer, how can I answer the questions?
It’s like a waiter in a restaurant approaching my table, without giving me a menu, and asking, “What do you want to order?” How do I know if I have no menu.
So in my book, doctors have much to learn about this patient-centred lark. And I use the word lark deliberately. I am all for patient centredness but NOT the way the NHS means, mostly playing at it – I often hear, “We have to put the patient first.” Which means, as a sub-text, I don't believe in it. And I see no evidence of genuine patient centredness in practice. If there were, there would be more listening to the patient. It will be a while, and much training later, before the NHS is patient centred.
Even if I do tell my GP what I want – I always go well prepared – I am usually told my reasonable request cannot be met … so why bother asking me what I want in the first place?
Did anyone mention pantomime? Oh yes I did!
So just when you might be laughing, let me burst your bubble – because the next scene is where I decide to mostly forget about doctors and do my own thing – I do my research, and I can access numerous blood tests privately -check out www.thriva.com – I consult with numerous other medical practitioners – acupuncturist, chiropractic, a doctor trained in ABC™ Advanced Bio Structural Correction, nutritionist, homeopath etc – and use the NHS for the “fix me” skills of A&E – and hats off to staff there, I have found them, and emergency wards, totally dedicated, competent and mostly compassionate. But their role is essentially to fix what’s wrong and get you home quickly as possible. Their role in medicine is not the creation of health.
We need a medical model which is about creating optimum health and not just treating symptoms.
Change is happening
So heed the warning sign, that whistle in the distance and the train thundering down the track named – "Self-responsibility."
More and more YOU the patient is being influenced to take responsibility for your own health and well-being, doing your own research, informing yourself about treatments, protocols, and side effects, finding counsellors and nutritionists and other medical practitioners. The sad thing is medical staff are not prepared for this either.
But this is the way forward.
The NHS has become a cumbersome Jack-of-all-Trades and Master-to-None. The bio-medical model it employs is outdated and too narrow for modern day medicine. Its times is spent on symptom treatment and disease management and not about creating health. One might ask why it is called a National HEALTH Service. It is unaccepting of many other healing modalities, approaches, and paradigms which could save it a fortune.
And even the Evidence Based Medicine movement is now used an excuse to ignore all other approaches for which there is not the money to get the evidence as to their efficacy. Big Pharma rules and the evidence based movement has been hi-jacked by unscrupulous vested interests and can no longer deliver its original objectives.
I keep being told by "authorities" that our medicine has to be evidence based, based in science, and that if science says so, then all is well. Do not be sold that line.
Science is not the beautiful, pristine, honest, ethical, full of integrity and truth thing you may have been told it is.
If you really read the date, you'll find it is highly influenced by the food industry, big pharma, governments, vested interests, by bias, by the design of the study and research, and who is paying for it. Our nutrition science is corrupted by the food industry, advertising that is a million miles from the truth, profit and loss, bottom line economics, They obfuscate the truth, promote false science trying to tell us something is healthy because it has no ADDED sugar, or something is low fat but to retain taste is loaded with unhealthy sugars.
So science is not this pure field or ocean of truth. This is the age of lies, as truth is trampled and falsity flourishes, its reach grotesquely amplified by social media and the internet. Where doctors trot out that insulin does not contribute to weight gain (it does) and that "eat less, walk more" is the route to treating obesity (it is not so which piece of evidence is the doctor basing such advice on?)
In addition there are many treatments and procedures that are routinely used by patients privately despite the lack of reliable evidence to show conclusively that they are genuinely beneficial, especially since, if all the doctor does is treat the symptoms, they never get to the root cause and treat that. Treating depression with drugs does not cure depression as the individual circumstances that caused the depression in the individual are seldom looked at. I know from personal experience.
Another good example, one close to my heart, is the issue of chemotherapy to treat cancer patients. Many cancer drugs prolong life for a few months, during which time the patient undoubtedly will experience a poor quality of life because of nasty side effects and numerous hospital appointments. And yet there are so many other approaches, without the use of drugs, which offer the patient a much better quality of life.
Yet most of us say nothing about this medical model because we as patients have become far too dependent on the NHS, on the opinions of professionals…we still see doctor as God. Some of us in fact cannot conceive any set of circumstances in which we would not see doctor as the fount of all knowledge.
“Don’t ask me about fitness … ask Google," asks top GP as she tell overweight patients to turn to the internet for advice – that was the headline for an article in the Daily Mail dated 9th June 2017. This was a comment made by Dr Clare Gerada, MBE, a former Chair of the Royal College of General Practitioners (RCPG). She was advocating that patients should be encouraged to take responsibility for their own health. She commented:
“The idea that you need to consult me as the GP to tell you where to go is a nonsense in tomorrow’s world. In yesterday’s patronising world where I had the knowledge and I kept it from you, fine, but you are just as responsible.
“If you don’t do that I am afraid that what is going to happen is that you have all the power and no responsibility.
“We are going to end up with a burnt-out system where there won’t be health professionals because we can’t take that responsibility.”
She claimed it was not the job of GPs to provide patients with information about health, fitness and diet but that they turn instead to the internet. The full article can be read here.
Whilst I agree with her, the GPs in my local practice sigh and take great exception to patients informing themselves via the internet. My practice nurse get visibly angry if I present her with updated knowledge on diabetes and nutrition, my own GP does likewise when I attempt to talk about obesity and exercise and ask to focus less on disease management and more on the creation of health.
Something’s gotta give here folks.
We need more GPs willing to come into the 21st century. (And before people shout at me – I said “more.” I know of some who really embrace technology and new ways.)
In her own work as a GP, Clare Gerada, is already using, as are GPs in remote Scottish locations, technology as an alternative to a face to face consultation. The technological advances available to doctors means that a 10-minute consultation is becoming very complex and time-consuming…when for each ten minute practice consultation it is claimed they can fit in three on-line consultations.
Advocating patient self-responsibility
In part, this website emerged as a contribution to encouraging people to become more self-responsible – by being more aware of their symptoms and conditions, being better informed about options, and being willing to take radical and if necessary, unorthodox (ie not orthodox medicine necessarily) approaches in not just the management of their health but in the creation of optimal health, leading to greater happiness and well-being.
Whether you are aware of it or not, agree or not, like it or not, we are experiencing a massive shift in the way that healthcare is delivered.
Why does our GP have to be our gatekeeper …when s0 much has to go through the GP, waiting for their blessing – or not?
I lived from 2000 to 2012 in Spain. There, I could buy most prescription drugs over the counter. My pharmacist got to know me better than the local doctor; he was always willing to give advice, if I asked for a product he would usually ask what it was for and invariably simply sold the product (ie I knew what I was asking for) or he would suggest an alternative. Very few drugs were not available over the counter. This use of pharmacists freed up the time of general practitioners.
If I wanted to check out the state of my health by eg testing my liver function, my cholesterol level, have an advanced thyroid function test etc there were private labs and I could easily pop in, and for a small fee have my bloods taken and the results given within days.
Why is Britain holding on to some Dickensian system simply because it doesn’t trust patients (or the Internet) to inform themselves? (The argument as to whether people have access to the Internet let alone be skilled in using it is for another day.)
I remember the days as a child growing up in the countryside, Aberdeenshire, there was one shop about four miles away from our home ; the shop was still called an Emporium – it sold about anything people in a rural community could ever want, from fresh to packeted foods, chicken feed to petrol. But the thing I noted was that shoppers would arrive with their shopping list, read from it, whilst the shopkeeper went to fetch each item. Lots of walking for the shopkeeper. A bit “Open All Hours.”
Contrast that with today and the customer self-selects from open shelves and the shop assistant’s role is primarily to take the money.
Extract from Health Secretary Jeremy Hunt's speech to the Local Government Association annual conference 2015.
Personal responsibility for our health
We need to start by taking more personal responsibility for our own health.
The independent, American-based Commonwealth Fund recently ranked the UK first of all major health systems in the developed world. On access to health services the UK is unparalleled. On the safety of care we’re amongst the best. Yet on one key measure we fell far behind. When it comes to preventing illness or leading ‘healthy lives’, we are bottom of the pack, ranked 10th out of 11. That is deeply undesirable in a taxpayer-funded system that relies on a sustainable level of demand for services.
This country pioneered through local government clean drinking water and clean air in cities - we effectively invented what is now called public health.
But looking at some of the indicators you wouldn’t know it.
Despite falling smoking rates, nearly 8 million people in England still smoke, and treating smoking-related illnesses costs the NHS an estimated £2.7 billion a year. Half the difference in life expectancy between our richer and poorer areas is caused by smoking-related illness, with two-thirds of smokers starting as children.
We also have higher obesity rates than nearly anywhere else in Europe. This is closely linked to soaring type 2 diabetes rates - up 61% in a decade, now affecting 1 in 16 of the adult population and costing the NHS £8 billion a year. While childhood obesity has plateaued, are we really content with 1 in 5 children leaving primary school clinically obese, with three-quarters of their parents not even aware that they have a problem?
Thankfully people are starting to take more responsibility. Doctors report dramatic increases in the number of expert patients who Google their conditions and this can be challenging for doctors not used to being second-guessed. But it is to be warmly welcomed: the best person to manage a long-term condition is the person who has that long term condition. The best person to prevent a long term condition developing is not the doctor - it’s you. Which is why last year, following changes to the GP contract, the number of GPs offering their patients online access to a summary of their medical record has risen from 3% to 97%. This needs to be the start of a much bigger change where everyone feels firmly in the driving seat for their own health outcomes and an area where the NHS and local government can work together.
Responsible use of NHS resources
Part of this change in mentality needs to be more personal responsibility for use of precious public resources.
On the back of Lord Carter’s report on inefficiencies in procurement and rostering in the NHS, we have recently begun a big piece of work to bear down on waste in hospitals. We are insisting on a laser-like focus from the hospital sector to make sure every penny counts.
But there is a role for patients here too. There is no such thing as a free health service: everything we are proud of in the NHS is funded by taxpayers and every penny we waste costs patients more through higher taxes or reduced services.
Yet estimates suggest that missed GP appointments cost the NHS £162 million each year and missed hospital appointments as much as £750 million a year. That is nearly £1 billion that could be used for more treatments or the latest drugs. On top of which we spend £300 million a year on wasted medicines.
People who use our services need to know that in the end they pay the price for this waste.
So today I can announce that we intend to publish the indicative medicine costs to the NHS on the packs of all medicines costing more than £20, which will also be marked ‘funded by the UK taxpayer’. This will not just reduce waste by reminding people of the cost of medicine, but also improve patient care by boosting adherence to drug regimes. I will start the processes to make this happen this year, with an aim to implement it next year.
Responsibility for our families
The third and perhaps most important area where we need to take more personal responsibility is around care for the elderly. Here yet again health and local government must surely work together.
You don’t need me to describe the burning platform. By the end of this parliament we will have a million more over 70s, one third of them living alone. Yes the health and social care system must do a much better job at looking after them. But so too must all of us as citizens as well.
Shockingly, in Edinburgh last week police had to break down the door of a top floor flat because it had been so long since the door had been opened, they had to pick their way through mounds of unopened mail, to reach the body of a man who may have been left undiscovered in his flat for up to 3 years.
Statistics from the LGA indicate that in 2011 in England there were 2,900 council funded funerals. That is around 8 ‘lonely funerals’ every single day, half of which were for over 65s.
Are we really saying these people had no living relatives or friends? Or is it something sadder, namely that the busy, atomised lives we increasingly lead mean that too often we have become so distant from blood relatives that we don’t even know when they are dying?
In Japan nearly 30,000 people die alone every year, and they have even coined a word for it, kodokushi, which means ‘lonely death.’ How many lonely deaths do we have in Britain - where according to Age UK a million older people have not spoken to anyone in the last month?
It is not all bad news: we have 6 million carers in the UK who do a magnificent job, even if they do not always get the thanks or support they deserve. We have some of the most active charities and social support systems of anywhere in the world. But the uncomfortable truth is that praising that heroic army of carers and volunteers - as all politicians do - is not enough. If we are to rise to the challenges we face, taking care of older relatives and friends will need to become part of everyone’s life.
Other countries are starting to wake up to this challenge.
A Chinese proverb states that ‘an elderly person at home is like a living golden treasure’. At the moment, around 40% of Chinese older people live with their children, but in Beijing they have a policy to increase that to 90% by 2020. China even passed a new ‘elderly rights law’ against ‘neglecting or snubbing elderly people’, which mandated that people should visit their elderly parents often, no matter how far away they live, with fines or prison sentences as penalties.
Western traditions would rightly resist state interference on this scale. But France too passed an elderly care law in 2004 requiring its citizens to keep in touch with their elderly parents. They did this after a heatwave left 15,000 elderly dead, many of whom were left for weeks before they were found.
In Italy, they have a well-established system of ‘badanti’ – a system of au pairs or ‘nannies for grannies’. They provide the majority of elderly care in Italy and take care of older relatives while busy parents go out to work.
In the Netherlands, they’ve introduced a different type of au pair system for elderly people, where students are offered rent-free accommodation in nursing homes in return for spending at least 30 hours a month with some of the elderly residents.
Another model is championed by the remarkable organisation L’Arche’, which has adopted a revolutionary approach to the care of people with learning disabilities. As a young man in the aftermath of World War II, Vanier L’Arche visited a grim institution in Paris for people with learning disabilities. He was accosted by a young resident who asked him simply: “Will you be my friend?” He was so struck by this cry of loneliness that he invited 2 men from the institution to live with him in his home. This became an international movement where people offer a year of their time to live alongside their charges. As Vanier said: “When you share the same bathroom, and your toothbrush shares the same mug, it’s different”, and there are now 147 thriving L‘Arche communities in 35 countries including our own.
And we have some remarkable home-grown schemes, too, such as the HomeShare scheme in Dorset to Forth Valley, Scotland; and the Shared Lives programme in 150 locations from Bradford to Brighton. Or the extraordinary efforts of individual citizens like Maria Boot-Handford, a speech therapist from Greenwich, who was so moved by the plight of her elderly neighbours that she negotiated with her NHS employer to work 4 days a week so that she could use her Fridays to spend quality time with 3 different elderly neighbours and visit local nursing home residents.
But individual examples of inspiration should not mask our national shame: 1 in 10 older people have contact with their family less than once a month and 4 million people say TV is their main source of company.
Despite many local examples of innate British kindness and decency, the national picture is far from kind and far from decent.
New carers’ strategy
We should also note the hard-headed economic arguments that impact on this debate.
All families have different needs and situations, and for some residential care will be right. But carry on as we are and we will need 38,000 more care home beds in the next 5 years - the equivalent of around 20 new care homes a month for the next 5 years. The impact of this on you, the local authorities who fund 40% of all residential care beds, would be disastrous. Care home residents are some of the most frequent users of NHS services, so the financial impact on the NHS would be equally severe.
Recent evidence suggests change is starting to happen - the latest ONS figures showed a welcome increase in multi-generational households. But with only 16% of older people living with their children in this country compared to 39% in Italy, 40% in China and 65% in Japan, we are starting from a low base and need to ask whether the pace of change is sufficient.
We are proud of the new rights for carers enshrined in last year’s Care Act and made a manifesto commitment to increase support for fulltime unpaid carers. Passing new laws requiring people to care for relatives is not the British way, but I do want to make sure we are learning from the best of what happens around the world. So I can also announce that my new Minister for Community and Social Care Alistair Burt will develop a new carers’ strategy that looks at the best of international practice and examines what more we can do to support existing carers and the new carers we will need.
The new strategy will ensure we deliver that - but it will do more. By looking at best practice from around the country and the world, it will seek to answer the big question: what do we need to do as a society to support people who are caring now, and crucially, for the millions who will have a caring role in the future? We can’t put our heads in the sand on this critical issue.
Conclusion: a new social contract
I have said before I want Britain to be the best country in the world to grow old in.
But the government - nationally or locally - can’t do this alone. Attitudes need to change too, so that it becomes as normal to talk about elderly care with your boss as about childcare. Family planning must be as much about care for older generations as planning for younger ones. A wholesale repairing of the social contract so that children see their parents giving wonderful care to grandparents – and recognise that in time that will be their responsibility too.
Responsibility for our health, responsibility for our families, responsible use of public resources. A revolution in personal responsibility to match the revolution in health and care provision that we are all determined to offer.
Thank you very much.
Clearly a major change in the way healthcare is delivered is now advancing; in England the number of GPs offering their patients online access to a summary of their medical record has risen from 3% to 97%. With that comes the patient’s responsibility to use it to good advantage. In my own GP practice it is difficult to get access to one’s records unless one makes a special request and in some cases has to pay.
With self-responsibility comes the need for greater patient discernment.
Take nutrition as an example; from personal experience, I know that the official advice from many health professionals, most of whom are NOT trained sufficiently in nutrition, the gut microbiome, autoimmune disease, etc to reduce the intake of fat and increase complex carbohydrates is WRONG and ineffective and invariably it is the health of patients that suffers or deteriorates. Turning to the Internet we still have the issue of the validity and suitability of what we read; can we trust the sites we access? I found Twitter a good source of sorting out good sites from not so good sites; I followed doctors who seemed to be at the forefront of updating knowledge on eg obesity, cancer, diabetes, auto-immune disease etc and through their Tweets were led to their websites and others they recommended. It didn’t take long to sort out the wheat from the chaff. But in the end, when it came to nutrition there was also the point that you cannot go far wrong by avoiding sugar, processed foods, grains, fast foods, loaded carbohydrates and instead eating meals based on raw, fresh ingredients i.e. eat real food. When it comes to the produce we buy, what we decide to cook, and how we eat is truly our responsibility. As I often say to a few friends who complain about some of the food they ate at home, "Who bought the food? Who filled the fridge?"
Doctors are not the go-to person for nutritional advice. Having contacted all the medical schools in Scotland I was not surprised to find that doctors get on average two hours training in nutrition over their five-year training. So why would I look to my GP to advise me?
So what does all this mean for patients?
We are moving to a time when we shall need health coaches or mentors. Patients may end up dealing with complex topics that are difficult to understand. They may need help but not the kind a doctor is trained for, especially if they are looking to not only manage a disease but transition to the creation of optimal health.
An excellent example is myself and Type 2 Diabetes (T2D). After many years of falling for conventional advice and doing what I was told, I can honestly say that the standard advice from the mainstream NHS does not work. It often doesn’t even help me manage the disease let alone cure it and no time is spent on how I can move away from diabetes and create better health. So, I live with ill-health, not optimal health. At least I did.
A few years ago, I started taking matters into my own hands; doctors and nurses did not like it, they did not like an informed patient, it challenges them, and often I would be ridiculed, told off, my explanations of how I had achieved improvements, despite being diagnosed as a diabetic, tossed aside as irrelevant. (This is also an example where I believe the NHS is so NOT patient centred – though am wise enough to know that does not apply across the board. I know there is an increasing number of professionals within the NHS who achieve excellent results by helping patients to alter their diet, lower their intake of sugar and carbohydrates and increase intake of healthy fats and then patients bring their blood glucose under control, their need for drugs is reduced and most lose some body weight. My GPs ar not among those doctors! I have done similarly, but no thanks to medical staff. And I also know many people with a diabetes type 2 diagnosis who have failed to successfully control T2D by complying with the conventional NHS advice.
If you are involved in an accident, or have a sudden dis-ease onset, then it is obvious that you have to place yourself in the hands of health professionals and be grateful for the treatment that may save your life. When I have had to do so, treatment has been excellent. Fixing people is what the NHS does, and usually does well. But it does not offer support in the creation of optimal health which is why we shall see an increase in Health Coaches.
The conclusion is clear ... YOU, the patient, really will have to take more ressponsibility then full responsibility for your health.
You will have to become your own radical healer, managing disease, creating health.
The Radical Healer then is someone who …
1 Accepts responsibility for their own health and well-being
2 Does not expect their doctor or other medical staff to have all the answers
3 Collaborates with any health professional – is open, honest, humble, questioning, informed, aware and when necessary 4 prepared to take radical action in their best interests
4Does all they can to inform themselves of how they can live healthily and follows the advice they then get ie they don’t just know about wise eating, they eat wisely
5 Is aware of signs that their life is going out of balance and takes steps to correct the imbalance so that things do not get to dis-ease state
6 Avails themselves, as personal cost permits, of the wide range of non-conventional approaches to health creation
7 Finds out what’s available locally, and at a distance
8 Is aware of their personal beliefs and how these impact on their health
9 Is aware of when they need to go outside conventional medicine for help and support – including the benefits from finding support groups
10 Listens to their body, the whispers it speaks, through signs and symptoms and intuitions
11 Considers their relationships – those that are working and need to be nurtured, those that have served their time and perhaps need to be let go
12 Considers how they are in relationships – too giving, too dependent etc – and whether the relationship is a healthy one
13 Considers how work impacts their health – are they working for a company that does not value them, are they overworked, underpaid, how does work serve them?
14 Considers the meaning and purpose of their life. If they are not in alignment with their meaning anad purpose, their health will suffer.
15 Finds ways to express their creativity, which adds to joyousness, which reduces stress
16 Acknowledges and expresses their version of spirituality (not necessarily religion) – they don’t just reject spirituality but at least consider what it is and the part it plays in their life and health
17 Is clear on what sexuality means to them and confidently expresses it
18 Realises the importance of the relationship between finances and health – develops a healthy attitude to abundance and finance
19 Considers the huge importance of their environment and how it impacts their health
20 Pays attention to the importance of their mental health and takes steps, where needed, to address any signs of poor mental health
21 Similarly, respects and reveres their physical body, lives in such a way that helps the body be as healthy as possibly, avoids ways, foods, and substances which work against the body.
Are you a Radical Healer?
Of the 21 items above, how many do you effectively take responsibility for, not just in your head, but in your actions?
I caution you to beware of the attitude of "I already know all this; I read about/heard about/studied it before, and it’s already quite familiar to me. " The great majority of people who feel this way regarding the principles of Truth are, for the most part, not applying those principles in their own lives for the upliftment of themselves and others around them. Where the principles of Truth are concerned, it is not a matter of ‘knowing about’ something. You must also walk the talk.
Thriva in the UK offers small scale home testing kits
http://vitahealthclinic.com/ a new approach to chiropractic (for information)
Introduction to Functional Medicine