I have tried everything

‘I have spent over a thousand pounds on my neck and I want it sorted,’ was Mrs Harrington’s opening statement. Indeed she had tried lots of treatments; acupuncture, physiotherapy, osteopathy and a variety of medications. She had seen a specialist and had an mri scan which did show some wear and tear of the vertebrae. He offered to inject her neck but she did not fancy that.
She is lady that has her own business and cannot afford anymore time off. Her husband sent her to get it sorted.
It is not easy to deal with a personality that has a mechanistic view of their body and a high achiever that is used to getting rsults.
Well listening and empathy always helps. Going a bit deeper with some quaestions can open things up. When did it start? What makes it better? What does she think is the cause? What is really important in her life? There was some resistance, but I think she began to reflect on her situation from a different perspective.
The consulatation ended with me suggesting to her to view ‘painful neck’ as a chronic condition that she needed to adapt to rather than look for a cure. Maybe some seeds were sown for her to begin to change her attitude.

Spiritual care

Spiritual care, what is it? How do we give spiritual care in our day-to-day consultations with patients? For holistic practitioners it is challenging because for them the question is, ‘Can spiritual care be separated from mental and physical care, or is it essentially part of everything?’

The answer has to be yes and no, and both. How we are in ourselves, and how we are with patients determines the space that allows a caring spiritual atmosphere to be present. With the intention of bringing benefit to the patient, whatever is meant to happen, will happen. A spiritual relationship in a consultation is when we are fully attentive and yet are detached from the outcome. I mean attentive mentally and detached emotionally.

However there are some prompt questions that are helpful in directing the conversation towards the spiritual dimension:

What is really important to you?
How do you find inner peace?
What do you think is happening to you- concerning your illness, etc?
What and who gives you support?

I like the picture of a visitor playing her guitar and singing to residents at a nursing home. Simply anything that can lift your spirits, is spiritual care.

Holism versus reductionism.

Sometimes I despair. Where are we going with this reductionist, target driven medical care?

Mary was referred to my morning surgery by the nurse. She was 83 years old. Her blood pressure was 160/90. For goodness sake she is 83!

Protocol guidelines say that her blood pressure should be 140/90. Mary had been taking tablets for her blood pressure for 15 years and her blood pressure had not altered over the last 4 years. But guidelines are guidelines.

She asked me if it was her nerves that maybe had put her blood pressure up. I asked what she meant and of course what she really wanted to do was tell her story. She had been a widow for 20 years and she was finding it increasingly difficult to look after her elder brother that lived nearby. She was getting more and more tired having to cope with him as well as her own house. She did all the shopping and looking after the bills. A cleaner came in once a week. Her family lived by and helped out when they could but she did not want to bother them too much with her troubles.

We as doctors want to check her blood pressure presumably to lower her risk of a stroke. Or is to reach our targets and get paid? She wants someone to listen to her story and offer a bit of support and advise. I hope she left feeling she had shared her troubles. After she left I contacted social services to see if they could offer some help for her brother.

My mother's death

Last week my mother died. She was 94years old and had been in a nursing home for 3 years. However up until the last 6 weeks she was alert and interested in everything around her. Despite her difficulty with speech when visiting her, she was first to ask how you were. She took a keen interest in everyone’s life. She always looked on the bright side. She was a happy, generous caring soul and that is how I will remember her, not the frail body of the last 6 months.

As a holistic practitioner we need to acknowledge that things happen to us and affect us too. We often deal with others grief and distress but how do we deal with our own? Who do we look for support? Doctors generally are not good at this and tend to deny many of the feelings and carry on at work regardless. If it happens to you, have time off to reflect and learn from the experience. It will help you develop and be a better doctor.

What did I learn? The most important thing when sitting with a dying person is the state of your own mind. I focused on creating a peaceful atmosphere for my mother. I ensured that she was physically comfortable then spent time meditating in her presence. I focused on love, light and peace. I felt calm and a comfortable feeling was created in the room. When the nurses came to attend her they commented on it.

One evening I went through all her own photograph albums, which gave me a perspective on her life. I felt many of the special people in her life were close and ready to welcome her. Although she was not responding for the last three days I spoke to her softly and reassuringly of how much she had given to life and how much she had been appreciated. It was now OK for her to go when she was ready and that everything was in order.

In the end it was very gentle and peaceful passing. Of course we will miss her, but I feel good that it was a good death.

Asthma and Hyperventilation

The last patient in the morning surgery was a lady with asthma who said she was not any better despite the treatment she was given last week.

She had been an asthmatic for 12 years and took her inhalers regularly. She had a recent chest infection and had completed a course of steroids and antibiotics and was worried she was still short of breath.

An acute attack of asthma can be terrifying and as breathing becomes more difficult- it can feel like drowning. No wonder people panic when it happens and are fearful it can recur. If you wish to view click

When I examined her chest was clear and her lung function had not deteriorated-I checked it on her peak flow meter. However I saw that her breathing was rapid and shallow, and when I pointed this out to her she said it was worse when she was anxious and sometimes her lips and arms started to tingle. This was not a worsening of her asthma but she was hyperventilating. These are classical symptoms of hyperventilation.

The remedy for hyperventilation is to slow the breathing and take deeper breathes from the belly. It sounds simple- and it is when you are calm. But it needs practice.

Lie flat on your bed with the palms of your hands resting on your belly. Try and relax, then watch your breathing. Breathe through your nose slowly and find your own natural rhythm to your breathing. Concentrate on your breath. Your hands should rise up when you breathe in, and fall when you breath out.

I do this if I find it difficult getting to sleep at night. It is like counting sheep-you rarely get beyond 10 before you are asleep.

I showed this lady how to do this and referred her to a physiotherapist to encourage her to practice. This will not only help her when she is hyperventilating, but the deep breathing will directly help her asthma.

Back from hols.

Just back from skiing holiday over Christmas. Lots of snow, blue skies, fresh air, exercise and relaxation. No TV or internet, and quality time with the family.

When I was a full time GP I took 8 weeks holiday a year, plus bank holidays and had a half day off a week with no nights or week-ends on call.

However, my first job as a surgical houseman was 108 hours a week with no days off and 2 weeks holiday each six months.

My early years in general practice we had eleven hour days, worked Saturday mornings and did a night and a week-end rota of 1 in 5. It was hard, yet rewarding. However looking back we all suffered various degrees of burnout, and in some instances depression and stress related illness. So I would not go back to those days.

As a holistic doctor I feel it is important to take time out to enjoy yourself and pursue other interests. And to have time for friends and family. But more importantly time for yourself-to relax and reflect -to have space to think, ponder and process feelings.

This needs planning. Book holidays and on days off do something you enjoy that is not work related. Also during your working day have breaks, even short ones. I play a short tracks from a CD on relaxation which is on my practice computer called Just-a-minute. These are one minute relaxation and meditation tracks. I find really helpful to keep up my energy and enthusiasm. You can download all 21 tracks for free.

My First Blog

My daughter is training to be a journalist. She blogs. She says if you want to communicate to anyone under 30 years old you need to blog. Blogging is the verb. A blog is what you write.

I think the holistic approach to general practice is important. So I am going to write a blog on my experience as a general practitioner and how a holistic approach is practical and useful to patients and doctors.

She also says that blogs should have links to other sources. Not references as we use when writing an article for a journal. But something that you can click on and get instantly connected to.

Have you heard of the 5th Estate?
‘Witnessing the rapid rise of wikis, blogs, and many other online social networks (such as FaceBook, YouTube, and MySpace), we wonder if we are ready for what has been called the Fifth Estate,- a new form of civil society participation, enabled by the growing use of the Internet, mobile phones, and related information and communication technologies.'

This came from the BMJ 13th December 2008. ‘How should health be defined?' Vol 337 p1364. That is an old style reference. Clicking on the above will take you instantly there.

My blog will be mainly case histories and may include podcasts and other such new communication developments. I hope you will connect to my adventure.