Letter to Professor Martin Marshall 11.10.2019

Dear Martin

It was a pleasure to witness your presentation last night.

You asked for comments. My reflections follow for you to consider as you wish.

You were erudite, succinct and precise with an evident passion for the craft of healing.

Actually you were on fire and frikkin awesome in expressing your dream and so obviously feeling great about it!  It felt you would rather die than continue the reductionist prescribing model in which we appear little more than box-tickers and pushers for companies primarily focused on their corporate profits and shareholder dividends.  Noticing and reflecting on the 10% iatrogenic (medical) harm component within the 11% share of health problems which can actually be actioned by modern medicine are both radical and brave moves to which patients and colleagues can only shriek in celebration and delight!

Your opening sentences referring to the bio-psycho-social AND spiritual dimensions of the relationship model of General Practice in the context of Re-thinking Medicine were music to my ears!  Recognising that transactional model of mechanical/ engineering care, which has been ignorantly imposed by policy and system makers, is adverse to patient expectations and needs as well as being causative in creating an undo-able job ratified my own feelings.  You are heralding in the new medical model and bloody well done for jumping over the parapet with these revolutionary concepts from within the hallowed halls!  Usually you can spot a pioneer by the spears, arrows and knives sticking out of their back so additional respect for so effortlessly tuning in to and moving with the new Zeitgeist!! You obviously have a committed body of supporters- wishing you swift conversion of all others including the abstainers!

You also spoke about exceptional consulting skills, doing new things to survive, harming the healthy, de-diagnosis, over screening and treatments with no impact on mortality and morbidity outcomes, and how patients value and want time and relationships in their patient pathway encounters with health practitioners.  You touched on the realities of constraints of resources and numbers of GPs (who prefer to work part-time nowadays in order to survive) and also how shared decision making, social prescribing, expanding non-medical team members whilst evolving the role of the GP, developing leadership and working with schools can harmoniously bring about the undeniably vital societal changes we all need.

There will inevitably be resistance to change with some espousing concern at the time it takes to stop a super tanker and turn it.  May you consider the suggestion and image of the situation being more akin to a Pooh stick twirling around in an eddy which simply needs a nudge to get back out in to the stream and be sped along in the firm current?  

In your presentation you encapsulated the very issues which have driven my medical journey since I gained the Membership of the Royal College of General Practice.  To add value to traditional methods of practice and improve benefits and boons to patients and myself has become a preoccupation which has fortunately ticked both appraisal and revalidation requirements. 

I noticed Helen Stokes-Lampard called for better access to alternative therapies to reverse prescribing trends in a Royal College of General Practice press release on 10.9.2019.  Patients gravitate to these complementary remedies like bees to honey- there must be something there which traditional medicine has ignored and chosen to remain blind to.  Following the psychotherapeutic adage ‘don’t kick the sh*t (it only makes a mess), hug it’ I’ve explored the ‘scene’.

The Faculty of Homeopathy, Championing Sustainable Lifestyle Medicine (enacted by parliament and now holding Royal Patronage) taught amazing listening skills, lifestyle advice, dietetics, exercise, value of communicating and connecting, self-care and some stuff about little white balls of sugar which peer-reviewed published literature has shown have greater effects than placebo!? I was a bit disappointed about that last bit being sceptical and quite ready to kick it all into the long grass, but it has helped in too many heartsink cases now, enabled reduced prescribing, especially of antibiotics, and I learned the Indian Government is regularly using homeopathic drugs to treat and prevent Dengue Fever after the vaccine failed- go figure!

The British Medical Acupuncture Society teaches skills which are rapidly and easily applicable in normal surgeries which reduce referrals, esp to musculo-skeletal conditions, opiate analgesia (endogenous endorphin release techniques) and patients love- sentinel case of chap carrying his crutch over his shoulder on the way out having hobbled in on it 10 minutes earlier- magic!

The College of Medicine, Patron HRH Prince Charles- Dr Mike Dixon is a mate of Dr Sam Everington- need I say more- the troops are already there bristling to engage and incorporate. 

The British Holistic Medical Association- Professor David Peters- wide focus on all manner of patient centred interventions also encompassing the retrieval of soul, spirit and mind with body and a recent publication majoring on Social Prescribing.

These are all medical organisations supporting nurses, physios, midwives, dentists, students as well as doctors in Holistic sustainable healthcare who have similarly been twinkling & twirling around in their own eddies.

A frequently prescribed resource is the online Sound Cloud mindfulness blog by retired GP Craig Brown whom the RCGP ran courses for GPs with to improve our resilience to continue doing the undo-able job- patients love it and some who have known the ‘headspace’ app rate it as being better.

As it was World Mental Health Day yesterday and there’s data indicating 70% of GP patients have mental health issues underlying their physical complaints it’s worth mentioning Emotional Freedom Technique (EFT) and Eye Movement Desensitisation and Reprocessing (EMDR) can be done in standard surgeries with significant benefit to appropriate Post Traumatic Stres Disorder patients who again get online resources to pursue and share well before the mental health services can even offer them an assessment appointment.  Bessel van der Kolk has a youtube clip patients watch to see if it suits and then can go to the library to read his The Body Keeps The Score book – Gary Craig is the originator of EFT and his Gold Standard EFT on-line resource with videos is easy for patients (and me) to navigate and apply.

Jan Alcoe from the Janki Foundation has worked with Craig Brown on his Sound Cloud and has herself published great resources for patients living with chronic diseases/ cancer and for people wanting to maintain health. Her own 7 minute youtube clip detailing her oncology journey for her advanced breast cancer is an easy watch during a standard consultation – and she is still blossoming, flourishing and leading guided imagery.

More radical still is the Rapid Transformational Therapy of Marisia Peer: “As adults, a stunning number of people go searching for love and acceptance in a mindset of ‘Please love me,’ instead of an unshakeable belief of ‘I’m loveable.” She looks at how we crave and seek connection and will avoid rejection at any cost. The answer is developing familiarity with the knowledge “I am enough”. If you google her your life WILL evolve.

Sophrology: “A mind/body technique that helps you achieve optimum wellness by calming and at the same time energising you. Using a range of simple exercises that include mindfulness, breathing and visualisation, Sophrology is a self-development training designed to make you feel and function better, but it can also be used to alleviate specific problems, such as anxiety, stress and burn-out, sleep difficulties and phobias. The method, developed by the neuro-psychiatrist Prof Alfonso Caycedo, has been used extensively in Europe for over fifty years. Recent discoveries in neuro-science have been incorporated into its practice, and Sophrology offers a great way for you to easily gain a feeling of optimal well-being, to feel less stressed and anxious, and sleep more soundly.”

Of course old traditional medical healing practices of shaman, druid, American Indian, nutrition, herbal, osteopathic and Asian practices such as applied QiGong are also worthy of their place in Rewilded Medicine.

Kind regards

Andrew

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