Medicine does not have all the answers … says a doctor
The power of modern drugs can be awe-inspiring, but social interaction and other activities are undervalued forms of healing
As a medical student I marvelled at the magic little
pills could do. I watched fatal malarial fevers dissipate and resolve,
I saw suppurating, oozing wounds smooth over and heal, cancers regress and disappear
under the wondrous effects of little coloured capsules and tablets. The power of modern
western medicine can be awe-inspiring.
But the more experienced I became, the more I began to
realise that for all its wonders there are many things modern
medicine cannot come close to healing or even understanding. We may have pills
to unclot blood and clear clogged arteries but we have nothing for a broken
heart or lonely soul. Our biomedical model of illness and disease can do much
but it lacks a lot.
How does a dying woman hang on until her grandchild
is born,
how are so many more boys than girls born after great wars, what is the
placebo
effect and how does it work? These are
some of the many things we cannot
explain and so we dismiss them as oddities or anomalies in
science.
We fail to realise and acknowledge the complex context of the person
that has
the illness. As Hippocrates said: "It is more important to understand
what sort
of person has a disease, than what sort of disease a person has." There
is no
pill which will have everything we need to make us healthy and there
never will
be.
In my career I have met some awful doctors and some
exceptional ones. The exceptional
ones have taught me that medicine is an act of love and brotherhood. That true
healing comes from people, not machines or chemicals or protocols or pathways
but from us all to each other. It
comes from art and companionship and love and trust.
Several years ago I visited the Bromley-by-Bow GP clinic. I
was struck by the story of a group of elderly Bangladeshi widows. These women who had relied
entirely on their husbands and were completely isolated by deep cultural and
language barriers. They almost all suffered with poorly controlled diabetes and
were regular attendees of the local AE and GP surgery.
The
surgery started a gardening group for these women and as
they got out and exercised and laughed and gardened together they
developed a
network of support. Their diabetic control improved and they became
significantly less frequent visitors to AE and the GP. Watching how this
group worked was one of several factors that inspired me and my
partners to focus, through our medical clinic, on wellbeing.
Specifically we work on six areas of wellbeing: lifestyle,
participation, relaxation, support, security and environment.
All these areas need to be considered and addressed in the
assessment and promotion of wellbeing.
It is hard to complete your chemotherapy if you are suffering abuse at
home. Your obstructive lung disease will deteriorate and not respond to normal
medical treatment if your home environment includes damp and squalid
conditions. Recent studies show loneliness is a bigger risk factor for having
another heart attack than not taking statin medication (the current gold
standard treatment).
If the NHS is to survive then we must look at the big
picture of health and wellbeing. We have developed a dependence on medicine
which is not sustainable. There
are many cheap, local and effective treatments which do not involve darkening
the doors of our struggling hospitals or GP consulting rooms. We need to look
to each other to provide participation, security and support to our neighbours,
friends and colleagues.
Our clinic in Brighton is the first
integrated NHS GP
practice. We use a wide range of therapies, including acupuncture,
massage and osteopathy, and as these therapies are not part of the NHS
we have set up a
charity to fund them for people on low incomes. We also have a centre
where we offer therapies in the visual, literary and performance arts as
well as support and companionship
groups. Some have questioned our actions. Of
course the biomedical model of the body acupuncture makes no sense.
However,
if I look back at the history of western medicine and how it has evolved
over
the millennia, doctors have done some wonderful and some awful things in
their
attempts to help and relieve sickness.
They have often held misguided views for too long and failed to accept
new ideas or listen to patient experiences with an open mind. In short
for all
its greatness the consistent failing of modern medicine has been its
arrogance. Our model of the body
explains a lot but it does not explain everything.
Perhaps the answer to the conundrum of how to meet the ever
increasing demand on the NHS is to extend the parameters of primary care past
the role of the medic and into the arena of wellbeing? I have been hugely humbled by the
amount of extremely talented people who have offered their services voluntarily
to the Practice. Artists, photographers, film-makers, dancers, authors,
therapists, retired counsellors and many others have come forward to help us
offer narrative workshops, art therapy, exhibitions for artists struggling with
mental health issues, singing groups, film production and dance workshops and
most importantly, companionship.
The role of a future practice will be more than consulting
rooms for GPs and nurses, it will offer a platform for people in the community
to give according to their ability and take according to their need.
Successful
projects such as ours rely on us all being open, embracing differences and
celebrating life together.
"If you want to go fast, go alone. If you want to far, go
together." – African proverb.
