Thursday, 29 December 2016

Watership Down

One of the most challenging times of my life was the three months from January to March 1973. Through those months alongside my fellow medical students I studied relentlessles for my 2ndMB (the exam that used to be taken after 5 terms of anatomy, physiology, biochemistry and pharmacology). It was a monster of an exam and required rediculous amounts of retained knowledge. Thankfully I scraped through. One of the things that kept me going was reading a portion of Watership Down for half an hour before I went to sleep. It calmed me down and transported me away from my problems to those of the rabbit warren, Bigwig and all.

It's a beautifully told tale and was written by Richard Adams who died this week at the age of 96 years. Subsequently made into a film with gorgeous singing from Art Garfunkel-one of the last vinyls I bought (before my recent conversion back to vinyl!).

Reading the book helped. It calmed me, it distracted me and gave me just a tiny insight into the struggle that others face in life, whether man or beast. And since most of us easily become preoccupied with our own challenges, it was a helpful nudge towards less self-absorption. We'd all be better off with what Tim Keller calls Self-forgetfulness. Something to aim for in 2017?

Tuesday, 6 December 2016

Suicide

I was very struck this week catching up on the BMJ (I tend to only read the obituaries to make sure I'm not mentioned), in reading about a correction. Someone had written a tribute for a colleague which had then been inaccurately reported as saying the deceased, 'committed suicide'. The BMJ apologised noting that the terminology recommended internationally (and endorsed by the Samaritans, www.samaritans.org) was 'died by suicide', or in North America, 'took his own life'.

I regard that as a good thing. Not least before suicide being no long regarded as a criminal act it is not something 'committed'. However it is more difficult to find correct language for someone professing Christian faith. Is their suicide a sin in the sense of a rebellion against God's rightful sovereignty?  Well I guess in some sense that is true, and yet what Christian hasn't often and sadly rebelled in less dramatic ways but without incurring the stigma of suicide.

As one writer points out the extraordinary words of the apostle Paul in Romans 8 give us considerable grounds for hope. Since neither life nor death-not even death by suicide-can separate us from the love of God, why should a momentary act of tragic self-annihilation be regarded any differently to other less obvious failings?

Of course more to say. Check out some helpful resources from John Piper here, and the Gospel Coalition.

I can only recall three suicides in my long career at Olney. All so sad in their own way. My first was many years ago and was of an elderly lady who found a chronic neurological condition intolerable. Her aged husband called me to her bedside where she had suffocated herself with a plastic bag. It was such a sad scene, and my immediate instinct was to spare him pain by suggesting that she died of natural causes. Of course I would have been wrong and was corrected by a friend who was deputy coroner with whom I discussed the matter. The aged spouse looked at her and said gently, "I still love her you know". Now I realise Dolly Parton wasn't thinking of this, nor indeed theologically, in her wonderful song, 'I will always love you', but it carries such a powerful message that I frequently come back to. The power of unquenchable love. And for those of us privileged to experience it, the relentless love of God.




Thursday, 1 December 2016

The empathetic doctor.


Like many GPs I grapple with how to help the patient with chronic (that is longstanding) back pain. Well probably not by shovelling opiates in their direction, since such drugs are fraught with difficulties and drawbacks. And nor are surgeons of much use here. Rather disarmingly one major contribution is "simply' to be empathetic. And yet it seems so touchy feely, or soft even, when such macho men as spinal surgeons are on the prowl.

Nonetheless a BMJ review from 2015 (BMJ 2015;350:g6380), points out that empathetic GPs are more successful at managing chronic low back pain than those who are not. So what is this magic ingredient? It is said that empathy is, 'unlike sympathy, which is defined as feeling sorry for another person, clinical empathy is the ability to stand in a patient’s shoes and to convey an understanding of the patient’s situation as well as the desire to help.' 1. It seems that some GPs, like the rest of the population, have this more than others, and yet according to Professor Hojat from Jefferson Medical College in Philadelphia, it's a skill that can be learned. So my sceptical colleague why should you bother?

1.    Your patients are more likely to appreciate your help and indeed more likely to follow your advice.

2.    Your patients are more likely to cope with and recover quicker from their illness

3.    You are more likely to experience job satisfaction.

4.    Your patients are much less likely to make a complaint against you.

5.    It will save you time! Really? Yea, it can enable you to focus on the patient’s real concerns and seek to address those, perhaps preventing repeat visits.

Empathetics is a course developed by Psychiatrist Helen Reiss from Massachusetts General Hospital. It encourages doctors how to ‘show up not what to say’. As James Tulsky from Duke University points out ‘doctors are explainaholics. Our answer to distress is more information, that if a patient just understood it better, they would come round. In reality bombarding a patient with information does little to alleviate underlying worry’ 2.

In her brilliant Ted talk, Dr Reiss teaches the acromym, E-M-P-A-T-H-Y. It’s a brilliant talk.

E-Eye contact is so important

M-Muscles of facial expressions-learn to recognize emotion

P-Posture matters, standing over a patient's bedside can be intimidating-sit down!

A-Affect. Learn to gauge patient’s mood

T-Recognise tone of voice signifying underlying emotion

H-Hearing. Hear the whole person, understand their context

Y-your response. Allow your emotions to respond.

Lots to think about here. I recall teaching a Communication Skills course to secmd year medical students at a London medical school, some years ago,. They really thought the subject was a waste of time. How sad and I guess by now they are realizing that empathy and other skills are as just important as any diagnositic or surgical skill they may have acquired.
References.
1.http://www.theatlantic.com/health/archive/2015/03/how-to-teach-doctors-empathy/387784/
2. ibid

Don't lose the shock!

I was talking to a patient this week who has worked in very senior positions in a number of companies. We were discussing how new employ...