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The Devaluation of Doctors

On By doctorlunnersIn Doctors, drlunners, GP, Healthcare, NHSLeave a comment

I was reading our kids Snow White and the Seven Dwarfs yesterday. A classic that as an adult you realise is creepy-as. We get to the bit where Snow White (bless her cotton socks for tucking into the obvs poisoned apple) is laying there in her glass coffin and prince Charmsville comes along, instantly falling in love with a corpse. If you’re able to move past the necrophilia, here comes the real shocker. The story reads that it is when they are carrying her back to his pad (?!) when someone trips and the coffin accidentally gets tossed about, thereby dislodging the piece of stuck apple in her throat that’s been causing all the problems. There is no corpse kissing in the original Brothers Grimm version of the tale – that was Disney trying to sex it up. And like a fool I never questioned the saviour prince kiss. A kiss that is replicated across the Disney franchise and tells impressionable little girls they need a knight in shining armour. For anyone who’s interested, the original story also has wicked stepmother dancing in shoes of hot coals until she dies at the joyous wedding event of Snowy and Charmsville. You’ll be pleased to know they missed out that delightful detail in the version we have. Not that she didn’t deserve some comeuppance, but I’d rather my 4-year-old didn’t feel mummy endorses torturing until death as a legit punishment option even for her cruel misdemeanours. Overall feeling on the original story? Gives with one hand, takes with the other. 

This all got me thinking about how easily we can get sucked in to believing nonsense by people clever enough to sell it to us in the right way. It’s how advertising gets us all. On a darker and sombre note, it’s how some of the worst atrocities in our history have been supported by thousands – if not millions – of people. Right now, there are many, many Russians who believe that bombing the Ukraine is justified because Putin and his cronies’ have careful state-controlled propaganda telling them so. 

I want to discuss with you how I believe Tory-driven propaganda, supported by the media (such as our NHS friend the Daily Mail, or what I shall henceforth refer to as DF, Daily Fail), continues to churn out misinformation about Doctors and our NHS. This torrent of negative tripe leaves the public confused, and the medical profession feeling demoralised and devalued. I am a GP so it is maybe easier for me to see the impact on my profession, but equally I do not think it’s far-fetched to say the abuse is commonly directed towards GPs in particular. It’s more common to find a money-grabbing GP headline than that scoundrel oncologist, you know? 

Karen (sorry to anyone lovely called Karen or any other name referred to in this blog in a less than shining light, I’m just picking names for story-telling purposes)

Last summer I saw Karen in clinic for an ongoing cough. Nothing unusual there, until we get to the end of the consult, and she pipes up with ‘so when are you going to start seeing patients in surgery again?’ I look up in bewilderment at the patient sat in front of me clutching the prescription evidence of being with me in this very room with her. I give Karen the benefit of the doubt and take a scroll though her records over the past year, checking to see if she’d come in since we’d open up our doors to any appointment type – could there have been a chance she’d missed the free-for-all booking memo? No. Karen had been in to see a healthcare professional in person on an almost monthly basis for various ailments over the last year. So, I say to Karen in the most kind and un-enraged tone I can muster ‘patients have been able to book in person reviews for over a year now, and I see you’ve been in a few times. Can I ask why you think you feel you can’t see us at the surgery here?’ 

Karen goes on to explain that ‘it’s what you read about in the news’, referring to the most recent unhelpful headline churned out by the DF. We conclude the consultation, and I somehow manage a forced smile to the departing comment of ‘don’t work too hard!’ Well Karen, I have another 20 patient contacts on my list for the morning on top of the 30 I’ve already dealt with, so it’s unlikely that I’ll get the chance to piss anytime soon, but thanks for the well-wishing, I will bid you adieu until the next time we no doubt see you in this building, you know, face to face. Please save some of your unhelpful banter for that trip. 

Karen obviously had no idea how terribly demoralising that consultation was, and I’m sure she would probably be sad to know how incredibly frustrating her comments were. As crazy as they sound from someone sat directly in front of me, I feel like her slightly misplaced beliefs are quite commonplace. Let’s consider some other common DF-type gems that crop up, shall we?

‘GPs are lazy, and they work part time.’ 

Ok, let’s consider the above Karen scenario. The British Medical Association (BMA) recommends that the maximum number of patient contacts for a GP a day should be 26. The number of direct contacts I had in just that morning was at least 50. That means that in a regular day in General Practice now on average we are probably dealing with 3-4 times the BMA safe workload advises. That is before you add in every indirect patient contact, every result and prescription request you have come through. It is relentless. There are no easy or even easier days in General Practice anymore. Every time I walk through the front door of work, I know there’s a chance at some point I will be so exhausted that I may well make a mistake. After a 11-hour day (a day where I’m supposed to work 8 hours), I then have to wade through the paperwork generated. So, when Rishi says I’m having a ‘morning off’ what I’m actually doing is sorting out all the work I should have had time to do the previous day. Because I want to be able to write a decent referral onto the orthopaedic team, and not just trot out a ‘Hi, please see this leg, many thanks.’ I also really need to start chipping away at some of those targets we have as GPs, ensure all the coding is in correct order, or we quite literally do not get paid (if you believe GPs mostly get paid for seeing you with a cough and cold, you’d be sadly mistaken). Oh, and yes, it would also be nice to see my children from time to time. Does that make me lazy? Maybe it does, but if that’s the case I sure as hell don’t want to know what it is to work hard. 

To get to this point in my career, I have had to excel at school, get into medical school, fund a 5-year degree that left me with consequent debt extraordinaire, and survive through the sheer hell of junior doctor years. On my first day as a junior doctor covering surgery, I worked a 13-hour day where I didn’t eat, sit down or go to the toilet. I had a drink because some kind nurses thought they should probably look after another rough-looking junior doctor. That night I slept badly, partly worrying if some of the life-changing decisions I made were right, partly from leg and feet cramps from presumably not having had anything but water all day. The next day I get up and do it all over again. 

And what was I paid for that first junior doctor job? A little over £21,000 (2011). Currently junior doctors are being paid an average of £14 an hour. We’ve all read stories similar to mine above, but there are those that still chose to believe Tory and DF bashing that those doctors, and in particular GPs, are all lazy and entitled and don’t deserve to be paid any more money. For anyone who went into GP as a partner 20-30 years ago, life was a lot peachier. But the reality now is many practices are going under and handing back their contracts because they simply cannot stay afloat.  Not long ago I read a DF article about how GPs were all money-grabbing because we were paid to deliver the vaccines. So, it’s now not even good enough that at the time GPs were instrumental in delivering one of the only UK COVID success stories, putting ourselves at personal risk and giving up days of our life to deliver a service that created enormous additional workload. The DF believes we should have done it all for free? But I’m sure they also said we need to have a clap for our efforts, so that’s all ok then – we won’t be able to afford tea, but we will get by with that warm fuzzy feeling of a group clap. 

‘Doctors are arrogant’

I think this feeling needs to be aired as a slightly separate issue. There are some that treat me differently after finding out I’m a doctor. Not that I announce the fact freely – we all know some who take the news as a free ticket to use you as their personal physician. What I’m talking about is the almost extension of the inferior-complex date syndrome – where boys/men feel their self-esteem ebb away on finding out you’re a medic (disclosure that I’ve not experienced this, but I hear it’s a thing). It’s like as a doctor some believe you must know everything and be able to interpret the innermost secrets of your liver from just looking at you and are therefore some kind of intellectual threat. I mean huge spoiler, we don’t know everything, and I need an extensive history, examination and probably bloods and ultrasound before I can tell you much about your liver. 

I have no doubt other professions feel this too, but the problem is with being a public funded service is that those complex feelings of self-driven insecurity are exploited by the powers that be. It makes doctors, especially GPs, easy targets to portray as the arrogant band of millionaires that need taking down a peg or two. I absolutely believe that my job is important, that I deserve to be treated with respect, and that my work should be appropriately valued. But that is true of anyone who puts in a hard day’s work (including historically undervalued and unpaid childcare, but that is a story for a different day). If I ever gave the impression that I believe I was better than anyone I would be mortified, and I know the vast majority of doctors feel the same (save one neurosurgeon I once had the pleasure of assisting in theatre, he was the very advert for arrogance, but he was also short so there was also some short man syndrome going on there). The truth is we live in an economy that judges our work value by way of renumeration. We need to ask ourselves if it is arrogant of junior doctors to want to be paid more than £14 for what they do. Honestly, I think it’s crazy that is even debated. 

‘Sickly immigrants cause NHS bills’

This enrages me. The belief that immigration is to blame for the demand placed on the NHS. If it wasn’t for all these people the NHS would be fine, right? Brexit has given racism a very sad green light. It’s that feeling that as a group we voted for the belief that letting all these pesky immigrants into our pure England and dishing out lots of cash to a bunch of foreigners at the EU (for all those much needed and collectively beneficial causes) were key reasons why our NHS was going down the plug hole. Good on us, we’ve got back our sovereignty, saved our economy and the NHS and put two fingers up to the big man. 

How’s that all going now then? Oh yes, there is if anything less money for the NHS because that Brexit bus promise was a lie. And we are desperately needing qualified healthcare professionals to come work in the UK from abroad – something that many of them, very understandably, stopped doing when the over 65 population decided to screw us all over with votes to leave one of the best things that’s ever happened to the UK. So now we are having to fork out more money to entice qualified professionals over. And partly because we no longer have access to the markets in the same way, we have to pay through the tooth for medicines, and end up with a lot of shortages. There are many studies that show the burden on the NHS from immigrants is no greater than those UK-born, and indeed some clearly show usage is less amongst our immigrant population. Overall EU immigrants have a net positive economic contribution to the UK economy. But Boris and his club of COVID jingle minglers, together with the DF, told us that Brexit would be better for the NHS. And it still makes me quite genuinely sad that too many believed them. 

There are three main reasons why the NHS is struggling with demand: an ageing population, the rise of long-term health conditions and ever-increasing expectations. Unfortunately blaming the EU and throwing shade on doctors is a lot easier than actually dealing with these problems. It’s much easier than dealing with the catastrophe of social care and our broken society. It’s much easier and sexier than funding delivery of proper preventative medicine in primary care – something that would truly bring down the rates of life-limiting, money-draining long term health conditions like Diabetes, heart problems and strokes. And I believe it’s right that everyone should have an expectation to receive good quality health care, but throwing blame at doctors is easier and wins more votes than dealing with the epidemic of Karens demanding that they be seen for their fungal nail infection within the next 2 weeks. Expecting good quality healthcare is one thing, being an entitled Karen threatening to complain if she doesn’t get her nail lacquer is another. 

Before the inception of the NHS many people with any serious health condition had to choose between death or poverty. Analysts think that there was some kind of nostalgia element to the Brexit vote – a yearning for a ‘better time’ before joining the EU. I totally get that many of us hold a candle for our formative years, but the thing is, Mavis, times were not better. Back in the day treatments were very limited, and really nasty stuff like Polio signed a death warrant for many.  And yes, for the good of the planet we need to think long and hard right now about how many more people we want to add to it as a whole. But did you know every single person living in England is descended from immigrants? The first to call themselves English were likely descended from Northern Europeans. So, what are we saying, we only don’t like the types of immigrants who look and sound a bit different? Oh no, because we are also ok with the doctors and nurses who may look and sound different, we need them. I mean, not fully ok, because Mavis still thinks it’s almost a compliment to come out with ‘well, he was Indian…but he was lovely.’ 

Do I support the health care sector strikes? Concluding thoughts

Yes, I absolutely support them. If nothing changes Doctors will not hang around to be devalued. They will continue to leave. Doctors will find other jobs where they can earn lots of money and aren’t an unrelenting target of government and media-driven judgement and abuse. Or they will go to another country where conditions and pay are much better.  And then we all really will be quite screwed. But maybe it will be ok because we will be regressing to the ‘good old days’ where we all have to shell out for any healthcare. I know Karen was probably just a bit confused about the mismatch between what she’s read and her actual experience. But I think we can all help by opening our eyes to what is happening. I’m hopeful the tides will turn, and the outlook may become more positive when the Tories are inevitability booted out. Let’s hope all the junior doctors are still around when that time comes. 

And you don’t need a knight in shining armour girls, but you do deserve one. They thankfully don’t come in the form of necrophilia or puckering up for a smooch though. I think they come more in the form of the guy willing to get up night after night to look after your newborn (shout out to my hubby there!). 

Really interested in your comments and discussion on this one all!

Coping – a skill seldom taught

On By doctorlunnersIn Anxiety, coping, Depression, Doctors, GP, mentalhealth, Mothers, NHSLeave a comment

Today was one of those days. Why do ‘one of those days’ happen? Does one unfortunate blunder happen and someone somewhere decides you’ve now signed up to a day of similar delights? I’m guessing we just notice these delights more. Either way today was one of those days. The highlight was my waving goodbye to 13 years no claims bonus and a wad of maternity pay by reversing into a lovely lady’s car. I then drove to a bodyworks place where the guy did his level best to not judge my lack of knowledge on basic repairs, insurance claims and the registration number or make of my car. One of those gem of conversations where you are fully aware you are doing feminism no favours.

This all got me thinking about how we cope when things are a bit tough and I guess is a follow on from my previous blog on mental health and life-is-tough syndrome. There are a lot of recurring coping strategies that I find come up both in my work and in life in general.

How to cope is never something we are taught, or generally talk about when we are blossoming teens. It’s like filling in a tax return. If we were all taught how to fill in a tax return and how to cope at school I think we’d all be a lot less stressed at the end of January. But no, we have to learn the recorder instead. (Disclosure: I loved playing the recorder).

Obviously how to cope can be a very personal thing, but here goes a stab at what I think are common coping tactics.  

Be kind to yourself

So I drove away from the literal car crash earlier and stopped half way up the road to have a cry about how stupid I am. Yes, it wasn’t my finest moment, but it really wasn’t a disaster, accidents happen and could have been a lot worse and all that. Unless you’re a narcissist (google it, I guarantee you’ll know one), we are all generally very quick to find some kind of fault with what we do. Our automatic reactions are too often full of badness, and moreso when we are generally not feeling great and in huge need of some positive response. I think it’s really important to stop the downhill spiral of negative reaction – par example, today I got from I’m stupid to I’m an awful mother very quickly. We all make mistakes, and life is tough, we shouldn’t be so hard of ourselves. It’s cliché but remembering to be kind to yourself can save you a lot of heartache.

Accept that it’s OK to have bad days

When I follow up patients with Depression I try to explain recovery from a bout of low mood doesn’t mean every day will be better than the last. Recovery will have dips, but over time the general trajectory should be up and the dips should be less black hole-ish. I (hopefully) remember to tell people that it’s good to remember this for life after recovery. It is OK to have bad days. It’s OK to have times when you’re not 100% or you’re not ‘on it’ like yesterday. I think we have a tendency to over analyse crappy days and we catastrophise events that really don’t need the drama label. It all causes us unnecessary stress, and that is never helpful.

Accept that OK is good enough sometimes

I think it’s important to be OK with things just being OK. Now I’m exposed to the mothering world, I’ve seen another example of how people find it difficult to not be excelling all the time. I see mothers anguished by the thought of little Johnny not wearing the gillet that matches the particular outfit Aunt Suze got him, and distraught at the prospect of him missing one swimming lesson (meaning he will ofcourse fail to meet every developmental milestone for at least the next 10 years). It is OK if little Johnny doesn’t have matching socks on for nursery. It is OK if he has one meal that isn’t home cooked from your nurturing mother hands. Little Johnny will survive. And I daresay will probably turn out less weird than if we persist in stressing over the constant necessity of waitrose finest in little Johnny’s life.

Pick your battles

Sometimes OK is good enough. Alot of those times when you need to accept ‘good enough’ will be when you are very aware things could be great, but to get to great involves a lot of effort on your behalf. I’m thinking of those classic work situations. You know that improvement could be made, but is it the right battle for you to take on right now? Lots of things in our lives drain our energy without us really thinking about it. Just getting through a normal day for many of us involves a lot of mental baggage and thought processing. It’s right to take on the battles when you think they are important enough, and you have the battery reserve to do it. But fighting every battle will not end well for you.

Make time for the important and the simple things

Imagine you are 80. You are looking back over the lions share of your life. What will you smile at remembering? What will matter to you? What will you be proud of have done? I’m skating close to the cliché again, but I’m reckoning all these things will have something to do with moments with family, close friends and maybe significant career achievements. This evening my daughter wanted to read The Gruffalo. On the 3rd time of reading, I was DONE with that mouse and his persistent wood strolling. But she wanted it one more time. So we cuddled up and read it a 4th time. And that made my car crash day good again. Make time for the simple things in life. It’s what makes a life a life and not a daily trudge to the time you can watch Love Island again (Disclosure: I have definitely had days where my highlight has been watching Love Island. Shameless).

Be present

Mindfulness. One of those things you’ll have heard of, maybe given a go, decided you felt no better after it so went back to worrying about Little Johnny’s gillet. I went through a phase of trying to do some mindfulness practice regularly. But then busy-ness happens and things fall by the wayside. Like flossing. Flossing and mindfulness, both definitely on the wayside list when things are busy.

But I try to take one thing from mindfulness – I try to be present when I’m doing important things. Like being with my 4 month old. We are sharing a moment where he’s finding the squeaky giraffe-cow type rattle hilarious. I try to enjoy being in that moment rather than let my mind wander to the pile of poop stained leggings from my potty training toddler, or to the grand total of fridge contents standing at one onion and a questionable stick of celery. Yes, both of these things have happened in the last week. I am too aware that being present (including literally) for all the moments you’d like to be isn’t reality, but even when we are super busy doing this once a day should still be achieveable. Being present means you can actually experience (and therefore live) moments, rather than floating from one tesco shop to the next.

Make time to do the things you enjoy

One of the symptoms of Depression is losing interest in things you used to love. I always find this symptom very sad. Feeling like the joy has been taken from you is pretty terrible. One thing we advise patients suffering with this to do is try to keep doing the things they used to love. Because one day it’ll start coming good again. And, although Depression and struggling a bit are very, very different, I do think that too many of us let the things we enjoy go by the wayside. Another thing to add to that wayside list. What we enjoy tends to come bottom of the priority list, because of the very nature of it – it’s what we enjoy, so we see it as an indulgence that we can’t possibly flirt with now we are adults and have responsibilities like not crashing a car. But making time for things you enjoy is hugely important. Again going back to the when-you’re-80 – you’re probably not going to remember that Saturday you dusted the house particularly well. But you may remember making time to read one of the classics. Making time for yourself does not make you selfish. It makes you more robust. It makes you less likely to hit rock bottom.

Be honest

This is a real bugbear for me in this age of social media and my-life-is-so-tremendous posts. Don’t be that person. That person is rarely genuinely happy with themselves, and for some reason gets a kick out of persistent my-life-is-better-than-yours statuses. All these do is make people who feel vulnerable feel worse, and make you (as in the perpetrator of these status irritants) strive to achieve the next ‘like’, as if your very existence needs to be validated by some chuff you’ve befriended online but you see on the 5th of never. I’m not saying don’t ever share goodness, but constant updates is not good for anyone involved. No-one is ever constantly that happy. Same applies for when you catch up with friends. I know I have a tendency to want to portray the beacon of coping motherhood, but it would be more cathartic for me if I was more open about honest. Goes back to the blog on mental health and talking more. Being honest when we talk. That’s key.

Don’t isolate yourself

The honesty with friends thing leads quite nicely into this nugget. Don’t isolate yourself. Again, withdrawing from social times is a common symptoms of Depression. And again I think we can all take something from this. How many times have you had some get together planned but decided 2 hours before that it’s dark and raining and you cannot to bothered to leave the well-bedded corner of your sofa to catch up with Gazza? We’ve all done it. But how many times have you forced yourself out and rolled in from that night out proud of yourself for making the giant leap out of the comfy corner? Many, many times. I’m not suggesting you say yes to every social event (also in my opinion not a healthy thing to do), but it’s important to stay connected, see your friends and family. We rarely feel worse for being round true friends. But we can definitely feel better for it.

Radiators versus Drains

I can’t remember where I first heard it but I wish everyone knew this analogy. Some people are radiators and others are drains. Radiators are those people who shine with positivity. Drains are those people who seem to leave you feeling like all the colour of the world has been sucked out. We spend far too long worrying about supporting the drains. We worry that we have to remain faithful to that person no matter what the cost to ourselves or our mental health. Being around a drain does nothing for any of us. It’s important to choose to spend time with the people who are healthy for us and our mental health. Drains can pull you down their plug hole of coping despair.

Get outdoors

I want to make this my last point. Just recently prescribing the outdoors has become a thing in Scotland. Whilst I think it’s pretty ridiculous we’ve got to the point where ‘the outdoors’ needs to be on a prescription for some people to get outside, it really does show how disconnected we are with the world around us – and how appreciating nature can help our mental health, and help us cope better. Being outside offers so much, yet so many of us will consistently choose to spend our time shuffled away indoors. Next time you feel like you can’t cope try going for a 10 minute walk. I bet there will be a part of you that feels better for it.

Final thoughts

Today I tried to tick off a lot of these coping gems, and now I sit here and realise I don’t feel so bad. It’s still a bad day, but I’m OK with it being a bad day, and that makes it better.

So go easy on yourself, be honest about how you’re doing, see your radiator friends and family and make time for yourself and the simple things in life. You’ll cope with losing your no claims better and your 80 year old self will thank you for it.

Mental Health – more talking, less labeling?

On By doctorlunnersIn Anxiety, Depression, Doctors, GP, Healthcare, mentalhealth, NHS, overdiagnosisLeave a comment

Did anyone know that Dwayne Johnson (you know, ‘the Rock’) has suffered with Depression? Yes ok, maybe you didn’t and maybe you don’t really care (in the nicest way I’m sure). My point is the wrestler is one of a string of celebrities and high profile figures who have put aside their fame and fortune to talk about how mental health has brought them to their knees at one or more points in their life. Money can’t buy happiness and all that. If you don’t know who the Rock is, google him (but also, how do you not know who the Rock is?). Yes, money and muscles do not make you immune to the black hole of Depression.

Depression and Anxiety

I’m going to limit my mental health gambit here to Depression and anxiety. They are ofcourse epic topics in themselves, but what I mean is I’m not going into the psychotic stuff. It’ll get too complicated, and I’ll start needing to remember psychiatry terms like folie à deux. That’s French for the eagle-eyed amongst you. It’s when one person in a relationship has some delusion and the other person in the relationship jumps onboard the same delusion wagon. I nearly went into psychiatry training, but decided my brain felt far to pan-fried with all of the thinking that needs to go into therapy. I feel it’s preferable for you to not be sizzling away at 3am for your career to be sustainable.

How we actually feel

So anyway, the Rock. Let’s start by thinking about some wise Rock words – ‘You’ve got to talk about it, and you’re not alone.’ Excellent and on point, Dwayne. I’m a huge believer we are not good at recognising how we feel, and when we do, we aren’t good at really acknowledging it, and even worse at doing something about it if those feelings aren’t terrific.

Think about it. What do you feel right now? You’re automatic reaction is to almost dismiss the question as being far too simple or touchy-feely. We are used to people asking us ‘hi, how are you?’ as a passing comment as we run to our next social function. And more often than not we ask the question in a way that is geared up towards only being receptive to a positive-and-short-response. How many times have you just said ‘good’ without even thinking about it?

So, what do you feel right now? Happy? Peaceful? Helpless? Angry? Worried? Frightened? Pained? Weary? Interested? Bored? Don’t say bored, throw me a bone.

It’s hard isn’t it? Before we even talk about it, we have to recognise it. We should be able to recognise what we are feeling at any time pretty quickly but we can’t because we don’t think about it enough.

Labels – are they healthy?

Let’s take a peak at what happens further on down the line – when people are diagnosed. When it comes to having a ‘diagnosis’ of Depression and Anxiety I feel that many patients fall into one of two groups – those who want to/are happy to have that label, and those who avoid doctor lunners and her sort at all costs because they don’t want that label, thanks very much. I think the former group mostly feels it’s helpful to have a diagnosis so they are able to have a solid explanation as to why they’ve been feeling so bloody awful.

The more experience I have though, the more I think that labeling people with a diagnosis may not be entirely helpful. And I think that’s true of many conditions – I feel like we have become a bit label-happy in medicine. When we write in your records as GPs we have to ‘code’ what you’ve come in with, or what your condition is. There are some great ones. Like ‘struck by macaw, initial encounter.’ Makes you leaving wanting more that one. Did the macaw return?

Whilst I get why coding needs to happen, and there are times where having a diagnosis is helpful, I do wonder whether our need to have a label in society hasn’t been helpful in recognising and treating the depressed or anxious people who really need help. I wonder if my clinics are seeing too many of the people who are finding life tough but who aren’t actually suffering with Depression or Anxiety, and seeing too few of the people who are definitely in need of help. Let me explain before you accuse me of being an unsympathetic sod.

Berny

Berny (not real, patient confidentiality means I can’t blab about anyone. But great name right? Not enough Bernys in the world) comes in because her boss is giving her grief. She’s taken off a bit too much sick leave and they want a note for the last week of absent Berny. She has three kids and struggles with not finding time for herself. Middle child is having problems at school, and her mum who used to help her out a bit can’t at the moment because she’s broken her leg. And it’s November and it’s raining.

I cannot tell you how many times a week I see a Berny in clinic. And before you say it, I pretty much always feel for Berny. But Berny is suffering with life-being-hard syndrome, and not a mental health condition. There is a big and important difference.

The symptoms

Let’s look at the features of major depression. To be diagnosed with this you need to have had persistent low mood or loss of interest in enjoyment in things you used to love. For at least 2 weeks. This needs to be accompanied by at least three other symptoms, like feeling of worthlessness/inappropriate guilt, no energy and thoughts of death. It’s all pretty intense.

To be diagnosed with a generalised anxiety disorder (there are lots of specific other anxiety disorders, but let’s not get our complicated pants on), you need to have been excessively worrying, and finding it difficult to control that worry for at least 6 months. And other lovely stuff needs to go with this – like persistently feeling on edge, real difficulty concentrating, being irritable or easily fatigued. And there needs to be at least 4 other physical symptoms – like trembling, palpitations, feeling sick or dizzy. Again, it’s all weighty stuff.

Back to Berny

My point is Depression and Anxiety are not life-is-tough syndrome. After a particularly delightful clinic one day I had a chat with a colleague who had a standard Berny consult. When she got round to trotting out the requested sick note, she’d hit a blank. Since writing ‘Life’ down in the reason for work absence is generally frowned upon, she scribbled down a bit of low mood.

I get it, life is tough. And tougher for some more than others I’m sure. I honestly have sympathy for that. And there are definitely times where life-being-tough does tip over into Depression or Anxiety. But in my experience the vast majority of Bernys who rock up in clinic are just needing a good vent, some helpful chats on coping mechanisms, and a standard doctor rant to pass onto their employer who should not be bumping them to their doctors for a sick note for less than 7 days off work.

Unfortunately what actually happens is Berny has a tendency to end up with an inappropriate label of Depression or Anxiety, or both if she’s really lucky. Usually because her symptoms are flirting with possibly ticking off a few diagnosis boxes (some of the criteria like not sleeping has so much grey area they’re a murky winters day), she’s in clinic with same presentation for the 4th time, and her mate Bazza was put on Citalopram so please could she give those bad boys a whirl.

It is my honest opinion that this is all not helpful for Berny. She’s ended up on a drug that isn’t going to fix her social problems.

And this widespread attitude is not helpful for any of us. It is fantastic we are all talking about mental health more, that we are getting better at booting out the I’m-so-weak-for-being-human stigma. But we do not need Depression or Anxiety to be used willy nilly. It devalues using the diagnoses at all. If everyone is labelled with it, when does it all become normal? And on that note, let’s talk about how common these things are.

1 in 4 people

Dwayne said it, you are not alone. 1 in 4 people will have some sort of mental health problem every year. That is a lot of people. Whilst I do wonder if too many Bernys are included in that stat, there are also too many people still not getting the help they desperately need. I can guarantee you now that there is someone you know who you think has life sorted that is suffering from an episode of Depression or Anxiety who hasn’t cashed in on any help yet. After you’ve probably given some thought to who that lucky gem could be, let’s think about why this is.

British stiff upper lip. The old stigma chestnut. The I’m-better-than depression or anxiety. It’s odd, we apparently spend a lot of our time trying to prove our worth or prove to ourselves and others we are ‘better’ is some or all of the ways. It’s exhausting. Why do we do it to ourselves and those people we supposedly call our friends? No-one ever comes out of those conversations feeling good.

Ignoring something that is adversely affecting your daily life is not healthy, and will never end happily. Yes sure it may seem super easy to just ignore this elephant in your head rather than try to deal with it, but Nellie isn’t going anywhere. Despite having some awareness of how awful they feel, some people can’t truly admit that they may have a mental health problem. If Depression was a broken leg, we wouldn’t ignore it and crack on with the hobbling. We’d accept we need to get help. And a bit of plastering.

But Depression and Anxiety are much harder. They don’t have a bone poking out of the leg to convince you something is wrong. They involve having to recognise and admit your feelings. And then talk about them. Yes, I said it boys, you need to talk to about it. Medication can quite literally be a lifesaver in some circumstances, but I see the pills more as a life raft in stormy waters. I know, so much cheese, but it’s the best I’ve got and you’re still reading so pipe down.

The real crux of long-term help with depression and anxiety is in the talking therapies. Medication can get you to the point where you are able to face life, to feel that you’re not so consumed with low mood or worry that you cannot function day to day. But to really address the problems you need to talk it out.

Final thoughts

We all have issues. We all have beliefs that aren’t helpful. And the truth is many, many of us will suffer with a bout of depression or anxiety in our life time. And that is OK. Just like breaking your leg doesn’t make you less of a person, neither does feeling debilitated by worry. What is not ok is ignoring how you are feeling. That and asking Berny to see her GP for a sick note.

The next time you see a friend ask them how they are. In a way that is genuine and ready for a real response. You may be the help they need to figure out better coping mechanisms in our frantic lives, or you may be the person to help them get help for a debilitating mental health problem.

Fat shaming – right or wrong?

On By doctorlunnersIn Body image, GP, Healthcare, NHS, ObesityLeave a comment

When I was in my late teens we jetted off for a sunny trip to wonderful California. Much fun had all round spotting a Grand Canyon and fearing for my life whilst my mother navigated the winding roads of Yosemite National Park. It’s strange what memories stay with you. A few of my most vivid memories from that trip are the sheer number of morbidly obese people and the enormous food portions. I remember sitting in a MacDonalds and have a McFlurry treat – they were twice the size of the ones back in the UK. I ordered a side of potato, and I was dished up a whole jacket potato. As a SIDE dish. Crazy.

Somewhere around then I developed a bit more of an interest in Public Health, and I’m now a strong advocate for prevention rather than cure in GP land. Many of you will know that the UK is doing a fantastic job of playing catch up to the USA with its obesity numbers. Is fat shaming helpful in tackling the problem?

‘Fat Shaming’

The term ‘fat shaming’ has been banded around quite a lot in recent years. My main issue with it is that people who feel discriminated against because of their weight don’t seem to be motivated to drop a few pounds. Infact, there’s a bit of evidence to say it makes us put on weight, do less exercise, or binge on the crisp cupboard.

So it turns out that humiliating someone into doing something may not be great. I don’t think this should come as a huge surprise. But there is a big difference between not humiliating someone and not addressing the problem period.

Health badness

Being overweight or obese has well known health consequences. Stuff like high blood pressure, high cholesterol, type 2 diabetes, fatty liver disease, heart disease, cancer…so much badness, but it feels like just as more evidence gets trotted out about how awful it is, more people are slipping into the high BMIs (body mass index, one of the common ways we measure how your weight is doing.  It’s not infallible but now is not the time to debate its merits. You can check out what your BMI is here).

Do we think these things aren’t going to happen to us? Do we think that medicine can just solve it if they do? Do we think that everyone is a little bit podgy and they’re still standing so it’s ok?

‘Everyone is a bit podgy’

A patient once said to me that she’d never ‘be skinny’ like me. Firstly, thanks, you can come again for calling me skinny. But seriously, at the time I was far from skinny – according to my BMI, I was overweight. I feel like our relationship with weight is so unhealthy now that we’ve seen a shift in what we perceive as normal weight. For some people, what used to be overweight is now largely perceived as normal, and it’s only when you’re quite obviously obese that we start thinking that you may want to shed a few pounds to avoid the old ticker snuffing it.  The risks start going up when you become overweight. That’s BMI over 25.

‘Medicine cannot solve everything’

I don’t think people really consider how bad the health consequences are. Let’s take type 2 diabetes. Getting diabetes isn’t just about the need to take a bit of medication a day, or possibly needing to inject insulin. It’s about the risk of having a heart attack, a stroke, or losing your legs, losing your eye sight, losing the feeling in your fingers. Yes, sure, medicine is great, but they cannot take away the risks associated with having type 2 diabetes. The truth is if you are obese, you risk dying early or suffering from some problem that will mean you won’t be able to run after your grandkids as well or fully enjoy that cracking retirement you had planned. Also just to tip money into the mix, you cost the NHS thousands of pounds if you run into all these diabetes complications. Not wanting to spark a debate about NHS resources and entitlement, just thought it’s worth a mention.

Body image

I just had to go have a breather after bashing out the reality of having type 2 diabetes. Feels harsh saying it how it is. On the subject of harshness, let’s talk about body image and how we agonise daily over how ugly we are.

None of us are immune to it. Let me go back to my reaction to the patient who called me skinny. My automatic reaction was how bloody wonderful that someone thinks I’m thin. We grow up with a constant stream of worth-only-with-attractiveness in our faces. I am very much aware of this now I have a little girl. 9 times out of 10 the first thing someone will say to her is a comment on how she looks. We all do it, me included. From before they can even understand what you’re saying, we are effectively telling our kids be beautiful or be nothing.  And then start the constant media stream. It’s a wonder any of us are sane. Fat shaming plays on our fear of not being beautiful, and therefore not good enough. That’s my other main gripe with it.

Lifestyles

I’m a big believer that most of our lifestyles aren’t super duper for our health in general. Our lives are so busy, we are quick to pick up the easiest thing for lunch, have breakfast on the go, slip into 2 pizza nights a week. I think it would be much better for us to slow up. Accept that you cannot be everywhere, go to every social function, reply to every text within the hour. How great would it be to give yourself time to prioritise and enjoy sourcing some of your food from local places and having time to cook nutritious food? Because that’s what used to happen right? People had to take time over making bread from scratch because they had no option. Now even if we want to make said bread, we feel like we couldn’t possibly because our lives are so busy. And there’s Hovis.

Your weight is a function of how much food you demolish and how much you burn through exercise. My other lifestyle bugbear is how we think about exercise. I was watching a Peppa Pig episode (as is my TV viewing these days) when mummy sheep said to Suzie sheep she’s working today running and jumping at the gym, to which Suzie replied ‘that’s playing, not working mummy.’

It’s sad that a lot of us feel like exercise is another chore we need to do, and that doing it normally involves a trudge to the gym. Getting our weekly 150 minutes moderate exercise (as are the guidelines for adults) can involve so much more than the gym. I mean, fabulous if you love the gym, nothing wrong with that, but there are so many more ways to get your exercise in. In my opinion, walking is fantastic. It also gets you outside and is great for your mental health. There are a load of sports you can get involved in to tick off your exercise goals – cycling, tennis, and, as the NHS website advises, rollerblading. Bit random, not sure how many patients will have dusted their roller boots off and got back on it after seeing that advice, but you never know. There are also lots of things that we can do in our daily lives to get in our exercise – doing the housework, lawn mowing, running around with the kids.

Disclaimer: I’m a member of a gym, I love it, but I also think they tend to create this divide of people-who-can and people-who-can’t. How often do we see obese people in a gym class? I rarely do. How often do we see people who are training for their 5th marathon and standing on their head whilst waiting for the yoga class to start? Regularly. I think gyms could do more to encourage everyone to get moving.

Childhood obesity

I want to say a word on this because having an obviously obese child walking into my clinic is one of the most heart breaking things I see. 1 in 5 of our 10 year olds are obese. Obese. Not overweight, obese.

I find it so sad because we are setting those kids up for a lifetime of health consequences. And then the stats are that their kids are more likely to be obese! 8 in 10 kids who have 2 obese parents will be obese.

We need to do more as parents. I get it, I know it’s hard being bothered to switch off Peppa and get outdoors when you’re so exhausted you wonder why we don’t get to hibernate through winter. But instilling healthy habits in our kids sets them up for life. If we can get them enjoying some form of exercise, whatever it is, they will have that for life and enjoy all the benefits, which include but are not limited to health (talking about things like self esteem – which links back to body image). If we can instill a good, healthy relationship with food, they will be far less likely to hit the walkers crisps every time things are tough in life.

Final thoughts

I say all of this like I’m currently sitting pretty with a normal BMI. I’m not, so huge solidarity if you’re in the same position. After having my second kid I had a stark realisation that I was slipping towards obesity. So I decided to do something about it.

Fat shaming isn’t helpful. But it also isn’t helpful for us to avoid telling people they are overweight. And whether you think being big is beautiful or not, it’s not healthy.

What I think we need is a healthy relationship with our body. And that relationship forms and grows from a young age with the guidance and support of our parents. If how we approach food and exercise is healthy, then I believe a normal body weight would follow.