One of my grandmother’s biggest complaints about immigrants, aside from their big noses and swarthy skin, was their smell.
Muslims everywhere are saying “I told you so” this morning. Continue reading “No alcohol safe to drink, global study confirms – BBC News”
That is not because we worry about the rare diseases we learned at medical school (although this is a well-known problem seen in medical students), but because we don’t worry enough.
As doctors we see thousands of patients with tens of thousands of symptoms, many of which will not have an identifiable cause despite thorough investigation. We call these ‘medically unexplained symptoms’. They don’t worry us too much – we know there is no serious underlying cause, and we know they will not get any worse or threaten our patients’ lives.
So rather than worry that our symptoms are caused by cancer, like many of our patients (especially the ones who check Google before coming to see us), doctors have a tendency to think that our own symptoms will be nothing serious. There are countless stories of doctors who have put off going to see their own GP until it was almost too late.
One of my clinical supervisors had pain in his chest for months. It was not bad enough for him to think it was a heart attack, so he just put it down to stress, or maybe a bit of heartburn. Eventually after the pain worsened and he started to feel feverish, he went off to see his own GP and was diagnosed with pericarditis – inflammation of the sac that surrounds the heart. He was off work for two months after that.
My advice to everyone is to see your GP as soon as possible if any symptom is something which you notice regularly and it bothers you. Even if it doesn’t bother you but it just doesn’t seem quite normal, I would much rather see you early on and tell you that it is nothing serious, than be faced with something that is already well developed and therefore much harder to treat.
I should start by saying that I like my patients – even the ones that are difficult. I don’t want anyone to think that this is just another rant by an arrogant doctor complaining that his patients are hard work. The hardest patients are often the most rewarding.
But my job is busy. Today, for example, I saw 29 patients, visited one at home and had telephone consultations with 4 more. On top of that there were 23 letters, 26 prescription requests and 34 blood results waiting for me when I got into work this morning.
Each one of them takes time and concentration. Some are fairly quick but others take much longer; the number of patients with complex health needs is increasing. At one point this morning I was running half-an-hour behind.
Please don’t misunderstand me, I am not complaining about any of this. I love my job. But that doesn’t mean it isn’t hard.
So much to do, so little time…
In order to do my best for everyone I need to be organised and run roughly to time (a half-an-hour delay isn’t actually that bad).
In a 10-minute consultation, time is tight. Most patients will talk for at least a minute before I can ask any more questions. In the nine that remain, I need to understand the patient’s story, examine them, formulate a diagnosis and management plan, write a prescription and/or request some further investigations, like blood tests and x-rays. I must then communicate all of this with the patient and make sure they understand.
I only have time for one problem
I have lost count of the number of times patients have mentioned another problem, just as I had been about to say goodbye.
It is usually “just one more thing” or “there was something else as well, doctor” asked in a hopeful, sometimes pleading way. The one I can’t stand is “while I’m here” as if I exist entirely for their convenience.
However they say it, my heart sinks. At that point in the consultation I have already mentally moved on to the next patient. The cogs in my head take a second to adjust.
Just tell them to f*** off
I know that there are lots of GPs who will very firmly, even to the verge of rudeness, inform the patient that they can only deal with one problem per consultation, and that they will have to re-book.
There are three reasons that I don’t say that myself:
- I have a natural curiosity in people’s illnesses. Could these new symptoms be related to the ones we had just discussed? If so, then the new information could be the key to making a diagnosis
- On two occasions in my career a patient has said to me, “And another thing doctor: I’ve been getting this heavy pain in my chest that goes into my left arm”. Both patients were having heart attacks.
- I am far too polite for my own good.
So when you next see your GP stick to one problem, book a double appointment or tell them upfront that you have several issues, so at least you can decide together how to approach them. Write a list if that helps you remember.
Limiting the time you spend with your GP will mean that someone else can get a bit more. After all, there is always someone who needs help more than we do.
I suspect that a lot of British people see Muslims as a drain on the NHS, especially in these post-Brexit, post-truth times. It seems to make logical sense that having more people in the country will lead to higher costs for the system, but I would argue that if more people in the country followed some of the teachings of Islam then we could actually ease the pressure on the system. Here are five brief examples but the full list would be considerably longer.
Alcohol costs the NHS hundreds of millions of pounds each year. This figure takes into account both short-term effects such as alcohol-related injuries as well as long-term health conditions such as liver failure. As most Muslims don’t tend to drink alcohol the benefit to the health service is immediate and easy to see. In my career I have only ever seen one alcoholic Muslim, but I have seen hundreds who are white British.
Obesity is the public health epidemic of the 21st century: at least two-thirds of British people are currently overweight or obese, and again the costs are into the billions. For a while it was thought that there was such a thing as “fit but fat” but recent evidence from large medical trials suggests that this is not the case. If someone is overweight but is not diabetic and has a normal high blood pressure, they are still at a higher risk of developing serious cardiovascular diseases such as heart attacks and strokes. If there was a word to sum up Islam, it would be moderation, at this applies to all things – including food. I once hear someone explain that the perfect diet was one-third food, one-third water, and one-third Islam. I have lost count of the number of my patients who don’t seem to understand the link between eating food and gaining weight; they come to me looking for tablets or a gastric band whilst they continue to eat most of their meals from a takeaway. Another aspect of Islam that might help is the practice of intermittent fasting: not eating or drinking anything between sunrise and sunset. This closely resembles the popular 5:2 diet which has been shown to effective.
Unlike alcohol, obesity is a problem that affects Muslims just as much as everyone else. One of the reasons is surely that everyone needs to eat some food to survive, whilst our bodies can thrive happily without ever touching alcohol.
Another obvious one: sexually transmitted infections occur most often in people who have multiple sexual partners and as we all know Islam prohibits sex outside of marriage.
Back pain costs the county billions every year both in direct health care costs well as lost productivity due to sickness absence. Back pain is a topic worthy of its own dedicated post. Some days it feels like every patient I see suffers with it to some degree. There are some ways that Islam could help. Muslim prayer has many similarities to yoga, which most people know can be used to manage back pain. The prescription to pray five times a day ensures that our backs get a good work out. Prayer also has the spiritual element which can help to reset the faulty pain sensing pathways which develop in response to chronic back pain. Psychological therapies and antidepressants are often used to help to manage the anxiety associated with chronic back pain. There is a vicious cycle: patient’s worry because they have low back pain and that worry makes the back pain worse.
Anxiety accounts for a huge number of sick days both directly and by exacerbating other problems worse such as migraine and arthritis. Anxiety stems from our in-built self-preservation system. When we sense danger out bodies release a cocktail of chemicals which enable us to run away faster or fight harder. These days our modern brains are overstimulated by threats such as money worries, relationship problems and work stress to name just a few. These threats don’t need us to make those chemicals in order to deal with them, but our bodies don’t know that and they release them anyway. That is why shaking, sweating, dry mouth, rapid breathing and heart palpitations are associated with anxiety. There are lots of medicines that I can prescribe to counteract some of the symptoms of anxiety but not of them can tackle to root cause and that is why they are often found to be ineffective. The latest NHS recommendation is that cognitive behavioural therapy (CBT) or self-help should be the first line treatment for most people with anxiety. One of the most commonly advised techniques is mindfulness, which helps to detach the body from the mind by focusing the concentration outside of our physical own bodies. All of this seems very similar to prayer to me.
Islam is a religion of communities, and having a supportive, trusted network close at hand is vitally important in most mental health conditions. I have seen too often the elderly patient who spirals into a crisis after the death of their spouse because that person was the only social contact in their lives; without them they become isolated and vulnerable.
I really believe that following Islam can have massive health benefits, both physical and mental and that much of the current demand for healthcare in Britain could be curtailed just by people taking on board some of the simple lessons that it teaches.