Feel Better, Live More with Dr Rangan Chatterjee - #232 Why Disease Isn’t Inevitable with Dr Ayan Panja

Episode Date: January 26, 2022

CAUTION: Please be aware that this podcast contains reference to suicide. Today I’m pleased to welcome back Dr Ayan Panja, who’s a close friend and now a regular podcast guest – as well as an accomplished podcaster himself. He’s a busy NHS GP, brilliant health communicator, and my partner in delivering our RCGP-accredited Prescribing Lifestyle Medicine course to fellow clinicians. We start off the conversation talking about the current challenges that exist for NHS GPs. We talk about the desperate need for more mental health care, and how and why the pandemic has lowered resilience levels in all of us.   Ayan takes us through the Symptom Web which we developed as part of our Prescribing Lifestyle Medicine course, but it’s also a tool we could all start using. It’s about looking at the eight key lifestyle factors that influence health, to help us identify and then address potential issues.   We discuss the bias that exists in modern medicine towards treating acute illnesses, while chronic conditions that build with time go overlooked. But there is so much we can all do to take control of our health and reduce the likelihood of getting sick. We also chat about the recent death of Ayan’s father and share our experiences of grief. We discuss how other people’s reactions can often be surprising, and what they can teach us about how best to help when someone is bereaved. Compassionate listening, we agree, is key – something that’s as important among friends as it is in the doctor-patient relationship.   Ayan also tells me about his own health podcast (called Saving Lives In Slow Motion, which I highly recommend) and the book he’s writing, to empower more people to understand their own health. It’s not published until 2023 but I know it’s going to be a must-read. I really enjoyed chatting with one of my closest friends face-to-face while the mics were running – I hope you enjoyed listening. Thanks to our sponsors:   https://www.leafyard.com/livemore   https://www.blublox.com/livemore   http://www.athleticgreens.com/livemore RCGP Prescribing Lifestyle Medicine course https://www.prescribinglifestylemedicine.org Order Dr Chatterjee's new book Happy Mind, Happy Life: UK version and US & Canada version   Show notes available at https://drchatterjee.com/232 DISCLAIMER: The content in the podcast and on this webpage is not intended to constitute or be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your doctor or qualified health care provider with any questions you have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have heard on the podcast or on my website.

I've never seen so much mental health need in my whole career. The gap that there is now, I think, in terms of the amount of need and how many people are out there that can help is too big a void. We need another solution. Hi, my name is Rangan Chatterjee. Welcome to Feel Better Live More. Welcome to Feel Better Live More. So today on the podcast, I'm really pleased to be speaking to someone who I have known since I was a child. His dad and my dad were very close friends and our families used to hang out a lot when we were young. It is, of course, my good friend and doctor of 23 years, Dr. Ayan Panja. Now, some of you will know that Ayan has been on my podcast several times before,

many times, of course, to interview me around the publication of my previous books. Ayan is a busy in-the-trenches National Health Service GP. He's also a brilliant health communicator. And together, we have co-created the widely acclaimed Prescribing Lifestyle Medicine course that is fully accredited by the Royal College of GPs that we have delivered to thousands of doctors and other healthcare professionals. Recently, we have put that entire course online and opened it up to all healthcare professionals all across the globe. And the link to that course for those of you who are interested in learning more is in the show notes section on my website, as well as the episode description in your podcast app. And we start off the conversation talking about the

current challenges that exist for NHS GPs and the changes to the way surgeries have run since March 2020, which has been really tough for patients and doctors alike. Nowayin shares the reality of his GP workloads. And I think for many people, this may come as a surprise. He talks about the tsunami of mental health problems that he is now seeing and how the past two years have affected the resilience of so many of us. We also talk about something that we have named the symptom web. It is something we teach healthcare professionals as part of our prescribing lifestyle medicine training course, but it's also a tool that we can all use on ourselves. It's basically about looking at the

eight key lifestyle factors that influence health to help us identify and then address potential issues. We also talk about the huge bias that does exist in modern medicine towards treating acute illness, while chronic conditions that build with time often go unmanaged and overlooked. But there is so much that we can all do to take control of our health and reduce the likelihood of getting sick later on in life, whether that be from heart disease, Alzheimer's, cancer, autoimmune disease, and so much more. We also chat about the recent death of Ayan's father. We discuss our own experiences around grief, as well as the importance of compassionate listening. That is just as important among friends and partners as it is in the doctor-patient relationship.

Ayan is one of my closest friends. He's also one of the very best clinicians that I know. I always enjoy catching up with him face to face with the mics running. I hope you enjoy listening. Now, my conversation with Dr. Ian Panter. You mentioned that work is full on. You are right in the trenches as an NHS GP. Why don't you tell us a little bit about that? Because there's a lot in the press in the UK, there's a lot of perceptions that people have on the outside. But what is it really like at the moment, would you say?

Yeah, it's a really good question. And I'm very aware that people get sick of people moaning all the time. And GPs often come across as a group that complain about how hard life is and how hard we work. And of course, you know, on the surface, you know, we're very well paid. And, you know, it's a job like any other. I think what's happened in the last year, year and a half, because of COVID-19, because of lockdowns, because of the way that we've been forced to work in some ways, the amount of activity that comes through to an NHS GP is so much more than it was even a year prior to that. And it's like a hamster wheel. The more work you do, the more work comes in.

You know, it never goes the other way. It's never quiet. And the perception, I think, because it's, you know, we're the closest to patients in some ways patients in some ways, we're not in a hospital environment, it's really difficult to see the risks. I remember there was a doctor that used to work for us whose husband has a hospital job and just could not understand how she was always late home from the practice and said to her, you know, how hard can it be? It's just a list of names on a screen. Completely missing the point that one of those names next to it might have tried to commit suicide yesterday, been seen by mental health, mental health referred back to the GP,

will only speak to Dr X. You know, that's one of about 80 or 90 calls, not calls because you might have to bring them in, obviously, but problems that you have to solve in one day. And that is a challenge, you know, and, you know, my colleagues and I, I think we do the best job that we can. And, you know, even with the most superhuman skills, there is a limit to how much you can do. So it's, you know know and what we see has changed as well i mean mental health um i've never seen so much mental health need in my whole career um and other things these sort of mystery symptoms that have been grumbling along that people put up

with um which we can talk about i mean i you know i i refer to it as evolving autoimmunity but just sort of people who aren't feeling right but like you can't quite put your finger on it and of course the medical model doesn't always work for that because we kind of think well can't really find anything sent you for loads of tests everything's normal carry on you know and so there's a lot more of that um i think everyone has just had such a hard time so i mean two things that really stand out there for me are of course the intense and potentially unmanageable workload really let's be honest right it's the nhs has relied for years on people going above and beyond the call of gc but it does seem to have ramped up massively regarding patients and what you're

seeing a couple of interesting things that you said one is that you have never seen this level of mental health problems coming in um you've been a doctor for what 25 years now is that no yeah not quite that's a long time but yeah 23 knocking on 23 i think yeah yeah okay so so so over 20 years yeah um i think these unexplained symptoms and evolving autoimmunity we should talk about as well but let's just talk about mental health problems what do you mean you've never seen it this bad you know paint a picture for us so not just in terms of stats where you've got you know a million people waiting for mental health treatment. So it's not a statistical thing necessarily, but just in terms of the qualitative nature of why people ring up.

So they may ring up with something physical. And if you, like myself, I think I'm fairly compassionate and I listen and I take the patient seriously and I want to help them. That allows them a bit more space to say, and actually, I'm really sorry, but, you know, I'm just not coping. And a patient I might have known for 10 years who is quite resilient, inverted commas, is suddenly on the edge. And as a doctor, I'm sort of thinking whoa you know if they're struggling then that that's you know you know that sort of thing where you think you know you play your friend at tennis and he's like oh you know my arm's injured and actually can't serve and you think oh actually his arm really must be injured because he's not serving

he'd normally you know beat me six six love six love whatever and it's the same with that you know you a lot of my calibration is on people i've known for quite a while and the ones that normally quite resilient on are not they're struggling so that's at the sort of milder end i'd say but then at the other end in terms of you know there's not a day that goes by on twitter now where there's there's a post about someone who committed suicide and no one knew. I'm sure you see them as well. A lot of them are NHS staff, unfortunately, really, really sad and horrific in a way. And, you know, for someone to get to that point where they no longer want to be here, I mean, you know, we've got to look at ways of making that a kind of never event and the problem is

that the the gap that there is now i think in terms of the amount of need and how many people are out there that can help is is too big a void we need another solution i don't know what that is but i just know what we're doing at the moment is the tip of the iceberg yeah i mean i think it's a massive problem yeah it is and i think the difficulty is the tools that we've always had to deal with whatever mental health issue it is whether it's anxiety depression or um just well-being which is i guess sort of proactive um a lot of those things just aren't working i think because of the environment because of restrictions but not just that we're you know in terms of well-being for example what makes well-being so digressing a bit but on my podcast there's an episode on well-being and i

think people who tuned into it were expecting me to talk about diet and exercise and and movement and actually what i start with is about environment you know if you if you are in a toxic environment say forgetting covid for now but if you are in a toxic relationship or your home environment is not good or your working environment is toxic, it doesn't matter whether you've got the healthiest diet in the world or you run across the South Danes every day, you will not have good wellbeing because, do you know what I mean? It's at a base level. And I think the problem is all of us are in a terrible environment at the moment because we're all going through these incredible, I don't want to use the word unprecedented,

but I've just used it, unprecedented times where our freedoms have been affected. You know, things that you take for granted, like seeing your family or just going to the shops or getting on public transport, suddenly are much harder to do. And we've been ground down. It's been a long haul.

Yeah, it really has. And this kind of pressure is literally creating a cauldron of bubbling mental health problems. Some will blow up now, some will blow up in years or in months, but it's still going on. I mean, would you agree with that? Or do you have a slightly different perspective? No, I do agree with it. And I think the difficulty and why it's so hard to get a handle on it is that you use the word bubbling up, you know, and in terms of language, that's exactly right. And my sort of way of putting that is that all of those things happen in slow motion, whereas COVID is very acute, you know,

and these numbers are very acute. It's like, look, there were X number of infections and X number of deaths, which are horrific stats, you know. So the deaths, you know, every single one kind of affects you, doesn't it, when you look at those numbers? But what's going on here doesn't happen acutely until it does. You know, the suicide, for example, which is an acute, awful event, is the end of the line of this kind of slow motion,

kind of this indolent thing that's going on that you can't really measure and you can't really see. But slowly but surely, a lot of lives are sort of falling apart, you know. And I think that's what makes it so difficult. You kind of need to be aware of, if there was some sort of magical early warning system, like symptoms, you know, which there are for certain conditions, obviously,

but, you know, then we'd be able to kind of take stock of them and possibly do something. But that doesn't sort of exist in medicine. It's not something that we're used to doing, that true kind of prevention. In terms of practical tools, and I know Thorwald just like you, that every case is different, right? So we can't necessarily say for anxiety do this, for depression do this. You know, there are some kind of common things that we know work

but you know we're very aligned in how we look at patients it's very individual it's very personalized to that individual's life and their triggers but in terms of sharing some sort of um practical bits of wisdom what are some of your kind of go-to tips, I guess, when people are struggling with their mental health? Yeah, if we're thinking about mental health, firstly, I totally agree with you. It's whatever it is, whether it's mental health or physical health,

it's all connected, isn't it? The whole thing is just connected up. We are a bunch of biological systems that are continuously intercommunicating. And when they start to malfunction malfunction you start to get symptoms you know and this is what i meant you know i'll come back to mental health in a second but when i was talking about evolving autoimmunity it's one of those you know how people joke about everything falling apart at 40 and that's not normally what they mean by that is i don't know

what's going on doctor you know i just i don don't feel right. I can't digest my food. My joints ache a bit. I'm getting these headaches in the morning. My wife thinks I'm depressed. And increasingly, I realize because that happens to a lot of people, they're all interconnected. Those symptoms are a sign of systemic malfunction. There's something not working correctly for them to get all of these inflammatory symptoms whatever they might be and mental health in some ways is no different i think the difficulty is that we've you know and if you look at you know what you and i teach on on our course the symptom web for example which are the eight kind of factors that give rise to anyone's health at any one point when

it comes to non-communicable disease. So we're not talking about the acute stuff. Non-communicable disease is something that you don't catch from someone else. So we're not talking about COVID-19, for example, but potentially long COVID, which is, you know, something that is established would fit into this framework or joint pains or feeling depressed or having heartburn. You know, these are things that you don't they come from with they arise from within if you like they're not things that you've caught from someone else i guess autoimmune disease autoimmune disease would fit well well into that

and and as you know you know the factors that we look at are you know stress sleep diet movement historical infections which are which i'll come back to, your environment, which you've already talked about, your genes, and then sunlight, which is a sort of a euphemism for vitamin D, but sunlight, probably better to be honest. And actually, if you look at those eight things, and you know, one of the things I've had to do this on myself, and I'm sure you have, I've had to do this several times, and I sure you have. I've had to do this several times and I do it quite often if I'm not feeling right. Something will pop out, you know, and I can tell you that, you know, my health pretty much collapsed when I was 40 and it took me about six months to work out why. And it was using this kind of framework in my head.

And I'll tell you what it was for me. So my daughter wasn't sleeping for about three years. And every night we'd be up almost all night. I had a lot of stress at work. I had a complaint that wasn't really anything to do with me in the end. But it was it was horrific. And I was my stress levels were through the roof. And the other thing is that many years ago, historical infections, I had something called dengue fever, and I was in hospital for two weeks, very, very ill. You were 18, 19 then, is that right? Travelling? That's right, yeah, with my mates Vic and Alex. And anyway, I was very, very poorly. But you forget about these things once you recover. But actually, historical infections, things like glandular fever, for example, they leave a stamp on your immune system. And you'll see that people that you know go on to suffer symptoms like

fatigue often have that kind of story in their background so those three things in my symptom web the historical infection of dengue fever no sleep for two or three years i say no sleep but very little sleep and very high levels of stress were enough to totally upset my system and overnight I literally couldn't think I remember going into Costa Coffee next to my surgery and not being able to order I always have the same thing as well which is a black americano and you know I was staring at this thing thinking my brain's just not working and you know my neck was aching I couldn't sort of literally overnight it was almost like my memory wasn't working. My joints weren't working. I was getting terrible bloating after me. I turned into one of these patients, you know, and the answer wasn't in any kind of medical intervention. It was about making adjustments and changing things in my lifestyle. I know people get annoyed with that phrase, but, you know, in my life, I guess. Yeah.

And what was going on there, you know, for the people who kind of thinking, well, what was wrong with you? You know, and a lot of my friends were like, oh, maybe you're depressed or trying to sort of stick a label on it going, well, maybe you just imagined it all, you know, that whole. I'm like, no, no, I definitely didn't imagine it. And I suspect it was that evolving autoimmunity it was system

malfunction where nothing was working my gut my brain everything was sort of off kilter and all the things that you talk about on your podcast and in your books and you know that i'm going to be talking about in my book which which will come out next year um is really about how you put that right and and you know the framework for that is something that you and i teach um and you know i it's one of those things i wish everyone kind of knew about because you know it works i mean we'll definitely get to the course because lots of people have been asking me for us to talk about it a bit more um that you know the course that we teach doctors and other healthcare professionals.

But I think your story is fascinating. And I think many people listening or watching this will resonate with that. And this phrase of evolving autoimmunity, I think needs a bit of unpacking because there's this kind of thinking in medicine, isn't there, that certainly the way we've been taught and the way much of it is practice is it's very black and white. You either fit into the disease category or you don't. So,

for example, let's take something that, you know, many people have heard of type two diabetes. you know, many people have heard of type 2 diabetes. Okay, when your blood sugar hits a certain mark, let's say on a type of blood test called an HbA1c, let's say at 6.5, for example, you know, we say you have type 2 diabetes. And, you know, 6 to 6.5 is pre-diabetes. So you can go get your blood checked. And if it comes back at 5.9 or 5.7, right, that is often reported as normal. And I think this is a great way for people to understand it. It's like, well, it may be normal, but is it optimal? Is it optimal for you? Right? Maybe your optimal was an HbA1c of five, and maybe it's progressively been going up, and now you're at 5.7. But potentially, if you do nothing, in three years, that may have crept into the pre-diabetic range or the type 2 diabetes range. And we often discharge

people like that. I say we, the profession. And there's many reasons for that. I think it is training. I think it's also the way the system is set up, but that's called normal, right? That is not normal. An HPMNC at 5.9, categorically to me, it is very rare that that is ever a normal result, yet it gets reported as normal. So it's this idea that by the time you get a diagnosis of type 2 diabetes, things were probably starting to go wrong for five, maybe 10 years. We know, let's say Alzheimer's, by the time you get a diagnosis of Alzheimer's disease, that process started at least 30 years ago in your brain. And actually, I think that's where medicine will evolve too. We'll start to pick up these things much earlier on. And I think autoimmunity also fits into that bucket where by the time you get

the diagnosis of, let's say what my dad had, right, lupus, that didn't, he didn't just wake up one morning with lupus. Now there were signals and triggers going into his body for, you know, for many, many years. Some I've touched on before. I've written a lot about this in my next book about what happened to dads. But this was a relatively, with hindsight, a predictable event that this was always going to happen. And I really feel we have to reframe things for the public, for the profession,

in terms of how we look at these things. You either have the disease or you don't. And as you say, maybe had you done nothing at 40, you know, you might have been sitting here now with an autoimmune disease, with a label and a diagnosis. Do you ever think about that? I do, I do. And listening to you say that, I totally agree with you. You know, this sort of idea that you wake up one day with celiac disease or lupus or any, you know, it's never like that, is it? There's something going on, you know, in your immune system way before that. But actually listening to you say that, sometimes what I do, I sort of think, let me just listen to this as though I was the doctor I was before I knew all this. And a lot of medics will be thinking, well, what do you do then?

Even if you do find that it's going to happen, what do you just get them on steroids early on or what? And the difficulty, I think, is that the interventions that seem very soft, like, for example, singing singing there's loads of benefits to singing you know because it sort of activates your vagus nerve for example and the vagus is important for stress management anxiety you know it also years ago i made a short film down in kent about copd chronic obstructive pulmonary disease, and how it actually improves your lung capacity. These are all patients with established disease by singing, yeah, and they were in a choir. It was wonderful. But I think the thing is, there is data on this stuff, but it's not kind of, because it's not a drug, or it's not a kind of intervention that

is going to have grade one evidence, it seems bit a lot of singing is probably a bad example but maybe dietary changes or exercise or sleep for example um we kind of know they're important and the thing that i think you and i try very hard to do is we we everyone sort of knows that those things work but but it's doing it that's quite difficult you know and fitting it into your life and i think i think we very much understand that and you've got to start with where the person's at to make sure that they can just do something you can't do all of it overnight it's very difficult some people do i remember a friend of mine he shall remain nameless he bought a stop smoking book very very

popular probably the best stop smoking book of all time and had read the whole thing in like 40 minutes and then rang me up and went i'm still smoking and i'm like you just tried too hot just just slow down you know and the problem is a lot of people have that attitude towards health and i think i think this sort of early warning you know these early warning signs it's about taking note of them and then slowly making some changes to see if they help. And also there's an inevitability in medicine. I think some medics that I know would be like, well, you're going to get it anyway. I mean, what's the point? There's that sort of attitude, which I don't buy.

Well, if you get in early enough, and even when you have crossed, let's say, the threshold, often you can turn it around, right? Often it isn't, oh, you're in the disease club now, you have to stay there. It's just not true. I wasn't taught this at medical school. I had to go out, learn it, like you, with our own interest. And, you know, I'm delighted that we have put it together for people in our course prescribing lifestyle medicine. You know, what's your take on the course? Because,

you know, it's hard for us to talk about it like this, but look, the feedback is just incredible. We've had, well, maybe over 2,000 people now do the course. You know, feedback is incredible. I think 95% of people say they're highly satisfied. Over 90%, I think, have said it has significantly changed the way they practice. And we're talking about initially, yeah, GPs. Many hospital specialists have come. I know there's been a psychiatrist, endocrinologists, cardiologists.

And now we're sort of expanding out i know i'm incredibly proud of the course um tell me about it from your perspective yeah i mean it's it was it was a bit of a i remember when we first did it in 2017 it was we didn't really know what to expect. And then we got this amazing kind of reception because there was clearly this gap that you and I had kind of known about for a while and other people had been sort of feeling it. And then as soon as that first course went out, we thought, wow, you know,

there's definitely something in this because people are coming back with so many success stories and just, you know, and me too too I'm extremely proud of it it's been we've sort of revamped it somewhat haven't we and it's sort of it's been updated and it's been kind of put online because obviously we used to do it face to face I mean we love doing it face to face you know what three four times a year we do it face to face maybe 200 250 people there we could talk to them. We could interact with them. That was great. And I hope we can do something like that again soon.

But, you know, we have converted it online. Yeah, yeah. And we can now have people from anywhere in the world doing it, which is fantastic. Which is amazing. And we, I mean, it's the same content, isn't it? As in, like, you know, you still get exactly what you would get because we filmed it here, didn't we?

Sort of down the road. And I think just going back to what you were saying about type 2 diabetes. So nowadays it's very common parlance in the world of medicine and well-being and the public that low-carbohydrate diets are helpful in type 2 diabetes. And I think you do a diabetes case on the course, um, you know, and it's a really, really brilliant moment for me because, um, a, you, you approach it from a different angle and B you realize that the case that you picked was a guy who was already on a low-carb diet and it wasn't working. And suddenly, going back to the symptom web,

he realised that there were other things going on in his routine that were driving his blood glucose up. It wasn't to do with what he was eating. Actually, he was so focused on his diet that that in itself was becoming stressful and that stress was actually driving his blood sugar. And you see this a lot, right? And I'm always trying to stand back and look at the big picture. When we think of lifestyle, food is something that gets a lot of attention for good

reason. Food is a very, very important factor, but it's not the only one. And it's not always the lever that needs turning. But I'm always thinking about lifestyle with my patients. I'm always thinking about what is it in their lifestyle, in their environment, in their past history, in their childhood experiences that may be contributing to the person that I'm seeing in front of me today. And then when you look at that, there's always a whole range of different ways that you can approach it. And, you know, I've tried various methods over the years and I feel I don't always get it right first time, but I kind of feel like I get a really good feel now of what is the key lever to turn that by default will correct

another three or four things straight away. So instead of trying four or five different things, what is the one thing I can turn? So let's say sleep, for example, people who are struggling with blood sugar, whether that is for type two diabetes or for something else. And many people have blood sugar ups and downs. Yes, the diet helps. I'm not saying it doesn't, but I think a lot of people don't realize that, you know, sleep deprivation will drive your blood sugar up. Being stressed, you know, your blood sugar going up is a perfectly normal response to stress, right? It helps you in that acute situation to mobilize energy and do what you need to do to get out of that stressful situation. But if that acute stress becomes

chronic stress, if it's your, you know, we're talking about the state of the world at the moment, right? If you're experiencing this low grade chronic day-to-day stress, well, for some people, that is why your blood sugar is elevated and i think that's what we do really well on the course is bring the big picture to people and i've got to be honest i think it is rather unique what we teach i guess it's not really a course right it's um we teach people a framework on how they can apply it. And I think that's why clinicians really, really love it. Because it's not just hearing, oh, I could do this. We're like, you could do a million things, right? Here's, as you mentioned, the symptom web. And then we

create something called the personal framework where people can actually, it actually spits out the lifestyle prescription for you. And, you know, it took us months to kind of come up with that. There's a real deceptive simplicity to it. But I think that's because people can learn. They can listen to, let's say, my podcast or your podcast. They can read books. They can learn about things. But it's then, well, how do you put it together for that individual?

And I'll be honest, one of the things I love, yes, I love that these know go on and then they help their patients or their clients I also love that the feedback we get is that they figured out how to sort their own health out as well there's a lot of that isn't there like I did the symptom well myself and now yeah there's my joint pain's gone or my mood is better. And in some ways, I actually think that's super important to do it on yourself because once you see the power, you're kind of sort of really invested. Do you know what I mean? I mean, what are your reflections on that?

Oh, yeah, completely. I mean, I think you and I are sort of living proof of that in some way. But, yeah, it's the most powerful thing isn't it where if you've experienced something yourself and you you you can feel that it works it and part of it is is what i was saying earlier on is that although all the studies that we sort of present and all of the science is evidence-based actually what, what this framework is, there's no sort of, although we are in the new product,

actually we're collecting data, aren't we? Which will show that it works, I guess. But yeah, it's a magic moment when they sort of think, hang on, it actually works. You know, I've just actually tried these things. And one of the things, again, one of the things that we teach the things i that we teach is is is

how to get that info out and this thing about understanding what someone's typical day is like is really important isn't it you know and often often there's not a week that goes by that i don't do this clinically you know in terms of consulting i'll often say tell me about your typical day because then you'll get a really good snapshot of that person's life. You know, like, you know, they might eat all their meals standing up. Well, no wonder you've got heartburn, you know, that sort of thing. As I'm hearing that, Ian, because I'm conscious that not everyone who listens to the show, but I say not everyone, the majority of people who listen are not healthcare professionals.

But I think that's a really key point there, there which is what is a typical day like for you now yeah we can ask our patient that to try and build up a snapshot but like everyone who's listening to this right now could try that exercise on themselves couldn't they yeah like they could try and honestly go not like your best day where you're living your best life, but what is a typical Tuesday like, right? How does it roll? And actually, I don't know what you'd say, I'd say write it down, right? Instead of just going in your head, yeah, sort of like get ready, have my breakfast, I drop the kids at school. No, no, no. I think people should write it down and go, okay, step by step, what do I do? I wake up, every little piece, what do i do i wake up every little piece what do i do you know how do you eat are you standing up are you rushing around are you having your your toast in the car whilst you're dropping the kit you know because people could sort of do it to themselves yeah

and you have to sort of watch yourself from the outside almost it's it's quite it's do you know what i mean you can't when you're when you're yeah it's kind of journaling right that's what journaling is it's like you stepping outside your life and looking in on it or that's one aspect of it you could journal your own typical day I like that

I hope people do that it's funny something random happened this morning which is only the second time it's happened to me in the last 20 years, I think. Just taking a quick break to give a shout out to AG1, one of the sponsors of today's show. Now, if you're looking for something at this time of year to kickstart your health, I'd highly recommend that you consider AG1. AG1 has been in my own life for over five years now. It's a science-driven daily health

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Usually, they offer my listeners a one year supply of vitamin D and K2 and five free travel packs with their first order. But until the end of January, they are doubling the five free travel packs with their first order. But until the end of January, they are doubling the five free travel packs to 10. And these packs are perfect for keeping in your backpack, office, or car. If you want to take advantage of this limited time offer, all you have to do is go to drinkag1.com forward slash live more. That's drinkag1.com forward slash live more. So I'm generally not an anxious person, I wouldn't say. So unlike some of my friends or family members, you know, I'm not sort of hardwired to be anxious i'm pretty laid back and um i was in a in a rush to get here and so i i rushed onto the train

i had to kind of run down the platform because i thought it said platform four and it was 14 so i went you know euston station it's quite, and it was like, I don't know, one minute before it left or something. So heart rate was quite up anyway. Went into this, into the carriage. And I'd sort of asked, when I booked the seats, I never actually sit in the booked seats normally, but I thought I would do some work. And I wanted one of those table seats, you know,

where your laptop plugs in and stuff. Anyway, I got there and there was an elderly couple sat there and I thought well I'll just leave them there but the train was quite busy and really hot and I suddenly thought I feel really claustrophobic I think I'm gonna have a panic attack and it happened once before when you know when in winter months where there's one train every two hours, and we, this was pre-COVID, we were sort of totally crammed in. And I remember thinking, oh my God, I can't breathe, you know, that sort of feeling. I'm sure a lot of people relate to it. So what I'd done years ago is I'd learned how to do these exercises, just because I, not because I need them particularly myself, but I can,

you know, tell other people about it. And one of them is this thing called anchoring, where you build a state. So say you sort of do a relaxation exercise for five minutes and you want to kind of mark it. You can pinch your earlobe like this. And if you do it every day for five minutes and keep pinching your earlobe at the end, after a while, you can just pinch your earlobe and a swathe of calm comes over you. It's just like conditioning in some ways so this morning i was thinking how you know because if you if you think too much about that feeling of your racing heart and the fact that you're feeling hot and bothered you suddenly want to just get out you know these people like who go on flights and

trains and i don't get that that this is like the second time i've only the second time i've had it in as i say in 20 years. And I sort of thought, what can I do to get my vagal tone up really quickly? So I generally always carry a bottle of water. So drinking water does it. I pinched my earlobe. I suddenly slowed my breathing down and I started sort of humming. It sounds ridiculous this, but all four of those things increase your vagal tone which is the nerve that kind of calms you down it's the opposite of flight or flight and within 30 or 40 seconds i felt fine that's not something that you teach on a course but the point is the science about the vagus nerve is out

there everyone knows what you what you have to do and i guess you know i do this one minute sort of meditation twice a day when i get to work in the car i do it before i go into work so that i'm ready for the day and then i do it sort of in the driveway when i pull up at the end of the day just so that i'm ready you know you're not taking the doctor's bag into the house and so i'm already slightly wired to be able to do those things so it's very easy for me to do but it's just an example of how you know you know is that a lifestyle intervention i don't know but it's it's sort of it's what i'm saying is there is some there's lots of thinking behind it but once you sort of start doing these things they become

second nature and easy i'm not saying it's a cure for panic attacks i'm just saying there are things that that can be done it's it's a great example of many things. I think self-empowerment is one of them, which is, you know, you've invested time in your life to understand what kind of tools you can take around with you in life in your back pocket, right? So what I love about those tools is that they didn't require you to have brought something with you in

your backpack yes okay the water okay the water but you know it wasn't it wasn't so onerous that let's say you didn't have the water there right because a lot of these things are a threshold effect aren't they it's not that one thing in isolation is always going to do the job but add two or three of them in together exactly and you start to get that impact and it depending on the level of stress and um i guess agitation or anxiety you know it will depend on how much how many interventions you need to use but i love that that you know pinching your ear free accessible you know a breathwork practice free accessible you happen to have water with you and humming right these are that is lifestyle medicine right that is wellness and i think it

beautifully illustrates the the art and science of medicine but i guess expanding that further the art and science of wellness yeah Yeah, I think you're right. I was sort of thinking, what would I do if I saw someone having a panic attack? You know, because sometimes you sort of think, as a doctor, what would I do if there was a person sitting next to me going through the same thing? And I think I would do the same for that. You know, sometimes I had someone come around to look at our house recently because it's bits are falling apart and it needs a bit of work and i said to him i said i want you to sort of think of this as sort of your house like what

would you what would you do if you know you had to i don't know fix this bit of wall or build a barbecue area whatever it is And it's the same. I'm very much like that with interventions. You know, I think something that's going to sort of almost help anyone because all of those things, you're right, they're kind of free. And, you know, we know the science will sort of work. You know, why it works is different. So some people will drink the water and think, oh, my mouth's dry. And now my mouth's not dry dry I wasn't thinking that actually but a lot of people having panic attacks would get

you know some relief from the water for that reason but so it's um it was just an interesting one because it happened today I just thought I'd mention it you know following that up then so that would have been I guess three or four hours ago, we could almost plot out what might your morning have looked like had you not had access to those things. So, you know, I don't know if you're up for that thought experiment, but let's say you weren't aware of humming, breathwork practice, pinching your ear and drinking water

as a way of trying to manipulate your vagal tone the only other way out is to get off the train i would i would literally have because you're sort of you know that you get something called hyper vigilance don't you with panic where the more you think about it the worse it gets and then you think i've got to get off i've got to get off i've got to get off this plane or train or whatever that's very common as well you know and as you talk about as we talk about the course as you talk about what you did on the train this morning like it just brings up for me that there's other concepts around lifestyle and not sure lifestyle is always the best term as you say because it really as you say it's it's it's using your life as medicine you know life medicine

might be better medicine better monica than um lifestyle medicine but yeah yeah it's something that i've discussed actually with gareth a videographer who's normally filming um he's never quite got the term lifestyle medicine we we speak about a lot he goes it's kind of like your life really isn't it rather than lifestyle and it's it's just interesting how we talk about these things but you know through the conventional lens of what lifestyle means to a lot of people, I would say, people understand this concept that lifestyle can be prevention, right? If I look after myself, let's take these four pillars, food, movement, sleep and relaxation. If I pay attention to those four areas, I'm going to hopefully reduce the likelihood that I'm going to get, you know, a heart attack, Alzheimer's,

even some forms of cancer, right? We know that our lifestyle plays a role in prevention. But what I've always tried to do in my public facing work, but also with patients, frankly, is really help people understand it ain't just prevention, right? It can also be treatment when you have got symptoms, right? You can use Lysol as treatment and you can also use it to reverse things. You know, we mentioned evolving autoimmunity a few times where we see people along that continuum where if we don't intervene, actually, if we don't help educate them in terms of how they can manipulate their lifestyle to influence their health, they might in two or three years end up with a more serious condition. And I kind of really still don't feel that is,

even when I talk to doctors, I still think we're missing that piece that it's not, oh yeah, prevention is better than cure, prevention is better than, okay, sure, I don't disagree with that, prevention is better than cure, but it ain't just prevention, right? You know, managing your stress levels better changes your biology, it changes your blood sugar levels, it changes your genetic. It changes your blood sugar levels. It changes your genetic expression. It changes how inflamed you are, right? So these kind of simple practices, breath work, coming, whatever,

they change your biology. Yeah, I mean, it's definitely shifted. If you look at every kind of guideline and every kind of, you know, if you look at NICE of guideline and every kind of you know if you look at nice guidance for example everything is always about earlier and earlier detection for things you know whether it's you know cognitive decline becoming a particular type of dementia you know oh we must sort of screen for this and pick it up earlier great but you know what are we going to do about it you know that that's the the conundrum isn't, oh, you've got altered bowel habit.

Oh, well, NG12, whatever guidance says you need this test. But then often they come back normal, but the person's still got symptoms. And so it's a bit, the intention is right. It's brilliant. But that's going on at that end. But then there's this sort of as i say as i said and you were saying bubbling up in terms of mental health but in slow motion there's this sort of growing army of people who who are sort of becoming ill you know as time goes on

sort of invisibly and it's not to you know not to scare people at all but but there are sort of things and i'm you know i'm a moderates i'm not someone who is perfect i'm no angel i you know as you know i probably you know i like a drink and you know all that sort of stuff you know but there's got to be some sort of counterbalance you know but if for example i say i like a drink but if there was something in my health that i thought you know what i really i really mustn't drink alcohol you know because it makes the difference between me dying in a year and in 20 years i'd give it up you know and i think i think that's do you know what i mean there's a sort of you know everyone's individual

and everyone's got their reasons for why they do what they do and i'm very aware of that you can't just you know habits are difficult to change aren't they as we know you mentioned habits you said at the start of the conversation how work is really really tough maybe about as tough as you've known it you're saying that you've never seen it this bad with patients in terms of the general mental well-being of your practice population and I guess the wider population as a whole on top of that you've obviously had a very difficult year um your dad died this year how has that been for you yeah really really tough I mean it was not really expected and I think I think there are lots of things that go through my mind you know he was 79 sort of not

far off 80 recently it would have been my parents 50th wedding anniversary so it was sort of you know it was one of those things and dad always used to kind of feel rightly or wrongly that his luck wasn't great and and he'd be sort of laughing now thinking oh typical i didn't make it to 80 and i didn't you know sort of you know this is just classic you know what was written sort of thing and um he's actually fairly well sort of person up until you know the point where he needed a knee replacement went in for this knee replacement, having mustered up the courage after like 10 years of almost needing it and sort of walking around with this funny limp,

but was cognitively really very well and then suddenly came out of hospital and was delirious, you know, which, you know, if you don't know what delirium is, it's a bit like acute confusion, you know, just getting up in the middle of the night, wandering around, not knowing where he was, you know. We didn't really know why. And it turned out that his blood sodium was low.

And ultimately, he actually had a lymphoma that hadn't been sort of picked up by anyone. And it didn't last more than six weeks and sort of, you know. And I think, you know, that's just the sort of the what, you know, the very clinical what happened. But what's weird about grief, I think, you know, nothing. I mean, we knew at one point, look, he probably wasn't going to come out of hospital because the longer you're in hospital getting kind of inpatient care, the worse your outcomes are likely to be when you're that age and you're sort of, they don't really know what's going on.

And it takes so much time with tests to find out what the underlying cause is for these things and um yeah i i i've got lots of reflections on the grief i guess the first thing is i was very lucky because i got to see him before he died and all the stuff i wanted to sort of say to him i was able to and i know a lot of people don't get to do that because there's a sudden death you know and you're far away and you think oh you know I never got to say this or that so you were quite lucky with that weren't you because you were away on holiday I was it was the first time we dared to go away for you know over two years because of what's been going on in the world and um we we only went to sort of Gibraltar because it was close and i knew if anything

happened i could get back but he he was i'd been to see him a couple of days before we were going and he was improving so i thought well actually looks a lot better but then a day into the holiday he just totally crashed which is like a medical term for just you know became very ill uh suddenly and i i knew i had to come back so then he only lasted a day after that so i we did the right thing coming back it was very very stressful but um you know and i there's just so much to do isn't there i know you've been through this but in terms of filling out forms and probate and telling people you have to sort of ring all of his friends and what one of the things that sort of not annoyed me but i found difficult was this you know a lot of that we've got mutual

uncles haven't we sort of as in like you know they're not sort of biological uncles but they're kind of part of that bengali community they're all nice very nice people but two things really one is a lot of people don't know what to say when someone's bereaved and they're kind of looking for an out in the conversation because it's quite awkward and the second one is this oh be strong for your mum you know which i totally get what they mean because they've probably been through this themselves but after a while i was thinking hang on what about what about what about me and my grief you know if i'm going to constantly be strong for you know there's an element of that and and and also some people who i wasn't expecting to be that supportive you know outside close friends were

were amazing and then other people who i was expecting a bit more from would were useless and i think that's another common thing because I say useless, I wasn't expecting, you know, anything apart from just sort of a phone call or something, but I think it's fear of not knowing what to say. You know, there's an element of that. And it's been weird. Nothing prepares you for it, you know. And I know the thing is a lot of people thinking, you know,

what was your dad and he was old and he passed away what's the big deal um but it's when it's the only sort of grief you've experienced that's your experience I can't imagine what it's like losing a child or a you know or sort of a sudden death that's unexpected at least this was sort of we knew it was coming but it's still it's tough it's much harder than i thought it would be is this your first like not as a doctor but on a personal level is this your first real experience of grief yes it is i mean as a as a doctor i've sort of helped be there for patients when they've been through it but never experienced it and so you're you're kind of trying to empathize and what i never used to get was occasionally my mum or and and some of my patients as well would get very very sad many years after losing their loved one do

you know what i mean by this you know and and not not because it was the anniversary or anything but they'd suddenly get a thought about dad or mom or the person they'd lost and become very sad. And I never, when I was much younger, I never used to get that going, well, I'm like, mom, it was like 20 years ago since, you know, Nana died or whatever, you know, her dad died. And she'd be like, oh no, I'm just feeling very sad.

I'm really missing him. And I didn't quite, do you know what I mean? When you're immature, you don't quite understand why that's the case, but it's the finality of it and the permanence where you suddenly think you know you take these things for granted like oh dad will sort that out or dad will know this and you can't just suddenly ring them I think on the flip side there's something about you know I don't know whether you feel this, but I sort of feel that, you know, dad's kind of always with me now and I don't have to kind of worry about him, you know, getting old or whatever.

In a way, I think about him more now that he's not around. It's interesting. You mentioned that a lot of people were looking for a way out of the conversation, because there is this general discomfort. I remember chatting to Julia Samuel, this amazing psychotherapist who came on the show, I think in September 2020. So almost a year and a half ago, we spoke, we had a great conversation. But towards the end of it, we were chatting about death. And we were talking about the language that we use around death, and how often we soften

our language to just sort of remove ourselves from it like you have lost someone and julia was very clear that she thinks that's problematic um because it keeps a distance between us and what's actually happened it's not allowing us to confront it and really deal with it and since that conversation i've been very intentional about not using that term, you've lost someone. So I didn't say to you, you lost your dad this year, which is how I might have said it. Like he's gone missing at Brent Cross or something. Exactly. I said, your dad died this year because that's what happened. Yeah. It's a fact.

It's a fact. And I think we do this a lot don't we and i think there is a discomfort and um one thing you said to me you know i called you pretty regularly i think in the immediate month or so and i remember you once were reflecting to me and you said you know you said something to this effect that I'm kind of getting the feeling that you never, you don't really grow up until you lose a parent. Was that what you said? You know, maybe you could clarify what it was and what exactly do you mean by that? Yeah, I know exactly when you mean and what you mean and what it was i think it was we'd spent a lot of time in the in the family home which was sort of in the process of selling now

but um and we were i was looking through lots of old stuff and and and i remember thinking god's like sort of getting rid of my childhood this is you know i've spent you know my i think my parents were in that house for 38 years. And I suddenly realized it wasn't really the object so much. It was more that, you know, losing a parent is like the final piece of becoming a proper grown up, I think, is what I probably would have said to you. You know, that feeling of, right, the buck stops with me now. feeling of right the buck stops with me now you know it's like you know in terms of being a not not like a family representative in an old-fashioned way but it's like there's no one sort of higher up to kind of ask or you know it's like oh is it okay you know and suddenly decision making and all of those things fall to you yeah i of course, everyone's experience of death is different, right?

So everyone's got the right to view it the way they want to see it. But I've thought a lot about that since you said it. And I don't know if it's true for everyone, of course. I really do think there's something to that. For some of us, I don't think we do grow up until we've lost a parent that was definitely true for me suddenly it's like okay it's you now it's not and I don't think I was even intentionally or unintentionally living in dad's shadow I really don't think it was that I don't think it's as as linear as that there's just something about it where as you say

the book now stops with you do you know what I mean yeah do you still feel that way now a few months on from saying that yeah I do I do I think it's what's even more ridiculous is I'm very conscious of that being a thing and I do feel that um but you you know I don't I don't think I've actually had that much time to grieve it's just been such a relentless year and we've just not stopped and so you know I've got a bit of time off coming up and I think it might sort of hit me I'm not even sure it's really hit me I haven't been able to chew it down I haven't had any sort of bereavement counselling all the things I would suggest to patients but I've had a lot of great

support, you know, from yourself and other friends and family. So, you know, and, you know, I hate these cliches, but you sort of sometimes, dad wasn't very sentimental. And so a lot of the other, the other funny thing is I sort of, I'm sure you get this as well. I sort of know exactly what my dad would say if he were here for example and that's quite nice you know you can predict almost what you know and that's what i mean they're always with you you know what i mean it's like yeah i know what you know i need some advice what would dad what would dad say and what would dad do there's an element of that and so yeah i haven't really taken stock of it i think i've just kept we've kept going there's been lots of other things to do like you know moving you know well that kind of speaks to something you said earlier which is

that often it blows up a few years later people suddenly experience real grief later now there's many reasons for that one of the reasons in my experience is that it wasn't fully processed and life got in the way as you're saying you are a busy busy nhs gp you've got two young kids you know your wife works um you've gone back into work and i know what your work days look like. They're pretty insane. We need time to grieve. We need time, you know, even beyond grief, right? We need time to understand our emotions. I honestly feel this is one of the this is one of the biggest wellbeing problems with people these days is the ease with which we can distract ourselves.

So therefore, because we can distract ourselves, we do, and therefore we don't lean into the pain, we don't sit with the pain, we don't understand what that pain is trying to tell us because it's much easier to have a beer glass of wine you know spend a couple of hours scrolling and i say that with no judgment and criticism at all i get the temptation do you think your experience this year has made you better able to counsel patients who are dealing with grief?

I think possibly in the way that all the things I've just mentioned now, in terms of my own feelings, you can now preempt and kind of understand when someone goes well you know my brother's being really difficult and my sister's just not talking to me because those sort of things happen as well because it's very stressful you know very stressful for everyone and everyone's processing things differently um and there are going to be potentially in families arguments and you know know, just about arrangements and who's doing what. And, and although we never had any of that, but I think, you know, being able to just say, Oh, you know, Hey, you know, some people just don't know how

to deal with grief. Don't worry just because your best friend hasn't rung, you know, that sort of thing gives them some context. So I think I'm certainly certainly i'm no grief counselor and and you know i'm not qualified to do that but i think just being supportive and compassionate and just listening sometimes you you need an extra you know someone outside of that immediate family to just be able to let off steam to um so so i think i'd like to think so yeah i think that's one of our main roles as healthcare professionals actually in terms of certainly in primary primary care in general practice i think being able to be a good listener with your words but with your body language as well I think it's one

of the most powerful forms of medicine we can give people because often they don't have it in their own life and often there's too much baggage and history with immediate family to have that kind of non-judgmental listening and I think this is again something that we do touch on in our course but it's something i didn't learn at medical school i have learnt i'm interested in your reflections on this but i i've learned that me being able to listen with compassion with empathy without judgment is medicine in and of itself Sometimes that is all you need to do. And someone can almost use you as their sounding board that's not sort of pushing back at them,

but they kind of process what's going on just because we provided the space for that. I don't know, what's your perspective on that? Yeah. Before we get back to this week's episode, I just wanted to let you know that I am doing my very first national UK theatre tour. I am planning a really special evening where I share how you can break free from the habits that are holding you back and make meaningful changes in your life that truly last. It is called the Thrive Tour. Be the architect of your health and happiness. So many people tell me that health feels really complicated, but it really doesn't need to be. In my live event, I'm going to simplify health and together we're going to learn the skill of happiness, the secrets to optimal health,

how to break free from the habits that are holding you back in your life, and I'm going to teach you how to make changes that actually last. Sound good? All you have to do is go to drchatterjee.com forward slash tour and I can't wait to see you there. This episode is also brought to you by the Three Question Journal, the journal that I designed and created in partnership with Intelligent Change. Now, journaling is something that I've been recommending to my patients for years. It can help improve sleep, lead to better decision making, and reduce symptoms of anxiety and depression. It's also been shown to decrease emotional stress,

make it easier to turn new behaviours into long-term habits and improve our relationships. There are of course many different ways to journal and as with most things it's important that you find the method that works best for you. One method that you may want to consider is the one that I outline in the three question journal. In it, you will find a really simple and structured way of answering the three most impactful questions I believe that we can all ask ourselves every morning and every evening. Answering these questions will take you less than five minutes, but the practice of answering them regularly will be transformative. Since the journal was published in January,

I have received hundreds of messages from people telling me how much it has helped them and how much more in control of their lives they now feel. Now, if you already have a journal or you don't actually want to buy a journal, that is completely fine. I go through in detail all of the questions within the three question journal completely free on episode 413 of this podcast. But if you are keen to check it

out, all you have to do is go to drchatterjee.com forward slash journal or click on the link in your podcast app. I really do. I mean, recently, one of my ex-partners who's retired, we were meant to be having his retirement party just before COVID lockdown one hit. And now, sort of two years later, we only got around to having it quite recently when things unlocked a bit and um so it's long overdue and he was a a gp cut from this cloth what exactly what you're talking about and i i would say i am as well um but what what mark was

very good at doing is that his patients a lot of of his patients just, you know, you could say they were dependent on him, but he was just very, very, very good. And I sat, you know, I sat in with him. I remember when I first started at the practice for the, you know, for a week or two, and often he wouldn't say anything. He would literally just sit there and kind of nod, but in a very kind way. just sit there and kind of nod but in a very kind way and i remember making a speech at his retirement just just off the cuff going you know there's lots of different types of doctors in this room you know there's some that are good at managing people there are some that are good at ticking boxes but mark's the kind of doctor that changes people's lives and and and he he did you know if you listen to the kind of stories that his patients tell you,

they'll go, yeah, I couldn't have got through the last 25 years without him. But if you're looking very clinically at, well, hang on a minute, if you're using the lens that unfortunately now modern medicine has to because we're so busy, that kind of medicine has been totally eroded. We don't get the time to do that it's really sad and some patients do need that continuity because you keep them going because and often they'll have enormous amounts of trauma in their in their life story which is why they need yeah compassion um and actually the medical model doesn't work it's like well and the problem

with now that we're having i think in general practice is because because there aren't enough gps um they're carving out bits of our work going oh we'll chuck a physio in and a pharmacist who are all great that's brilliant but people don't sort of work in bits you need someone to kind of do you know what i mean but a lot of doctors do think that's the way that it works. It's like, well, you can just, you know, mental health, just book them straight in with the mental health person. That's fine. But if it's someone that I've known for 10 years,

it's much better that I, I may not be as good at mental health as that particular practitioner, but that's not the point. I know their whole story how they tick they you know there's this trust that we're not just this kind of robot with all these different parts that we can just oh mental health let's just put that part in there to get yeah tuned up and then put it back into the hole it's and i think that's what we like to think we offer as gps

it's whole person care isn't it person care, exactly. You say that's the way modern medicine needs to go or has needed to go because it's so busy. I don't think we need to go that way. I think there have been pressures that have put us down that way but I don't think we needed to and actually I think if we do a cold hard assessment of how well it's working it's just not working for so many chronic uh low grade sort of lifestyle and environment driven problems it just doesn't work and i guess that's the kind of doctor who when an external source comes to monitor you know what's going on what have they done how many boxes have they ticked it's like well that stuff isn't showing up as well on those parameters

but in terms of what he's doing for patients it's like that phrase isn't it that not not everything that matters can be measured and not everything that we measure matters yeah absolutely that sums it up i think and you're quite right and there's lots of research on this as well in terms of you know kind of you know compassionate inquiry compassionate listening active listening all of those things and and and some one something that springs to mind is the work of Milton Erickson, who was a sort of a doctor and a hypnotherapist as well. And he looked at lots of recordings of doctors and patients and found these patterns and found that doctors who talked down to patients

generally had worse outcomes, and the doctor-patient relationship wouldn't work. Whereas if the doctors who listened and were compassionate their patients had better outcomes they were less likely to complain you know and it makes sense we talk about as a doctor patient relationship but it goes beyond that because what is a doctor patient relationship it's a relationship yeah exactly yeah i know it's just been labeledelled. It's labelled a certain way, but think about an interaction you or I might have with our wives, right? Well, does it go well if someone's talking down to someone? Well, no, clearly not.

Does it go well if someone's not actively listening and trying to butt in and give their opinion? Kind of no. So, yes, there's something unique about it in one level, but then you could argue that all relationships are unique. It's about fundamentally being a compassionate human being who's sensitive to the needs of people around you. And I guess if you can do it in your consultation, hopefully you can do it outside your consultation in all aspects of life. Of course, it's not always that easy, is it? Because we can get triggered by the people closest to us do you know what i mean it's just a relationship it is it is yeah absolutely i think that's the hard thing

with that one of the things years ago that i realized is you know how sometimes it's very easy to say oh so and so is really irritating you know um it's an easy thing to to think and one of the things you know that you know i'm writing a little bit about is how you know your habits become you don't they and and what i what i mean by so-and-so's really irritating is that the things that that person is doing their behaviors are actually irritating actually irritating. It's not them. And the way I sort of myself kind of manage that is I try and look at people's behaviours rather than thinking it's them.

Otherwise, anytime anyone does anything, you think, oh, well, they're an idiot or they're whatever. And it's not actually them. It's that their behaviour is there for a reason. And if you look at the behaviour and separate it from the person you can handle it a lot better i find that as a doctor as well as just a human being so tell us a little bit more about the book i'm so excited you've got this book deal oh thank you yeah yeah i think you know the articles you've written in the press you know the mainstream press for years i think

are very well written very i think you're a very stylish writer oh thank you um so i for one can't wait for it but it's not out for a long time is it no that's right it's out in january 23 and um essentially the book is it's on health and well-being i'm not going to give the title away but it's got in it kind of you know a lot of the stuff we've just talked about today, but kind of taking charge of your health and laying all these things out and almost in a sort of a programmatic way thinking wait a second i just i need some knowledge but i also need to know what i'm about what makes me tick and how i can fix myself partly because you know that kind of medicine and those sort of symptoms, health services that in this country are available for free are buckling that sort of empowerment that you want as an individual to be able to be more in control of your health, but also understanding certain nuances. think you and i know that on our course a lot of our colleagues it's not because we're any cleverer we've just sort of done more reading or whatever but these little sort of elegant tools that that

just work very quickly it's it's not i wouldn't call it health hacks exactly but they're sort of things that that are totally based on evidence and science that works but people just may not see it in that way you know just like some of the concepts in your books i think it's got a lot of that type of writing in it and i i'm you know i've got to write it actually i'm sort of nervous i'm not going to be able to submit it in time but um yeah i'm really i'm so excited because it's just it's almost like my you know i don't want to sort of pick myself up but my my kind of, in my head, my kind of clinical wisdom put in pages in a book. I think it would be incredibly valuable because, you know,

so many patients want to see you. There's always a long wait because of your manner, but also because of, I think, these little clinical pearls, these practical tips that you have accumulated. You know, by the time the book comes out, it'll be 25 years of practice pretty much for you. That's tens of thousands of patients that you've seen in very challenging conditions, in short consultations, in pressured consultations. So, you know, you have to figure out very quickly what works, don't you, for real patients in real life with busy lives right how can you

give them tools that they can access and make them better so i think it's going to be great i've enjoyed our conversation i didn't quite know where it was going to go today no we never do and um we'll definitely talk again on the podcast yeah yeah i'm excited about the book good luck with the writing process thank you mate um just to finish off podcast is called feel better live more when we feel better in ourselves we get more out of life given what you're seeing day to day in your job as a medical doctor i wonder if you could just share at the end some of your sort of final thoughts or tips for people who are struggling right now yeah um i think it's fair to say that everyone is struggling more than they were and And the world is very uncertain. And people that like

certainty are the ones that are struggling the most, I would guess. And things like anxiety and depression come from that place of uncertainty. You know, particularly if you're someone who's a perfectionist or someone who is able to keep on top of lots of things, those things are not possible in this day and age. And so my sort of one piece of advice and what I try and do myself is just to live in the moment because at the moment that is all we can do. And if you kind of live from moment to moment to moment, what you'll find is that the background environment and the background interference of how doom and gloom things are just won't get to you just savor the moment if you're sipping coffee

really taste it if you're talking to someone really look in their eyes and try and clock the color of their eyes when you're listening try and listen to the the timbre of what you're listening to be in the moment as much as you can and that way you'll get the most out of life. Great advice. Really helpful. Thanks for coming up on the train. Thanks for coming to the studio. And I'll see you soon, mate. Yeah, see you soon. It's been a pleasure. Thank you, mate. Really hope you enjoyed that conversation. As always, do think about one thing that you can

take away and start applying into your own life. Thank you so much for listening. Have a wonderful week. And always remember, you are the architects of your own health. Making lifestyle changes always worth it, because when you feel better, you live more.