Feel Better, Live More with Dr Rangan Chatterjee - The Healing Power of Compassion with Dr Julian Abel #138

Episode Date: December 9, 2020

Today's conversation is about one of my favourite topics – compassion. Compassion doesn’t just make us feel good but it can have powerful effects on our health and longevity. That’s something today’s guest has proved to great effect. Dr Julian Abel is a recently retired consultant in palliative (end of life) care and joint leader of the Frome Project, which aimed to end loneliness and improve health in a town in Somerset, by building community connections. In providing compassionate alternatives to medical intervention, Frome saw emergency hospital admissions drop by 30 per cent along with improved quality of life scores, health outcomes and costs. In this conversation Julian shares the evidence behind using compassion as a therapeutic tool, explaining that good social relationships are more powerful than pretty much any other intervention we have, including giving up smoking, drinking, diet, or exercise in helping us live longer. Compassion is far from the soft approach, it is in fact more powerful than many of the medicines we have. Julian also talks about his own experience as a palliative care doctor and the lessons he learned from people at the end of their lives. He shares many uplifting and empowering stories that will convince even the biggest skeptic that compassion and connection should be at the centre of everything we do – after all, it is what makes us uniquely human. Show notes available at https://drchatterjee.com/138 Follow me on instagram.com/drchatterjee/ Follow me on facebook.com/DrChatterjee/ Follow me on twitter.com/drchatterjeeuk 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 other qualified health care provider with any questions you may 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.

We've been led to believe that the medications are going to save us, but in fact what we're saying is that the compassion and the social relationships are often more powerful than the medication, and that if you deal with that first of all, that's when you're going to make the biggest impact on people's health and well-being. Hi, my name is Rangan Chatterjee. Welcome to Feel Better, Live More. Hello and welcome to another episode of my podcast. Today's conversation is about one of my very favourite topics, and that is compassion. Now, as you're about to find out, compassion doesn't just make us feel good. Compassion can also have powerful effects on our health and longevity. And that's something today's guest has proved to great effect. Dr. Julian Abel is a recently retired consultant

in palliative care, that's end-of-life care. He's the co-author of the wonderful book The Compassion Project and he's joint leader of the Froome Project which aims to end loneliness and improve health in a town in Somerset by building community connections. In providing compassionate alternatives to medical intervention, Froome saw emergency hospital admissions drop by 30% along with improved quality of life scores, health outcomes and costs. So what exactly is compassion? Well, in our conversation, Julian defines compassion as recognising a need in others and being motivated to do something to alleviate it. And as his compassion project shows, it is inextricably linked with social connection. Loneliness can increase our risk of dying by 30%.

While there's a growing body of evidence demonstrating that good social relationships are more powerful than pretty much any other intervention we have, including giving up smoking, drinking, diet and exercise and helping us live longer. Compassion is far from the soft approach. It is in fact more powerful than many of the medicines we have. In our conversation, Julian shares uplifting and empowering stories that will convince even the biggest skeptic that compassion and connection should be at the center of everything we do. After all, it's what makes us uniquely human. This is a feel-good episode that I hope inspires you to explore some of the easy ways that you can bring compassion into your life and the lives of others, starting today.

Now, here's my conversation with the wonderful Dr. Julian Abel. The medical outcomes of compassion are so powerful that if you want to use the best treatment, you have to use the most effective therapeutic tools. And compassion is the one that is the most therapeutic. And so part of the conversation about, you know, doing the podcast and getting this out there and everything is about saying, look, this is, we need to change medicine

because it's more powerful than most of the medicines we take. Yeah. You know. I mean, Julian, for me, compassion, it feels almost like it's the right thing to do. It feels good to us as a human being when we're compassionate to another individual. So what's interesting for me is that you're showcasing in your book a load of science that is backing up kind of what we already know, right?

I think that's exactly right. And those moments where we feel that the love and compassion, we all recognize them. And there might be deeply profound moments like the moment we first see our child or we kiss the person we love or we hold our child's hand, any of those moments, they're more than just an emotion. You can feel physically different. But they happen on a small scale as well. Like when you go to the shops and you chat to somebody or, for example, on the way here, I chatted to Petter, the taxi driver who knows you, and he's such a nice guy. And when you have that conversation, you feel like, well, this is good. This is a – I enjoyed that and I appreciate it.

And all of those things, although they are an emotion, they also have got a physical, a biochemical and hormonal components to them. But I guess the essence is that we all know that it's the right thing. And I guess this gets to the heart of the subject matter. The point about writing the book was really to say, look, we need to elevate compassion as a high value, as something that we need to pay attention to all the time, and something that is as applicable in our personal lives, our lives at home, as it is in our schools, our places of work, our politics, our media. And it's not just that it's a nice thing to have. It has a profound impact on everything that you do, including running profitable businesses or even thinking into the future, thinking about the environment

and being compassionate even for our children and our children's children. Because if we can bring in that compassion, we can then make sensible decisions which are not based on short-term personal gain. How would you define compassion? So a much debated topic and people get really pernickety about the details of it. So you can define it as saying, well, we all know what it is to suffer. And we know that we don't like suffering. And so we want to be happy. And we recognize that other people suffer in the same way. And when we see that suffering, it's not just that we want to do something about it.

We're actually motivated to do something about it. We're actually motivated to do something about it. And so you can define compassion as that sense of a common emotion that motivates us into action. But I would say that human emotions don't fit fit very neatly into categories and and because it's not just compassion is like a thing on its own you know because it comes with kindness it comes with loving kindness as well yeah and and when we have love we have compassion and if our love is without compassion that's problematic and if our compassion is without compassion, that's problematic. If our compassion is without love, that's problematic. Yeah. I mean, it's half the problem that I even asked the question, how do we define it? Is that actually one of the problems in that we're trying to put our

rational brain lens, our scientific lens through, okay, define it. What does that actually mean? And then if we can't, so we can't put it in a neat little box, we don't give it its validity, we sort of underplay it. I completely agree. And I would say that we might want to define compassion using our kind of logical frameworks, but we can also connect it to our direct experience. We can recognize it within ourselves. And I think that in the context of how you practice as a doctor, you know, that what we're, we've been led to believe that the medications are going to save us. But in fact, what we're saying and the whole basis of our argument is that the compassion

and the social relationships are often more powerful than the medication. And that if you deal with that, first of all, that's when you're going to make the biggest impact on people's health and well-being. There's a narrative, isn't there, in society that good guys can last, right? And it's kind of this capitalist sort of, you've got to push the other person down, you've got to keep pushing, you know, you can only make it to the top, whatever the top means, by, you know, elevating yourself at the expense of others. And your work clearly shows that that is not the case at all. But for

sceptics right at the start of this conversation who are thinking, well, you know, you're a lot more experienced than me, but two experienced doctors, I've got about 20 years clinical practice, what are you on now? Well, I'm now retired from clinical practice, so that's 40 years of slaving away at it. Wow. Okay. So, you know, over double what I have had. Okay, so with all our clinical experience between us, we're saying that compassion is one of the most important things we can do. Now, for people who are sceptical of that, how would you convince them? So, I think there are four good reasons as to why compassion is a good idea.

four good reasons as to why compassion is a good idea. The first is that when you look at the evidence of what happens from the positive side of compassion, the evidence is really profound. And compassion is the basis of social relationships. And there are numerous studies out there which show that social relationships have a profound impact on health. And in particular, there's one that I always quote by Julianne Holt-Lunstad, and it's the impact of social relationships on mortality. good social relationships are more powerful than pretty much any other intervention we have, including giving up smoking, drinking, diet, exercise, whatever else you care to mention, helping us live longer. And that's more than just a nice thing. That's because it's embedded in our biochemistry and our biology. The second reason is when you look at the impact of loneliness, and loneliness increases your chances of dying early by about 30%. And I know you had a podcast

with Vivek Murthy, and he wrote a book about all of that with loads of evidence in it. The third reason is that when you look at the presence of hormones like oxytocin and oxytocin receptors, you find them throughout the animal kingdom. And human beings are the most social of animals. Now, the presence of oxytocin and noxytocin receptors, which is the hormone that is associated with compassion, the so-called socializing hormone, its mere presence means that it has an evolutionary advantage. It couldn't possibly be there without it helping us.

It couldn't possibly be there without it helping us. And what that means is that actually we survived through being compassionate and being kind. That survival of the fittest, interestingly, was a term that was invented by Herbert Spencer, not Charles Darwin. And he started social Darwinism, which has got loads of implications which are not so great. But in fact Darwin wrote a book on the impact of emotions in man and animals so that we can look from an evolutionary perspective and call it survival of the kindest rather than survival of the fittest. We didn't get through the ice age by beating our chests and killing each other. Actually, there's plenty of evidence which showed that we helped each other out. People with significant disabilities that they got in childhood living to old age. And then finally, I think a piece of evidence that helps because

it's measurable. We can look at the outcomes of what happened in the compassionate community program that happened in Froome, where we saw emergency admissions drop by 30% at a time where they were increasing everywhere else. And there are no interventions ever which have reduced population emergency admissions. I've got one other thing to add that I forgot. And that's the Harvard and GLUEX studies of adult development, which studies began in 1938 in Harvard, looking at what happened to people through measuring year on year and re-interviewing and looking at the outcomes.

And the fourth leader of the study, because it's gone on for so many years, says it's if you want to lead a happy, healthy, long life, it's all about relationships. And the basis of relationships is compassion. And so if you're thinking about why is compassion more than a good idea, compassion and and so if you're thinking about why is compassion more than a good idea it's because it has a profound impact on everything we do and everything we touch and even from a personal perspective if you want to be healthy and happy be compassionate yeah you can actually have well can you have a selfish reason for being compassionate? Like if we look at this individualistic culture that many of us are falling prey to these days,

this idea that, oh, if I'm kind to someone else, it's good for me. Is that a good enough reason to be kind and compassionate? Or does your kindness and compassion have to be with no strings attached? So it's best if there are no strings attached, but it has to start somewhere. And I think that it makes sense to be compassionate, but sometimes making sense isn't enough. making sense isn't enough. We tend to think that we make decisions based on reasoning, but it's much more than reasoning. Our decisions are based on emotion and inspiration as well. So that if you think about the three things together, the reasoning, the emotion, together, the reasoning, the emotion, the emotion being this feels right, and the inspiration being I'm so inspired by what you do, I'm going to do that as well, that they all come together at the same time. And so not only can you reason that compassion is a good idea, you can know it and

feel inspired by it as well. and hopefully you know not only are we social animals we have the capacity to choose hopefully we provide a really good case for being more compassionate yeah you know she was saying that it reminded me of when i used to work in oldham right in the center of Oldham. What would be called from the data, a deprived community, low socioeconomic status. And I used to get up back then, I think this is pre-kits or maybe when my son was very young, I'd want to get to work by about 7.15 or so just to get through the blood results before I started seeing patients at eight o'clock. And I used to also love missing traffic. And I'd stop off on the way just in my

town at, you know, a local cafe that was open. I'd stop off, I'd get myself a coffee. And initially, I'd be getting it, I think, as a takeaway. But very quickly, you know, I'm a chatty guy, so I'd start chatting to the barista. And then before you you know, every time at the same day, the same, the same caffeine addicts would also rock up and you end up, you know, I didn't know them apart from through the coffee shop. I didn't have their phone number, their text number, but we built up a bit of a rapport, a bit of a 6.30am club, like a community where you'd actually really look forward to seeing them and go, oh, how was that yesterday? And I'm sure that changed how my day went down, even though if I

may not get home till 8pm that night, that little dose of compassion and connection, I think would get me through some very stressful days as a GP. Yeah. I mean, it's heartening, isn't it? It's heartwarming. Those moments, even those light moments where you have a gentle chat with someone, they're heartwarming. We feel it and it sustains us. And what's great is that that sense of heartwarming is not just with you, but it's everyone involved in it. And you start to gather there because you know you're going to meet some friendly people.

That's a great story. Yeah, it's just, and I'm sure people listening to this or watching it on YouTube will also, if they think about it in their own life, they'll know those little moments. And I've heard you speak. I heard your TED Talk, which is brilliant. I really hope people at the end of this go and listen to it. It really is wonderful. And I think some of that data you just went

through, you presented, didn't you? I remember when that slide came up. What was it? It was which interventions have the most impact on, was it on longevity or your reduced risk of getting ill? So on the technical side of it, it's the odds ratio of mortality. And that's... What does that mean for people who don't understand that? Exactly. That means what are your chances of dying with the different types of intervention, of dying prematurely? And obviously, that if you give up smoking, you reduce your risk of dying significantly, but not as much as social relationships. And likewise with diet exercise. And the one that tickles me the most is the drug treatment of high blood pressure, because the impact of treating high blood pressure on your risk of dying prematurely is dwarfed by the impact of social relationships.

And by the way, as you and I both know, if you have good social relationships, you know, that's your oxytocin spinning around your body, your blood pressure drops. So maybe you don't even need the treatment so much yeah i really i want to hammer home that point because i think the first three like there's a graph on there and you plot it out beautifully and the top three things were all related to relationships social relationships and drug treatment of high blood pressure was right you know it has an, but it was dwarfed compared to that. And for people listening to this, if there's any healthcare professional, or I know a lot of medical students and junior doctors also listen, you know how hammered home it is that, you know, properly treating blood pressure will have an impact on reduced heart attacks, reduced strokes, etc, etc. What Julian is saying

is based upon the data, your social relationships, the impact that will have dwarfs the impact of drug treatment of high blood pressure. So I don't think any of us are saying don't treat high blood pressure, but I think we're just trying to elevate the importance of compassion and relationships basically to the very, very top of the pyramid, right? That's it. And something I've come to realize recently is that actually the treatment of high blood pressure is quite a good model for bringing compassion and social relationships into the therapeutic environment. Because if you think about it, if you're treating high blood pressure, what you're doing is the first thing is you're screening,

you're identifying people who have got high blood pressure. So you measure everyone's blood pressure. And when you find it elevated, you prescribe a treatment. And then you follow up with the treatment to see whether the blood pressure has come down or not. And you alter the treatment until you get the required response. Well, why not take that same model about social relationships into your routine clinical practice? So what about making a routine assessment of your patients about what their social relationships are and then think about what you can do about that within the consultation because it's more effective than

most of the medicines we use. So why not bring it in as a matter of routine? And we know from Froome that the results of when you do that is absolutely transformational. Well, let's go into Froome, right? Because what happened in Froome is remarkable. A lot of people listening to this probably won't be familiar with what happened there. So maybe you could paint the picture for us. What was going on in Froome before? What did you and colleagues introduce? And what was the profound impact that you saw? Okay, so Froome is a market town in Somerset, which is a county in the southwest of England. It's a town of 28,000 people in a county of 500,000 people. And it's always had

something of an independent streak about it going back through the years. And even the last two election cycles has had independent town councillors. There are no political party members who make up the town council. And at one point, a number of the local GP practices combined together. And there's an incredibly good natured, sensible, clear thinking GP called Dr. Helen Kingston. And she wanted to try and find a way of having moved to a large practice of making sure that the care was coordinated, that there was good exchange of information between the practice members. And at the same time, she understood that so much of what we do as doctors is not related to drug treatment and wanted people to feel supported by their community.

So what she did is that she employed Jenny Hartnell, who's got a background in community development. And Jenny started a community development program in the town of Froome, but from within the medical center. And then she combined the two. And we can go into more detail if we have time about what the community development involved. But needless to say, it was really about bringing the community together and making use of the incredible wealth of resources that are present in every community. And then if people are feeling lonely or isolated, which is very, very common and is worse in illness, in fact, then there's a way of connecting that community resource to what happens inside the medical practice. So I'll give you an example to demonstrate it. And I talk about this in the book. There's a

lady called Kathy who was a businesswoman who got a very severe form of acute rheumatoid arthritis. And she lived in Froome. She lives in Froome and she's got a dog, which is really important to her because she walks a dog first thing in the morning. And she's got two children and she didn't really know the people around her that well. And the rheumatoid arthritis actually put her in a wheelchair within the space of three weeks and her whole life was devastated. So she went to the doctor and said, look, I need a sense of hope that this isn't my life from now on and so and so the doctor said uh okay look i'm going to get you to see a health connector a health connector is somebody who is trained in motivational interviewing but is not a health professional and so rose a health connector went went to see Kathy and said, what do

you want? And Kathy said, I need to meet some other people who are going through this because I need to know that I'm not stuck. And Rose said, I got just the thing. And so Kathy goes off, first of all, to the self-management group for people with chronic disease that's in the medical center. And then she goes from the self-management to the pain management, to the exercise, out into the community. And then she's connected to this incredible wealth of people of all the stuff that's going on in the community, whether it's talking cafes, which is what you had down your coffee shop, or whether it's a knitting group or an art group or a healthy walking group or whatever it is. And Kathy makes this journey from being somebody who

was relatively isolated and focused to being somebody who is deeply engaged in the community. And she describes the outcome of it about how she has got friends for life. And she knows that they are there for her and she is there for them. And her life is transformed. Not only does she regain her health, she regains her happiness. And that the combination of the medical treatment of her disease with this wealth of support transforms her life. When you say she regains her health, right? So she gets tapped into that when she's been diagnosed and I think you said she's in a wheelchair.

So when you say she's regained her health, what happens? I mean, what does she get to? What's her pain like? What's her mobility like? Her sense of who's around her, who her friends are, her joy in life, her reason for living. Everything is transformed. And so it's a personal journey of increasing health and well-being and transformation. What's interesting, Julian, for me, as you described her improvements there, is that we started off talking about pain and mobility. And of course, the medical treatment may have helped that, but I also have seen enough to know that actually it could also be a lot of the other stuff as well. The feeling of connectedness can absolutely reduce pain in my experience. But you said at the end, her joy in living in living her love for life that all that sort of stuff the kind of softer stuff that often in medicine we don't measure but in many ways that's

the most important part of being alive the most important part of being a human being on planet earth is how much fulfillment how much joy do we get day to day? Whereas I really feel that medicine has, possibly without realizing it, become very reductive and we measure blood tests and we do pain scores. Now, of course, reducing pain is really important and can improve people's quality in life. But I think we've overvalued a lot of those, I guess, more objective parameters at the expense of potentially some of these subjective ones. 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

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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. I mean, you know, obviously I agree with you. And my clinical background is that of a palliative care physician. So pain is something I'm, so for those who don't know what palliative care is, I looked after people with terminal illnesses. Mostly cancer, but it applies to any kind of illness. And of course, you know, pain is a significant part of it.

But when you're treating people in pain day to day, their mental state has a profound impact on their sensation of pain. And if you just use medication to try and control their pain, you're never going to get completely on top of it. to try and control their pain, you're never going to get completely on top of it. But if you start to deal with what matters most in life, and what matters most is so often the people we know and love in the places we know and love, you know, that if you start to work with all of that, then a similar kind of transformation that happened to Kathy can take place. And of course, if people are feeling loved and secure, then their anxiety goes down, their pain levels go down. And actually, you know, then you start producing all the things that we naturally produce as human beings, including oxytocin and endorphins, which are the morphine-type compounds that we naturally produce inside us.

Yeah. I mean, I can't get that out of my head that your biochemistry, your biology, your physiology changes when you have close social connections, when you're compassionate to someone else or they're compassionate to you, it matters so much. And I think, as I said to you in the kitchen just beforehand, I sort of get sent so many books these days and often I don't even get to look at them, what's in them, but there's something about yours that just lit me up inside. The Compassion Project, A Case for Hope and Human Kindness from the town that beat loneliness. I was just, right, I'm straight in, you know, I just couldn't stop reading it. It really is where personal, professional, all of my interests basically collide on this topic. It's something I think a lot about, particularly as my public profile

has grown and I communicate a lot on social media with people. And I want to talk to you about social media because I understand that apart from a minimally used Twitter account, I'm not entirely sure you do much, which is possibly why you look so happy, well fit, despite having worked for over 40 years as a doctor. But I very much always lead with compassion. And that means you won't get as much growth as other people who don't, because you won't, if you go divisive and you go with sort of toxic kind of messaging, you get all the engagement, you get all the sort of, you attract that kind of, you attract those kind of responses as well. You really trigger people. And I want to be part of the solution. I want to try

and, you know, as Gandhi says, be the change that you want to see in the world, right? So, there's a lot out there that we feel we can't change, we can't control. But I guess we can all control whether we choose compassion or not, can't we? Exactly. And I think you're doing a great job. And I think when we look around us, that we can put our compassionate spectacles on and see whether there's the presence or absence of compassion. And so often when you look at what happens in social media or what happens in the media in general, or if we're hearing about politics or business or environment, and we've got our compassion glasses on, we see that it's absent and it's heartbreaking to see.

And so that what I hope is that actually we provide a really good argument to say, this is down to us as individuals, that within our life, we can choose to be more compassionate in any given situation we're in, whether we're at home dealing with the kids or down the shops or in our workplace, actually at any moment we have the choice to be compassionate or not. And if we choose compassion, not only is it good for us, it's good for everyone around us. And so in a way, the heart of all of this is down to an individual level. It's about each person and every person choosing to be just a little bit more compassionate, because I guarantee that once you start, you'll never stop.

Why does this matter so much to you? Is this something that you felt as a kid as a teenager or was it your experience as a palliative care doctor you know seeing people towards the end of their life you know what was it or was it a combination so it's interesting that you say that and it's something that i've thought about a lot and I can remember it being important as a child, like wanting the world to be a better place. And actually, most kids are like that. Actually, the children have got a good sense of what's fair and what isn't fair. And I somehow clung on to that. I don't know why.

And I somehow clung on to that. I don't know why. And that was my motivation, as it is for, I think, everyone who goes into anything to do with healthcare, is that they have this basic motivation to try and do good, to try and help. And what I found was that it was central to what I felt was most helpful. And so when I went into medical school, it was back in the day, you know,

and it was the time of Margaret Thatcher, funnily enough, and that point where the health service really starts to get constricted and disinvestment. And health service at that time was extremely hierarchical. And, you know, the doctors were these kind of magical figures and it felt very uncomfortable to me. And I took a diversion away from medicine for a few years to study acupuncture and osteopathy, particularly because they seem to embody somehow a greater sense of this compassion and working with people and all of the complexity of people. But I also felt like there was something valuable in there and I got drawn into palliative care, which is a place where that compassion is

particularly strong and vivid. So for for whatever reason it's always been with me and and i found it's it's carried me through and led me into you know these the outcomes of frume were totally unexpected but the reason for doing it was to give people the best treatment and and and so it's kind of fortunate circumstances where what's interesting about Froome is that there are some really tangible, measurable improvements, which are groundbreaking through the application of compassion on a population-based level. Have you had interest? Because what was done in Freem is remarkable. I remember the first or second prescribing lifestyle medicine course that I and one of my colleagues, Dr. Panja,

teaches to doctors and other healthcare professionals about how to personalize lifestyle interventions for their patients, not only as prevention, but also as part of the treatments. And we put up a slide actually from one of the first Guardian articles, I think that actually spoke about the work in Froome, which we thought it was just incredible to showcase that to doctors. But, you know, it would seem it was so groundbreaking, you would almost draw the conclusion that everyone should be knocking on your door going, well, we want those results in our village, in our town, whether that's in the UK or beyond.

So what kind of interest and what kind of knocking on the doors have you had? Well, a lot. And from that article, which was written by George Monbiot in The Guardian, And from that article, which was written by George Monbiot in The Guardian, we got worldwide interest. And literally from every continent, we had people ringing us up saying, tell us about it. And it takes time for things to get off the ground. And the pandemic hasn't helped. But we've got interest from all over the world where people are starting these kind of projects in particular there's a lot of interest in Australia and New Zealand and Scandinavia as you might imagine they're quite sensitive to all of this and there are projects starting in

Colombia and the US so there's a lot lot of interest. We have projects running in Wales. That one article amazingly had generated a huge amount of interest. Yeah, it's unsurprising really because what you're offering is reduced hospital admissions, reduced emergency attendances, improved quality of life scores, reducing healthcare costs, basically, but at the same time, improving outcomes, which seems to be the holy grail for any healthcare system around the world. But what's fascinating is the way you're doing it, it's almost the opposite of how medicine and how society has gone really. And I know I keep making this point, but I think about it a lot. So everything's quite reductive now. Medicine,

I feel for all its benefits, some of the, I think, unintended consequences of super specialism is that we reduce everything down to this blood test or this body part. We don't see the connections. It's all very individualistic, right? I'm going to see you and give you your plan. And I get that. And I see the merit in that. But it strikes me as that what you're offering is, it's almost the complete opposite. It's almost saying, there's too much pressure on you as an individual to sort your own health out. Let's get you in a switched on community where you can talk about it, where you can actually connect and foster these loving, intimate relationships. And it strikes me that

you're sort of saying by doing that, by putting the focus on community rather than the individual, actually individual health improves, right? It's where we're putting the focus. I think that's right. I mean, you know, you can think about a number of ways in which that's expressed. So you can think about things like the men's shed and the women's shed, and you don't need to be ill to go down the men's shed you know it's something you can join in and and if you like it's a love laughter and friendship that happens along the way what is the men's shed for people who don't know yeah okay so the men's shed is uh uh it's a in fact a national association and it's where men can go

because men like building things and i've got that weakness as well. I'm forever down the builder's yard, you know, picking up bits of wood. But, of course, people have a lifetime of experience. And so people like to share and pass that experience on. But it's also a place where people can get on and do stuff and make things and find that love and laughter on the way. And what happens is transformational in those moments. So one guy, for example, talks about how he had a stroke

and he was really angry afterwards, kind of active guy, and then his wife leaves him and he's at rock bottom. And he goes down the men's shed just for something to do and and he makes friends there and he says you know and tears up as he's saying it he says well uh whenever i ask somebody to have a cup of tea or something like that they never say no and he says i never thought i'd have friends like that again. And that's not because somebody is ill. That's just the daily life. Anyone can join in. And that keeps you healthy, keeps you out of hospital, keeps you sane. But then if you think about you have a

physical or some kind of mental illness, and you think that if you can bring in that community support, it makes a huge difference. And just to give you an example, you think about something like diabetes and what 5% of our population have got maturity onset diabetes and a further 5% are pre-diabetic. They're at risk of developing diabetes. Well, so that's so much to do with lifestyle. And it's all very well for a doctor to say, actually, you've got to cut down your carbohydrates, stop eating sugar. But what on earth does that mean to somebody who might not know how to cook properly, might not have a shop nearby, may feel overwhelmed by the price of food, and who may feel lonely and isolated because they've got this disease,

and what do they do now? Well, if you start thinking about how you can add in community resource to that, then you can start thinking about, well, what about other people who are in the same situation? And what about if they figured out what to cook, how to cook? If you're a widower and you never did the cooking, what on earth do you do? And where do you buy the food from? And how do you buy fresh food that's cheap? And if you do it together, is it easier? And what about if you start cooking for each other? Yeah. And then you start building these relationships. And not only do you lead a healthier lifestyle, you get all the benefits that we've been talking about

that happen with your biochemistry and your physiology and everything from the love and laughter that you develop with the people around you. Yeah. I love the way you bring in type 2 diabetes because yes lifestyle plays a huge role in the development of it but also how we might treat and manage it and a lot of the focus tends to go on diets and i understand that but we gotta not we've got to make sure we take in that big picture, right? Because I think it's so important. Well, it's interesting when you think about it as well from the perspective of how can policy support this?

And there's a move towards this now with the development of primary care networks, which is changing the way that the GP practices work and they work more in harmony together. But as well, they've got something called link workers. And link workers are people who do what's termed social prescribing. And I've got to take a little detour here because whenever the term social prescribing comes up, I have a kind of involuntary shudder because the term itself suggests that you can have a prescription that you give to somebody to deal with your social life. It's like, okay, I don't know about that. I'm a doctor. I don't know about that. I'm going to give you this prescription and that will sort it all out. And

it's got a paternalistic edge to it. And actually, it's probably the most powerful thing you can do. And so the term that I think describes it much better is compassionate communities about being connected to your communities. So there's been a greater development of trying to embed this stuff into the infrastructure of how health services work. So there is a greater recognition of the impact of relationships, but it's still got a huge way to go. And how do you change that down to the level of the individual consultation? And what do you do with communities where you nourish this community spirit? In fact, the way that I've tried to describe this is that you can think about that management reduction of symptoms, whether those, you know, from the palliative care perspective, we talk about the physical, the social, the psychological and the spiritual, is that you want to reduce the negative impact of those symptoms.

But actually, that doesn't give you health and well-being. That doesn't give you joy in life. Simply just treating the symptoms is not enough. And if you go for the joy, the love, the well-being, the compassion, the things that give you meaning in life, the well-being, the compassion, the things that give you meaning in life. Actually, the whole compassionate community intervention is a way of enhancing all of that. And that actually, not only does it make people feel joyous and better and connected and meaningful, it has a profound impact on health as well. And that impact is bigger than the medication. And I think that the message that I think both you and I are trying to get across is that actually if we concentrate on that and we enable and enhance that,

not only do people reduce their burden and risk of disease, they enjoy life. Yeah. I mean, I love the way you talk about our own personal experience. I think it's, we sometimes forget about that to tune into how we feel. But let's flip it around, like when you were trying to define compassion. so talking about suffering, or let's think about, you know, and I challenge anyone who's listening or watching this right now to actually do this, and think about when was the last time you had an argument with someone? Let's say your spouse, your partner, your child, or you left a snidey comment on someone's post on social media? How do you feel afterwards, right? Let's say you were right and you got your point across. How do you feel afterwards? Even if in your head you were

right, if there isn't that compassion, you don't feel good. You can't stop thinking about it. You think, you know, we don't feel good about ourselves when we haven't, let's say, displayed that compassion to our partners or even to people online, right? So it's not just that we know it feels good when we are compassionate to someone else. We also know how negative it feels and how toxic it can be when we don't do it, when we do the opposite, right? I mean, let's think about that in terms of childhoods, about what happens if parents in particular, through their own life circumstances, are struggling. And maybe they've had difficult childhoods themselves and life has conspired against them.

And the care and the compassion for children is not as strong as it should be. And maybe there's not so much care and maybe there's anger and sometimes physical and mental abuse. again and again and again over a year, over years and years as children are trying to find that place in the world that has a profound impact on how the lives of those children unfurl. And the ability for people to have good, healthy relationships when they're suffering with this burden of stuff that's happened in their past, is really tricky. And, you know, this acute childhood events is a really well-described field about as the number of events start to accumulate, that has really profound effects on people's mental and physical health. And even to the point of dying young and drug and alcohol abuse and all of those

kind of things yeah and and having obesity and carrying excess weight you know there's a strong strong link between adverse childhood experiences i think it was dr vincent feletti i think who's the lead in that study i think so so what about we start to add in compassion to all of that? And what about we add in the community resource? And rather than saying, oh, you've got to be more compassionate, which is actually not helpful, because it's like, oh, I'm just trying to do my best, you know. What about going, actually, there are other forms of support that you can get from the people around you. And you can develop friendships and find solutions to the many problems that you're facing, the people around you. And you can develop friendships and find solutions to the many problems that you're facing,

which in a way is the essence of community development, is that we say that communities, when communities come together, as Cormac Russell of Nurture Development says, it's about what's strong, not what's wrong, that we build relationships and we recognize the strength in all of us. And we start to create the warmth of the environment where we can start to solve the problems that

we face. And it doesn't matter whether those problems are financial or environmental or whatever comes to the surface. Communities acting together through the warmth of human relationships is how we get the transformation. And it goes back to what you were saying. This is not so much the individual, but it's people together. It's communities.

And the reason why that's so powerful is because that's how we evolved. We evolved in communities, that it's a really important part of human evolution. And I would add in one other thing here is that we have been led to believe that acquisition is the way of happiness, that if we have beauty, if we have lots of goods, that's how we're going to become happy. And there's an interesting point at which that becomes much more explicit, particularly in the capitalist world, at which that becomes much more explicit, particularly in the capitalist world,

where this guy called Edward Bernays, who was a nephew of Freud, said that he wrote this book called Propaganda back in 1928. And he said that we can't wait to persuade for people to buy stuff. We have to persuade them to buy stuff. And from that moment onwards, you have the marketing industry, which has just grown and grown. And yet, and yet, in my work as a palliative care physician, you know, I talked to literally thousands of people about dying and about what was important in their lives. And often through the course of the illness, people felt a diminished sense of self because they couldn't do the things that they recognized

as being important to them. But with the people around them, they appreciated the people around them for their love and their care and their friendship. And so we tend to have this kind of dual standard of thinking about acquisition as being meaningful for ourselves. But we appreciate the people around us for the quality of the character they have. the people around us for the quality of the character they have. It sounds like you're saying that we judge other people differently from the way we judge ourselves. Precisely. I mean, it was a conversation I had with nearly every one of my patients. I would say, look, have a think about the people who you really appreciate the most

and why you appreciate them. the people who you really appreciate the most and why you appreciate them. And people would say it's about their love, about their kindness. And they would say, has the love and the kindness diminished in you even though you're not able to do the things that you usually do? And of course, the love and the kindness is still there. do. And of course, the love and the kindness is still there. And I would say we don't need to be terminally ill to appreciate that. That's something that we can do now in our lives. If you like the people around you for the qualities of their character, it's kind of at the heart of it all is, well, you can develop develop those qualities yourself you don't have to become

a saint you can just do a little bit and become a slightly kinder a more compassionate person that makes me think about compassion and what we really mean because those patients i guess then are saying yeah you know i i can't you know what you, I don't really have any value anymore because I can't go and meet them or I can't go walking with them anymore or whatever it is. But you're sort of reframing it again. Yeah, but you can give love. You can still be the friend that is probably all they ever valued in you anyway. It wasn't whether you go walking with them or not so i guess there's another point here when we talk about compassion are we talking about compassion to others or actually are we talking about compassion to ourselves well both actually and and um

having written the book i started out with with a podcast as well, which I've called Survival of the Kindest. And one of the people I interviewed was Jason Mills. And Jason, he lives in Australia, and he comes from a diverse background of Papua New Guinea and Philippine. And his childhood was a little difficult. And then he met a compassionate nurse, and it inspired him to go into nursing. And then Jason went on to do a PhD in compassion and he talks about the role of self-compassion and about how self-compassion helps us

to be more compassionate. In other words, that compassion is applicable, if you like, universally. And we have to apply it to ourselves, you know, just on a reasonable level. We have to manage our lives. People may think that if you're really compassionate, you exhaust yourself so that you've given everything to everyone else, and then you can't do anything because you're exhausted. And actually, that doesn't work. We have to be realistic.

We're human beings. You know, we have limitations. So how do we have compassion for who we are and what we do? How do we appreciate the value? And how do we share that with the people around us? value and how do we share that with the people around us. I'm so interested about these conversations you would have had with thousands of patients near the end of their lives. I'd love to hear more about that. I mean, what were some of the other themes? Did people repeatedly say the same thing or did they repeatedly not say particular things? And I guess

how might I and the listeners learn from what people have learned at the end of their life and i guess the natural extension of that is what did you learn from that and has it changed the way that you live your life that's a great question so i'll give you two two examples uh so uh one is that the the people who used to impress me the most were the people who came to the end of their lives and they weren't great businessmen or didn't have massive achievement, but they approached death with a sense of peace. of peace. And when I asked them about that, they said, well, I've had a good life. I've had good people around me. I've had great children. I love my husband and my wife. And I feel satisfied with the way that life went. And to be so open and face death in this peaceful way, to me, was really inspirational and impressive. And then I remember one gentleman who I treated who was a great international business leader. And he was talking about this subject and his wife was there.

And he was saying, I can't do, I can't run my businesses and who am I? And so we talked about appreciating people for who they are and why he loved his wife and all of that. And then his wife popped up and said, people loved you for who you are, not because you were a great business leader. And she encapsulated that so perfectly, just the way that she said it. And of course, he understood about the powerful impact of the kindness and quite a lot of the physical and emotional suffering that he had got better quite quickly. And he was able to die peacefully with that. And I think that it absolutely gives you a sense of what's important in life and what's not quite so important.

Yeah. I think many of us, myself included, need that reminder. Nice to learn from people at the end of their lives about what truly is important. I think we get so caught up in small things, don't we? About, you know, is this right or is that wrong? Or, you know, God, that shouldn't have happened or this. And actually when it's all said and done, it comes down to connection and relationships. That's what we value the most.

It's amazing. I remember when I started off as a GP and it was, I can't remember, some sort of social event or I don't know, a conference. I just remember chatting to a lot of the older GPs and they would all say, I just remember one moment they all said, you know, one thing they wish they'd done. And I've heard this so many times from older GPs. I wish I hadn't worked so hard and I wish I spent more time with my family. I never, ever once heard anyone say, I wish I'd spent more time at work. It never ceases to amaze me that, you know, one thing I say a lot, particularly when I'm teaching doctors, is I say, connect first, educate second. And it's something I've learned through my years of clinical practice. I remember early on as a GP, sometimes I'd be a bit flummoxed when

a patient came in. I didn't have maybe as much experience as I wanted. What the symptoms they were coming in with and the protocol that I had next to me in terms of how to treat them didn't seem to marry up some of the time. And I thought that just doesn't feel right. So I would just chat to them, right? I would make sure I took time to connect so that they felt heard. And that's a basic human need for anyone, frankly, whether it's a patient doctor relationship, a husband-wife relationship, parent-child, we all want to feel heard. And, you know, going back to the doctor-patient patient relationship the amount of times doctors say to me oh patients don't do what i tell them to do and i'm like well even that phrasing

kind of tells me a lot there you know if you're telling a patient what to do i don't blame them for not doing it right because no human ever does something when they're told to do something and that's where this whole idea of connect first, educate second comes. Like I have genuinely found, and I used to say, oh, I'm really lucky, you know, my patients are really compliant, but actually I don't think it is just luck. I think it actually, when you look at it, is if you take time to connect and that patient feels heard, then they're open to listening to what you have to say. But if they don't feel heard, or they feel you're just trying to shove a treatment plan down their face and get them out the door, and I get there are pressures, there are time pressures, of course, the impact

is going to be limited, right? Connect first. And we know that that is in any aspects of our life. When people know how much we care, then they're interested in adhering. And I think it was in when I was researching you before you came today, I think I heard a talk or an interview where you speak about four qualities, I think, compassion, love, friendship, and laughter. But you said without compassion, you can't get the other three. I wonder if you could elaborate on that a little bit. 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. 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. you 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. in your podcast app. I try and relate this to personal experience because then we have that intuitive sense about what's right or what's not right.

And if we think about the relationships around us, we know that if the person we're talking to doesn't care for us, is not interested in our well-being, you know, we have an incredible intuition of about who to trust and who not to trust. If that basic compassion is absent, then that's not a relationship that will develop or will last. There's a really great book by a woman called Susan Pinker called The Village Effect, The Impact of Face-to-Face Relationships. And she describes from the cradle to the grave about how we devote so much of our time and so much of our effort

in developing what's good, safe social relationships, even from the moment where we're born, where the first thing we see is our mother's eyes, hopefully, if all goes well. But then, you know, one of the first things that children learn to do is mimic the facial expression in the person in front of us. And then we just, as we grow up, we are learning all of these social skills all the time. We have incredible sensitivity to it. And we're trying to figure out our place in the world. So for example, one of the people I interviewed was Paddy Wivel. and paddy is a documentary filmmaker

and he did a beautiful documentary along with my sister about schools and they just they just put into they did filming from the playground and and they did it at a distance and they followed this one girl in particular um and they were trying who you could see the struggle she was having to find good social relationships and and what happened in the playground and how much of the time was devoted to can i be in with this group or or that group or am i on my own and the heartbreaking rejection that takes place. And I think that it goes on. And like Paddy went on and did the same work in prisons and in Ethiopia. And looking at how much our whole human development is based around trying to find our place in the world

it's so important to us is that documentary available online to watch is it uh there's one called boys and girls and i'm not sure if it's still available but the one on prisons is still available and and it's beautiful because he's looking for that humanity and looking for uh those expressions of kindness and humanness that come out in places where we might not expect them yeah well we'll find the link we'll put it in the show notes so i definitely like to watch that it's interesting you know you you make the case in the book you make the case you know many on many occasions that it's kind of baked into us, it's baked into our DNA, it's who we are as humans. And I think we

really saw that in March and April 2020 when, you know, before anyone really knew what was happening with the kind of restrictions and the lockdowns, what we did see at the start was kindness and compassion returning into everyday life. People looking out for their neighbours, doing the shopping for their neighbours, you know, little things. But I guess it was, if you think about it, why was it so striking to us? It was so striking to us because it's so rare now in terms of, I don't want to say it's rare. I don't want to believe it's rare. I guess somewhere along the line, and as you say, this capitalist society where we've been encouraged to buy more, get more things, get more stuff, get these houses, insulate ourselves off from people around us, we've kind of lost it somewhere,

haven't we? That actually, it's who we are as humans. I think that's right. And what's interesting about Froome, to come back to that, is about, you can ask a question about, can you do that on a population basis? Can you take an area and start to develop the things which create a greater sense of community? And the answer is yes, you can. That you can work at the ground level and bring people together. Streets and neighborhoods, creating compassionate streets and neighborhoods, looking over the garden fence to check on your neighbor, and then thinking about the things that interest you. And it doesn't matter what it is, because there'll be other people who are interested in the same thing. And then thinking about, okay, well, why don't we have all of that information available?

So I'll describe briefly about what went on, because it's so amazing. So then you've got, well, there are all these groups in the community. In any community, there are hundreds and hundreds of these groups going on, whether it's Knit and Natter or people going for walks or book clubs or- This isn't free. Anywhere. It happens everywhere. And so why not gather all of that information together so that you can stick it on an easy to use web page

so that people can access it, including the medical practice. So if you have somebody who comes in and says, I'm isolated and lonely, or if you're in a cafe and somebody talks about being isolated and lonely, you know exactly where to go to get that information. But then what about, there are many people who don't want to belong to a group. And many people, you know, they said to Jenny who organized a community development service,

I don't want to go to a group, I just want to talk to people. So Jenny went, oh no, we'll have a talking cafe. So she developed a talking cafe down the cheese and grain on a Monday morning. You know, it's just, and it's a table with talking cafe and the cheese and grain on a Monday morning you know it's just and it's a table with talking cafe and people just gather around and then people who come from the groups

whether it's Patrick from the men's shed or the walking group they can be there as well and then they can introduce people ask questions okay so now you've got the talking cafe and you've got the web directory well why don't we why don't why don't we train people in the town to be able to access this information they know the stuff that's on the website and they know that they they know about the talk cafe they know about health connections from end it so the next thing is that jenny starts a program of community connector training. These are people who just know about what's going on in the town. So, so far, 700 people have been trained as community connectors in Froome. Then we know that on average they have 20 conversations a year about how the people of the town can connect up to the people of the town.

That's 14,000 conversations a year of compassionate conversations in a town of 28,000 people. And going back to David Hamilton, each one of those little conversations is a little explosion or beacon of compassion with oxytocin and the ripples. And what that means is that when you go to the town of Froome, whether it's you're in a cafe or in the library or as a community support officer or a receptionist or anyone might be a community connector, we're all community connectors in fact, is that you have this sense of people are listening out for you and they're with you. So Froome has got this reputation of being a friendly town. So people are now moving to Froome because it's a friendly town. I mean, it's amazing.

Yeah, it is amazing. I mean, there's so many thoughts going through my head. One of them is you mentioned the websites where people can see all the things that are available, including the medical practice. So that made me think that's so beautiful because, and again, just to check I've interpreted this correctly, but it seems then to me that the GP practice is just one part of a whole raft of interventions that are available rather than us, oh, I'm not well, let me go to GP first and then from there get tapped in. It's like, well, hold on a minute. Maybe going to my GP isn't the right first step. Is that right? Is it? So it's just, yeah. And I love that. I love that. It's less focused on the doctor and the medical practice

again. What else is available? The other thought I had is, you mentioned these community connectors, I think you said it's about 700. And also that kind of we're all really community connectors, that's the beauty of it. But I wonder, are some of these kind of official community connectors, are they ones who've struggled themselves and have seen the benefit and then they want to give back because it would strike me that if you were lonely and you got involved and you got benefit so many people like that then want to give back and say well let me help that's it and that story about kathy that i told you earlier that she became a community connector and she's now a strong advocate and connecting people up in her community. It's people helping people. That's it. You know? Yeah. It's so simple, isn't it? It's

so simple. It's so lovely. It's so basic. It's so innate. But think about this, like you're sat as a GP and you're seeing a patient and you're you're a human being you've got in you've developed this incredible sensitivity to what's going on with someone else it's a natural part of you growing up you know you have a nice environment you're a nice family and you learn all these healthy relationships and you're sensitive and then you know whether the person in front of you irrespective of of what they've come in for, you know on one level what's going on with them. The difficulty that you have as a doctor is how on earth do you do something about it?

Well, what about we make it really, really easy for you? And that you have the health connectors, the people who work one-to-one, the people who are trained in motivational interviewing. And you know that if somebody's really struggling and they can't see the wood from the trees, you can go, I don't have to sort this out, but I know someone who can. Or you can see that the person is outgoing and really wants to get out there and do something. And you can go, well, look, let's have a quick look on the web directory, which is really easy to use. And I can print this stuff out for you and I can connect you up with all of these resources, whether it's

if you're homeless, all the stuff that there is for homeless people or whether, you know, it doesn't matter what it is, all the hundreds of different, all the listeners can go to the Health Connections Mendic website and explore it and see the stuff that goes on in every community. And what that means is that in terms of your consultation, actually, you're able to address the issues that matter most to people. And you're able to do it within the timeframe of what you're doing. And in fact, it saves time because

you don't have people coming back again and again for the problem that you're not addressing. Yeah. And that's disempowering for doctors as well, because A, they feel they don't have enough time. B, if they're taking the whole weight of that patient's problems on their own shoulders and they're unable to help because they keep coming over and over again and actually the problem ain't necessarily that physical symptom the problem is the environment that the loneliness right so you actually help i think doctors get their love back for their profession that's it by taking the pressure off so so we started a project in an Iron Bevan health board in the poorest areas of Gwent. And we say to the doctors, you know, when we're talking about implementing this project is, you know, we've got three outcomes.

The first one is improving the lives of our patients. The second one is improving working lives. So people get back that love for their work. And the third one is, you know, reduction in cost. But, you know, so what? You know, and we had GPs, you know, just to give you a clue that some of the, in those deprived areas in the Welsh Valleys, you might have one or two GPs for a practice of 10,000 people.

And absolutely, you know, they can't employ GPs and they're run ragged and their lives, work-life balance has gone way amiss. And a number of months into the project, they start finding that they're able to solve the problems that the patients are coming in with and that we've worked out about the bits that the GPs do best and the bits that everyone else do best. And then they start to say, this is why I came into medicine 16 years ago. This is, I can now practice in the way that I want. And I think that, you know, for those people who are listening, who are health professionals, this is about rediscovering your love for what you're doing, rediscovering that you're not left at the end of the day with a sense of emptiness because

you haven't been able to give the care that you would want to give to solve the problems of your patients. You find the joy and the love back in the work that you're doing yeah i i love that and it's something i'm so passionate about it's it's very similar to the feedback we get after our prescribing lifestyle medicine course a lot of the feedback we get is yes this has helped us change the way we practice medicine but the ones and that makes me happy. But the thing that really excited me when they say, you know, I love my job again. I love what, you know, I think on the second one, we got an email on the Monday morning in the private Facebook group, someone said, that was a busy Monday. I've seen 42 patients. And you know what? I absolutely loved it. I feel like I've learned

new tools on how to help my patients now. And I think that's the part that doesn't get spoken about enough. Actually, I think a lot of healthcare professionals are frustrated. They don't like 10-minute consultations. They don't like that they're having to try and fix societal problems in the consultation room. It's very disempowering. room. It's very disempowering. Julie, I wanted to ask you, in Froome, with these resources, with these community connectors, what about young men? We know that young men, males around the country, are really struggling with mental health, high suicide rates. It's all very well if someone knows that they're lonely and feels isolated. But I've had patients, let's say 35-year-old patients come in before, young men, who thought they were depressed. And actually, they were, but actually it was depression

secondary to loneliness. And when I helped them tap into a local community, or they reconnected with friends who they just were too busy to see, actually a lot of their depression symptoms went away. So I guess what I'm trying to ask is, men are typically known for not being that great at asking for help and looking for help. Did you have, you know, in Freem, were there issues with accessing certain parts of the population who I guess may be more resistant to that help in the first place? I think that's really a lot to do with your skills as a clinician. If somebody is presenting to you and thinking about how well can you listen and how do people talk about their problems.

And I think that one of the key bits of that is about what matters most to people. So they might come in with a knee ache or a back ache, but can you get that round to a conversation which says, well, what's going on in your life and what matters most to you? And I think that the process then becomes, well, what is it that interests you? And this is where the community development side of it comes in. Because if you've had a program going on in the community where there's lots of activities and lots of different kinds of activities, and it doesn't matter what it is, whether it's model railways or men's shed or sports clubs. If you've got those things at your fingertips that you can access, you can find out and that you can connect people into

something that they're interested in. And like I was saying, it's the stuff that happens along the way that makes a difference. The interest is just how people gather, but it's the love, laughter, and friendship that happens along the way that actually helps you solve those problems. And it might be that your problems are loneliness, but you've also got a problem with debt, or you've got a problem with the neighborhood you're in. Well, what about if you can connect people up so that they can start dealing with those problems as well? There's a fantastic example of the Beacon Housing Estate in Falmouth where a couple of health visitors went down there to do health visiting and it's one of the poorest areas and massive deprivation and

drug and crime and young men feeling disconnected and isolated and not knowing what to do and creating havoc around the place. And they realized that actually that being health visiting wasn't going to make any difference at all. So what they did was they became community activists and they got the community together and said, look, what about, start having community meetings? What is it that's going on? And they would say, we've been deserted by the police and by the council. And so the next thing they did is they got the police and the council in. And then the police and the council said, well, we've given up on you.

And they're going, why have you given up on us? And they started this process about re-nourishing their communities so that people could find a space and felt a sense of belonging. And the council estate becomes transformed through this process of community engagement. process of of community engagement and and when you start when you start thinking like this that examples become so many there's this like for young men you know boxing gyms might work really well there's this really innovative guy who started this thing called run them crew he's a he's a dj i can't remember his name but i thought you were going to say Run DMC there. Yeah, yeah. Is that? No. Run DMC. And he was somebody who came from a diverse background and felt disconnected and isolated.

And he used to run through the streets of London at night. So he thought, okay, I'm going to start a running club. And so he starts this running club where all these people come together and start running together through the streets of London at night. And it's what happens along the way that makes all the difference, how they support each other, how they see things differently. The examples are so many. I mean, you're a fan of parkrun as well, aren't you? I am, yeah. Does Froome have a parkrun?

aren't you i am yeah it does uh freem have a park run uh i live down in freem does have a park run but i live down in cornwall and um and there's a very nice park run in the small town of helston that i used to go to but um obviously since the since the pandemic it hasn't been going but it's just a lovely environment you know because i like i mean parkrun is i think is just a prime example of everything you're talking about right it's how community-based interventions are transforming lives and you know it's it never ceases to amaze me how impactful parkrun can be um even for non runners even for people who just volunteer i've got a couple of patients who don't want to run they volunteer it's changed their life improved their mood they they feel part of something greater than themselves there's a there's a lovely story

about uh how park run started and i'm useless with names and i'm getting the guy starting but but he went to a pretty strict uh uh private school in south africa and he moved to the uk and when he was an adult and and he was saying his life was pants you know he he's he'd lost his job his girlfriend had kicked him out and he was life was at rock bottom and he just wanted to go running with his mates and he didn't want the harsh regimes of you know being told what to do by by a very authoritarian trainer so his main thing was uh like we'll go and run around uh bushy park but we'll have a coffee afterwards and chat and we'll make it as easy as possible for people to join in and the first one was like 13 mates and he got this token and people could then do the run and have the token on them and just meet up every week for a run and a coffee.

And then it spread because he made it so easy for people to join in. And then other people started park runs. And now there are park runs all over the world 20 million people a week running five kilometers or walking it or whatever they can manage as long as they can just make it and be there and make friends it's it's great it is and i think the key there was he made it easy right we've got to make these things easy if we want people to do them. It's what, you know, we've spoken about before on the show about, you know, how important it is to make things easy when people want behavior change. But I think behavior change is interesting, isn't it? Because when we talk about behavior change, myself included, we're talking about it on an individual level. As this individual, how do you create behavior change but actually it's a lot

easier making behavior change when everyone around you is doing the same thing well yeah and and you think about whatever you're doing you do it together doing together makes the biggest difference yeah i've got another great example far away um uh is um i don't know whether you saw a film called dawn wall um i haven't yet it's it's a film about this guy who is obsessed uh by climbing this particular route in el capitan and he spends seven years um preparing for it and initially he does it with his wife who's a great climber but then their relationship breaks down and and he chooses this he compares up with this other guy and they uh and and if you're uh this is a spoiler alert so if you don't want to hear this then just switch off for a little bit but but there's a point uh on the climb where he makes it across this particular pitch but his mate doesn't and they spend the next

three weeks hanging on the side of the wall for this guy to try and make it and he can't make it and eventually they decide okay look i'm going to go to the top you know and so the guy just his climbing partner becomes an aid but he's about to get to the top and and and uh tommy this guy goes you know it doesn't matter doing it without my climbing partner is meaningless and he gives it up and and he goes back and they and he says we're going to stay here until you've done this section again it's and and like he gives up this great ambition solely to be with his friend i've got i've literally i've got tingles all over my body hearing that because that's it isn't it yeah that's the essence of of living what what joy is it and doing it by yourself right it's if we think back to those

special moments in our own lives are they are any of them really when we're truly alone or is it when we're with other people when we can share it right that's it there's another example that i love which is about the brownlee brothers and um you know the the triathletes. And they're doing this race and it's, you know, Alistair is beating Johnny again and, you know, the Spanish guy is between the two of them and Alistair's getting to the finishing line and he sees on the finishing line, he sees his brother stumble and fall just about not to make it across the finishing line. So he stops and picks up his brother and loses the lead to the Spanish guy

just so that his brother can make it over the line. You know, giving it all up for that sense of being with the person you love, you know, it's just great. I mean, that's probably a wonderful place to start winding up this conversation um do you think i've really really valued the work you're doing i think the book is amazing i would definitely think people should check out your podcast i think it's i've listened to a couple of episodes including the the one with the the chap from iraq who now lives

in canada and i think i i won't give the spoiler away for that. I think I'll link to it in the show notes if people want to listen to that. I hope the work you've done with your colleagues does spread around the world. I think it needs to. I think it's high time that it does. Just to finish off, Julian, I call this podcast Feel Better Live More because when we feel better in ourselves, we get more out of life. And in your many years as a clinician, in your many years as a human on this earth, what are some of your top tips for people right at the end now, for people who've heard, who've been inspired by what you have to say, but what can they now do in their lives that are going to improve them for the better? I think the first thing is to really appreciate that you are already compassionate, that we swim in a sea of compassion. And we have to appreciate the

fact that if we make somebody a cup of tea, if we give someone some food, if we do talk to people down the shops, if we give our friend a lift, if we help out, these things are so close to us that they are happening all the time. And it's really worth devoting some time to just go through and appreciate that you have this incredible treasure of compassion that is going to help you live a happy, long life. And then having appreciated that you've got this natural compassion, that you have this natural gift, is to come to the firm conclusion that it's really worthwhile being compassionate. And then think about how you can apply that in your life. And that might be calling up the people that you love or telling the people that you love that you love them, or looking over the fence and asking about how the neighbor is just chatting, or seeing if there's something that you can do that will help

or thinking about, you know, what is it you're interested in and are there other people interested in doing the same thing? And, you know, there's a fantastic story about Incredible Edible. Your listeners might like to look at that, you know, about how three women just went, why don't we start gardening, producing vegetables for people? And this international movement comes from it. Or if there's something that you're interested in and nobody else is doing it, do it with a friend. Just simple things, you know,

it's like I was saying, make small steps because once you start, you will never stop. small steps because once you start, you will never stop. Julian, thank you for making the journey up to my studio today. Thanks for the incredible work you do. And I look forward to the next time we get to have a conversation. I look forward to it. And I think as well, you know, I think we're doing similar kind of work. I think there's so much commonality between us.

And I absolutely respect what you're doing and your desire to help as many people as possible, more than just giving medication. And you know, your books, your TV programs, all of those things, they all contribute to this place of making the world slightly better. So I have total respect for what you're doing. Thank you. How was that for you? Do you feel inspired to bring a little more compassion into your life today? I know that I certainly do. Please do let us know on social media what you intend to do or what compassionate acts you are already doing. I'll try my best to share your own stories on social media so together we can spread the kindness and the positivity. Now, do you think someone in your life could do with hearing this episode? You can do a compassionate act right now

by sharing this conversation with your family and friends. This is absolutely an act of kindness. And don't forget, it has benefits to you as well as the other person. And of course, don't forget this episode, like all of them, is available to watch in HD on YouTube if they prefer videos as opposed to audio podcasts. If you go to the show notes page on my website, you can see links to Julian's wonderful book, The Compassion Project, that I highly recommend. You can also see links to his TED Talk, his own podcast, and articles about his work in Froome. Now, whilst we're on the subject of compassion, my new book, Feel Great, Lose Weight, comes out

in the UK at the end of December 2020. It's all about a compassionate approach to weight loss. In fact, the book is about so much more than weight loss. It really will help all of us be kinder and more compassionate to ourselves as we start to understand our own patterns and behaviors better. I am really, really proud of this book. And if that sounds like something you may want to read more about, you can order a copy right now in paperback, ebook, or as an audiobook, which I have narrated. A big thank you to my wife, Vedanta Chatterjee, for producing this week's podcast, and to Richard Hughes for audio engineering. Have a wonderful week. Make sure you have pressed subscribe, and I'll be back in one week's time with my latest conversation. Remember, you are the architects of your own health, making

lifestyle changes always worth it. Because when you feel better, you live more.