Day 794

Spending a few days in the countryside has brought out some stark differences from London.

No one walks with head/ear phones on in the countryside.
People greet others even if they don’t know them.
Even though people live far away from each other, they feel connected.
The abundance of nature allows for a free flow of energy as opposed to the rigid urban boxed-in compartmentalisation leading to desperate loneliness and isolation.

Last month I heard that as a man stood in despair at the edge of a tall building contemplating a jump, onlookers egged him on, poised with their cameras. Once I got over the initial shock of the implications of this fact, I began to wonder whether people had truly lost their compassion and empathy or whether they were unable to differentiate between real and virtual worlds. Are the lines between these two worlds too blurred for some of us? Do screens dominate our lives to the extent that unless it’s happening on a screen, it’s not happening? And if it’s happening on a screen it’s not real anyway?

“The Matrix is a system, Neo, and that system is our enemy. When you are inside, you look around, what do you see? Businessmen, teachers, lawyers, carpenters, the very minds we are trying to save. Until we do, these people are part of that system and that makes them our enemies. You have to understand that most of these people are not ready to be unplugged and many are so hopelessly dependent on the system, they will fight to protect it. The Matrix is everywhere. It is all around us. Even in this very room. You can see it when you look out your window or when you turn on your television. You can feel it when you go to work, when you go to church, when you pay your taxes. It is the world that has been pulled over your eyes to blind you from the truth.”

Morpheus, in the movie, “The Matrix”

Day 787

The Francis report concluded that patients were routinely neglected by a trust that was preoccupied with cost cutting, targets and processes and lost sight of its fundamental responsibility to provide safe care. An estimated 400 to 1,200 people could have died unnecessarily there between 2005 and 2008. In addition, the inquiry heard that receptionists in the accident and emergency department had regularly triaged patients

The public inquiry heard common themes of call bells going unanswered, patients left lying in their own urine or excrement, or with food and drink out of reach. Patient falls were also concealed from relatives.  An inward looking organisation, with a low staff turnover, the trust suffered from a lack of new ideas and a negative culture that became entrenched. Extremely poor nursing care was at the heart of this enquiry bringing into question ‘empathy’ in health care professionals.

Studies have shown that physician empathy is significantly associated with desirable clinical outcomes for patients with diabetes mellitus and should be considered an important component of clinical competence. ( Source: http://www.forcedo.org/wp-content/uploads/2013/03/The_Relationship_Between_Physician_Empathy_and.26.pdf)

A qualitative study of empathy in 3rd year medical students showed that inhibitors of empathy may originate in the hidden curriculum creating a greater distance between patients and physicians. Cynicism as a coping strategy, primary importance of technical knowledge, emotional control, becoming and being a professional hence keeping a professional distance from patients reinforced lack of empathy. One student explained that exploring a patient’s true feelings is not permitted. She noted that she explored and discussed patients’ emotions less than before because she felt that it is not accepted within the medical educational environment.(Source: http://bmcmededuc.biomedcentral.com/articles/10.1186/1472-6920-14-165)

Good bedside manner is nothing but a practical demonstration of empathy. Can it be taught and learnt?

While at one level it is possible to ‘understand’ how another person might be feeling (cognitive empathy), not everyone is capable of feeling how the other person might be feeling (emotional empathy). Both are essential for people in caring roles.

In all my years as a practicing doctor, I have learnt that patients are not just a source of inspiration for me but a primary source of learning. Books can only teach you so much. Most valuable lessons come from patients and from observing the attitudes and behaviour of senior colleagues.

Considering the fact that GP training in the UK is the shortest amongst all European countries, patients must be treated with greater respect as sources of learning. In my specialist training of 7 years duration, I learnt a lot about Anaesthesia. GPs are expected to learn a fair amount about everything in 3 years. (http://www.rcgp.org.uk/news/2016/october/mental-health-is-key-in-the-gp-training-curriculum-says-rcgp.aspx)

Am I optimistic? Yes. The government is waking up. There is hope.

 

Day 734

2 months ago I made a presentation entitled ‘Understanding Resilience’ to a group of roughly 30 people in their twenties. It was well received and the feedback was encouraging. Here is the quantitative analysis, marked out of 5.

Content:  4.39

Presentation: 4.38

Relevence to me:  4.13

Overall:  4.38

It was interesting to see that the lowest score was to do with relevance. It means that while most of them liked the content and had an overall good impression of it, many of them thought it didn’t apply to them.

Perhaps it reflects the fact that at present they feel strong. Great! Long may it stay that way! If I had attended a presentation like that a few years ago, I would have thought the same. But I do hope that if any of their friends, colleagues or family is in a vulnerable place they will be able to spot that and reach out to them. I also hope that if they see a distressed stranger, they will be sensitive to that and offer support.

The low score could also indicate an inability of some of us to acknowledge our own fragility.

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Day 700

When our GP heard of Saagar’s death, the first phone call he made was to the Medical Defence Union and they advised him not to call us. Despite having known us for more than 7 years and seeing Saagar every 2 weeks with us for the last few months of his life, he did not call us on his death.

A qualitative study of GPs’ experiences of dealing with parents bereaved by suicide by Emily Foggin et al was published last month in the British Journal of General Practise.

It acknowledged that bereavement by suicide is a risk factor for suicide but the needs of those bereaved by suicide have not been addressed and little is known about how GPs support these patients, and how they deal with this aspect of their work. 13 GPs in the UK were interviewed in a semi-structured format. It explored experiences of dealing with suicide and bereavement.

GPs disclosed low confidence in dealing with suicide and an unpreparedness to face parents bereaved by suicide. Some GPs described guilt surrounding the suicide, and a reluctance to initiate contact with the bereaved parents. GPs talked of their duty to care for the bereaved patients, but admitted difficulties in knowing what to do, particularly in the perceived absence of other services. GPs reflected on the impact of the suicide on themselves and described a lack of support or supervision.

It concluded that GPs need to feel confident and competent to support parents bereaved by suicide. Although this may be facilitated through training initiatives, and accessible services to refer parents to, GPs also require formal support and supervision, particularly around significant events such as suicide. Results from this qualitative study have informed the development of evidence-based suicide bereavement training for health professionals.

Ref : http://bjgp.org/content/early/2016/08/15/bjgp16X686605

This evening a vigil was held by SOBS (Survivors Of Bereavement by Suicide) at Hyde Park to remember those lost through suicide. Some of the people there had lost a brother 25 years ago or a sister 5 years ago or a friend 1 year ago and so on. Some of the families had not been able to speak about it for many years. Others had kept quiet as they were not sure if anyone would understand. But in that space, we sat together on the brownish-green grass with the pictures of our loved ones and lit candles in their memory and we opened our hearts. For about 2 hours we claimed that space and made it our own knowing full well that we are being listened to and perfectly well understood. What a rare gift that is!

When it comes to suicide, post-vention is pre-vention.

 

Day 691

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A snippet from life of a Helpline call centre:

11.51: Bullies at school are telling the next female caller to take her own life. She’s upset and agitated and feels anxious about talking to her parents or GP. After talking through the issues, she says she’s not in immediate danger and will try to talk to her parents and seek support from her GP or the charity if she feels it necessary.

13.49: A mother calls about her son who is struggling at university and has told her he may as well not be alive. She is worried he might be suicidal.

The adviser talks to her for half an hour about asking her son directly about suicide and discusses what other support he may need, including talking to his GP and giving him the HOPELineUK details. Afterwards, the mum says she is more confident about speaking to her son.

18.32: With the suicide prevention advisers on calls, a voicemail is left by a young man. He calls back eight minutes later and starts apologising for calling the helpline.

He’s made plans to take his own life today and despite calling his mental health team and telling them he’s suicidal, he’s still waiting for his case worker to call back.

After 42 minutes on the phone with the helpline suicide prevention adviser, he’s much calmer and says he won’t take his own life today.

18.53: A young transitioning transgender person calls, admitting she’s feeling suicidal today. She spends 23 minutes talking through her issues with a suicide prevention adviser who works with her on a plan to stay safe over the coming hours and signposts her to support networks she may find helpful.

19.38: A text comes in from a young father who says he’s feeling suicidal. He suffered domestic abuse as a child and, as a result of alcohol and drug addiction, has lost contact rights with his own children. He says he has his suicide method in front of him and is intending to end his life.

Let’s break the silence. Hopeline number: 0800 068 4141

Source: https://www.thesun.co.uk/living/1732567/a-caller-wants-to-die-until-he-talks-about-his-cat-suicide-prevention-helpline-hopelineuk-works-to-prevent-hundreds-of-suicides-every-day/

 

Day 687

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“Is it wrong that I secretly enjoy this bit very much?” asked a deeply religious young lady as she was going off to sleep as a result of having received some anaesthetic medications from me this morning.

The turmoil and the innocence of her question made me think about how much of our life is governed by what’s right and what’s wrong. On the one hand it in an important judgement to make and on the other it can be completely stifling if we take it too far. It can make us judge others and ourselves rather harshly. After all, the past and the present is witness that many thousands of innocent people having been rightfully and ruthlessly killed and ruined in the name of a ‘loving, merciful and forgiving’ God and ‘democracy and liberty’.

Being ‘right’ often does nothing more than instil a sense of false superiority, designed to control the feelings and behaviour of others and confine them and society to very narrow boundaries. People who believe they are ‘good’ and ‘right’ constantly look down upon others who may be different.

According to a story from Hindu mythology, Lord Vishnu had 2 wives – Laxmi, the goddess of fortune, and Alaxmi, the goddess of misfortune. Both of them believed they were the most beautiful. So, they asked Vishnu, “Which one of us is the most beautiful?”
Vishnu said to Laxmi, “When you arrive, you are the most beautiful.” And he told Alaxmi, “When you leave, you are the most beautiful.”
What is the correct answer? Who is really beautiful?

“Existence knows no right or wrong. The beauty of existence lies in doing what is appropriate, rather than relying on morals and ethics.The life process seems to be so chaotic and unbearable for you that you are trying to bring some silly sense of order by establishing your own principles, your own morality, your own ethics. If you bring your own silly sense of order to life, you will completely miss the magnificent order of the existence. There is no need to be orderly. Existence is in perfect order.” – Jaggi Vasudev.

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Day 681

About 5 months after Saagar’s passing, one of my close friends sent me a subtle message suggesting that I should be careful about what I write in my blog as a few of my work colleagues read it regularly and if I appear to be too fragile or vulnerable, it might have a negative impact on my professional life. I understood her concern. The medical profession is not known for its understanding and compassion for mental frailty in colleagues.

Dr Wendy Potts was a GP in Derbyshire who blogged about living with Bipolar Disorder on a regular basis. One of her patients read the blog and complained to her Practise. The doctor was suspended. A few weeks later she ended her own life.

Firstly, I don’t understand the basis of the complaint. Would patients complain if their GP had diabetes or cancer?

Secondly, I don’t understand the basis for suspension from work. If the doctor’s performance was not questionable, then there is no ground for that.

Ref : https://www.theguardian.com/uk-news/2016/aug/26/gp-found-dead-after-being-suspended-over-bipolar-disorder-blog?cmp=oth_b-aplnews_d-2

This is one of many examples of poor treatment of medical colleagues with mental health issues. I think we are a long way from seeing parity between physical and mental illnesses as the ones who are supposed to put that into practise are themselves caught in the stigma associated with mental illness.

(PS: apologies for not being able to insert the link to the article in a better way. The ‘link’ icon on my page doesn’t seem to work anymore. Any ideas? )