by Dr. Rangan Chatterjee
I love general practice but I don’t love the way general practice operates at the moment. Many of my patients feel frustrated by the short consultation times and feel as though they’re “on the clock” from the minute they walk in. This results in them pre-filtering information that they deem relevant to the consultation, which doesn’t help them or me.
GP satisfaction isn’t any better. A recent study published in the Lancet warns that General Practice in England is reaching “saturation point”, with job dissatisfaction and stress amongst GPs at their highest levels for over a decade. I believe that if you have unhappy doctors, you will have unhappy patients.
Do we need longer consultation times? Absolutely. But I believe that there is another key factor in improving patients’ health outcomes as well as doctor satisfaction: medical education.
Getting to the root cause
A few years into my job as a GP, I realised that I was probably only helping around 25 per cent of the patients walking through my door. Sure, I could give them a drug to “suppress” their symptoms but was I getting to the root cause of the problem? No.
One of the problems is that in medical school we are mostly taught a model of care suitable for acute problems, that is primarily pharmaceutical based. However, the health landscape in the UK has changed dramatically over the past few years. The vast majority of chronic problems that I see today – such as type 2 diabetes, obesity, gut problems, insomnia and headaches – are largely driven by lifestyle choices.
Take diabetes. In April 2016, the World Health Organisation (WHO) reported that total diabetes cases had had nearly quadrupled to 422 million in 2014 from 108 million in 1980, with nearly one in 11 adults worldwide affected by the disease – the majority of these are Type 2.
Type 2 diabetes, like many chronic diseases, is potentially preventable and is largely driven by our lifestyle and environment. So, why is the UK spending over £20 billion pounds every year on the direct and indirect costs of this condition?
We have known what needs to be done for many years now so why are we unable to stop this avalanche cascading forward with no sign of slowing?
I often chat with my colleagues about this and a recurrent theme pervades: We were not given enough training in nutrition, lifestyle or behaviour change. Good health occurs outside the doctor’s surgery – not inside.
Fundamentally, chronic problems need a different approach to acute ones. The magic bullet intervention that works for acute illness does not work as well for chronic problems. These often need many small but positive changes that, when implemented together, can have a powerful synergistic effect.
Addressing the real issues
My frustration with the situation led me to seek out individual study in nutrition, lifestyle interventions and movement science. I also learnt a framework of how to put this all together and apply that knowledge in a safe and effective way. This has reignited my passion for my job. Most importantly, my patients are reaping the benefits.
I am delighted to have had the opportunity to showcase the power of a different approach to medicine on the BBC One programme Doctor in the House. For a month at time, I lived alongside three very different families, observing them as they went to work, slept, grocery shopped, exercised and ate. This gave me the insight I needed to put a range of simple and effective changes into effect.
The success of these changes demonstrated that such varied conditions such as type 2 diabetes (both new and established), obesity, menopausal symptoms, eczema, and many more can all be substantially improved and even reversed using the power of nutrition and lifestyle. Yes, that’s right, reversed.
The era of the generalist
I’m also passionate about promoting the value of the expert generalist. In one episode of Doctor in the House, I worked with a five-year-old boy who had three seemingly “different” conditions: abdominal pain causing time off school, severe eczema and gastro-oesophageal reflux. When we first met, he was taking three different kinds of medications from three different doctors.
I was the first doctor to put it all together for the parents and explain that the root cause of all three was the same. By addressing this one issue, all three conditions were almost fully reversed within a few weeks.
As a society, we have over-emphasised the role of the specialist and undervalued the role of the generalist. In order to tackle chronic disease effectively, we need to move from the era of the super specialist into the era of the super generalist.
I believe that there is a strong case to put nutrition and lifestyle at the heart of medical education so that together we can better serve our patients. It is time to change the trajectory of chronic disease that is already making the NHS as well as many other healthcare systems unsustainable.
The British Medical Journal is currently running a Too Much Medicine campaign, which I fully support. I believe it is time for modern medicine to acknowledge that we have lost our way somewhere – over-diagnosis, over-investigation, over-medicalisation and over-treatment. We need to get back to the root cause.
What we put on our plates and how we use our bodies are the most powerful tools we have. It is time to start using them to take back our health.
— Dr Chatterjee