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personal-health-journeys-blog · 7 years ago

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Redundant subjectivity?

Professor Stephen Pattison,

Hon. Fellow RCGP

October 2016

I am ashamed to admit I have learned to dread going to my GP. Indeed, I positively avoid going, even when I think it might be useful or even essential. Letters inviting me for health check-ups lurk unopened on the kitchen table and eventually find their way into the bin

Thinking about this lamentable situation, as one who ‘should know better’, I guess my phobia has grown over the years and led to a fundamental lack of trust in those over-burdened, hard-working souls charged with my primary care. And I think at the heart of this it feels as if my subjectivity is now more or less completely disregarded.

I go to the GP with a small agenda of, usually minor, problems that are important to me, but insignificant in the great scheme of things. And instead of attending to my concerns, the GP, attending in the first place to a computer screen, and then pushed no doubt by prompts and advice from government and other health bodies, insists on taking my blood pressure and interrogating me on my lifestyle before giving me unasked for advice about how I could live a healthier and better life (as if I didn’t know that I could do that, and were not ashamed of the fact that I don’t). I leave the surgery edified but effectively deafed out, both guilty and demoralised.

My partner has had worse experiences. An experienced psychotherapist, she has lately become hypothyroid, a condition she was warned years ago that she might develop. The condition became so serious that she thought she would have to give up her flourishing practice as she could not think properly. The GP’s response: the blood tests show that you are within normal range so we are not going to do anything about it. But you seem rather depressed, so why don’t we give you a mental health plan and refer you to psychiatric services?

My partner has quite a good sense of the difference between depression and physical depletion, but this seemed to count for nothing in the face of the statistics and the external guidance that appeared to have captured the GP’s mind, judgment and prescription pad.

We later talked about how if you actually go to the doctor saying you feel low, you can be administered heavy-duty psychoactive drugs without recourse to any physical tests whatsoever. It appears, then, that the subjective experience of patients sometimes ‘trumps’ all other information, and is sometimes irrelevant, however lousy the patient feels, however close to some statistical border line they may be, and however cheap the treatment that might be prescribed for them (a daily dose of levothyroxine is very cheap, I understand).

I write in a spirit of perplexed solidarity with GPs. My perplexity revolves around the changing value of subjectivity in illness and clinical encounters, the value of different kinds of evidence and the nature of the role of doctors in a world that is served by more and better information and testing than ever before.

As to the changing value of subjectivity in illness and clinical encounters, it seems to me that until patients and doctors can model themselves on machines, behaving consistently and predictably over time, there will always be a value to subjectivity. If nothing else, it will get in the way if it is ignored and patients will become avoidant, angry or any number of other unhelpful, distressing things. This will be painful in the subjectivity of doctors whose own varied and needful persons cannot be regarded as a mere unhelpful contaminant perverting the course of rational investigation and treatment in the clinic – surely?

The patient-doctor relationship is complex and deeply contextual, affording and needing many different kinds of evidence for a mutually satisfactory outcome and collaboration to be achieved. What is statistically true for the population generally may or may not be relevant for particular individuals. It is likely that if you smoke you will acquire nasty diseases and have a shorter life. That did not stop my father from indulging in heavy smoking for about seventy years of his life before he died, having lived a full and happy life, at the age of eighty six. Scientifically-derived information is, at best, only half of the information that is needed to work with patients and other narratives and kinds of information are important – especially to patients themselves.

Which brings me to the role of doctors, called in some countries ‘personal physicians’. It may be that in someone’s mind or ambition the aim is to make humans redundant in medical encounters so that people can self-diagnose and -treat with the aid of a computer and sampling kit. But until that day dawns, is it not the job, the skill and the satisfaction of GPs to mediate between data and facts of various kinds and the subjectivity of patients, learning from both and arriving at a satisfactory outcome in which in some sense patients feel better able to engage with their lives? I think I have heard many senior doctors in the RCGP argue precisely for this kind of skilful, compassionate and mutually rewarding approach.

So this short piece is just to affirm to clinicians that this would be much appreciated by patients and that it is not yet a reality in all local practices. We patients would really like you to take our subjectivities seriously – we are stuck with them, willy-nilly. More to the point, if you don’t, you may find that the capacity to deliver on ‘evidence-driven’ targets of various kinds is threatened by our avoidance and non-co-operation. Trust depends on taking people and their concerns, however apparently trivial, seriously, and upon attending to them. So please inform the sources of guidance, protocols, and targets that you and your patients are persons with awkward and delightful subjectivities, not just numbers. That way, we will all get on much better enjoying happier and healthier professional relationships. Who knows, maybe the outcomes of encounters that take subjectivity more seriously may be cheaper and more effective in the long run?

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personal-health-journeys-blog · 7 years ago

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Libraries are not just about books: A Place for Arts and Health

"The arts call us to wake up, to feel, to communicate and share. For this to happen a room needs to feel convivial, not medicalised - so many spaces now seem to be boxes where the body is shut off from natural light thereby losing a vital sense of connection to the time of day, to the outside world, to seasons and weather all of which contribute to our vital sense of connectedness. A room needs to be easy to clean - a place where paint, chalk or clay can be used and washed away after without the pressure of keeping the room pristine during a session. A room, studio, needs to be a place that invites creativity - where paintings, images, poems, music can be shared The room needs to feel it can be owned by a group for the brief time they gather and create within it, room to move”. Miranda Tuffnell

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personal-health-journeys-blog · 8 years ago

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South Lockleaze

Old Library Gardening The garden gathering on Saturday morning was a great success, with our largest turn out yet of people helping out in the garden, getting seeds planted, tidying up the front beds (to rid them of the Sycamores!), weeding the paths and coming up with a plan for the growing beds moving forwards. Two of the beds are on their way to becoming Salad & Medicinal beds, so we can both grow food & plants for picking, sharing, eating and learning! If you have any plants, plugs or seeds you think might fit, then do let the garden group know - they'd be most welcome! The morning session had a total of 6 adult volunteers and 3 children volunteers, but with ongoing gardening needed now the Spring is with us, do get the 1st Saturday of the month into your diaries if you think you can join in with this lovely little group! There's also a bench in the garden that could do with some love & attention - fancy an upcycling project? You're welcome to get stuck in :) South Purdown Yesterday morning, Sunday, we had our South Purdown tidy up & bug hotel fix up. Unfortunately with only a turnout of 4 people this time (myself & my partner, + two from North Lockleaze), we didn't get as much done as we'd have liked to, however managed to move all the wood and fill up the bug hotels, plus fill 3 bin bags of rubbish, so considering the numbers, it was a successful morning! Still lots to do, but of course trying to keep such a large area for us all to enjoy tidy & clean is a project that needs more hands on board, so i'd be really keen on knowing if there would be a better time or day that would be more suitable for you to join in, or whether anyone has other ideas on how we can make this more successful in the future. Please do let me know! Do remember that our green space is a place for us all to enjoy, but with the recent council cuts & park cuts, looking after these spaces is no longer in the council remit aside from cutting grass and emptying full bins, so anything we as a community can do to look after this space is more important now than ever. Keep Up-to-date Do keep an eye on the Facebook groups for upcoming events, activities & workshops, and do share any local news on the South Lockleaze & Purdown Neighbourhood Group page, to keep everyone updated. This is a place for us to chat, share, inform and learn together, whereas many of these emails are one way, so it would be great to hear from more people as to what we are doing as a community or what we can do, to improve this beautiful neighbourhood! You may have also seen the lovely new noticeboard that was installed last Friday! Thanks to Steve England & his son for coming down and hope this will help keep you all updated when the Old Library isn't open or for those not on Facebook - have you seen it? What do you think!? :) Look forward to hearing from you soon, lots of neighbourly love, Emily On behalf of the South Lockleaze and Purdown Neighbourhood Group C.I.C. Follow our Neighbourhood on Twitter: @SLAP_Bristol Follow The Old Library on Twitter: @OldLibrary_EV

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personal-health-journeys-blog · 8 years ago

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Children's’ Book Space Life Rooms Walton Liverpool (Former Carnegie Library)

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personal-health-journeys-blog · 8 years ago

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Life Rooms

PUBLIC ENGAGEMENT IN THE LIFE ROOMS, RICE LANE, WALTON, "OLD INTO NEW". Dr Robert G MacDonald RIBA, Design Panel Member, MerseyCare NHS Foundation Trust. INTRODUCTION; The former Walton Carnegie Library (Built 1911) has been converted into a centre for learning, recovery, health and wellbeing. The MerseyCare NHS Foundation Trust plans to improve the community's local connections by forming partnerships with various environmental, community, health and learning partners and become a one stop well being shop for the public and service users. THE LIFE ROOMS CONCEPT; Within the Life Rooms is the recovery college, where people who are in a health improving condition, can drop in for variety of activities. The Life Rooms are a therapeutic link between hospital and the community. The Life Rooms are challenging stigma and building confidence amongst mental health service users. Drama is being used to build confidence and creating positive body image. Creative writing is used in creative arts and using comedy and the arts. All these new skills can lead to getting a job and mental health issues of anxiety, depression and the complexity of psychosis can be talked about with councillors in a quiet and safe discrete place. All these positive experiences take place in the Life Rooms and Recovery College and can lead towards well being and good mental health. MerseyCare have plans for more Life Rooms in the future and a new one has been developed on Lord Street in Southport. The intension is to engage and develop partnerships with more local communities. There plans to enlarge the book stock and reading books for young and old is still important and there is awareness of libraries for health and combinations with GPs surgeries. There will be more memorabilia in the library and evidence of increasing footfall. The question was posed and asked can the building reduce stigma of mental illness ? FEEDBACK & CONVERSATION; The group of MerseyCare users provided feedback about the project. The built environment is very good, clean, tidy and even posh ! The reception is welcoming. Should staff wear badges but they are very friendly and helpful. There are a good number of of accessible PCs. Food and drink costs are running at loss because of being run by a Children's Charity and the. Competition of McDonalds. Musicians are asking for space for music performance and to hold Festivals. The Acoustics of domed roof was discussed and should music be playing in background ? We need to understand the psychology of cafes. The spaces are quiet, roomy and spacious with warm light warm light at times. The book and computers stock is good. The Local groups are a good resource and the Prospectus for the recovery college is informative and helpful. Friendship groups could be organised and perhaps clubs for watching movies. Craft clubs and a crèches could be organised. There are reading difficulties in the local community and post school reading clubs could be held. Could there be exercise clubs, Yoga classes and healthy eating groups that would assist physical health and well being ? These classes could focus on over fifty groups and incorporate outside walking groups. Self employment advise is needed because local unemployment is high. SUGGESTIONS FOR FUTURE PARTNERSHIPS; Professional bodies, Different Church Denominations, Dog walking groups with families, The Cinnamon Trust, Liverpool Architectural Society LAS, Merseyside Civic Society MCS, West Derby Society, Alt Valley Community Trust, Links with volunteering groups, Community nurses, Associations with the Three Universities, LJMU, Hope and Liverpool University to develop Mental Health as Action Research. RGM

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