He scowled in reply; there, you see, our conversation had only begun and I’d already made him unhappy.
We are doctors; we do terrible things to people. They come into the surgery like healthy folk and go out as patients.
If they’re really unlucky we confine them to an institution where the occupants are routinely left immobile, deprived of sleep, fed a diet that is tasteless and nutritionally marginal, and experience the de-humanising indignity of being half-naked all the time.
It doesn’t have to be this way; the average age of a patient in general practice is 75. Many have multiple diagnoses, and their care is incredibly complex, and above all requires more of our time. But our time is in increasingly short supply, so much of it wasted on the worried well and on health promotion.
Health promotion is a sacred cow; it’s so obviously a good thing, beyond reproach, how can you argue against it? Every few years a health minister comes out with the ‘free healthchecks, free MOTs!!’ mantra, which makes a good political sound-bite but has minimal evidence base, takes up huge amounts of resources, and leads to vast amounts of bureaucracy and paperwork. And we remember with a shudder the farce of the ‘Health promotion clinics’ in the early nineties.
The human body is not a machine, but a complex, ever-adapting system. Keeping such a entity in good shape might seem a correspondingly complex task, but as Dr Seuss observed, sometimes the questions are complicated but the answers are simple; eat a balanced diet, take regular exercise, don’t smoke, don't drink excessively.
It’s not rocket science, the message is clear and simple, so why it should take up so much of our precious time is unclear.
Of course, just because health promotion is simple, doesn’t mean it’s easy; the world is full of fleshpots and hedonistic distractions, and it’s up to governments to enable and improve access to healthy lifestyles.
But it shouldn’t need a consultation from us; we have sick people like Joe to look after.
- Dr Farrell is a GP from County Armagh. Follow him on Twitter @drlfarrell