I’ve always been interested in how the type of medicine I learned about in medical school can sit alongside lifestyle approaches and complementary support.
Some people call this an Integrative medicine approach. In an integrative model, self management is a major pillar of good health and wellbeing, particularly for those with a long-term health condition. Doctors are well placed to support this, but people know what works for them.
I work with people affected by cancer and also in a general practice setting, but many of the issues people experience are similar in both situations – wanting to feel more informed and more in control of their health.
A key consideration is how, as doctors, we can make people more resilient and not just treat or paper over symptoms. For example, if someone has a urinary tract infection I may well prescribe antibiotics but then I’ll look at whether we can reduce the risk of them getting it again in future, by talking with them about what they drink and eat, how they sleep, rest and exercise and how stressed they are.
By increasing my appointments to 15 minutes minutes rather than the standard ten – and making that upfront investment – I find I can get under the skin of of a problem and come up with a better management plan with a patient which, in turn, means I see them less frequently.
This approach also lends itself to cancer care and is increasingly important as those with the condition live longer and more fulfilled lives compared with people diagnosed with cancer a few decades ago.
Cancer treatment can be invasive and toxic but lifestyle approaches and complementary treatments can help reduce the side effects. We teach people at Penny Brohn UK about the importance of good nutrition and physical activity and explore practical support mechanisms.
The mind can be an important ally, but people affected by cancer report high levels of anxiety and depression and experience relationship difficulties post-diagnosis and treatment, so we promote mindfulness training, counselling and group discussions which reduce the chances of them getting dragged down by negative thoughts.
Keeping connected to the things that give cancer patients purpose is inherently important. There’s lots of research that shows people who have strong reasons for living generally do better and we try to help them reconnect to that.
I qualified as a GP in 1989 when there were very few groups pushing a people-powered health agenda, but now issues of finance and customer demand have helped to bring it to the fore. Patients are now asking me what they can do to help themselves and it’s becoming a more recognised discipline.
We’re also learning from other countries. In the US for example some centres are much more advanced when it comes to getting people to see the ‘whole picture’ of health. Most big cancer hospitals have a department of integrative oncology because patients want it, and if they have health insurance they’re opting to be treated at a place that provides this as a treatment option.
There are some hurdles though. Various initiatives come and go and it’s the sustainable presence of these offers that attract users. There are also issues of demand and equity of access. There are many self management groups and sessions, but we’re not always able to reach the people who may benefit the most.
The crux of people-powered health is for patients to choose things that make them feel better and ensuring they don’t take on too much responsibility and over burden themselves. You can’t take professionals out of the health equation. People, especially with an illness like cancer, still need professional support but it should be on a more equal footing to provide information and assurances and then they can take control.
- Dr Catherine Zollman is a GP in Bristol and medical director of Penny Brohn UK, a charity specialising in a holistic approach to cancer care. More information on people-powered health is available from Nesta’s The Future of People Powered Health 2017