The doctor will move in with you now.

نویسنده

  • Helen Macdonald
چکیده

If only I had more time with my patients they would be healthy, I would be fulfilled, and the world would be a better place—so the myth goes. General practitioner Rangan Chatterjee threw away his 10 minute appointment slots and moved in with patients for this series. Pratiksha, a middle agedwomanwith obesity, stress, and anxiety and a variety of symptoms, consumed pots of over-the-counter remedies. She and her partner, Sandeep, taking three antidiabetes agents and with poor control of his type 2 diabetes, were the subjects of the first episode. In the second episode a weight lifter with chronic back pain and an appetite for prescription opioids, who turned out to have body dysmorphia, took centre stage, along with his youngest son, who has eczema. So what happened when Chatterjee had more than 10 minutes? The extra time seemed to increase the amount of testing. Reviewing the series in the Guardian Filipa Jodelka wrote, “A functioning body is a treasure trove of burgeoning disease and worrying statistics if you run enough tests on it.” Several of the tests raised my eyebrow, such as cortisol sputum tests for stress—really? A scan to demonstrate visceral fat in obesity: what does that change? The glitz of the high tech tests overshadowed the unglamorous reality that many of the diagnoses related to lifestyle. A notable exception was the conversation about opioid addiction and the diagnosis of body dysmorphia. There was obvious discomfort, but also bravery, on the part of Chatterjee and his patient in dealing with it. We got a rare glimpse of a consultation with a psychologist. And if that prompts patients to access psychological services to understand how self perception and negative thoughts can drive unhelpful behaviour and damage their health, the programme will have been worthwhile. Some of the explanations veered towards alarmism, presumably aimed at motivating change. Doctors may have cheered to hear Chatterjee’s management plans dominated by lifestyle changes to tackle obesity, diabetes, and eczema. But the manner of his lifestyle prescriptions seemed paternalistic, with little patient involvement in the footage shown. And at times the advice seemed extreme. For example, wheat and dairy were excluded from a boy’s diet to tackle his eczema. At the same time his mother was asked to change their washing powder and the boy’s bedclothes and to freeze his teddy. It seemed unlikely that she would form a clear picture of the causes of her son’s eczema. Similarly, fasting and a diet of radical sugar exclusion may have exceeded routine management of diabetes or obesity. Combined with exercise, this regime meant that Pratiksha and Sandeep lost much weight, and Sandeep improved his HbA1c despite a reduction in his drugs. But how sustainable will the changes prove? What effect will Chatterjee’s visits have on new problems?Will these families get better at identifying and managing harmful behaviours? Will they consult differently? Will they be healthier? Will viewers change their behaviour? As our public broadcaster, could the BBC have gone further? Many people know that their diet and exercise levels are unhealthy. And people see their doctors knowing that their behaviour contributes to symptoms and disease. But, by focusing on individuals, did the BBC miss a bigger picture? How do we create a society where work, shopping, eating, and home environments make healthy choices the easy ones? And how do we stop doctors and our healthcare system overinvestigating and overmedicalising individuals, when it is our broader society that seems in greater need of our medical attention? There are plenty of ideas out there.

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عنوان ژورنال:
  • BMJ

دوره 351  شماره 

صفحات  -

تاریخ انتشار 2015