The Medic Journal

The musings of a final year medical student

Friday, 14 December 2018

Lifestyle Medicine backlash

Is there a backlash against Lifestyle Medicine? It’s a movement I feel passionate about, so I was taken aback to hear more and more doctors seeming dubious and critical of it.

I was surprised when Margaret McCartney, GP and previous stalwart BMJ columnist Tweeted last month: “Please stop promoting ‘lifestyle medicine’ as a new thing. It’s basic social and human care, and should not be a conduit into non ebm [and] private healthcare.”  

I didn't know how to react to this. This is a person I really respect and have enjoyed her columns, who now seems to poo poo an area I believe in. There was a mixed response to her view. Firstly, I wasn't aware that doctors were using it to promote private healthcare. After a bit of Googling, I can see what McCartney is getting at. It's not ethical if HCPs are promoting Lifestyle Medicine with a veiled ulterior motive and potential financial gain. To my knowledge, this only represents a tiny proportion of those who wave the Lifestyle Medicine flag. 

A lot of the arguments I have heard against Lifestyle Medicine include the feeling that 'eating well and exercising is common sense'. It absolutely is not. We are constantly bombarded with misinformation and a culture that praises dress size, calories and aesthetics over health.  Lifestyle Medicine is just as equally about dispelling nutribollocks, as it is providing evidence-based advice. However, doctors don't receive enough formal education on nutrition, exercise or mindfulness. While doctors learn plenty about the social determinants of health, what actual practical advice are they taught that can be given to patients? In a 2017 survey published by the British Journal of General Practice, only 20% of GPs were broadly or very familiar with national physical activity guidelines. We all know we should eat healthily and exercise, but how do we execute that? How do we incorporate that into our busy lives? This is what birthed the concept of Lifestyle Medicine. 

Are sensible recommendations for eating and exercise a new concept? Of course not! But now more than ever, we need our health care professionals to be a reliable, knowledgable group of people that are clued up on all these fads so we can go to them to help us understand what to believe. And if we do want to be healthier, we need advice on how to do that safely. That is what Lifestyle Medicine is.

Thursday, 22 November 2018

Feel the fear and do it anyway

Somehow I am now a final year medical student, and in nine months I’ll be starting my first job as a doctor. I’ve passed the dreaded finals and I’m trying to learn how to do the job. 
As I am towards the end of this degree I have been reflecting on this insane journey. Medical school has been this constant rollercoaster that has challenged me in so many different ways. I have absolutely loved it, but sometimes hated it. I have felt the happiest, but sometimes the unhappiest I have ever been. 

Overall, what has struck me most is the need for self-confidence. Through every obstacle, whether it be a research project, an OSCE, a presentation or a DOPs, I have doubted my abilities. You would have thought by now I would have overcome that fear, but it seems to transfer itself on to whatever medical task I am given.

And so, my current focus of self-deprecation is around my A&E rotation. It has been really tough. It is the first time I’ve properly worked in an emergency department and it feels far removed from the other placements I have done. On top of that, there is the expectation now that as a final year student I need to try to spend less time observing and more time doing the job under supervision. There is a certain irony in working so hard on your skills, but once asked to use them you feel you can’t do it. In all honesty I’ve never considered ED as a career, so I wasn’t exactly looking forward to it from the start. My fear of failing was so strong that it stopped me from truly getting stuck in and having a go. For example, saying no to trying to cannulate a ROSC patient who had just come into resus. With a lot of encouragement, I reluctantly did my first catheter. These are things I’m trained to do and have already been examined on, but when it becomes real it seems like an impossible task.

However, what I have realised is that so many medical students feel the same way. Medics in younger years have asked me for my advice; hearing their worries reminded me of how much I also struggled with those lectures and exams. I have openly said on social media about my A&E struggles and several lovely doctors have reached out - they too can relate to how I feel. They remember the fear, the voice that says you’re not good enough when really you are. Laureen reminded me of a post she had written, which includes the quote “Feel the fear and do it anyway”. She also described the hesitation before cannulating a difficult patient. We all have self-doubt, but we don’t always show it. 

I then watched a fantastic TED talk about the skill of self-confidence. I had never thought of self-confidence as a skill as such, but now I believe it really is. I definitely recommend watching it if you’re like me and need a confidence boost. 

As I wrote this I was thinking of a photo to add to the post. I chose the photo above of me on my medical elective this Summer. I knew I wanted to go to New Zealand, so I made the choice to go out there on my own. Looking back, I can't believe I decided to go to the other side of the world, my first time solo travelling. Luckily I didn't let the fear stop me from making the most of the opportunities I had. 

Tomorrow is my first A&E night shift and I’m very nervous. I don’t want to go but I have to. I absolutely love being a medical student and I am so glad and grateful to be on this course. I’m trying my best to not to let fear get in the way of that.

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