More than once I have heard a patient say ‘we need one of your kind in every GP practice’, and I smile and I think – so true, but in my lifetime?
And whilst I can but dream, it has taken some effort this month to refocus my thoughts back to the world of nutrition and away from all the political commentators that have occupied my attention of late. However, an interesting observation by two highly respected consultants in the field of Nutrition, Michael Ash and Antony Haynes, in their Nutri-link newsletter caused me to reflect on the parallel they observed between the worlds of politics and medicine.
They spoke of the fracture lines that have always existed within society and politics, which they now see surfacing in medicine. Fractures can result when movement encounters inflexibility, whereas flexibility within systems better enables and accommodates change.
Primary Care is an example of such a system, struggling to meet the rising demand for appointments, whilst at the same time experiencing significant challenges for retention. I wonder if some of the frustration that is prompting so many early GP retirements, is in part due to the disconnect between the type of health concerns now presenting in their consulting rooms, which require a different sort of intervention from the type GPs have been trained to deliver?
The interventions that can achieve positive outcomes for many chronic health conditions today involve lifestyle change. But such advice – sounding like a dose of common sense – is invariably met with dissatisfaction and resistance by generations brought up on a ‘pill for an ill’. I sympathise, because real behavioural change needs support to achieve, whereas the few words of advice a GP can deliver to a patient hoping for a magic pill, goes in one ear and out the other.
For example, let’s look at a typical patient presenting with symptoms of metabolic dysfunction. This may be intermittent digestive discomfort, with creeping weight gain, and a GP may order some blood tests to rule out various diagnosable conditions. But broad reference ranges mean sub-clinical metabolic dysfunction can persist for years before a state of positive pathology appears. Once that is reached, a drug can be prescribed to ‘manage’ the disease, a pill for an ill. Except many of these ills are avoidable, they might have been prevented, if only the signs of metabolic dysfunction had been recognised earlier and suitable advice tailored to that individual, (to encourage compliance). This approach of looking upstream to identify root causes offers the best hope of halting the progression towards the subsequent disease.
Science is now revealing that cardiovascular diseases, diabetes and many mental health conditions are largely due to controllable lifestyle factors. Even the existence of a ‘genetic predisposition’ needs the input of an environmental lifestyle factor to trigger the expression of the genes. So the more lifestyle is revealed as causative, the more frustrating it must be for good doctors, who lack the training to effectively deliver early, preventative, lifestyle interventions.
It’s not rocket science to ‘look upstream’ for root causes. And it’s not difficult to marry the removal of such root causes, to the potential to lower the risk of any subsequent disease. And whilst doctors feel poorly equipped to deliver dietary advice, the concept of ‘disease prevention’ has grabbed the public’s attention of late, and reflects the sort of change needed in a healthcare model currently lacking the flex to evolve quickly enough in this direction.
There are initiatives appearing across the pond, the Institute for Functional Medicine is a leader in this field, and their model has informed the curriculum of Nutritional Therapists for some years now, so the sooner Primary Care in the UK recognises this and realises the valuable contribution that registered Nutritional Therapists could make, (trained in the IFM model), so much the better.