“Your joints must be telling you something”? I said with my voice rising slightly higher in pitch at the end of the sentence and my head tilting slightly to the side to unconsciously give the message that I was asking a question.
In my question I had deliberately used what is known as ‘selectional restriction violation’, because her joints couldn’t really talk to her and tell her the answer, neither did I want them to, all I wanted her to do was to think and hopefully come up with an answer herself. I hoped in this way I could somehow get my message across that she needed to lose weight without being too direct.
Unfortunately if the walls had ears (to quote another selectional restriction violation) all they would have heard was the silence of her puzzled expression.
At least 30% of my patients are obese, 8% of my practice population have diabetes and probably the same amount again are pre-diabetic, this lady fulfilled the criteria of the former and was well on the way to becoming the later.
The World Health Organisation now says that;
More people in the world today die of conditions related to obesity, and being overweight than famine and starvation.
and in some societies despite modern medicine, education and society providing all of their population’s basic needs, life expectancy is shorter for this generation than the generation before.
In the UK the swelling girth of the population brings with it a whole new set of problems, according to the Office of National Statistics the health spend in the UK is roughly 9.4% of GDP this percentage has stayed much the same whilst healthcare costs have increased. This basically means that those of us on the front line need to do more for less and we are feeling the squeeze.
Whilst GPs in the UK are tightening their belts their patients are outgrowing theirs, couple this with inactivity, smoking, and alcohol poor lifestyle choices amount to about a quarter of all deaths.
Recently the Royal Colleges and other medical bodies have rallied with a call to treat inactivity, and I fully agree with this call to action, but how do we do it on the front line? it takes more than good communication, and consultation skills to help people make the lifestyle changes that they need to make in their lives.
A person needs to feels motivated to make the changes they need to make, I can try and wave the carrot of a vision of a more compelling future, I can use the stick of the pain of their present situation, but lasting change is near impossible if there exists little intrinsic motivation within that person to change in the first place.
Unfortunately sitting on the sofa watching daytime TV whilst eating ‘feel good’ processed foods high in sugars and carbohydrate may only compounds the situation but this lifestyle is certainly a hell of a sight easier than the effort of getting up on a cold winter morning to earn the minimum wage.
Do I collude with this lifestyle by continuing to prescribe analgesia and tranquilisers like some of my colleagues, or do I bravely make a stand against the curse of sofarisation that affects today’s society.
Apparently I don’t listen, neither do many of the other doctors in the practice and like my peers I was wrong to blame her weight for pain in her knees, and perhaps the consultation could have gone a little better if I hadn’t suggested that exercise and some lifestyle changes may be the solution and that the effort to sign on every week was not an appropriate reason for yet another sick note.
Reflections after a busy week in practice, roll on Monday morning.