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What is your approach to the biggest health risk of our time?

Sixty to eighty percent of people are now overweight or obese. This is associated with considerable morbidity. Yet it is a very complex issue and the causes of the condition are many and varied.

…..the dramatic rise in the incidence of obesity in many countries appears to be due to the complex interaction of a variety of factors including genetic, physiologic, environmental, psychological, social, economic, and political. Wright and Aronne

The experience of overweight people with healthcare professionals is not universally good.

Seventy‐six individuals (aged 16–72) were interviewed. Most had struggled with their weight for most of their lives (n = 45). Almost all had experienced stigma and discrimination in childhood (n = 36), as adolescents (n = 41) or as adults (n = 72). About half stated that they had been humiliated by health professionals because of their weight. Thomas et al

Over my whole 40 year dieting history I found two doctors who have said ‘well, come back once a week or once a fortnight and I will weigh you’. I found that very helpful and useful, because you feel like somebody is on your side. (65 year old female)

 They have helped because they guided me and pointed things out and they were there for me. If I’ve got questions they are helpful. (28 year old female)

 Oh well, I have spoken to my doctor about it and he just says get more exercise. I did mention it to one other doctor and he said there is only one way to lose weight and that’s meal replacement drinks or tablets. So I never went back to him because I don’t agree with that. (49 year old male)

 My doctor keeps saying, you need to lose weight. And I say, yes, I know that and I want to and I try to watch what I am eating, but it is just getting harder and harder. (59 year old female)

If you are a healthcare professional it is very likely that you will see several people today who are overweight or obese. How will you raise the topic with them? How will you know they want to address the issue? What help will your offer? How do you know you have been helpful to others in these circumstances?

Picture by Paola Kizette Cimenti

Do you mind if I don’t take your advice?

Your customers, clients or patients are free to choose. Despite your most earnest desire to save them from themselves they may choose to pass on your advice today. Is that alright? They may decide never to give up on the donuts, to stop smoking or head to the gym. As a consequence they may continue on the way to chronic illness. Do people have responsibilities from the ethics point of view?

Autonomous patients do have duties most of which are left out of mainstream medical ethics. Some of these duties flow from the obligations all persons have to each other; others are the
responsibilities citizens have in a welfare state. More specifically, patients have duties corresponding to those that render doctors captive helpers. Patients have to- morally have to do their best to ensure that they minimise this captivity and enable doctors to be willing helpers. Although doctors remain captive in the face of acute or life-threatening illness, it is not unethical for doctors to free themselves from this captivity in cases that fall short of life or death. Draper and Sorell

Picture by Viv Lynch

Are you catering to those who need you?

40 years ago people older than 65 years of age were a minority in the population. In the very near future they will be a significant minority and for some service providers they will be the majority. Healthcare is a good example. However the population may be ageing but it is also changing.

This aging population has many options from which to choose and they are looking for more than just a particular retailer, restaurant, product or service. They want their purchase to count: to satisfy mental, emotional and even spiritual needs as well. Older consumers: Redefining Health and Wellness as they age.

How has this been factored into your plans for how you will respond?

Picture by Nicolas Alejandro

Are you worried they’ll never stop talking?

It’s a busy day at work and the next customer, client or patient settles in to tell you something. Are you secretly asking yourself:

 How long will this take?

Will it pay off allowing them to take a couple of minutes to speak about whatever’s on their mind? Have you tried it and timed how long before they stop?

Studies have even shown that participants are willing to give up between 17% and 25% of the monetary reward offered for talking about others in order to feel the intrinsic rewards of talking about themselves. And outside of the lab, 40% of our everyday speech is devoted to telling other people how we feel or what we think. That’s almost half! Belle Beth Cooper

So if you want to do something special for your client, customer or patient give them a chance to say what they want- you might be surprised that it doesn’t take that long and pays enormous dividends.

Picture by Stiller Beobachter

How do you sneak work home with you?

You might not bring a sheaf of paperwork home, you might turn of your mobile devices and never carry your customer, client or patient home in a bag. But you might covertly bring them home in your cranium.

So you never actually leave work. Those at home notice that you are ‘absent’. Yet you won’t actually achieve anything because the conversations you are having in your head aren’t real. The videos you are watching in your head are imagined. You are already back at the office even as you board that bus or pull out of the carpark. Your performance at work tomorrow will suffer as a result. It could be framed as irresponsible, unsustainable and not conducive to the best results tomorrow. It’s also your choice. Not your employer’s.

As part of creating this new, healthier environment, engage other people to help you. Ask your friends and family members to help you stay away from work. Give them permission to remind you to put your phone away (and don’t get annoyed with them when they do). Find activities you can do with them that prevent you from working and that distract you from work-related thoughts.

Step away from work — and watch disaster not strikeEven if you do create these plans and an environment conducive to seeing them through, you still need to be willing to disconnect from work for a period of time. That can be anxiety-provoking. After all, you might miss an important email; something could go wrong; important work might be done badly or not done at all. Art Markman

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What do you do to unwind?

As a health care professional you are encouraged to have some down time. According to research:

Burnout and satisfaction with work-life balance in US physicians worsened from 2011 to 2014. More than half of US physicians are now experiencing professional burnout. Shanafelt TD et al

In the UK, NHS

More than half of salaried and locum GPs suffer from stress as a result of their work. BMA

So if you are in healthcare how and when do you unwind? How do you know it’s working? Are you too busy chopping the wood to think about sharpening the saw?

Picture by Zach Den Adel

Are you aware when you are flagging?

Are you aware when you are tired? Do you look at your reaction to any situation and wonder if it came from a place of fatigue? How do you deal with that?

When we are tired, we are attacked by ideas we conquered long ago. Friedrich Nietzsche

This study aimed to evaluate the variations in mood states and empathy that occur during the internship year. Consistent with our expectations, results of the first administration of the POMS and IRI demonstrated that interns in this cohort arrived with high levels of vigor, energy, and a well-established ability to demonstrate empathic concern. However, as early as November, we found that significant mood changes were already evident among our cohort. Interns became more angry and depressed. These data support previously reported findings that internship negatively affects personal well-being. Bellini et al

Fatigue and sleep deprivation, associated with long working hours and shift work, impacts on doctors’ personal safety, increasing the likelihood of occupational accidents, road traffic crashes and needlestick injuries. It also increases risks to patient safety through clinical errors. BMA

Picture by Dominique Archambault 

Why do you keep me waiting?

We often have to wait in line to be served. In healthcare that happens a lot. If you had to wait an hour or more every time you needed something from somewhere would you continue going there? Why or why not? Does queuing have to be  fact of life in healthcare? How long before someone works out it isn’t necessary and offers an alternative? What will happen to those places that fail to keep up?

Although appointment systems are often designed to avoid doctor idle time (without considering patient waiting time), it is possible to reduce patient wait time without significantly increasing doctor idle time.

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Could you do better?

Do you think your work could be better? How? If you think it could be improved what are you waiting for?

The intense debate about how to move forward is a sign that overtreatment matters,” Brownlee says. “We want everyone involved and sharing their expertise on potential solutions. There is room for many political ideologies and beliefs about how to pay for healthcare. The crucial step right now is to get the medical community mobilized around the idea that overtreatment harms patients

BMJ Jeanne Lenzer

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Where were you when I was bored and saw this?

The triggers are everywhere- Hungry? Thirsty? Bored? Sad? We have something for you right now. Meanwhile your advise is a quiet voice in the back of their mind. There is an entire industry dependent on people’s bad choices, they are not taking a holiday this year working on how to influence them more than your diet and exercise program. There’s another industry depending on those choices so that you- doctor- will prescribe their neatly packaged answer to the expanding waist lines and furred arteries. It’s about the economy. The show must go on.

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