Humanising Healthcare

We have to start by building a more compassionate society 

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Burnout rates have reached epidemic levels

Experts are calling for an internationally coordinated research effort to identify evidence-based strategies to reverse the rising tide of burnout within the medical profession.


UnivadisA Trusted Medical Reference

In a new editorial published in the BMJ this month, Jane Lemaire and Jean Wallace at the University of Calgary say the medical profession "must change its culture to tackle the toxic aspects of medicine that cause and sustain burnout”.

Experts are calling for an internationally coordinated research effort to identify evidence-based strategies to reverse the rising tide of burnout within the medical profession.

In a new editorial published in the BMJ this month, Jane Lemaire and Jean Wallace at the University of Calgary say the medical profession "must change its culture to tackle the toxic aspects of medicine that cause and sustain burnout”.

They propose several changes to help drive this transformation, including viewing doctors' wellbeing as central to patient care, and even as a missing quality indicator for all healthcare systems. “Improving the working lives of clinicians should be viewed as key to optimising health system performance alongside other established aims such as enhancing patient experience, improving population health, and reducing costs,” the authors said.

“Human resources are the most important asset of any organisation. As doctors continue to grapple with staying well, it is imperative that they have the support of their profession and their healthcare organisations to maximise their ability to care for themselves and their patients safely and effectively,” they conclude.

Lemaire, J.B. & Wallace, J.E. Burnout among doctors. BMJ. 2017;358:j3360 doi: 10.1136/bmj.j3360

Redundant subjectivity?

Professor Stephen Pattison, 

                                                      Hon. Fellow  RCGP                                                       

October 2016 

I am ashamed to admit I have learned to dread going to my GP.  Indeed, I positively avoid going, even when I think it might be useful or even essential.  Letters inviting me for health check-ups lurk unopened on the kitchen table and eventually find their way into the bin 

Thinking about this lamentable situation, as one who ‘should know better’, I guess my phobia has grown over the years and led to a fundamental lack of trust in those over-burdened, hard-working souls charged with my primary care.  And I think at the heart of this it feels as if my subjectivity is now more or less completely disregarded. 

I go to the GP with a small agenda of, usually minor, problems that are important to me, but insignificant in the great scheme of things.  And instead of attending to my concerns, the GP, attending in the first place to a computer screen, and then pushed no doubt by prompts and advice from government and other health bodies, insists on taking my blood pressure and interrogating me on my lifestyle before giving me unasked for advice about how I could live a healthier and better life (as if I didn’t know that I could do that, and were not ashamed of the fact that I don’t). I leave the surgery edified but effectively deafed out, both guilty and demoralised.

My partner has had worse experiences.  An experienced psychotherapist, she has lately become hypothyroid, a condition she was warned years ago that she might develop.  The condition became so serious that she thought she would have to give up her flourishing practice as she could not think properly.  The GP’s response: the blood tests show that you are within normal range so we are not going to do anything about it.  But you seem rather depressed, so why don’t we give you a mental health plan and refer you to psychiatric services?

My partner has quite a good sense of the difference between depression and physical depletion, but this seemed to count for nothing in the face of the statistics and the external guidance that appeared to have captured the GP’s mind, judgment and prescription pad. 

We later talked about how if you actually go to the doctor saying you feel low, you can be administered heavy-duty psychoactive drugs without recourse to any physical tests whatsoever.  It appears, then, that the subjective experience of patients sometimes ‘trumps’ all other information, and is sometimes irrelevant, however lousy the patient feels, however close to some statistical border line they may be, and however cheap the treatment that might be prescribed for them (a daily dose of levothyroxine is very cheap, I understand).

I write in a spirit of perplexed solidarity with GPs.  My perplexity revolves around the changing value of subjectivity in illness and clinical encounters, the value of different kinds of evidence and the nature of the role of doctors in a world that is served by more and better information and testing than ever before.

To read this article in full visit the BLOG


Public Libraries - can they help to  revive  the practice of "Humane Medicine"? 

Dr Malcolm Rigler   M.B.Ch.B. Associate FPH, FRSPH, Member  CILIP  Health Group

In his book , "The Death of Humane Medicine" Petr Skrabanek   makes it clear that doctors these days  now seem to  worry more and more about the risk factors of specific diseases such as cardiovascular disease  , stroke and diabetes  - treating such risk  factors as enemies to be  battled against. They   seem to  worry less and less about the anxieties and worries that  patients bring with them into the GP consultations. Skrabanek calls this approach to medical practice "coercive  healthism". 

Prof Stephen Pattison  - who holds  a Fellowship  of the College of GPs   - puts the matter cogently in his short paper ( attached) tilted  "Redundant Subjectivity "  suggesting that "the ambition seems to be to make humans redundant in medical encounters" .

This sad state of affairs was predicted by Rick Carlson in the 1970s  in his book "The End of Medicine"  in which as a lawyer he  finds that 

modern  medicine has little or nothing to do with health  and well being but has become pre -occupied with dysfunction and the failure of the organs within the human body. 

Another  writer Dr Michael Wilson  in his book "Health is for People" and in other writings    makes the  point that "our era is one of 

enormous pols of loneliness in densely populated cities , and alienation between races ; our diseases are 

psycho-social , such as stress , heart attacks, blood pressure , anxiety , violence , divorce, abortion , ulcers and 

the effects of substance abuse such as alcohol and tobacco  , plus the consequence of  our lifestyle , obesity  , car accidents ,delinquency , pollution and unemployment." He writes " Medicine has little to do with such things". He concludes that we are lumbered with a style of hospital medicine which is misfitted to the disease pattern of post-industrial society. 

Finally Prof Ken Judge  writes:  "the main causes of disease in our society are unemployment, lack of social support and poor education". It was as a result of my study of these texts and these issues over past decades that some time ago I came to the conclusion in my own mind that :

"The GP within the NHS has no enjoyable or creative future until the  partnership work that  needs to develop  between Public Libraries and GP practices comes to be fully understood  and well supported  financially and in every possible way by both GPs,   Librarians, Govt  and all the funding and commissioning bodies within the UK". 

Why should  Libraries work with GPs ? 

1.   Libraries can offer safe , neutral spaces and places for  GPs, Teachers, Social workers , Librarians , Artists and  Policy  Officers from all agencies to meet and  share ideas for creative change and to develop practical ideas for  the work of "salutogenesis" ( the promotion of health) that must now be developed in every Village, Town and City in the UK. 

2.   Only Libraries can adequately respond to "the learning needs of patients and carers" in any language under the sun. Often Patients have  "learning  needs" for digital skills, or  building social capital, and  many  would  benefit from  "guided web surfing" about medical conditions and treatment options. 

Work in the library can also help to   secure  truly  "informed consent"  from patients  for planned treatments  and procedures. 

3.   The few books   mentioned in this piece - and many others -  are available through Public  Libraries not from  any   GP Practice. Many other books and texts supporting  change from a  "disease eradication ,  treatment  focused -medical model" to a  "salutogenic model "  of 
health and social care services  can also be found in Public Libraries. 

But is it Art?

The Sound Agents

Moira Kenny

“Art is not what you see, but what you make others see.” ~ Degas

Before the Medical Profession came in to being and gentrification bulldozed streets in favour of retail parks and student accommodation, people would turn to women in their family or neighborhood, who came together to aid the sick, deliver babies, look after children and the infirm, lay out the dead and organise funerals.

Since the creation of the NHS General Practitioner Service in England in 1948 many changes have occurred, Doctors working in densely packed urban areas were committed to their patients running GP practices and caring for patients who had no money to pay for their services. Dr William Duncan became the first Medical Officer of Health as some GP’s employed debt collectors, some lived in poverty committed to helping the sick but constantly struggled to make ends meet.

Somerset GP, Dr Malcolm Rigler argues ‘in 2017, we have arrived at just such a point in the development of medical / health practice whereby we need a new kind of "medical officer of health" devoted not to infectious diseases but to our modern epidemics of loneliness, obesity, dementia, heart disease and community development’.

Dr Rigler and Liverpool based artists John Campbell and Moira Kenny: The Sound Agents, founded Health/Arts/Libraries Project (H.A.L) in 2015. The aim of the project is to work with librarians across the UK to design and deliver a series of Arts Projects, Events, Publications, Workshops and Training Sessions to offer help to patients and carers in their search for information and understanding about health, social care and life changes working along the theme of "Libraries on Prescription" and Salutogenesis.

Aaron Antonovsky (19 December 1923 – 7 July 1994) a professor of medical sociology, specialised in the relationship between stress, health and well-being. Antonovsky developed the Salutogenesis theory ‘sense of coherence’ to describe human health rather than factors that cause disease. The salutogenisis model was derived from interviews of Israeli women who were concentration camp survivors, despite experiencing inhumane conditions stayed healthy. Antonovsky’s wife Helen developed an ‘Orientation to life questionnaire’ in 1987 to provide people with a ‘sense of coherence’ about life and challenges. (

 “The key elements in the salutogenic development are, firstly, the orientation towards problem solving and, secondly, the capacity to use the resources available. Over the years the Salutogenesis has become an established concept in public health and health promotion'.  B. Lindström, M. Eriksson, BMJ, Volume 59 Issue 6

Dr Rigler states ‘Scientists and health professionals must work with librarians and colleagues who have a background in education and information to introduce the salutogenic framework to the public in an accessible way, focussing on people’s resources and capacity to create health than the classic focus on risks, ill health and disease’.

He goes on to explain the way these patients view their lives has a positive influence on their health. These characteristics are a key concept to ‘The Salutogenisis Model’ a theory concerning how specific personal dispositions make certain individuals more resilient. This theory needs to be the key focus of a transformation of both GP practice and community library service.

"Information, fully understood, is a key part of care. Patients need such help to give clear consent to treatment and investigation. This project enables patients and families to grasp the essence of the issues and play a full part in the decision-making process" Sir Kenneth Calman, Chair of the National Library of Scotland, one-time CMOH.

Libraries need to be the centre for computer assisted learning for patients and carers once the doctor has given a "prescription for learning". Computer Assisted Diagnosis ‘Person Centred Epidemiology Practice’ is a learning opportunity that can be accessed in any language using computers in libraries led by librarians and GP's working together.

In 2013 The Sound Agents were invited to work with Dr Simon Abram's, GP and senior partner at Great Homer Street medical centre in Everton. Dr Abrams was Medical Director at UC24 for 7 years and was Medical Director at UHUK from 2008-2014. He took up position of UHUK Chair in July 2014.

Dr Abrams introduced the artists to a group of patients who together founded The Greaty Arts Group. The group led by Dr Abrams and The Sound Agents met every week in the surgery waiting room and discussed the relationship between the GP and the patient and how it could be improved. The arts group was based on arts on prescription and Salutogenesis rather than traditional painting or dance the art forms organically developed into developing short films and writing scripts using story boards. Their story, the patient’s personal life story was key to the meetings.  The group discussed social capital and continuity, gentrification of their neighbourhood leading to a depopulating area, deprivation, depression and loneliness.

“Health is more about people than diseases, the issues in Liverpool are more about the "social side of life". "We have inter-generational problems here about the lack of work. We have a depopulating area. You cannot treat these problems in the conventional way." Dr Simon Abrams

The Sound Agents working as artist in residence in Great Homer Street Surgery aimed to help the patients set up The Greaty Arts Group as a social enterprise and teach the group skills to run a not for profit organisation.

“In 2013 Awards for All funded us with a grant of £10,000 to work with patients in the waiting room and teach them how to set up a blog or website to write stories about their illness and treatment to help others. Dr Abram's works with zero tolerance patients. Computers were installed in the waiting room, funded by the NHS and Liverpool City Council. 

When new patients arrived at the waiting room to join the group, we were surprised to learn that they had no previous experience of using a PC. We spent time showing them the most basic steps, starting with how to turn the computer on and built up a relationship with a small group of people who were interested in joining us each week while the project lasted. Continuity is key, the funding ended and the surgery was demolished. Dr Abrams has now moved along with his patients to a surgery 'up the hill' and has taken the computers with him, they are used every day by his patients who call in to the waiting room not to see the doctor but to job hunt and enjoy having access to the internet”. The Sound Agents

A symposium event was held at FACT in 2014 to bring people together to discuss the project and find a way forward to carry on working in the waiting room and later when Dr Rigler became involved, the ideas developed for artists to work not only in GP waiting rooms but also in libraries. 

For more information and to view short films made by The Sound Agents with Dr Abrams and some of his patients who set up The Greaty Arts Group discussing social capital and continuity.

"Action is the foundational key to all success." 

Pablo Picasso 

Trainee doctors should study impact of arts on health, inquiry says

A cross-party parliamentary report says it is “time to recognise the powerful contribution the arts can make to health and wellbeing”.

Trainee doctors should study the impact of arts and culture on health and wellbeing, a cross-party parliamentary group has said.

After two years of assessing the impact of using museum visits, dance classes and other arts interventions in healthcare settings, a parliamentary inquiry has concluded the arts can help the health service save money, tackle long-term conditions and support “longer lives better lived”.

In a new report, the All Party Parliamentary Group on Arts, Health and Wellbeing (APPGAHW) implores the Government’s culture, health and education secretaries to develop a cross-governmental arts in health strategy.

It also calls on Arts Council England (ACE) to support arts organisations in making health and wellbeing outcomes integral to their work.

“We believe this material compellingly demonstrates the opportunities that exist but have yet to be seized widely,” writes Lord Howarth of Newport, Co-Chair of the APPGAHW, in the forward of the report.

“As it is, the United Kingdom is still very far from realising more than a small modicum of the potential contribution of the arts to health and wellbeing.”

He adds: “The conundrum that we have found ourselves pondering is why, if there is so much evidence of the efficacy of the arts in health and social care, it is so little appreciated and acted upon.”

Inquiry report

The report, ‘Creative Health: The Arts for Health and Wellbeing’, assesses current research on the impact of arts in health on different stages of life, and makes a series of recommendations on improving policy and practice.

Chief among these is the creation of a new “strategic centre” to support the advance of good practice, promote collaboration and inform policy and delivery. Intended to be a gathering of networks, rather than a physical building, the centre would aim to fill knowledge gaps about the impact of arts in health programmes and encourage coordinated approaches to funding.

The report also calls on ACE to identify health and wellbeing as a priority in its ten-year strategy for 2020-2030, and says additional funding is not necessary to support “significant extensions of the work we would like to see”.

The conclusions chime with recent arts in health initiatives, including a dance-based falls prevention programme that was found to be more cost-effective than the NHS alternative, and a healthcare provider in Cheshire that has committed to prescribing singing and other artforms to treat conditions such as asthma.

Difficulties making the case

Acknowledging proponents of arts in health have “too often not made their case as well as they should,” the report speculates on the current barriers to extended collaboration.

One suggestion is arts organisations have not embraced arts and health to the same extent that they have embraced education. But the report also notes that discontinuities of funding – and “large-scale withdrawal of funding” in some parts of the country – have “genuinely prevented” arts organisations from supporting health and social services.

“Local authorities, even before they were under the present draconian pressure to reduce expenditure, have not given high priority to spending on the arts,” Lord Howarth writes.

He also suggests the medical sector is reluctant to prescribe art-based interventions given their assessments of arts in health evaluations, which are not suited to using large-scale randomised controlled trials.

This thinking echoes comments by Dr Cliff Richards, former Chair of NHS Halton Clinical Commissioning Group, the Cheshire healthcare provider which has begun prescribing art-based interventions. He told AP the arts are “usually seen as fluff”, as people working in healthcare look at the evidence from “a scientific point of view” and believe the research evidence “isn’t as strong as it should be”.

The report ends with aspirations that the Government’s explicit commitment to respond to the inquiry’s recommendations, made in last year’s Culture White Paper, will result in a dedicated cross-party consensus.

“It is time to recognise the powerful contribution the arts can make to health and wellbeing,” Lord Howarth adds.


Robin Youngson cofounder, Mitzi Blennerhassett Medical Writer Hearts in Healthcare
PO Box 63, Raglan 3265, New Zealand; 2 Slingsby, UK 

Australia -Libraries Team up with Occupational Therapists

Merseyside Civic Society

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Professor Stephen Pattison Hon. Fellow RCGG

Redundant Subjectivity? 
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Asking the Way - Mike White

Directions and Mis-directions in Arts in Health 2014
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Beyond Retail

Redefining the shape and
purpose of town centres

"Town centres have become too reliant upon retailing. The town centre function needs to be re-balanced to provide a broader range of alternative functions, including employment, commercial, leisure, community, residential, healthcare and education. Local authorities and public sector agencies have a key role to play in ensuring towns and cities do not lose public and private sector jobs to out-of-town locations, leaving a rotten and decaying core. Independent research organisation Centre for Cities Beyond the High Street: Why our city centres really matter report clearly demonstrates that where jobs are located can affect how well a city’s economy performs. For example, for retail if a city has more jobs in out-of-town locations, it reduces the number of people who have to come to the city centre" Mark Williams Taskforce Chairman Partner, Hark Group 2013

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Books For Dissident Doctors

REVIEW Respectable Lynsey Handley

THE LIFE ROOMS 2017/2018

file:///C:/Users/Moira/Downloads/Prospectus-April-2017. pdf

                                            This project is created jointly by THE SOUND AGENTS & PARTNERS IN HEALTH (Midland) Ltd