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Dr Rangan Chatterjee: ‘Medicine is missing the big picture’

 The star of the BBC’s Doctor in the House on why GPs should practise ‘lifestyle medicine’

Dr Rangan Chatterjee has become the poster boy for the growing movement to tackle overtreatment. From being a jobbing GP in Greater Manchester, his life has been transformed by appearing in the BBC’s popular Doctor in the House.

The programme, watched by five million people each week, involves Dr Chatterjee being invited into a family’s home to probe every aspect of their lives in order to solve an intractable health problem, often by introducing a new diet or exercise regime while cutting back on any unnecessary medication. After two series he has become a household name and in terms of public profile is one of the most influential GPs in the UK. But his ambitions extend even further. Recently, he has set about changing the face of his profession with an RCGP-accredited training course on lifestyle medicine. He spoke with Pulse editor Nigel Praities about the importance of embedding lifestyle-based treatment into the NHS.

How did your approach to ‘lifestyle medicine’ come about?

In my first week as a GP, a young lady came in who felt very low and requested antidepressants. I looked at the prescribing protocol and it didn’t feel right, so I said: ‘Look, I’m tight on time and can I book you in for a double appointment tomorrow?’ So I spent more time with her and got to understand what was going on in her life. I kept on doing this and within a few weeks she was considerably better.

That patient’s case inspired me, but the turning point was when my son was six months old and had a convulsion on a holiday in France. He stopped moving and the doctors were particularly concerned as his temperature was normal. He had two lumbar punctures to try to work out what was going on. We were scared we were going to lose him.Then the doctors came in and said he’s had no vitamin D in his system, so he’s got rickets.

A completely preventable vitamin deficiency nearly killed my son. I thought: ‘I’ve got an immunology degree, I’ve got MRCGP with merit, and I haven’t managed to stop my son from getting this?’ I started reading up about vitamin D and the gut microbiome. I read lots about nutrition and lifestyle. I became obsessed. I applied those principles to my son, who’s thriving now, and my patients. I reignited my passion for general practice and I truly believe that in medicine we are missing the big picture.

Isn’t there a risk of promoting the idea of a ‘hero doctor’ being able to solve every problem?

Of course, some of this is public health, but these problems are putting an incredible strain on the NHS. Every drug we prescribe has real-life side-effects – antidepressants are a prime example. I’m not saying they have no value; many patients seem to benefit, but many don’t do so well and there is a risk of suicide. As a profession we need to take a step back and take a more rounded approach.

But as an individual doctor you can’t affect roads, public transport or other things that contribute to people’s lifestyles

Modern life makes it incredibly hard for many of us to live healthily. When I worked in Oldham, trying to buy a healthy lunch within a mile of the practice was close to impossible. But doctors are still responsible for looking after people’s health. In the first season of Doctor in the House I diagnosed a woman with type 2 diabetes; 30 days later her blood tests were no longer consistent with the diagnosis. Two years on, she texted me saying: ‘My blood sugar is even better than when I last saw you.’ She has not cost the NHS any money in the past two years, she’s not gone to doctors’ appointments. That’s absolutely incredible.

How can GPs produce such results in 10 minutes?

It comes down to is how you prioritise it. I could say: ‘Nigel, your blood sugar’s really high – you’ve got type 2 diabetes. I’ll probably put you on medication.’ Then, as you leave with your prescription: ‘You know what, you can lose a bit of weight and it could probably help your condition.’ Or I could say: ‘Hi Nigel, your bloods have come back, you’ve got type 2 diabetes. Now, 95% of the time this is driven by the way we live our lives. This doesn’t happen overnight, it’s been building up in your body for five or six years. If you’re interested I can help you figure out what we can do.’ That’s a completely different conversation.

 

dr chatterjee rangan rob

dr chatterjee rangan rob

Aren’t you asking GPs to become public health doctors? They don’t necessarily want to nag patients, they want to…

I’ve never nagged a patient in my entire life. Why? Because they’re fellow human beings. The way we create change is by treating our patients like equals. I will write out a lifestyle prescription and give it to them, saying: ‘Forget everything else, focus on these three things and I’ll see you in two weeks.’ I am not anti-medication, but most doctors recognise we are giving out way too many drugs for things that are lifestyle problems. I’ve a patient, a five-year-old boy. He was under a dermatologist for horrendous eczema, a gastroenterologist for his reflux and regularly saw his GP with stomach cramps. By changing his diet and helping him improve his gut health, in four weeks all three problems had gone. I’m not criticising those doctors, that’s what I would once have done, but we became doctors to help people and that kid’s life has been transformed.

What mark out of 10 would you give the NHS’s record on supporting GPs to work in this way?

Two. We’ve got all this tick-box stuff that leaves little time for patient care. That’s why so many doctors are burned out. But once you understand the science of lifestyle medicine you can get your love for your career back. You start getting people off medication, you start getting people better. I love my job now, I’ve always been proud to be a doctor, but there was a time when I couldn’t see myself doing this over the next 40 years.

Is there an issue with medicalising problems that shouldn’t be?

Yes, it’s the language around it, the conditioning, and this is why I’m passionate that we need to know about this stuff, so we can start the conversation in those 10 minutes and inspire a patient. I feel my role as a doctor is to educate and inspire most of the time.

We are giving too many drugs for lifestyle problems

It sounds to me like you’re saying GPs just need more time

I’m not saying the GP has to do it, but we must have access to lifestyle change services, so when a patient comes in, we can tell them there is a class running right here in half an hour, and it takes 20 minutes. If we have to refer and wait two weeks, everyone switches off and nobody attends their appointments.

What do you think about NHS Health Checks?

Being more proactive about picking conditions up early is going to be absolutely critical. There’s a growing conversation about this, I get about 10 emails from medical students every week, inspired by something they’ve read or seen, particularly when the [BBC] series was on. If we had a drug that did what exercise can do, it’d be on every front page of every newspaper. The crux of the matter is we’re applying 20th-century thinking to 21st-century problems. GPs are brilliant at filtering information and with some specific science-based lifestyle training we would just have a bigger toolbox.

How did you get involved with the BBC?

My practice manager sent out an advert saying the BBC was looking for a doctor to test a new concept that if you have more than 10 minutes with your patients can you get better health outcomes. My dad had died a few months earlier and there was a huge hole in my life, because I was a carer for him. I think the BBC went through about 1,500 doctors, and chose me. I didn’t know what would happen and it’s been the most phenomenal experience of my life.

The disillusion among GPs is not just about workload, it’s also because the tools we learned at medical school don’t work for many of our patients. I don’t claim to have the answer; I don’t know how we fit this into the way the NHS is structured. But if as a profession more of us were trained in how many different conditions can be improved by specific lifestyle interventions, that would be a good start.

Dr Chatterjee will be presenting at the 'Prescribing Lifestyle Medicine Course' in London on the 28 April

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Readers' comments (15)

  • What Now?

    The disillusion among GPs is being the medico-legal dumping ground for everything and everyone else (in a under resourced failing system)

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  • What Now?

    Whilst at the same time being extremely expendable with often no personal ownership or pride in the ship

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  • He is quite right of course, but the realities of the system make it impossible to practise medicine in this way.

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  • Rangan is absolutely right. And I also suspected a defeatist attitude in the comments.

    The reality is - if a doctor changes their mind set about where the locus of control lies within any consultation, they can not only achieve better results, but also improve their job satisfaction.

    I am not lying when I say I literally look forward to every patient walking in through the door now because I am keen to see how I can facilitate their self-care journey and open up a whole new dialogue they have never encountered before.

    Yes - we only have 10 minutes. But we have 10 minutes multiple times over and it is this which makes this the very core of what GPs should be doing.

    The whole health narrative needs to change (as well as consulting style) to empower doctors to shed their reliance on drugs and foster personal responsibility for healthcare. Otherwise, we are not "first doing no harm."

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  • Not so long ago the first line treatment for T2DM was “lifestyle change”.
    So we all enthused on better eating, more exercise, smoking cessation etc., but be honest, how many of these patients were able to control their diabetes adequately this way? Frankly, not many, and one by one they gravitated on to metformin et al.
    A small minority of enthusiasts might keep it up, but most quickly fall off the wagon, with a variety of excuses.
    When idealism meets the real world, there is usually one hell of a crash.

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  • Knowledge is Porridge

    Told a fat guy, smoker, with high blood pressure he was ready for an MI.
    2 years later, didn't recognize the same guy. 5 stone lighter, cycling 100 miles a week, BP better than mine and very chuffed to tell me about it. I was inspired, I can make a difference...finding those moments is like panning for gold

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  • We had a patient with a new diagnosis of type 2 DM. We spent a great deal of time pushing lifestyle changes and finally adding a small dose of metformin. His HBA1c was excellent. He then saw a locum Dr and decide to stop his medication after a documented discussion (against the advice of the locum).

    He failed to turn up for a repeat HBa1c or follow up and took up drinking. Landing in hospital with a complication. He is now trying to claim compensation as he claims the locum stopped his medication. It didn't help that the hospital reg blamed GPs for starting medication straight away!

    So beware of just offering lifestyle changes in our compensation culture.

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  • sorry should be "not starting medication straight away"

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  • @Dr Nabi
    'I am not lying when I say I literally look forward to every patient walking in through the door now because I am keen to see how I can facilitate their self-care journey and open up a whole new dialogue they have never encountered before.'

    Cardigan 2.0
    "your locus of control narrative, with big wooden buttons"

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  • Hahahaha!

    I have never been called a cardigan before. I am absolutely thrilled! Can I get a trophy? (Or a new cardigan?)

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