Dr Justin Amery
Role GP, GP trainer and author
How is health practice for you, these days? Too many patients, demands, constraints and cuts? Patient needs edged aside by points and targets, while your own needs sink beneath the waves? Me too. So I decided to start exploring, and ended up writing a book (or five).
Five lessons I’ve learned
Be prepared to revisit, deconstruct and rebuild even your deepest health beliefs. Let’s start with the basics. Ask yourself: what is health? Better still, try drawing it. Tricky, isn’t it? Why? Health has no concrete existence. You can’t wave at it as it passes your window. It is a state of being, of consciousness, which varies from person to person and moment to moment. If we don’t actually know what health is, perhaps we have some other cherished beliefs that need challenging too?
Stop thinking there is a ‘right way’ to practice. Do you fall into thinking there is a ‘right way’ to practice? If so, consider the fact that glib, dualistic and simplistic practice models and targets don’t really match the messy, relational and often chaotic world of our practice. Fortunately science and philosophy suggest that the universe is messy, relational and chaotic too, so maybe we are doing something right.
Test the ‘evidence-based’ claims that underpin your work. ‘Empirical’ knowledge is knowledge based on what we can observe. If we can’t observe it, we can’t find evidence for it. Health is a personal state of consciousness, which we can’t observe in others. Empirical study can therefore logically tell us very little about health itself.
That’s not to say empiricism has no place. On the contrary, it has helped root out all sorts of ineffective and harmful practice. Evidence-based practice (and its offspring such as guidelines, targets and regulations) can be very useful tools. But they also make dreadful tyrants if we forget that they are only tangential indicators of health, not health itself. So beware of false prophets.
Try and create the right conditions to practice creatively. Creativity partly derives from the dance of two mental processes: ‘divergence’ (the sudden ‘eureka’ birth of an idea) and ‘convergence’ (the painstaking realization of the idea). To diverge we need to be peaceful, relaxed and unfocused. To converge we need to be stimulated, focused and driven.
Guidelines, targets, regulations and outcomes all push us towards convergence but it is harder to see any triggers for divergence in modern health practice, and we have rather forgotten how to pursue it.
Look after your own health through your practice: health-practice can also be also ‘self-practice’. Patient-centeredness is all very well and good, but without us practitioners there would be no health practice. So we have to be ‘self-centred’ too.
This is, paradoxically, not selfish. We are our own tools, and to be effective we need to stay sharp. Fortunately health practice has everything we need to make us happy and fulfilled: connection, learning, challenge, value and opportunity. There are pressures, restrictions and pains but we can avoid being tyrannised by these if we can get our perspective and balance right. Such ‘self practice’ is the foundation for all our health practice.