My guest today is Dr. David Peters, Professor Emeritus, Westminster Centre for Resilience, College of Liberal Arts and Science University of Westminster, London. He has co-authored or edited five books about complementary therapies including The Encyclopaedia of Complementary Medicine in 1997, followed by The complete Guide to Integrated Medicine in 2000, Understanding the placebo response in complementary medicine and Integrating Complementary Therapies: a practical guide for primary care both in 2001 and in 2007, New Medicine.
David started his medical career as a musculo-skeletal physician and gradually branched out to include osteopathy and acupuncture working with the relaxation response, yoga and meditation. A particular clinical interest of his is in dysregulatory syndromes where pain and/or fatigue often overlap, and in the autonomic imbalance and breathing pattern disorders seen so frequently associated with them.
There is a pandemic of chronic diseases that is decimating the world. Diseases like obesity, diabetes, arthritis, high blood pressure, heart disease and, of course, cancer. What has gone wrong? Many things; industrialization spewing toxins into the air, water and food, consumerism, “hunting for unreachable goals”, large discrepancies in income. For example, there are many neighborhoods in large cities where the average life expectancy is 60 years, while a few miles further, it is 80.
David takes groups of doctors suffering of burnouts camping into the woods for a day or two. Works like magic. For this and much more, listen or watch the full interview.
As a follow up, my next guest will be Dr. Mel Borins, author of Go Away Just for the Health of It, An Apple a Day: A Holistic Health Primer and A Doctor’s Guide to Alternative Medicine: What Works, What Doesn’t and Why. He has written extensively on stress management, psychotherapy, acupuncture, traditional healing, herbs and complementary medicine. Hope you can join me.
If you liked this podcast
https://www.psychologytoday.com/intl/contributors/thomas-r-verny-md
My guest today is Dr. David Peters, Professor Emeritus, Westminster Centre for Resilience, College of Liberal Arts and Science University of Westminster, London. He has co-authored or edited five books about complementary therapies including The Encyclopaedia of Complementary Medicine in 1997, followed by The complete Guide to Integrated Medicine in 2000, Understanding the placebo response in complementary medicine and Integrating Complementary Therapies: a practical guide for primary care both in 2001 and in 2007, New Medicine.
David started his medical career as a musculo-skeletal physician and gradually branched out to include osteopathy and acupuncture working with the relaxation response, yoga and meditation. A particular clinical interest of his is in dysregulatory syndromes where pain and/or fatigue often overlap, and in the autonomic imbalance and breathing pattern disorders seen so frequently associated with them.
There is a pandemic of chronic diseases that is decimating the world. Diseases like obesity, diabetes, arthritis, high blood pressure, heart disease and, of course, cancer. What has gone wrong? Many things; industrialization spewing toxins into the air, water and food, consumerism, “hunting for unreachable goals”, large discrepancies in income. For example, there are many neighborhoods in large cities where the average life expectancy is 60 years, while a few miles further, it is 80.
David takes groups of doctors suffering of burnouts camping into the woods for a day or two. Works like magic. For this and much more, listen or watch the full interview.
As a follow up, my next guest will be Dr. Mel Borins, author of Go Away Just for the Health of It, An Apple a Day: A Holistic Health Primer and A Doctor’s Guide to Alternative Medicine: What Works, What Doesn’t and Why. He has written extensively on stress management, psychotherapy, acupuncture, traditional healing, herbs and complementary medicine. Hope you can join me.
If you liked this podcast
https://www.psychologytoday.com/intl/contributors/thomas-r-verny-md
SUMMARY KEYWORDS
medicine, doctors, patients, acupuncture, burnout, system, resilience, sympathetic, parasympathetic, stress, arousal, feel, understand, unscientific,
SPEAKERS
Speaker 2 (88%), Speaker 1 (11%)
1
Speaker 1
0:02
God morning. This is Pushing Boundaries, a podcast about pioneering research, breakthrough discoveries and unconventional ideas. I'm your host, Dr. Thomas R Verny. My guest today is Dr. David Peters, professor emeritus Westminster Center for Resilience, College of Liberal Arts and Science, University of Westminster, London. He has co authored or edited five books about complementary therapies, The Encyclopaedia of Complementary Medicine in 1997, followed by The complete Guide to Integrated Medicine in 2000, Understanding the placebo response in complementary medicine and Integrating Complementary Therapies: a practical guide for primary care both in 2001 and in 2007, New Medicine.
Now I understand Dr. Peters, that since these books were written by you, you have moved on from researching and writing about complementary medicine. Your research and training interests now are in doctor's well being and burnout. Am I correct in that? You're awesome. Thank you. So welcome, Professor David Peters.
1:34
Thank you. Nice to be here.
1
Speaker 1
1:36
Thank you. Well, why don't we start by talking about the psychophysiology of resilience, and the development of interventions to support resilience and recovery? Could we do that, please?
2
Speaker 2
1:53
Yes, certainly about 10 years ago, I was invited into guy's hospital, the guy's hospital is part of a very, very large group of hospitals in central London. I think they currently have about 30,000 staff now. And over a million patient contacts a day. So
1
Speaker 1
2:16
remarkably, one patients a day.
2
Speaker 2
2:20
Yes. across, across across this very large organization.
1
Speaker 1
2:25
Okay, that's astonishing. Please go on. Yes. Yeah,
2
Speaker 2
2:29
I think I'm right about that figure the sound far too much. But as a consequence, they are one of the major teaching hospitals, in in Britain, and into the teaching hospitals in Britain go our new new doctors. And in Britain, we have a system whereby all new doctors after qualification after their finals haven't done five years of studying University. They do two years of we used to call it Hausmann. Nowadays, it's called foundation year, and rotate through various specialties. And so these, these young men and women, mostly young men and women have come straight from school really at 18. Gone through five years of medical school at 23, they suddenly hit the reality of working on the wards with many, many, many sick people, they will of course, have been exposed to, to illness and disease and death in their medical students yet, but but when you begin to take responsibility from for patients, it's quite a shock to the system. And I was asked in two guys to develop a program to teach them about coping with the strain and stress of practice. And I began to do that with George Lewis, a wonderful colleague and professor from Southampton, about 10 years ago, with the support of Diagne Roger Singam, who is a senior obstetrician there, and we developed a program quite simple, quite sure to three hour program with all the foundation your dogs, which is about 120 a year would take part in. So what did we want to teach them? Well, what we what we decided would be best to help them understand is yes, indeed the psychophysiology of resilience. And in order to do that, we ask them to really focus on their own experience of what's what's a good day in medicine, and what's not good day in medicine. And pretty quickly, even after a few weeks, in their first year of Hospital Medicine. They were talking about, oh, a good day is I have time to do everything, and I have no sudden demands on me. And people aren't rude to me, and nobody believes me, and I maybe get Sankt. Sometimes I perhaps get time for lunch. And we said, this is not setting the bar very high in new, do we say well, how often do you get good days like this? Now 10, eight years ago, they'll probably say, a couple of days a week. Nowadays, a response is more likely to be maybe once a month. So things are getting more difficult, however, but We then talked about, well, what gets in the way. And what gets in all the things you could expect. organizational factors breakdown of it. Impossible numbers of patients, unreal expectations, breakdown in the team, all of those things. So we realized that there was a limited amount we could do to change those factors. So when you asked me about how to help people be more resilient in in medicine, some of the things our activities we can take part in practices we can learn, that make us individually, less prone to the stress response. But a lot of the demands, and systemic dysfunctions are hard for us to to address. Now at this point, Thomas, I can I can talk about this difference between the individual and the system directly. But I would say please note, there's a parallel process in medicine as a whole. If you ask me, how do we keep people? Well, how do we keep people out of hospital? Most of the answers wouldn't be about medicine. They'd be about politics, housing, education, all sorts of things. So so we have this, this this question. Resilience is in our terms, the ability to tackle cope with adversity without to greater personal price.
7:01
Excellent. Yes. Yeah.
2
Speaker 2
7:03
Now, the point about that definition is adversity. It's not an option. As they say, pain, pain, pain, pain is pain is in the territory. Suffering to a degree is optional. So how we respond to the circumstances and can be bounced back. When we can bounce back and to a degree, we do unless the stresses and demands are too great. But what about bouncing forward? What about if you like post traumatic growth? So we're talking about all these things, and the the framework, we talk about them, as far as the individual resilience is concerned, is about the nature of our evolutionarily hardwired, survival emotions. So everybody looks a bit blank when we talk about this, and I say, well, so tell me about the autonomic nervous system. And they go oh, it's like a seesaw. When the when the person being nervous system is active. The sympathetic nervous system is downregulated. Okay, that's, that's more or less true. So it's a sympathetic nervous system a bad thing? Well, too much stress and adrenaline and high blood pressure. And, yes, but what gets you up in the morning? Oh, yeah. The sympathetic nervous system. Okay. So so it's okay to be in sympathetic higher arousal, give you feel safe. i Yes. That's a good idea. Well, when you are in somebody's high arousal, and you don't feel safe, what does that feel like? And they go, this is interesting of a time that you were really in a high stress situation, and what happened in your body, and they go, Oh, I don't know. What Okay, so you're walking down the road, and you suddenly some paper flies up in the air. And what do you do? We shout, we jump back. Yeah. I said, we kind of freeze. And then we noticed that we just a piece of paper. I said, Okay, that's the acute stress response. And it happened because you were highly aroused. And something in you said I'm not safe. And what's the emotion? They go? Oh, fear. Okay. Fear, any other emotions around that sort of sudden shock? Anger, okay, flight and fight. So we talk about flight and fight is safe. It's unsafe activation of the sympathetics. So say what about what about safe activation? When When do you get a highly activated sympathetic nervous system when you're feeling safe? Well, when did you last? Get excited about something? Ah, yeah. Okay. So when you feel excited what happens? Oh, yeah, I may I get more active and I probably get a faster heart rate. So we do Talk about the the that axis of the, of the arousal emotions. And then we talk about what happens, what happens after the sudden shock. And people say, Well, I'm, you know, I calm down well, how does that happen? Do we talk about parasympathetic nervous system? And then somebody might be in a smart kind of way. So well, that's okay. If I slow down and feel safe. That's me. Relaxing. Yeah. I said, Yeah, it's like you've you've, you've been out on the hunt, and you're going back to the cave. And all the necessary healing processes happen. So somebody might say, Well, what's it like to feel still an unsafe? I say, Well, you tell me, rabbit in the headlights. You know, the lights are on nobody's home dissociated. Do you know anybody like that? That you've seen anybody like that? Have you been like that? And so we talk about that, that, that kind of fundamentally dorsal vagal parasympathetic shutdown. So we look at those four quadrants, and we explore them, and then it will do it, we're working one to one, I use some biofeedback. Because but biofeedback allows us to, if it's biofeedback of heart rate variability, you can actually track what happens as you move into parasympathetic arousal. So we use a little bit of kit from heart maths, to show that. And so, so what we what we can do fairly quickly with doctors, who are not generally interested in the abstract and fluffy. But who are very interested in hard data, and maps and models that build on fundamental physiology and evidence. So we give them an idea about why we get stressed because of evolutionary biology, because they have to survive. And we give them a strong set of ideas about how to slow down into the parasympathetic upregulation. And we do that very simply by teaching and breathing, breathing, focusing, grounding mindfulness. And in a way, that's the that's, that's, that's the basis of what we're doing with doctors. However, there's a lot more to it than that, because in the second part of the workshop, we will ask people to consider where their cave is. Using that metaphor of you've been, you've been hunted, yeah, high activation, unsafe, or you've, you've been hunting, activation safe, you slow down, well, where do you slow down? When do you slow down? How do you slow down, because if if the if there are no opportunities for interrupting the stress response, you begin to get the cascade of persistent stress and high arousal. And that, of course, ultimately, is is the seed for pathology. However, once again, because he's a young people, are those everywhere? There's a tendency isn't that with human beings to say, well, I know it'll, it'll, it'll kill me in the end. But yeah, what the hell are you going to do? You know, I'm going to carry on cognitive dissonance. So I say, well, well, stressful, stressful will probably make you will eventually, but you're young and bouncy and juicy at the moment. But could you live at this pace? In 20 years time, 20 years time. And we talk about how the HPA Axis eventually doesn't doesn't come back to baseline. But long before that happens. Stress before it makes you ill makes you stupid, and unfriendly. And they go, Oh, that's it. That's a pretty strong soundbite. So I then explain why that is partly because when we're operating in in limbic midbrain, HPA axis, high stress wind up, we have relatively less access to the medial prefrontal cortex. So we're a bit we make more errors. And we've we've demonstrated that in some of our recent meta analyses of what happens to patients and patient contact when we're burned out. So we know that we make more mistakes when we're in that persistent wind up state. And the other thing that happens I go along with Steven Porges here and his polyvagal theory is that when we're when we are in the physiology of unsafety, the social engagement organs are relatively switched off. So we're talking about a doorway, and we don't hear it properly. And not only are we focused and not broadly picking up all the cues, but our cortex is rather switched off at smiles are not genuine. And so we appear, we appear less friendly. And eventually, of course, we leave and go into dissociation. And that, I suppose, what I've said so far is that, that is the burnout trajectory, we go into higher and higher arousal unsafety. Having gone past our peak performance, because we need higher arousal, we want to be in the in the hunting mode, hitting targets, doing good, feeling purposeful and meaningful. And then if demands are too great, we overshoot, we remain in high arousal. And if we can't recover, on the weekend off, or a series of weekends off, and we continue to be in higher hours, or we eventually go into that long, downslope, having gone through the panic zone, and into dissociation. And that's, that's, that's the basil X pass, really, we start with, we start with, not necessarily start with, but there's a sense of, I'm not doing a good job here, can't do a good job here, and begin to lose myself value and racing to harder, become physically and emotionally exhausted. And eventually, I begin to turn off in order to cope. Yeah, so we become detached.
2
Speaker 2
16:31
This is dissociated, cynical. So that that's, that's why it's, it's, it's terribly important in medicine, to understand that this trajectory is not because we're bad people, it's often because we do try so hard that we shoot over the point of peak performance. And we tried to go the extra mile, to continue doing what we're doing, and hoping that everything will get better, when in fact, what's happening is our performance is getting worse. And when that happens, we make more mistakes, we communicate poorly, we we become part of dysfunctional dynamics in our team. Patients become more dissatisfied, they sense that we have lost empathy. And we know that doctors who are empathic, or are perceived as empathic are sued a great deal less, which is a pretty important for our bottom line. But in addition, you know, we don't as doctors go to work to do a bad job. No, we, we want to do good. And we find ourselves caught in these, these pliers, really where the system not only the system, but mainly the way we think about medicine, and the finances of medicine, the politics of medicine, or conspire against our being able to do what is fundamentally an altruistic act of being part of a healing profession, with high values, timeless, timeless purpose and meaning. And it's very weird. If you'd like to think about it Thomas, that 50% of us at any one time say we are burned out what has gone wrong.
18:35
And what is the answer?
2
Speaker 2
18:41
Well, one of the answers may be
2
Speaker 2
18:51
industrialization, yes. I think in in, in, in in the northern world. We have we have mechanized medicine to such an extent in order to cope with demand and technology has become so intensive. And the range of tests and the multiplication of knowledge and the expectation of patients and perhaps the financial drivers. I mean, all these things are making us have to run very, very fast, almost a standstill as individuals but also as organizations. I think the other thing is and then they're not disconnected is that we are faced with a huge worldwide pandemic of chronic disease and many of As many of these ills and ailments are the results of the way we live, and many of the ones that aren't, are the results of environmental issues and difficulties and pollution and poor food. Diabetes alone will bankrupt the British NHS in a few years time. There are already I forget the numbers of deaths of diabetics, diabetes, type two, and in in in America, and I don't know how it is in Canada, obesity rates are absolutely legendary and incredible. And and all the more. So there is there is a perfect storm brewing because these chronic diseases don't respond terribly well to external intervention. They need to be self managed. And in order to self manage these problems, people need a different kind of doctor think, and a different kind of health system, which would be putting much more emphasis on prevention and health promotion. But you know, somebody once said to me, the business plan is big food makes you sick, and Big Pharma picks up the profits. Yes. I mean, I wouldn't I couldn't possibly comment on far too diplomatic. But that kind of thing being an Englishman, but it could look that way. Couldn't do.
1
Speaker 1
21:38
It looked at and you didn't see it. I didn't hear you say that. But allegedly, allegedly right. Now, that's very, very true. Very true. So you have arthritis, you have diabetes, you have high blood pressure, obesity, all those things, right?
2
Speaker 2
21:58
Yes, and no, of course, all of them are to some extent, including a lot of mental illness, especially depression, but now understood to be inflammatory disease. That's right. And stress. And stress is pro pro inflammatory. And we live in an industrial consumer society, where the people place very high value on stuff. Yeah. The most expensive person is that guy, or the woman who dies with the most stuff? Yeah. And so this, this consumerism and this chasing, hunting, is hunting unreachable goals? is another part of what some people say is the the unconscious business plan of our times. So yeah, I think we have a we have a, we have a crisis, which is I think the sociologists talk about the crisis of representation. But really, basically, what is life all about? What is medicine all about? What's going wrong with the system, the culture as we know it, and it's very obviously a culture that's in decline. Business, as usual, is not going to work for much longer. I'm whatever you call the business. So the agriculture business, the medicine, business, the financial business, the extractive industries, they're struggling really hard. And the harder they struggle, the more damage they do. I wouldn't say that about medicine, but I do think medicine is becoming part of the problem. I'm with I'm with Ivan Elliot, who, you asked me who I might invite to supper? I think he was certainly I wouldn't be on my list. And he, he wrote limits to medicine and medical nemesis, what, 40 years ago, I need it. He said that, that social iatrogenic illness that that medicine is beginning to create problems. And I think we can see, we could name quite a few of them. But there we are, where we are in the system that we are in medicine does amazing things. It does amazing things. And for those of us who can afford it, and in countries that can't afford it, we have lives that now stretch well into the 80s. Some of it, I guess is is due to medicine, a lot more of it's due to plumbing and housing and education. But medicine takes the credit. But of course even so in even in a country like ours in a in a I think I read a statistic not long ago that in the poorest area of Glasgow in Scotland, the life expectation is just below 62 miles up the road, it's in the mid 80s. So these these health inequities are are truly truly awful, really, and, and a great indicator of something that's, that's, that's gone, that's gone wrong, if that's only if we think human wellbeing is an important aim of a culture. And I happen to believe that, I think probably it Z aim of a culture. And the question then is how do we? How do we support human human well being?
2
Speaker 2
25:37
So those are those are the big questions. And of course, medicine, medicine can't answer them. But while they're not being answered medicine is having to pick up the pieces.
1
Speaker 1
25:49
So, having said what you did, and I totally 100% agree with everything that you have said, how were you able to persuade the people in power to allow you to teach this kind of non scientific and in quotation marks, like yoga, meditation, acupuncture, how to persuade, you know, your superiors, the people who make decisions, that this should be taught to younger doctors?
2
Speaker 2
26:31
Well, I haven't I mean, that's not that hasn't been my aim. The the innovative, clinical work has has all been in, in primary care, in family medicine. And we still have a great deal of freedom in, in primary care medicine in this country, to innovate. The, of course, it has to be done under a search umbrella, like like all innovation, you can you can achieve a lot as long as you're evaluating what's going on and as long as it's done ethically. So the I think the evidence for musculoskeletal medicine, for acupuncture, for psychotherapy, counseling, and those have been my key areas, is strong enough to support proposals for pilot pilot, pilot evaluations. And those those have been that's been one I've been doing really working in primary care, since the 1990s. innovating in those ways and evaluating those things. As far as as far as mind body medicine, yoga meditation goes. To say that unscientific is certainly you can't say that now about mind body medicine, in the light of neuroscience. Everything that we know now about meditation, Benson's relaxation, response, mindfulness, even mindfulness and impact on telomeres, I mean, we, we now understand a little bit of how about meditation turns into molecules. So we've, there's a very strong scientific base for aspects of mind body medicine, equally, equally around Yoga, you can you can, you can take yoga and look at it through an eye or Vedic or Vedantic lens, or you can look at it through that sort of a neurophysiological lens. And in going through one lens, it looks extremely unscientific to the other, you can find very good reason to support it as a clinical intervention. So it's not it's not hard to find the argument for using these innovations. What's much more difficult is to find opportunities on a large scale for bringing them into the system. And so I'm, I'm, I'm, I've always worked on the small scale, you know, I haven't, although my my work in this area has been recognized internationally. And I can't I can't say that it's made a huge impact inside the NHS. And that's, I think it's quite different in, in in America, I don't know how it is in Canada, sent down again, but in America because a lot of a lot of health care is paid out of out of one's own earnings and not through any kind of related tax burden. The state has little say In, in what the doctors, they're saying what a doctor can do. And market forces determined that if people want a mix of conventional and unconventional, unscientific medicine, they're free to pay for it providing it's done well and safely. So innovation, all my, and I have huge reservations about and neoliberal financial system and the politics of it. There is more freedom to innovate in, in private medicine, but in in this country, where most medicine is, is in, in the hands of broadly speaking, state decision making, we have to, we have to work in a different way. The unfortunate thing is, even within our system, where we have committees that set guidelines and look at evidence based medicine, some of the evidence for acupuncture and musculoskeletal medicine has been ignored. Because Because in in a struggling system where budgets are tight, it's easy to say, well, what are we going to do? We can employ an acupuncturist for a year, or we can do three more hip operations. Any commissioning sick is going to say, Well, look, now what are the quality adjusted years here? And the math says, now you've got to pay for the brother pay with hip hop's? Yeah, yeah. So so each so there we are budgets, finances, evidence based medicine, evidence based medicine, based on randomized controlled trials, which don't always they don't always encompass what's going on, in interventions like acupuncture, or osteopathy, or psychotherapy, where individual skill is what it's all about. Yeah, so there's no such thing really, as acupuncture, there is only the combination of the patient, the technique, and the person who's skilled the skilled operator. And you can't really fit that triad into a into a randomized, blinded, controlled trial very easily. So anyway, that's for all these reasons, I gave up. But effectively felt like pushing water uphill, when I was trying to get complimentary medicine more into the NHS, and move back to my my own prime concern, which was better medicine happens when you have happy doctors. For all sorts of reasons, not least being the empathy, the empathy bit, and the the communication bit, and the concordance bit, no, people like their doctor, and especially if people think the doctor likes you, everything goes better. Everything goes better. Maybe that wasn't the so we wouldn't have placebo controlled trials. Because the relationship matters.
1
Speaker 1
33:19
So looking back on your own past, from childhood to the present, to what do you ascribe your particular openness? To what I guess at one point, anyway, was a fairly novel way of looking at health, you know, like you said, complementary, but I'm thinking more of a better word that would be more descriptive of, well, non traditional, let's say non traditional. Yes, yes. Yes, possible for you to be Elson that kind of an experimentation and exploration?
2
Speaker 2
34:10
Yes. Yes. Well, language is important, isn't it? And so non traditional means whatever is outside the mainstream that's taught in the background has been in the big hospitals. So
2
Speaker 2
34:27
I think I think my own experience and remember I'm a child of the 60s and getting on their medicine in in large urban teaching hospitals and the relationships and the culture. That the patriarchy, the sexism, the power relationships, the the the disabling, incapacitating way, we, we we related to patients, the lack of any sense of mind body connection of the relationship. One of those things made me quite unhappy about what I was learning of the tradition to all that was embodied in, in what you would then have call conventional medicine. So there was a big hole in my medical education, medical education, with two big holes. One was, well, what's what's what's emotion? What psychology got to do with all this? And what's how? What is health? They were, they were not neither. Neither of them were touched on in my years at medical school. And I didn't, I didn't, you know, you don't know what you don't know. And it was only when I came out of medical school and felt radically unprepared to be a doctor, that I began to look elsewhere. And that was a circuit that took me about 10 years to come back into conventional medicine. And it was it was the 1970s by then, and it was a collision. A viewer, I don't know how old you are Thomas. But if you remember the 70s, certainly in London, you had from the West, you had excellent. Yes, yes, initial movement, you had all of that piling in from from, from from the west gushed out. So wonderful stuff from the east, you had my Rishi, Mahesh Yogi and the Beatles and, and all kinds of wonderful ideas and, and in the middle of it in in the 70s. In London, there was a huge up swelling of all rather ungrounded omnipotent ideas about what we could become, and what what what alternative medicine could do, French medicine could do. And I was very much swept into that looked at how me up, see acupuncture, then meditation, yoga, all of those things I took up with and eventually went you lived in a commune in a community for years and spiritual practice. And that that was the 70s. And then I, I discovered that there really, there was, there was something in mainstream medicine called psychosomatic medicine. psychodynamic psychotherapy, there was there was the beginning of an interesting research into meditation, Herbert Benson and all the others. And the relaxation response perceiver response, I discovered that there was something called Family Medicine. And by 1980, that's where I was I landed in, in British family medicine. And in one of the first practices where we actually combined mainstream medicine, with acupuncture, osteopathy, even homeopathy, my my partner, my, my senior partner was practiced homeopathy too. And, and I'm from there, I got involved in the first big projects, using integrated medicine in the community. And then we founded the university department to look at the crossover between psychodynamic psychotherapy, social work, and medicine, including complementary medicine. And that took me into the 2000s. And interact right in the 2000s, most health authorities, most most health groups in the country, were spending some money on complementary medicine. And then the backlash happened. Yeah, that whole evidence base medicine revolution began. And if it wasn't, if it wasn't a randomized double blind trial proven, or it wasn't guidelines, by by the National Institute for Clinical Excellence, then you really couldn't do it anymore. And, and by that time, I felt this is this is justifiable. If you're spending state money, you need to account for it. And you need a transparent system of outcomes. And so we I began to do some pilots around that and found the outcomes are actually quite good. But But we could never do a randomized trial for all kinds of good reasons, not least the large amounts of money they cost. But by then again, but by then I suppose I was looking at my own career end and looking back on my own experience, and by then I was also working with young dog To this, and realizing that actually, if I was faced with what they're faced by, I wouldn't be a doctor, I wouldn't want to be in the profession. And I'd certainly discourage my own sons from becoming, becoming doctors. And I wondered why, and these are very fine, very fine young people. And at the same time, the first inklings of how very prevalent burnout was becoming in the profession. This is becoming clear that there was something wrong with business as usual. And so we read or read already founded the British holistic Medical Association, whose motto is physician heal thyself back in the 80s, because we saw this coming up the highway and I started a journal called the Journal of integrative journal with holistic health coach, I, I still, I still edit. He said, good. Time to vlog. So this is this is the journal I did. Yes. And it's a very beautiful thing. This issue actually is edited, is CO edited by medical students who have been who we asked what's missing? And they said, well, emotional intelligence, a student voice. Why are we talking about roots and values? Social prescription? Why we talked about what's happening in the community? Compassion, human dimension, planetary health? Yeah, so yoga for students. So there's the young generation. And this is really, really hopeful, and particularly generation Zed, they, they they they look at medicine as it's being taught, and delivered in hospital. And they're very skeptical. What, something's wrong here. And so we're, we are we are inquiring now we've got a national survey going up of students experience, and foundation, your doctors experience. And we're trying to imagine a parallel curriculum to augment domain stream. And I think it would be it would be largely about resilience. But resilience, not just about individual neurophysiological resilience, but the whole person resilience. I mean, what, what is it that that makes us buoyant? And as I look out my window through the magnolia tree, on the river estuary, under this beautiful blue sky in this spring, I know that and part of what makes me resilient is my connection to nature. Yeah, so one of the things we've been doing with young doctors, and and actually consultant specialist senior doctors, is we take him into the woods. We take them on retreat. Yes. We organize retreats for GPS and doctors, we take the groups of 1516 into the woods, and we and we, we say we stay off grid for 2436 hours, and we sit around campfires talking about medicine, and what it feels like, and then we the impact on mood, Thomas, you would not believe I would in 2012. In 24 hours, they come in we do the perception of mood scale and, and the perception of stress scale. And they're through the roof, that they're depressed. Just they don't like themselves. They've got no vigor and an after 24 or 48 hours, 24 hours, that everything improves. I don't know. We don't know how long it improves for but but they've their vigor, their vitality, their self value, their levels of anxiety, huge improvements. So I suppose it's no surprise I mean, ever since Roger roll riff found that people who can see the window after a gallbladder operation spent 48 hours less in hospital. There's something though, what's going on here? So there's certain things we need and we're encouraging doctors to get a life. Yeah. There's a paper called if one in four doctors is bonafide doctors is burning out. What about the other four, which is written A while ago, I think it'd be half and half now. And it's what you'd expect. It's having it's enjoying your patience. It's having professional boundaries, having a life outside medicine, having curiosity CPD. It's yeah, it's all those things that make make our professional life enjoyable. And that's hard when you're in organizations and in settings, possibly where you're chasing impossible repayment of student loans and It's 100,000 pounds paid back now in this country and it's a hell of a lot more in the States. So it's more difficult when you're working in a on an industrial production line, where their demands are high. Conflict is high, and you don't feel like you're doing a good job. That's what Maslow said burnout is too much demand. Team conflict, not feeling like you're doing a good job values conflict. And I think in large industrial healthcare delivery organizations, that's a pretty normal day. And so half of our doctors are, are having a hard time and not enjoying themselves, not enjoying the work enough not enjoying patients, and patients are, I think internationally, much more prepared to, to push back and demand better, is happening. But you asked me, you asked me how I got into into this this range area? And I guess that's the answer is historical. I think probably, if you did my my end and my Personality Inventory, I'm not very neurotic. And I'm very open. That helps, despite which I stayed in mention.
1
Speaker 1
46:19
Right. Right. So you, you refer to the questions that I sent you before this interview, so I want to go back to it if I could. My question was if you could have dinner with any three people dead or alive, who would it be?
2
Speaker 2
46:39
This is like Desert Island Discs, you know, what would you what? 10? What 10? What 10 pieces of music would you take away to live for everyone? i In the end, it boils down to three people. Yes. All of which are represent two key areas of interest and inquiry. Now, the Joanna Macy. Basic ism is a Buddhist scholar and activist who created a social organism and a social network called the work that reconnects. And I run by I've been trained to run her style of workshop. The basic basic idea is it's part of what's called dis despair and reconciliation work really did we are we are in we are in a very difficult position now as a species. Unless Unless something changes, we are we are going to run into a very serious train wreck. So how do we change our relationship to the planet? And the first question is, then well, can you bear to feel how bad things are. So Joanna has helped us to find ways to look at our despair, but then also to, to move into ways of being part of the solution. And, and that moves on to my, my, my my next guest, who is Thomas Berry. And Thomas Berry wrote a book called The Universe story, the book called The Great work. And he's a Jesuit, scholar and academic, in the tradition of tired Ashada, I would say, who calls himself a geologia. And a theologian, who's presented this wonderful picture of deep time of what it is as human beings and as a species. And we are in this codependent intelligent Gaia system. And what is our role as, as individuals and as cultures in the coming years, in order to fulfill our human, our human species potential, and then and then the third person is a relatively new member. The guests at the table is called Roland Griffiths and Roland Griffiths is a American academic, who is probably the great researcher on psychedelics. His work on psilocybin and spirituality has is is is part of what you were implying before? How do we take the ineffable something like health and systems like yoga or meditation and, and how do we render them scientifically explicable, and so Griffith is part of that work. And so I sort of conversation between a Buddhist scholar and activist, a Catholic geologia and, and deeply insightful man into the great work of humanity, and a great researcher such as Roland Griffis with his understanding of neurobiology and the psychedelic dimension. I thought that would be a great conversation.
1
Speaker 1
50:36
That would be very interesting. That would be very interesting. Well, before we run out of time, just one more question. What is the most important thing you have learned in your life?
50:53
Only love matters.
1
Speaker 1
50:55
So totally agree with you? Totally. That's, that's how I feel. It's really the only thing that makes a difference, isn't it? And cats, and yeah, and you are practicing it and your cat, which is like a huge cat. It's like a little lion. What do you call your cat? Peaches, peaches, peaches, peaches and cream,
2
Speaker 2
51:26
peaches and regalia, which is a musical piece by Frank Zappa.
1
Speaker 1
51:31
Well, David, thank you. Really, thank you so much. It has been fascinating. And as a follow up, actually, my next guest in a couple of weeks will be Dr. Mel Borns who is author of Get Away Just for the Hell of it, which I'm sure you would appreciate. Also an apple a day a holistic health primer. Right. And the doctors guide to alternative medicine what doesn't work and why. He has written extensively on stress management, psychotherapy, acupuncture, traditional healing, herbs and complementary medicine, and hope. Perhaps you David and my other friends can join us. So again, thanks, David. And hope we can do this again in a little while. Sure. Lovely to talk to you. Thank you David. And enjoy the nice weather and sunshine. I hope your your Canadian spring. Come soon. Yeah. Wonderful. A wonderful year. Thank you David and take care of yourself.