Your Life Lesson from a 6 Week Old Baby

Well here we are. Forty-eight hours into being a GP registrar and I still have a licence to practice. TICK. All my patients are still alive. TICK. My colleagues still like me (I think).  TICK. I’m still rolling with the Lycra. TICK. Time to make hay while the sun shines.

Of course you and I know this will only last a certain while. After all, life – real life not Hollywood life – is also about the curve ball, the surprise, the unannounced.

And with that in mind, let me tell you about my youngest patient of the day –  a little man just six weeks old. I mean, Love Island was on for longer than he has been alive. He came with that fresh book smell we all love, and naturally had attached to him a two attentive first-time parents who had bought enough from MotherCare to prop up any ailing economy.

My task of this 15 minute appointment – the six week baby check. It’s a head to toe job where I basically make sure this little man has been put together properly. Thankfully I have done this before; Not quite an ‘old hand’ but not quite a ‘popping to the loo to Google “how to check a baby”‘ situation  (there was a time, yes).

To the tune of my lazily scraping chair (my legs are feeling the cycle ride today), I get up and grandly announce for them to strip their baby down and put him on the examination couch. They get to it like a pair of eager army recruits, peppered only with the under the breath exchanges of short, terse words as dad struggles to negotiate the Panda themed baby grow – fully aware that my judgement of their parenting hangs on the very task. I tap some notes on the computer while quietly enjoying the mini-domestic unfolding. Two minutes later, the little man is prepared and I step up to the mark. Game time.

As I stare down upon him sprawled on the examination couch, all pink, chubby and squirming, I can’t help but think how happy he looks. Not a care in the world.large

How your luck can change, little man.

Like a burst water main his own ‘little man’ suddenly kicks into action and he starts to pee. I have never seen something so remarkable. He has managed to pee in the perfect arc – enough to rival one of Mother Natures rainbows –  launching it over his body and straight onto his face. Instagram would have loved this.

The expression he gave was golden. If I could paraphrase on his behalf, it would have been “W.T.F”. If you don’t know what that means – good on you – that’s clean living.

And so in that moment it reminded me of a valuable life lesson. Sometimes shit just happens. I mean this little man didn’t expect at that moment in time to get a face full of urine – especially his own. But he did. Likewise we don’t expect to fall ill, get dumped, not have the level of fitness we did 10 years ago, or realise one day that we don’t fit into our jeans anymore. But we do.

It is however, what happens next that counts.

Do you stand up, dust yourself off, learn from it and move forward? Or do you bathe and wallow in the fact that something bad happened and fail to even try to move past it? My humble advice – think like my little man in clinic – he took it in the chin (literally), had a bit of a cry,  some milk and then had a nap. By the time he has woken up, he’s shaken off the experience and is onto the next adventure.

Maybe we should all take a leaf out of his book when life urinates on us.

See you next week.

Nick

Twitter: @DrNickKnight

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First Impressions are Difficult in Lycra

So this is it. Twelve months time and I will be, barring an catastrophic cock-ups on my behalf, a fully qualified GP.  My wife is thrilled – it means we may be able to finally upgrade from the Citroen C2 – which while a spritely 1.1L car – does feel a little bit like forgetting your P.E. kit and having to borrow the cast-offs from the lost property box. Sorry, Citroen.

On the plus side, my final twelve months are in GP surgery within cycling distance. Sorry Citroen – you’re dumped. On the morning of my first ride to work, inspirational thoughts of Sir Chris Hoy, leapt into my mind. He really rocked the lycra. After then staring at the exceptionally pathetic state of my cycling lycra collection, those same thoughts leap out my mind. Replaced was a steely determination that swept over me (last experienced when tacking that stuck ring pessary in clinic), and after a few sharp inspired breathes, conjuring of warm thoughts (for the sake of my own dignity), I wrestled into my lycra.

Thirteen miles later (it’s actually only 11 miles away from home but I got lost – twice), I arrived at my new GP surgery. Home for the next twelve months. I’m excited. The bike locked outside, I took a moment to whisper some inspiration words to myself – “don’t kill anyone on your first day” (extremely difficult given that I just observing this week) – and stepped into the surgery.

Now they say first impressions count.

I really hadn’t thought this through.

A first impression that says professional, diligent, and presentable – are a real stretch when you are standing in front of your new boss, two receptionists and the surgery clinical manager dressed in what can only be described as a gimp suit for wayward cyclists. A fatally placed water splash mark from my (cold) water bottle over the groin is the sucker punch.

Like anyone caught compromised, I realised, on the balance of things, that I had two options; Apologise profusely, trying to explain the series of unfortunate life (and faulty water bottle) choices that led to these lycra choices and regain some impressional ground back – or, pretend like there was absolutely nothing wrong and, that this is just the way I roll.

I, ladies and gentlemen, chose to roll.

Next week I begin to see you – the patients. I cannot wait. Let’s enjoy the next twelve month adventure together, shall we?

Nick

@DrNickKnight (Twitter)

 

THE HEALTH CONVERSATION: Prologue and how to use my book

The Health Conversation: My online book for everyone

By Dr Nick Knight

@drnickknight

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This is a book for everyone.

I have written it with a mere personal hope to remind, refresh and recharge the actions that we may take in life and which influence our health.

Be rest assured that closing your eyes and listening to whale music does not feature.

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About the Author

Nick is a 34 year old doctor training to become a General Practitioner with a special interest in fitness, exercise and lifestyle health. He currently lives in London with his new wife, Jess. They both dream of escaping to the countryside one day and getting a dog called whisky. Nick, incidentally, also likes whisky.

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Disclaimer

Please consult your General Practitioner before enacting upon any of the advice or descriptions in The Health Conversation. This book is written for everyone but health prescription needs to happen on an individual basis.

 

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Content

Prologue: My Passion

How to Use This Book

Modern Living

What is Health?

Key Tools

Twenty One Conversations for Twenty First Century Health:

Conversation 1:                Age as a Barrier

Conversation 2:                Alcohol

Conversation 3:                Bodyweight

Conversation 4:               Celebrity

Conversation 5:                Death as Part of Life

Conversation 6:                Diet

Conversation 7:                Exercise

Conversation 8:                Existing Health Conditions

Conversation 9:                Family Empowerment

Conversation 10:              Internet

Conversation 11:               Mental stimulation

Conversation 12:              Mood

Conversation 13:              Sedentariness

Conversation 14:              Sexual Relationships

Conversation 15:              Sleep

Conversation 16:              Smoking

Conversation 17:              Social Respect

Conversation 18:              Stimulant Drinks

Conversation 19:              Stress

Conversation 20:              Teamwork

Conversation 21:             Technology Drain

A Quick Reality check

What to Do Now?

Summary of The Health Conversation

Appendix 1:                       How Doctors Diagnose

Appendix 2:                       Snapshot Health Card

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Prologue: My Passion

I often wondered what a prologue was. Yes, I am most certainly not going to pretend to be clever enough to know already. Thanks to the Internet (which we will discuss in all its shades of grey later), I now know it to be an act or event that leads to another. Here is my prologue – from garden hole to GP trainee.

 

It all began when I was a kid. To me, playing was largely defined as throwing my battle-scarred action-figures on their latest mission into some cavernous muddy hole (that I had joyfully torn out of the wonderfully manicured garden-bed that my parents had slaved over), and then dunking them in some ice-cubed filled water pit. Little did I realise that this was the start of my fascination with the human body. You see, deep down, apart from the subliminal messages I was sending my parents (clearly I wanted a pond) I was asking my action figures to ‘survive’ in extreme and challenging environments. I was asking them to push their, albeit plastic, physical abilities and mental strengths to their very limits. I was, I guess, concomitantly testing 1990s Chinese manufacturing durability.

 

Now that passion, to explore the human body and mind, it seems has never left me. In fact, 25 years on, that child’s play which saw me constantly muddy and sacrificing toys to huge garden holes, has grown into my career. And I bloody love it. You see after three long degrees including a degree in Sports and Exercise Science, a PhD in Performance Human Physiology and finally a degree in Medicine, I now work as a doctor in specialty training to become a GP by 2018. I should add that this was never the plan. I chased a girl to Oxford to do my PhD (she then dumped me a month into being there). I then only went into medicine initially after a stint in the City, where I fast realised I a little too rough around the edges to cut it or enjoy it. I wanted to roll my sleeves up and have an adventure.

 

Ok, so it is true that all my patients might not have just escaped from some muddy garden hole (though I’m sure it happened in a movie once) or bucket of ice-water but what’s happening to them is not a million miles away – their bodies are being stressed, attacked and challenged – this time however by disease, illness, trauma and the degenerating chronicity of their health. And you know what, this isn’t anything that new; Thousands of years ago Neanderthals had similar problems, and then some, in the form of hunting huge carnivorous animals with a bit of sharpened wood. No thanks.

 

Nowadays and exponentially more so since the supercharged and flamboyant arrival of the 21st Century, a new problem is thrown up: choice. Choices are all around us. It is these choices that are leading many of us blindly and unwittingly into health troubles. We have our modern day health enemies, hidden as wolves in sheep’s clothing, like as our dear and old loyal friend the television remote, fast-food on every paved street, and a pathogenic and inherited fear to break a sweat with some exercise. Trust me when I say that if our bodies had a voice these would not be the choices they would make. That is the thing though isn’t it. They, our bodies, do have a voice. They are making their statement of intent and distain at what we are doing to ourselves very well known: heart attacks, type two diabetes mellitus, obesity, depression (yes, depression) and chronic lung disease.

 

Of course luckily for us we also live in an era that celebrates unbelievable advances in scientific research that filters from the laboratory into our everyday lives, and developments in medicine that allow us to identify, treat and prevent disease better and earlier than ever before. And you know what, for me, it’s that fine balance, that personal artistic interpretation between the wise, the not so wise, and the dam-right stupid choices we make in life, combined with our pre-determined genetics and those life events that just happen, that make you and I just so fascinating to explore.

 

I feel incredibly fortunate to be a doctor. We have a privilege to go beyond the looking glass and step into and affect (hopefully for the better) our patients’ and their families’ lives. With that comes a responsibility, one which I take very seriously. This book, I hope will reflect that, and too reflect my passion for health. It is just one way in which I wanted to share what I have had the privilege to learn, see and experience as a doctor in his early years.

 

Right, so serious paragraph aside, how do I want to wrap up my first ever prologue? Whether it’s the science behind our health, or how medicine helps us battle and beat disease and disability, I admire the human body. It transports us into a hidden world full of life, death, adventure and struggle that rivals any Hollywood Blockbuster.

 

And for me, it all began with one plastic toy and a garden hole….

 

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How to Use This Book

 

“Whether you think you can, or you think you can’t – you are right” [Henry Ford]

 

This is a book talking to you about every day issues which influence your health. It’s a mix of my opinion, observation, rant and information. That’s it really. There is I promise, no hidden agenda, no magical secrets revealed to lead you to everlasting good health and no hidden message. It is not a Sudoku puzzle of health but should instead be Ronseal™ for health i.e. it does what it says on the tin.

 

As such I have written The Health Conversation without any long scientific, medical or encyclopaedic rambles. It is instead written largely from my memory (which is not great, I must confess) using the last 15 years of experience I’ve been fortunate to have across science, health and medicine. This calls upon what I have learned in academia, anecdotally experienced myself, seen in society, and learned inside the NHS.

 

There is too very good reason I have chosen to write it this way. And no it is not because I couldn’t be bothered to drudge up the umpteen oversized (and overpriced) medical and scientific textbooks that now live in my basement cohabiting in unison with the mould that is slowly over taking it but it was rather a genuine conscious choice to leave them there. You see by doing this, the detail and depth of information I hope to provide will stay true to my goal of delivering digestible, simple conversations about health and the issues surrounding them that we all need to be aware of. In keeping with this same theme, I have deliberately renamed the chapters as conversations and kept them short and snappy at to three pages or less. Let’s be honest, if I can’t summarise in three pages what you really need to know about one of these topics I’m not doing my job of delivering digestible information! Besides, who really wants to read a 4th, 5th or even 6th page about smoking or exercise?! I know I bloody-well wouldn’t. If I wanted that, I’d go back to medical school again. At the end of each conversation I’ve included 5 key takeaway points.

 

So that’s my part of the deal. What do I ask from you in return? Well, first of all I want you to treat this book like that friend who’s not quite on your Christmas card list but you see them occasionally for coffee (when it’s convenient to you and you’re at a loose end). By that, I mean pick this book up, put it down, dip in, and dip out. I want you to enjoy it when you read it but not be burdened by it. Of course, it may also be that not all of the health conversations are relevant for you – in which case, please don’t read them and do something more fun instead. Perhaps on the other hand, it may be that a particular health conversation is relevant to a family member or a friend. If this is the case, pass them the book with the chapter ear-marked for them.

 

Now I only have two requests to seal this completely unofficial and in no way legally-binding partnership between you and me. The first is that you must have hope. Jokes aside, we all possess the ability to fine-tune our health. Just consider that quotation by Henry Ford at the top of this chapter for moment; it’s about self-belief isn’t it? That is the reason why it’s my favourite quote. For self-belief is fantastically potent and contagious and has the ability to transform our lives and those around us. Whatever your goal, perhaps triggered by your doctor’s orders, your parents’ comments or just something you see in the mirror that you are not happy with, you can achieve it. Don’t listen to any silly bugger who says otherwise. So please, that is my first request, that you have hope. It costs nothing. The second and final request is please be patient. Things do not happen overnight. If you can overcome this, the greatest adversary to any goal known to human-kind, you will in time, achieve your goal.

 

So that’s it. If you can have hope and be patient then this book may help provide insight, direction, and support to you as you go about achieving those health goals that you yourself decide to set.

 

Before we launch into the twenty-one conversations that form the body of The Health Conversation, I want to talk to you about a three matters. The first matter to discuss is the many challenges that modern living has unceremoniously thrown in our face (while supposedly enriching our lives) and how these have affected our overall health. The second matter involves asking you to consider what health actually means. Yes in the first instance this is a seemingly simple question but actually I think it’s more complex than we may first think. Finally I hope to provide you with three principles (the knowing-doing gap, self-motivational interviewing, and the contemplation cycle) that I’d like you to have in the back of your mind as you thumb through the various health conversations.

 

Remember – don’t think too hard as you read this book. It’s designed to inspire not give a headache.

 

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Modern Living: THIS CHAPTER WILL BE RELEASED NEXT WEEK

Have a great week, all and please come and say hi on twitter and share this blog.

Nick

@DrNickKnight

The Greener Grass? Life in Primary Care Medicine

As I type this I can only describe a ‘buzz’  about me; physically and mentally I feel pretty good right now. I don’t mean to sound smug when I say that but rather just that I feel I have been on quite a tortuous journey with medicine and how it aligns with my way of life and desires for the future. I am more relaxed, happier, driven and my old self again – after probably 3 or 4 months of losing those aspects a little. Even my family tell me this – and as we are all aware, probably the majority of families know their children best.

So what’s changed?

The short answer is that I have moved out of secondary care medicine (that’s hospital medicine) for 4 months and am now working in primary care (that’s general practice). Life is very different for a doctor in primary care. Now although I am still very wet behind the ears in general practice, being stumped by how to treat Mrs Smith’s achy joints, or little Jimmy’s sore red toe after his swimming lesson – for I am used to patients with severe sepsis, widespread infections, acute heart failure, and massive strokes – I never had to worry too much about the less acute side of medicine.

General practice doctors are true generalists – and I envy their knowledge. It is so broad, so encompassing, that they have to know a little about everything – both the chronic conditions, such as Dementias, Parkinson’s Disease, Chronic Heart Failure, Diabetes, and the acute conditions such as recognising meningitis in a sick child. To make this all more challenging – they typically have about 10 minutes per consultation to take the history, examine, diagnose, and make a plan – whether that be for further investigations or management. And they do it all without the support of investigations on their doorstep – you can’t get a ‘quick X-ray’ or ‘blood test’ or’ MRI scan’ to see if they do have a disc prolapse. You have to use your intuition and experience.

This week, as it is still part of my ‘introduction’ phase of my rotation as an FY2 to general practice, I am doing joint sessions with a GP before getting my own patient list next week. This means that we are both in the consultation room, and take it in turns to sit in the ‘hot seat’ and lead the patient consultation with the other watching in the corner. This is great fun! However, what is beginning to wear a little thin is, during the times when it is my turn to sit in the corner and observe, the patient walks in and says “oh, you’ve got a medical student with you”.

I AM NOT A MEDICAL STUDENT!

I have to just smile, and usually say nothing and bite my lip. My poor lip – it has taken quite the beating this week.

I really enjoy the set up of general practice too – you get a nice big office which, as Louis from X-Factor would say “you can make your own!” and super-comfy chairs. And SO much tea.The training scheme too is more condensed that hospital medicine (though I do appreciate for the ‘patient’ that this may be a less than favourable situation) and so you are qualified much sooner – with a lot more flexibility.

Now I have spent a lot of time reflecting this week about that word – flexibility. I know that I my ambitions are slightly skewed compared with many junior doctors for I not only want to be a good, safe doctor first, but I want to write about health, do some sports and exercise medicine, get more into media work (for the love of talking about it not the public eye status, I should add), and also some expedition medicine. This globally is within the context of having a family – most importantly for which, I have time for. General Practice is the ONLY career path (beyond leaving medicine altogether) that would allow me to do this. I will stand to be corrected on that…

That is food for thought and something that I need to mull over in the lead up to choosing my career route. The deadline for that decision, out of interest, is this November – so not long to go. I feel I know what is the most natural decision to make but I will talk it over with my family first – they are often my voice of reason!

This week I also got a better understanding of what a GPSI is. Now, pronounced “GYPSY” , I never really quite got why all these GPs had such a strong affiliation with the Gypsy community…and then I discovered that is stood for GP with Special Interest. Oh. As my mum would always (and still does in fact) – for someone seemingly smart, I can be very stupid. I cannot disagree. In the practice that I am at currently, we have GPs with special interests in maternity, diabetes, genito-urinary, musculoskeletal, and dermatology. I could be a GP with a special interest in Sports and Exercise Medicine.

I like the sound of that.

 GP

Needless to say after a relaxing weekend seeing friends, going to the cinema (Expendables III, oh dear), and some reflective walks through Battersea Park, I feel very good about things. I am looking forward to hitting the GP practice tomorrow for another good week. It’s a busy week too – I have to finish another article for the Independent, and I am doing my final filming session for the Discovery TV show called “What Have I Got” – more on that perhaps another time. All in all, life is good.

Have a great weekend everyone,

Dr Nick