FROM THE FRONTLINE… William House GP
Self-care and the expert Most mornings I listen to the Today Programme on BBC Radio 4. Like much of current affairs programming, ‘stories’ are accompanied by comments from people directly involved and by experts, often professionals or academics. Inevitably swine flu has been a frequent feature. On 20 July the focus was on swine flu risk for pregnant women and the ‘conflicting advice’ being offered by the NHS website and other ‘expert’ sources. A pregnant woman was heard complaining about this and, scattered through the programme, there were interviews with Professor Steve Field, president of the Royal College of GPs, Dr Boon Lin from the Royal College of Obstetricians and Gynaecologists, Jane Draper, BBC health correspondent and Andy Burnham, Secretary of State for Health. The story added up to a substantial chunk of the broadcast. Finally, the minister said ‘Everyone must make their own judgements ... they don’t want government to tell them how to live their lives’. This story was about self-care and it tells us much about the pickle we are in as a society. Firstly, it tells us about the media. I guess most people would consider Today to be a relatively serious current affairs programme aimed at an educated middle class audience. What will listeners have taken from these items on swine flu? Perhaps ‘none of them
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know what to do’ or ‘they can’t even agree among themselves.’ Yet the experts all emphasised the same simple advice: getting on with your life as usual, good hand hygiene and covering your mouth with a tissue when you cough or sneeze. But, of course, repeating this endlessly doesn’t make for exciting broadcasting, so a story is contrived which distorts the message. A deeper problem is the implied message about experts. The very fact of calling in the expert portrays a problem as complicated. It’s easy to imagine listeners to that programme thinking: ‘If these ministers and professors don’t know what to do, how am I supposed to know?’ This is a disempowering response, and if repeated over and over (in and out of the media) it will lead to a disempowered population. Of course, most experts, whether doctors, academics or ministers of the Crown, are happy to allow themselves to be cast as the vessels of knowledge and expertise. The minister’s words quoted above belie the position generally taken by politicians: politically attractive but simplistic generalisations that often work poorly in the individual case. But it gets worse! The language of the expert has crept into everyday thinking and speaking. In healthcare particularly, technical medical information is readily available from the internet and we can easily believe
that this medical-speak will enable us to look after ourselves. But this is not real empowerment. I am often asked how I feel when a patient walks into my surgery clutching web downloads or magazine articles. Of course, many of these are tainted by a vested interest – to sell a product or make a good story – but even if they are not, they are often a distraction from an underlying health problem which is being masked by anxiety over disease, the narrow discourse of the expert and a sense of detachment from the deep sources of health and wellbeing. Mainstream medicine says much about technical fixes and prohibiting unhealthy behaviours, and little about finding wellbeing. The role of the holistic physician is to become a mirror for the patient, enabling them to understand their predicament at a different level so they are empowered. This doesn’t call so much for technical expertise but rather self-knowledge and ‘empathic projection’ – knowing and feeling some of what the other feels. It is an imaginative and creative act that entails showing vulnerability. The most powerful self-care is not done alone, but in partnership. This is a different kind of expertise that enables us to know the meaning for us of what we hear and read. You don’t have to be a professional to do this, but it is better not to listen to too much radio!
© Journal of holistic healthcare
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Volume 6 Issue 2 Aug 2009
