Evolution of Medical Training

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Recently there have been several early stage developments in the delivery of changes to medical education, namely the recognition of the absence or insufficient knowledge on the role of nutrition in the management and reversal of complex non-communicable diseases.

I am one of 4 people who developed a 1-day masterclass for GPs and medical professionals who must operate in a very time constrained clinical environment and yet still deliver meaningful proposals for people to change their behaviour patterns. This is an entirely different type of care than can be developed over 60 minutes, yet they are now empowered to engage with their patients in a way that creates partnership – and believe me when I say that the impact on their clinical life and their patients is already being felt in hospitals and GP surgeries around the UK.

It is in general appreciated of course that only long-term and consistent dietary pattern can benefit human health, or conversely, induce inflammation and increased oxidative stress if an unhealthy diet is followed, that leads to chronic disease. To convert this knowledge beyond a public health message and the ‘eat a balanced diet’ sop to many thousands of people daily,  takes commitment and intervention, and to intervene you need to know the what, why and when.

Some practitioners have raised comments that this ingress into clinical training by medical professionals will see a loss of business for them, as patients that turn into needy clients have their need met by the local GP. Yet nothing could be more wrong or more disconcerting. A three-year training in nutritional therapy or other nutrition courses is very different from the short training being offered to GPs, yet every hour they spend becoming enthused with the power of lifestyle change means that your clinical expertise becomes better appreciated and understood.

Even the massive organisation that the NHS is cannot be sustained, so economic reality will drive the need for different approaches including eventually spinning out clinical care to NTs, as at a cost of £11bn a year on direct NHS costs and the same again on indirect costs of type II diabetes alone, will bring the organisation to its knees.

If you were able to catch the BBC Radio 4’s food programme you will have heard how various small changes are occurring, but more importantly how these are being welcomed by the trainees. Never in my clinical life (over 35 years) has there been such a receptive audience and whilst there remain sceptics, this is the way forward for the country and the world in terms of health delivery.

But an article in The Times by Clare Foges on 2nd April suggested that “If our health service is to be affordable long-term, and if it is to be fair, then we need to talk about deserving and undeserving patients.” She goes on to say: “The NHS crisis is a personal-responsibility crisis, so when it comes to what is rationed, what is prioritised, and who pays more for the NHS through their taxes, the axe should fall on those whose behaviour has impacted their health, not on those who have done nothing to bring about their condition. Where possible and reasonable, the “undeserving” patient must be made to pay for their lifestyle choices, whether financially or through the de-prioritisation of their treatment.”

Now there is much in her argument that you may be nodding with, but we all know changing behaviour is tough, for everyone, and if the primary clinician is to catch this risk early, he or she needs specific skill sets to be able to direct, guide, cajole and encourage – hence the need for more training.

The NEJM has created a free online training plan for clinicians to help them learn how to change behaviour pointing out that all patients are not the same. Even in the case of the same diagnosis, there are differences in what individual patients want out of their care (outcomes) and what is important to them along the way (processes). Trying to achieve a good result without understanding how a patient defines “good” requires assumptions that often lead providers astray. Why not sign up

Finally, a paper: The influence of diet on anti-cancer immune responsiveness out in March 2018, eloquently pulls together numerous immune related events mediated by foods and food concentrates, a worthy one for your repeat read collection and ideal for the family member who still does not get why you do what you do!

At the end of any connection, in addition to the length and quality of life, one important outcome of care is peace of mind. When a care episode is over, it matters to patients/clients whether they feel confident that all that should have been done was done, independent of other outcomes. Confidence is built through good communication, a sense of teamwork among different providers, and the belief that the provider(s) cares about the patient.

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