Dr Rupy: Today's episode is a little bit different to the norm. I'm catching up with good friend of mine and fellow GP Dr Ayan Panja. You'll recognise him from previous episodes where we discussed heart and brain health, and he has been practising medicine for 22 years since qualifying from Imperial College London, my old university. He also co-founded and teaches on the RCGP accredited course, Prescribing Lifestyle Medicine, also known as PLM. He's writing a book that I cannot wait to read. It's due for publication in January 2023 and he mentioned some things about symptom webs. It will become clear when the book comes out. Plus, he is host of a brilliant podcast called Saving Lives in Slow Motion. And this is what this whole episode is really based around. I text him, I said, look, I love the podcast, I'd love to promote it on mine. And this is a podcast where Ayan takes 15 minutes of your time to give his perspective on health and wellbeing, which is quietly mind expanding, as he puts it, informal but professional and very, very listenable. It's so good, in fact, it's become one of my favourites, and I've embedded one of my favourite episodes that you're about to listen to right here. And this is going to be before me and Ayan chat on my podcast. This podcast is from his Saving Lives in Slow Motion backlog. It's on medical myths and it runs for about 12 minutes. I'm going to leave it there. I really hope you enjoy it and I'll see you in about 12, 13 minutes.
Dr Ayan Panja: Hello, hello and welcome to Saving Lives in Slow Motion. Now, today, I'm going to be talking about medical myths. Yeah, this is a bit of a fun episode really because medical myths are all around us. How many times have you heard remedies that your relatives or friends or people that just randomly offer medical advice come up with and you think, wait a second, where does that come from and is there any truth to it? So I thought it might be fun to look at a few of those and there are just so many. And most of us, you know, experience this from early, early life really. There's, there are lots of myths that creep in. You know, the commonest apocryphal one is an apple a day keeps the doctor away. But you know, there are just so many. Carrots being good for your eyesight, cold water giving you stomach cramps, breakfast is the most important meal of the day. You know, it goes on and on and on. And the time it really sort of hit me was about 15 years ago when I had a really bad sty on my upper eyelid. And it was, it was awful. It was so big and very visible, quite painful as well. And I'd just been doing the usual hot compresses for it. But what was interesting was that almost everyone who walked into my room that day gave me some advice on what to do with it, including putting a tea bag on it, rubbing apple cider vinegar on it, putting garlic on it, or even an ice cube. It was astonishing, but every single one had something different to offer me. It was really sweet actually, because they obviously cared. And I must hasten to add, I didn't actually do any of the things that were on offer. It also got me thinking about the fact that a lot of people swear by their one thing for everything. So most of us know someone like this where their life is dominated by that thing, whether it's Himalayan salt or turmeric or forest bathing or ice cold showers. And you know, they become really quite evangelical about that particular thing. It filters into every aspect of their life. There's a lot more to medical myths than, you know, home remedies and things like that. And if you're interested, one of the show links is about a program I made in 2013 with Ellie Cannon and Pixie McKenna called Health Freaks where people did exactly that. They brought in their home remedies and then we sort of gave them a verdict as to whether we thought there was any validity to it. Quite interesting, so you can have a look at the trailer for that. But other medical myths include things that are a bit more nuanced. So for example, proverbs or dictums, you know, like we only use 10% of our brains. Is that true? Or crossing your legs cuts off your circulation, or that stress makes your hair go grey. And is it right to feed a cold and starve a fever? And I guess for me as a doctor, you know, most of you that know my work know that I'm extremely curious and I always want to get to the why of the why, the root of the root. And it frustrated me when I was a junior doctor that I didn't know the answers to these things, even though a lot of them are just folklore. It's nice to know whether there's any truth to them. So I'm going to cover a few of them and go through the reasoning behind whether they're true or not with a bit of the science and then also post some links to ones that are interesting because we, you know, this is a fascinating area and I know people love this kind of stuff. And also, is there anything useful that we can extract from these myths that might help us feel better or live healthier lives? So let's start with the 10% brain one. You know, is it a myth that we only use 10% of our brains? Short answer is yes, it's a myth. So the next question is, if it's a myth, where does it come from? And many people say it's from the work of William James, who was a psychologist in the early 1900s. And he did a lot of work on fatigue and the fact that people often don't feel like they're firing on all cylinders when it comes to mind and body. But you know, like any good rumour, that seems to have been taken as gospel and it's just been perpetuated through the years by various people, including Albert Einstein, as a sign that we don't fulfil our potential. Actually, when you look at functional MRIs and you look at PET scans of the brain, most of us use most of our brains most of the time. And of course, remember that the brain is neuroplastic, so you can learn new things into old age. So that's all good news. Okay, so what about crossing your legs? Is it really bad for you? Does it cut off your circulation? In fact, I often tell patients not to cross their legs when they take their blood pressure because crossing your legs temporarily spikes your blood pressure. Well, there's a few things about leg crossing which may not be so good for our health. It's one of those things, isn't it? No one does it until a certain age and it's a very sort of adult thing to do, you know, sitting quietly somewhere politely, people often cross their legs, you know, whether it's on a tube train or in a meeting or wherever. So it certainly wouldn't be a good idea to cross your legs all the time because A, it does cause a spike in blood pressure and B, it's probably not good for your posture. It can cause your pelvis to rotate or tilt and that can sometimes lead to lower back pain and the like. In physical terms, going back to the actual veins in the leg, of course, it's not good to cross your legs and leave them in that position for a long time because the blood's not going to be able to move and circulate very well. So if you're say on an aeroplane or something for a long flight, I would definitely recommend that you don't cross your legs during that, just because you want to kind of keep the blood moving. Right, so what's next? Going grey, stress making you go grey. It's funny, isn't it? Those, those kind of myths come into common parlance. I remember an old GP colleague telling me, oh, why give yourself an ulcer? You know, why go grey early? Meaning, you know, why give yourself stress by, you know, taking on extra work or whatever. Now, this is a really interesting one because again, you would think that most doctors would know why we go grey. What's the sort of mechanism behind going grey? We know it happens in older age, but you know, can stress trigger it? This is an interesting one. So the actual mechanism, you know, in terms of chemicals, as to why we go grey is because of a build up of something called hydrogen peroxide in our hair particles. And that happens naturally as part of the aging process, but it also happens if you have a lot of what we call oxidative stress going on in your cells. And that is to do with inflammation and, you know, if you've got another condition, for example, and potentially if you are very stressed. So there is some truth, I think, to that. It's not the kind of thing that you'll find studies on, you know, does stress cause grey hair. But it's something that can be explained chemically in terms of a process. So the more hydrogen peroxide you've got bounding around, the less melanocytes, you know, the actual sort of coloured pigment in your hair you have. Of course, there are, you know, genetic reasons as well. And I've got friends who, you know, one side of their family go grey very early, so that's also a big factor. Okay, so feed a cold and starve a fever. How many times have we heard that one? Where does it even come from? Well, apparently, it was, you know, a bit like modern day press or PR. It was first coined by someone called John Withers, who was a lexicographer. He wrote the dictionary back in 1574 and wrote, fasting is a great remedy of fever. As far as I know, he didn't have any scientific background. And you know what? The jury's out on this one. I'm going to let you decide for yourself because from, you know, animal studies, there is some evidence that actually starving a fever helps, particularly in flu-like illnesses. But another school of thought says that you should feed both a cold and a fever. Your immune system effectively needs boosting and one of the theories is that the fasting state actually improves your immune response. But there is also a small amount of evidence that chicken soup actually has a beneficial effect on mucus. There's lots of theories around this. One of which is that chicken soup is rich in something called carnosine, which is a natural type of antioxidant, and that seems to have more of an effect, you know, chicken soup seems to have more of an effect than any other liquid food in helping mucus to flow and kind of helping the body kind of rid itself of the cold virus. How amazing is that? So in summary, I'm going to leave you the links on those and you can decide what to do. It seems like the jury's out. Some people say feed everything, others say, hey, you know, fasting when you have a fever might help. Ultimately, what's my view? I reckon just go by how you feel and be guided by your appetite. Just while we're on the subject of things like colds, another adage is that kids get colds. And that's very much true and there's an obvious reason for that and that's because their immune system is immature compared to that of an adult and they have lower levels generally of something called IgA or immunoglobulin A, which means that the linings of their nose and their lungs, you know, where they secrete mucus from, that response is not as efficient as it is in an adult and so often the mucus hangs around a bit longer. And as such, you have the adage that kids get colds. Okay, so what else? There's just so many that we could talk about. Are eggs bad for your cholesterol? Are nuts junk food? Are night caps any good for sleep? Is chocolate an aphrodisiac? Does garlic improve libido? Oh God, I just, you know, could go on forever with this one. To cucumbers help puffy eyes? Does green tea help weight loss? What do I pick? Okay, so very quickly, night caps generally aren't good for sleep because they may help you get off to sleep, but as you metabolize the alcohol throughout your sleep, it will get to that level in your blood where it's a stimulant and tend to wake you up or disrupt sleep. So that is a myth. With libido and garlic, there was a small study just in men. It's 49 of them. You can see this in the show notes. And they were given a compound with garlic extract, ginseng and velvet antler, and it looked as though that improved their erectile function. I mean, firstly, the study was only in men and there were other factors apart from the garlic. So who knows, but garlic, you know, does improve blood flow. There's some studies on that. So and and with all these things, you know, with all these myths, occasionally there's sort of there's some truth to them, but it's really hard to kind of say, yes, it's true or no, it's not. So I guess I'd be nice to come full circle and look at the one about an apple a day. Where does that even come from? Apparently, it comes from the late 19th century and originally went something like this. Eat an apple on going to bed and you will keep the doctor from earning his bread. So, actually, there is some evidence that apple eaters are less likely to see a doctor and that's in the modern world and I've linked the study there on the show notes. So there is some truth to that. And apples, if you can eat them and you're not allergic to them, just contain so much good stuff. You know, they contain fiber, vitamin C, lots of flavonoids. Yeah, and actually improve the quality of your gut flora, the bugs in your gut, which of course is the food for your immune system. So they're a great thing to incorporate. If you're not an apple eater, it's a great thing to just have as a snack. I wasn't for many years. I preferred biscuits and things, but now it's very much a part of my daily routine. Of course, the cynic could argue that apple eaters just hate doctors.
Dr Rupy: I really hope you agree. It's pretty darn good. So give him a follow and check out his backlog on behavior change, wellbeing and tons more. Now, me and Ayan are about to catch up. Recently, Ayan unfortunately suffered the tragedy of losing his father quite unexpectedly from cancer. So we talk about how he's dealing with the grieving process and bereavement in general, as well as his work on upskilling lifestyle medicine practitioners of the future, plus some mutual love for Nitin Sawhney and Talvin Singh, whose music I will link to in the show notes. This might be upsetting for some people who are undergoing bereavement, but I think it's really important to have these pragmatic discussions and and talk about it openly, which I really commend Ayan for doing. He's going through the grief, the grief process at the moment. So that's what you're about to hear. But there is some humor in this too. We've known each other for years.
Dr Ayan Panja: Yeah.
Dr Rupy: Yeah. And and you know, we we text all the time. We don't always record everything that we say in a podcast, but it's nice to do this every now and then just to check in and also, I just love sharing your knowledge with as many people as possible because you've definitely inspired me in a massive way, probably more than you you know and you know, I know you're a very humble person, so you probably this is probably cringy. You're probably cringing as you hear this, but it's really important for me to remind you of just how impactful you've been in my career and how our conversations are as well, because that really does shape the kind of content that I put out there and and I love your projects and everything else. So, before we get into it, let's, no, of course, mate. Um, talk to me about your year because you you've had a tough year. Um, you've been really authentic on social media. You've really sort of been pretty transparent with everything you've gone through. So for for those who don't know, tell us about what's been going on.
Dr Ayan Panja: Yeah, um, it has been a difficult year and I think the last time we you and I could have met up was was at Nitin Sawhney, wasn't it? Which I think you went with your crew and I I was with mine and I we didn't sort of meet up because it's it's amazing night, wasn't it? But um and um and the reason he pops into my head is that um my dad passed away in the summer of this year after a kind of it was really odd actually. He he went in for a knee replacement that he'd been putting off for about 10 years and finally thought, you know what, I'm going to go and get it done. And then had it done and just wasn't recovering after he came out of hospital. And then we didn't know what was going on. He was really confused, losing weight. And it turned out in the end that he had a sort of something called a T-cell lymphoma, this sort of cancer of the lymphatic system that hadn't been diagnosed because they're really difficult to diagnose. It wasn't like it was anyone's fault. And then died about, you know, six weeks later. And um, the reason Nitin Sawhney pops into my head is when we were, you know, thinking about the aftermath and the funeral, I was trying to pick some music. So the funeral wasn't a religious one particularly. There were sort of elements of, you know, spirituality in there. But I picked a song called Bengali Song by Nitin Sawhney, which really resonates with me. It's off one of his very early albums called, I forget the name now. Oh God, how embarrassing. I think it's called Disciples, something about the priest. Anyway, it's a spacing the priest, I think it's called, but but um, and that was an album before I even knew about him, but it really sort of gets me there, you know, because it sums up um, for me a lot of my dad's kind of early life. And so that kind of loss, you know, you hear about people passing away all the time and we see it in our work, don't we? But until it sort of happens to you, it's definitely the sort of the closest relative I've lost and the sense of loss is just is is enormous. It's nothing really prepares you for it. And what I would say for anyone who has lost a parent, it's almost like, you know, losing your parents is like the very last bit of growing up and becoming a a proper adult because you sort of, it's a really odd thing and no one, you know, one of my very close friends has just lost his dad a few days ago and he's going through what I did and it's a it's a really difficult time. Um, also, you know, I my parents lost their parents years ago and I I never really totally understood why it was that my mom would still to this day get sad about her parents dying. I'm like, mom, that was like 35 years ago, you know. But the point is that loss, that sort of sense of grief never, never really leaves you. You you you live with it and it stays with you. And you know, as you what you were saying about social media, what I what I try and do on my podcast is talk about really sort of what makes us human. It's called saving lives in slow motion and what what does that even mean? Well, it's kind of what I think GPs should be doing or do in our in our working life. And it covers areas that relate to everyone but are not kind of strictly medical. So grief is a very common one. I see lots of people who are grief stricken. And you know, you don't just get over grief. That's that's the thing. If you've never been grief stricken, you don't really understand that it's something that's permanent. It's it's not sort of, oh, you're okay now. You know, oh yeah, your dad died, but you're all right now, surely. Surely everything's back. You know, and the problem is the world just carries on and um, doesn't wait for you. Do you know what I mean? So it has been tough. I mean, I've had to move my mom up near me, which is great because I see her sort of nearly every day. Um, but that that is not a small feat. You know, she's moved out of a house that she's sort of lived in for the last 38 years, probably hasn't stayed a night alone for the last 38 years. You know what I mean? And that's a big adjustment. So, so lots of adjustments, lots of change, but um, yeah, you know, learning to kind of adapt to it like we have to as as as all, you know, creatures do to their sort of environment.
Dr Rupy: First of all, so sorry. Um, we've talked about it before. Um, but uh, when you told me it kind of came out the completely the blue as as I'm sure it did for you as well. And this is still very fresh for you. So I imagine you're still going through a lot of that process yourself. Um, and like you just eloquently said there as well, you never really get over it. You're always going to have some element of grief or bereavement. Um, but in terms of how you are coping, considering you are someone who's super experienced with breaking bad news as well as dealing with patients who are going through similar scenarios. Um, have you found that some of the coping strategies that you've been talking to to other people have been easier to put in place yourself or is this something that, you know, you just kind of we we have sort of the instruction manual, but putting to into practice those things that we tell other people is is actually uh near impossible or a lot harder than we thought.
Dr Ayan Panja: Yeah, I I I totally agree with that. You know, it's it's um, and and I think the reason why grief and bereavement is so unique, I I now realize is that there is just nothing else like it. It's on a totally separate level to anything else, you know, and I say in in in my pod episode about it, you know, people who lose a child, for example, I I have no idea how they cope, you know, I mean, I really don't and and I, you know, I have a lot of admiration for anyone who can get, you know, get get on with their life after that. But but but you're quite right. I mean, a lot of our learning as doctors is through patients, isn't it? And what they sort of go through and what they tell you. And one of the things that really struck me, struck me after the after my dad's death is how many people you suddenly have these intense relationships with. So we had to get a celebrant to take the funeral. So they have a really special set of skills, you know, they rock up at your house, they don't know you from Adam, and suddenly within two hours, they've got a really good understanding of what your dad was like, what your mom's needs are and what the family dynamic is, you know, and so she she was amazing. She sort of came in and it was me, my brother and my mom sat around and she was like, she was looking at my mom, she goes, yeah, your boys are definitely in charge, aren't they? You know, and she she could sort of spot that, you know, the way that the three of us sort of, you know, kind of roll if you like. And um, and that was amazing. And then suddenly you're you're in contact with a funeral director and they again, they have to have a really special set of skills. And I'm not demeaning any any any anyone's sort of suffering, but you know, they do that for their job every day and but you know, like we do as doctors, but you, you know, they were just super professional and and I think as doctors, we're sort of hyper aware of how people communicate and, you know, whether they're just ticking boxes and there was none of that. They were really, really compassionate and and these are things that are essential services, you know, like health care. They are because we all die and all of us, you know, if you can actually nowadays not everyone can afford a funeral, which is another issue in itself socially, but but um, and and and the word essential kept sort of cropping up in my head in that, you know, essentialism, you know, I suddenly started to think, do you know what, time's like my only commodity that really matters. You know, you suddenly realize the value of it when someone passes away. And so, yeah, it's a blur and you're you're your head is a bit of a a mess. I think the first, the first sort of few, you know, days, weeks, I'm sure this will relate to anyone who's had a loss of of that grief process. You up until the funeral, I felt that dad was sort of still with us, you know, even though he'd passed away, he was very much there. And then as soon as that's over, you get this weird feeling. It's a it's a little bit like the feeling that you get after you get married or a big sort of celebration but with a totally different energy and you just feel you don't know how to think. It's just it's very empty. Um, and so yeah, I'm still sort of, you know, I don't think you ever get back to how you were before it happened, you know, which is a another coming to terms with thing and I'm I'm now much sort of more selective about things. So I don't rush to sort of email people back necessarily because I think that can wait, it's not important, it's not essentialist. Do you know what I mean? And so, um, it makes me, I don't want to sort of come across as, oh, he just sounds like he's just become more selfish. Maybe, maybe if that's the way you want to put it, but um, you've got to just, you've got to kind of look after yourself and kind of really think about what's important in your life. And if nothing else, that it does that in spades because you're never going to bring that person back. You've just got to, you know, acknowledge that it's just a it's a terrible loss. So, um, you know, and I I'm lucky. I I got on well with my dad, you know, I know people often don't have that relationship and it's much harder for them because they think, oh, I wish we'd made up or I wish we'd sort of said certain things. And I got to do all that. So, you know, um, I'm I'm blessed in that sense.
Dr Rupy: That's a really interesting perspective actually. Um, you know, considering some people have broken relationships and when they pass away, there is never the uh ability to, you know, make reparations and make amends. Um, so actually having that close relationship is something you cherish, you know, that I think that speaks to like the way you're processing things as well. And the um, the other thing that I uh wanted to pick up on was um, how certain people have different ways in which they process grief. So I've got a a colleague of mine who's uh mother passed away two years ago and to this day, you know, we'll be chatting and then she'll break into um, into a crying session, which is totally fine from my perspective. I mean, like, you know, obviously we we deal with this all the time. Um, but for that person, they often feel quite guilty that or embarrassed that they're still having this, you know, deep bereavement reaction considering it's been two years and to your point that you said earlier, sometimes it could be decades and you'll still have that visceral reaction to loss because it is part of that human experience. And you know, I I'm I'm really lucky in that I still have both my parents and the closest relatives I've had that passed away to me uh have been my grandparents. Um, that happened quite a few years ago. Um, and despite that and despite seeing so many people, it's really hard to like really truly understand how you might be feeling in this moment. Do you know what I mean? It's it's it's it's a difficult one. Whenever I talk uh about grief to people, for example, I spoke to Mo Gawdat um on the podcast a few weeks back and uh we were talking about his son who unfortunately passed away from a routine operation. It was an appendicectomy that went wrong. Uh he was only 19, I believe at the time. And so he had to process that whilst having depression himself. Um, so you know, having having a more open conversation about grief and bereavement in general is something that we don't tend to do very well as British people, I if I'm honest, like in different cultures, they they have more of an appreciation for it. So I'm glad we're having these kind of conversations, but I always on a personal level, I always struggle to really connect with how that might be feeling, uh how you might be feeling. I can only just try my best.
Dr Ayan Panja: Yeah, yeah, completely. And I think I think um, what's really interesting is um, health coaches who are not clinical and and haven't sort of had years of for want of a better phrase, thinking like a doctor, you know, in terms of that generating a hypothesis and trying to match the evidence with guidelines and and the reality in general practice is everything is undifferentiated and really nebulous. It's very hard to apply guidelines unless someone's had a heart attack and you want to know what dose of statin they they need to go on or that sort of stuff, you know, with established disease and and entities, it's different. But when you've got someone who's not feeling well or functioning well and you've already tried everything and they've been round the houses to specialists and, you know, back to you three or four times, a different approach is what's needed to move them on from where they are, you know. Um, I don't I mean, I'm sure you remember but we used to disparagingly call patients heart sink patients. It was something we were taught in our VTS and I I I'm not sure how that would sit nowadays. I don't even know whether I can even mention the word because it's just not appropriate and and it was a way of um categorizing people effectively patients that doctors found difficult, you know, and I I forget the sort of sub categories now, but there's one that's called the entitled demander and then one's called the manipulative help projector and but actually they were they were very much sort of doctor psychologist sort of constructs. But really, you know, if you and at the time we were told, well actually all what you need to do with these patients is just listen to them and that's sort of hand, you know, manages them. There's some truth to that because if you, you know, if if a patient sort of gets the impression you don't want to really help them, you might as well forget it, you know, your relationship's just not going to come to anything but something bad. Um, but there is always a way of moving someone from zero to one, you know, however difficult. And health coaches, I mean, our health coach gets results with people that I could only dream of and that's because A, she's got more time, but B, she really understands behavior change and, you know, what makes people tick, you know, how people work, not in the physiological, anatomical sense, like reading textbooks like Snell and all that stuff that we had to do at med school. It's a it's a totally different thing. And in a way, analogous to what I sometimes what the conversations I have with medical students that come through from UCL or or Imperial, they I can see when they're ringing a patient or when they're seeing someone, they've got this medical knowledge they're trying to sort of, you know, grapple with and trying to work things out. But they're also trying to speak patient's language without, you know, and actually we just do it without thinking now, don't we? because we've done it for so many years, but but it becomes this unconscious competence thing where you're making all those calculations and thinking what could this be, but you're still speaking as if you're just having a normal chat. And um, it's a bit like that, you know, and that's why the the hard, some of the hardcore think that this stuff is all soft and kind of fluffy. It's actually not, you know, some of those interventions, if you measure them, as we know, they the outcomes are incredible. So I mean it it um, but it's, you know, it is the the, you know, part and parcel of the way the future of health is has got to go. Um, we live we live in a toxic world, unfortunately. And unless, you know, that direction is all about pharmaceuticals and looking for, you know, ways of of of, you know, biological ways if you like from a chemistry lab, you know, of managing it. And this direction is what can we do ourselves? And I think that's the sort of the simplest way to to look at it. There's a place for both. Um, you know, I'm not against drugs at all, but it's um, this stuff is more important than a lot of people think, I think.
Dr Rupy: I wanted to ask you about um, saving lives in slow motion. Um, the podcast is great and you know, we're going to listen to an episode that I want to feature on this. Um, is the book going to be called the same uh name? Is that is that what we're going for?
Dr Ayan Panja: No, I can't I can't give away the book title, I don't think at the moment. But but the short answer is probably not. I'd love it to be. Um, and my original sort of book pitch was that and you you know more than anyone how publishers kind of work and think and I'm I'm, you know, I've got a great publisher, but um, it wasn't quite, I think the feeling was, oh, that's a brilliant idea, brilliant concept, but it's more like a second book rather than a first book. Um, they know what they're doing with that sort of stuff. I think I think the book I am writing at the moment, so there's definitely a book in saving lives in slow motion and actually the, you know, kind of what you hear on each episode of the podcast is almost like a chapter in itself, you know. So that's that's parked for at some point. The the book I'm writing is much more a sort of a a manual of sorts. So I think the world, the public, publishers, they like plans, they like manuals, they like handbooks, they like something that is easy and instructional for the reader. It it sits slightly uncomfortably with me because I don't like telling people what to do. That's not what I'm about. And the book isn't like that. It's not preachy in any way. But it lays out a lot of basic things, some of which do come up on my podcast. So there's a whole section on behaviors and understanding yourself because if you don't, if you can't do that, there's no point in reading on. I think it'd be interesting to see who buys it because I think men who tend to buy that sort of thing are always looking for the health hacks, you know, what can I, you know, I'll just tell me what to just to do. It's like, it doesn't it doesn't really work like that. You know, one or two things do, like for example, um, around town, there's a bit of a joke, any of my patients who bump into each other, it's like, oh yeah, I met Mrs. X in Morrison's or whatever and you know, she said since you told her to take vitamin D in winter, you know, she's not not felt unwell at all, you know, and all this sort of stuff. But that's just that's basic boring stuff that we all know about vitamin D supplementation. But there's a there's sort of, I've sort of thought, well, how can I, you know, by keeping it individualized, how can I sort of put all of this into one book? So one whole section is on the symptom web, which is, as you know, we teach on the course. And that's, you know, very much part of the IP of the book and understanding your own symptoms, you know. Um, so I think it'll have a lot of value and I think it's a book that makes sense. Um, and yeah, I I, you know, I'm nervous about saying too much more about it, but I'm really I'm really excited, you know, it's uh, yeah, I think it'll be, I mean, you you've probably seen snippets for it, you know, I'm sure I've sent you the the first the opening and stuff like that. So yeah, but it's it needs writing and the the deadline is not that far away now. It seems ages away, doesn't it? You know, you've done it many times with your books.
Dr Rupy: You push it back and back and you're like, I'll get it written, I'll get it written. And then like two weekends before you're like, oh my God, I've got to do 10,000 words a day or something. So it's yeah, it's it's a lot of work. But closer to the time, um, we would have to chat about it in a little more detail uh when it comes out because uh I I I've seen the snippets of it and I know it's going to be a fantastic book and uh I think a lot of people are going to get it, not just a few people. I think a lot of people are going to get it. And it ties in quite nicely with what you teach on PLM now as well. And you you mentioned earlier, sorry that you've revamped it. So it's very different to what I experienced um four years ago, I think it was now, which is I guess what some people might see as a more traditional approach to teaching a subject matter to medics. You know, anyone who's a medic listening to this will understand what that means. It's you go to a conference, someone goes on stage, you go through a few case histories, you might see a um some interaction of how that works. Uh how how have you moved the the course along?
Dr Ayan Panja: Yeah, so we we it's really interesting because Rangan and I, we kind of we loved that that first course, the first sort of iteration of it, but we realized that there were bits missing from it. So what was missing was and actually this is from feedback from people who come who who invariably love the course, but they'll go, you need a bit more about behavior change in there because there really isn't any. And one of the things that we realized was that, you know, if you're a if you're a good doctor, so someone like yourself, doesn't really have to work very hard to probably convince patients to try something because you're personable, you're compassionate, you're not patronizing, you know, and they realize that actually, you know, do you know what, I'm going to give this a go. So so the behavior change sort of comes by the, you know, by default of charisma if you like, because you just sort of, you know, it's like, well, I don't I've never really had to sort of think about changing the patient's behavior because they just they just do it, you know, or or they try and they don't it doesn't work out. And but but actually that's just luck and a bit of fluke. And what you do need certain tools to, you know, like motivational interviewing or, you know, um, kind of assessment scales to see how activated a patient is. So there's a lot more of that. And that that part of the course has been provided for us by Practice Unbound, who we've partnered with, who's an amazing organization down in Brighton, um, and and actually which yes, close to home to me because obviously that's my hometown where I grew up and I'm not going to have any links there anymore apart from apart from them. So and they're amazing. They they um, kind of are a, you know, they they do a lot of work with primary care and have a lot of products that help make the lives for, you know, lives of primary care teams easier. The other thing that they do, which is really exciting for anyone in the NHS that buys the course is that you can now track data through NHS clinical systems like EMIS. So they're doing all of that work and that's really exciting when you have a data dashboard to prove that the interventions work. I think that's the bit that's been historically missing and that's the bit where people are critical going, well, you know, how do you know it's worked just because he says he feels better. Um, so to track that would be great. So I'm really excited. And like I said earlier, it's about alignment for me. Um, everything chimes and everything is sort of, you know, my clinical work, the book, the course and the podcast are all, you know, in the same, it's it's very it's very stressful, isn't it? If you're someone who um, everything you do is slightly different. It's like, oh, you know, I'm sure you know people like this where it's like, oh, they've got this business where they rent out cars, but then they're also a lawyer and then they're also they run this kids football school. It's like, hang on a minute, what, you know, they're they may have a common sort of purpose behind each one, but actually they're not the same thing. And I think there's a huge amount of overlap in all these, which makes life much easier because you're using it's it's really taxing. We know the evidence on multitasking is is just really bad for us, isn't it? In terms of stress. And actually this doesn't feel like I'm having to multitask as much because the subject matter in all three of these, four of these areas of my life is pretty much the same. Do you know what I mean? I'm sure you you've experienced this.
Dr Rupy: Yeah, totally. Yeah, I mean, like it's so lovely to hear you talk about that alignment there. Um, and uh, it's certainly resonates with me as well because, you know, someone doing books and podcasts and stuff, when they when they're all sort of in the same vein, it kind of is easier for me to compartmentalize instead of having multiple different uh areas of of I don't know, business or, you know, different sort of hobbies. I I find that quite hard myself and I, you know, you're right about the evidence around multitasking and how that can create strain. Some people just thrive and and I'm just not one of those people. But um, I'm really interested in the in the inbound stuff and how that connects and is integrated with the system so you can track data because one of the my bug bears with with the stuff that I do is I know the minority of people that I see in A&E will ever pick up my book, will ever listen to a podcast for an hour or two on whatever a health topic it might be. And to really get to changing people's lives at scale, you have to upskill all other medical professionals such that we're all singing from the same hymn and we have this culture around, you know, holistic medicine, preventive medicine, whatever you want to call it, as just part of medicine. And also the um, the products and the interventions made available to everyone from common systems like EMIS, like System One and all the other uh uh clinical tools that we have in primary care. So that that is fantastic. That is awesome. And I I can't wait to see that scale. I mean, you you're pretty much like that's you're in the tech industry, buddy, like
Dr Ayan Panja: Yeah, well, it's yeah, I I kind of, I mean it's not it's not happy in a way. It's it's basically what frontline, you know, uh primary care teams do and it's just capturing what they do and trying to and I mean it doesn't have to be complicated because we already do a bit of this with our clinical systems for, you know, weight, blood pressure, for example, or mood, but but this is it's a bit more than that. There's there are more and it's taken, you know, the team have worked so hard over the last six months to to find things that are validated because you can't just, you can't just have a drop because when I first started doing the templates, I kept, one of my drop downs was, oh yeah, feels better, feels worse, feels the same. And and the data kings were kind of going, no, no, that's just that's not good. I'm like, I'm like, what, why not? And and I get I get it. I wasn't quite that bad, but but there are certain there are limitations with codes. For example, when you're coding diet, it's just diet good, diet average or diet poor. There's only three codes for it. So and I wanted something with 16, you know, it was it's very complicated. It got very messy and that's why practice unbound, that's what they do. That's one of the streams of their sort of talents and their business. And so I thought, hey, I'm never going to be able to do this. I, you know, because of time and other things. So, yeah, it's really exciting. I I I cannot wait for it to kind of hard launch. We haven't quite got there yet, but we're it's it's good stuff. Yeah.
Dr Rupy: I can't wait for it. Oh, you must you must send it over to us to to have a look. I'd love to to see what you've done. Yeah, as well. And yeah, no, I I'm super excited about that. You know, I actually I wanted to ask you, um, so the the other night when we're at Nitin Sawhney, um, the first half, I remember listening to the first half, I was like, he's played all the bangers. He's literally played all the amazing tracks. I was like, how is the second half going to get better than this?
Dr Ayan Panja: I thought that.
Dr Rupy: And the second half was incredible. Some of the music I I haven't heard before because they're brand new tracks, but I was blown away. Blown away.
Dr Ayan Panja: Yeah, and it's I think the thing with him is that it's the story that goes behind each track and he's and that's the thing that makes it and you and you can sort of feel the pain and the kind of, you know what I mean, the emotion. And then and then everyone obviously knew he hadn't done Nadia until the end, you know, the sort of his kind of opus in a way, that track is just so great, isn't it? But I think I think the other thing with Nitin Sawhney is sometimes you listen to his his his, he's a bit of a generalist, isn't he? Like his sometimes some of his music sounds like a bond theme. Yeah. And then some of it sounds like music my mom might have listened to when she was growing up. It's it's really difficult, but he it's but all of it is at that level of, you know, the quality and the the actual musicality is amazing. And he sort of mastered lots of instruments like his flamenco guitar and and his piano. I mean, he's just yeah, and he and he he curates it so well. It's sort of he picks, you know, he hand picks his sort of band, doesn't he? It's uh it was a such a great, yeah, I I love it, but
Dr Rupy: It's it's such a he's such a true maestro. And I remember because I mean, I'm uh 36. I'm not going to ask you your age on on on the podcast or anything, but you're a few years older than me. And I think
Dr Ayan Panja: 48, mate, 48. I'm going to be 49.
Dr Rupy: So so certainly when I was growing up and um, you know, being Indian, second generation, going to a predominantly uh Caucasian school and you know, not really having too many links to my heritage. I remember it kind of clicked when I listened to Nitin Sawhney because he was someone who really blended and actually gave a bit of identity to people who might have that sort of mixed thinking about where they're from and and you know, lacking those links to their their cultural heritage. And I remember listening to like, you know, his flamenco guitar and then like uh Kathak on top of it and the uh the Indian um sort of uh vocals and then, you know, it's intertwined with English and it's like, this is this is us. This is I I now have some sort of identity. This really appeals to me and it's unique because it wouldn't immediately appeal to someone who's, you know, English uh versus someone who grew up in India. This is it's really reflective of that. And that yeah, that's why it's really resonated with me.
Dr Ayan Panja: Yeah, yeah, definitely. I I I remember the first time I felt that actually it wasn't Nitin Sawhney actually initially, it was when I was a medical student, so it would have been mid 1990s and we used to go to the Blue Note in Hackney and there was a club night called Anokha. So Björk would always rock up there and Talvin Singh would be there and Talvin Singh got me really into that whole, you know, that world and and I remember thinking, yeah, this this just I can feel it, you know, it's just it was it's it's amazing. I totally with you. Um, I think you're right. It's um, yeah, it's it's a very unique sort of, yeah, it just it just yeah, we're it's almost made for us. But I think I think any good music kind of talks to people like that, you know, if you ask somebody who listens to Dire Straits, they'd say, oh no, no, that that album's written for me because, you know what I mean? But it really it but I think I think you're right. Yeah, yeah, absolutely.
Dr Rupy: Talvin Singh uh inspired me to start the tabla actually when I was like 14 or 15. I remember trying to learn it and I've still got some rhythm, but um, his track uh Butterfly is up there, one of my favorite tracks of all time. Amazing. I just Yeah. Yeah, it's I'm going to have to play a bit of the music to for the intro to this podcast actually, because otherwise no one will understand what we're talking about.
Dr Ayan Panja: Yeah, let's do it. Let's do it. Definitely. Oh, listen, mate, thank you so much for having me. I really appreciate it. It's been a pleasure as always and I I really I love your work honestly and um, as I say, you're for your Mediterranean bean recipe or whichever one it is in that book that comes out now and again. The pineapple salad, that's it. I love that.
Dr Rupy: Great, great. Thanks so much, mate. Take care.
Dr Ayan Panja: Have a good day. See you later.
Dr Rupy: Bye now.
Dr Ayan Panja: Bye.
