Dr Punam: I guess it was the very first time I had experienced what that vulnerability of being on the other side of the consultation table feels like. I just wanted somebody to just listen to what my anxieties were and everyone was like, well you're just anxious, you're just traumatised. Here's an antidepressant, this will fix it. And I'd never really felt the need to listen to my intuition until that point and there was just lots of different things that happened that made me look not just at my own life, but really as to, it's kind of informed the kind of doctor I am now.
Dr Rupy: Welcome to the Doctor's Kitchen podcast with me, Dr Rupy, where we discuss the most important topics and concepts in the medicinal qualities of food and lifestyle. Today's podcast is very different. It is the doctor dinner party experiment with your lifestyle doctors. Five incredible doctors who you're going to learn a lot about over the next hour. I decided to cook an entire dinner party for all of us sat around a table. We had loads of plant-based recipes, za'atar salads, we had roasted veggies, tahini, pomegranate, you name it. And I managed to do it all in less than an hour. And if you want to see how I did that, check it out on the YouTube channel. I'll show you how to make all those five recipes. I'm actually quite proud of myself about how I did that. So make sure you go check that out. The lifestyle doctors consist of Dr Chintal, Dr Vanita, Dr Sumi, Dr Christy and Dr Punam. They are a group of doctors who are passionate about helping patients and the public live healthier lives. They have a broad yet unique set of expertise between them and they've decided to use their knowledge base to really help directly with patients by doing community groups, lots of different workshops and you'll learn a bit about what they're up to on this pod too. They have an incredible range of specialties. Dr Chintal is a central London GP and trainer for Imperial College, passionate about food. Dr Vanita is a paediatrician and nutrition specialist and her goal is to simplify nutrition and lifestyle messages for everyday life for her patients. Dr Sumi is an NHS GP partner and trainer in Southeast London with a passion for teaching lifestyle medicine and she's also a director of culinary medicine UK with me. Dr Christy is a West London GP specializing in preventative medicine but alongside being a doctor, she's also a qualified physiotherapist and acupuncturist. And lastly, Dr Punam is the medical educator in Glasgow. You'll definitely be able to listen to her accent. She's also a trustee and director of the British Society of Lifestyle Medicine. You can find out more about their individual bios on the doctorskitchen.com website. And in this pod, we talk about the changing role of the general practitioner and how that's changed over the last couple of years, how they juggle family life. A lot of the doctors on the pod today have kids themselves, what actually makes a good doctor and why medicine can stifle creativity and how this is sometimes an outlet for them. Psychotherapy and counselling as a mandate for all health professionals and why we need that. We also talk about actually what it takes to be a doctor and how the label of doctor can mean anything from someone straight out of medical school to someone else with 20 years plus experience and you'll find out exactly how much experience there is across the table with these five doctors during the pod too. We touch on the personal experiences of some of the doctors, resilience, paediatricians having the worst levels of burnout, mindfulness prescriptions, nature scripts, if giving people food prescriptions would be something that would entice behaviour change, who knows. If you've ever been interested in the art of the consultation, the shared management strategy, the guiding of the consult from symptomatology to diagnosis to treatment, I think you're really going to enjoy being a fly on the wall at this dinner party. And I must say their work in community groups, the free workshops they do, the fact that they're trying to get directly to people who won't be listening to this podcast, they won't be following us on social media. This is real game-changing stuff and I'm honoured to have these incredible doctors on the pod. I really hope you like it. As always, you can find this information and more at the doctorskitchen.com. But for now, enjoy the dinner.
Dr Rupy: How did you guys form this little Spice Girl crew?
Dr Chintal: We still haven't figured out who's who here.
Dr Vanita: Well, we all met for brunch one day, didn't we? And I looked around the table and I said, come on girls, let's do something. We each have this interest, different interest in lifestyle medicine and different expertise. So with Chintal, she's an amazing chef as well, but creates recipes for families. We've heard what Christy does, she gets you to exercise when you've only got one minute or two minutes. And with Punam we've got mindfulness, meditation, stress busting. But then we have to put it all together. So we've got Sumi who's the health coach. How do you actually get it into your life? Because you're never going to do that unless somebody's helping you to do that. It's really hard to put all these things into people's lives and we know that because we do it every day with our patients. So we thought, why don't we do something like a platform or some events? So that's how we started.
Dr Christy: How did we all meet though? I remember meeting you.
Dr Sumi: We met at the College of Medicine conference, didn't we? The food and medicine.
Dr Vanita: And I met you there as well.
Dr Sumi: And then I knew Vanita through there, so then we all met. And then we actually came to the first culinary medicine meeting.
Dr Vanita: Oh yeah.
Dr Sumi: We met. That's the very first time we met was when you put the call out for culinary medicine. This is over 18 months ago.
Dr Rupy: You're the glue.
Dr Sumi: So that's where we first met.
Dr Punam: And Punam and I first met in the best place ever, at Peggy Porschen. We met at Peggy Porschen. Yeah, because well obviously I'm not from London, so I met all of you on Instagram. And then I just met you at various events. But then also one of the other things that I do is I'm a trustee and one of the directors for the British Society of Lifestyle Medicine. So obviously being very passionate about lifestyle medicine, I kind of picked up very quickly that you know all of us were into the same sort of thing. And we kind of connected really over that, over various coffees and high teas and quite fancy. But yeah, that's how it all came together.
Dr Rupy: And how's that been received? Because you guys have run some events where you all speak and you essentially give your perspective on lifestyle medicine.
Dr Christy: It's been really good actually. We did the first event that we did was more for families because we realised that there's a lot of people out there who are promoting lifestyle medicine, but actually it's generally for the kind of converted already. So we were trying to target the everyday person and the families and the children. So we had a really lovely local community hall event and it was so nice. And we had families come and their kids and it was just really relaxed and we did little workshops. I did a little exercise area, you did a cooking area, you talked about nutrition and you guys did mindful eating and talking about routine and it was it was so nice. It was so relaxed and it was just a fun, fun, fun day. And yeah, so it was great.
Dr Rupy: I like that that kind of acknowledgement that a lot of people who we speak to on social media platforms are already of the converted. The people that are going to actually look for healthy eating advice online are probably those who are already educated enough to understand the impact of it on on health outcomes. So you're essentially trying to translate that into meaningful actions for communities and people that you see on a day-to-day basis to try and interact with. Because everyone sat around this table is primary care. I mean with the exception of yourself, Vanita.
Dr Vanita: I'm primary care community.
Dr Rupy: Exactly, yeah. So you're a paediatrician but you're a community paediatrician. Everyone else here is general practitioners. All the other things that you are as well.
Dr Punam: But I think one of the biggest things that kind of connected us also because certainly for Vanita, Chintal and myself, we're mums. So it was that kind of bringing in the family element was very important because it's how do you actually integrate sort of your well-being and wellness into your everyday life and making it a way of life. And that's what we wanted to communicate with people because a lot of these events tend to be focused on adults or sort of the working people and which some of our events will be catered for, but actually we hadn't seen somewhere where you could really have an inclusive family event where children and the grown-ups and the grandparents were all getting involved and learning about how do we make a routine as a family? How do we, you know, make easy ready sort of easy meals every day? How do we factor nutrition in our everyday lives? So I think that that was what was really lovely and we had Daryl there. So we like brought lots of fitness and fun into the day. It was just, it was super fun. We enjoyed it so much.
Dr Sumi: And I think for all of us, I think we all feel the same. We don't feel like we've got enough time for our patients. So a typical GP consultation is 10 minutes long. So we'd all love to spend longer going through things with our patients and this provides that platform to we just spend time, you know, we're not rushed. Everyone has something to contribute. And the thing is we're all in it together. We're all learning at the same time. I don't think doctors profess to be having the perfect lifestyle. There's no such thing. So when we're spending a bit more time, you know, delving into our interest in prevention and lifestyle, we're learning when when I was running a meditation workshop, I'm learning at the same time. I'm meditating with people who are turning up. You're going thinking about your routine, how can you improve it? And I think doing things like that really helps us to spread that message like, you know, beyond, you know, the realms of social media, which is you know, really, really useful.
Dr Rupy: Yeah, I think like when you're working in primary care as well, you you're in a very privileged position where you interact with a whole bunch of different specialties, a whole bunch of different patients with different issues. And it really is quite grounding, I find. At the same time, quite overwhelming. So having that, and I think we're getting better at understanding our own vulnerabilities and our own shortcomings. Like I don't know as much as I'd like to know about motivational interviewing and and health coaching. And so I'm fascinated that you've actually done some formal sort of training in that.
Dr Sumi: Yeah. So, I've been interested in prevention from quite early on in my career and I think like a lot of GPs, I felt quite frustrated that I didn't feel equipped to help my patients make the changes they wanted to. So I was really lucky. There was a Department of Health sponsored course. I applied, I got onto it and during that course, we learned the different types of conversation frameworks that you can take on with patients. So it's helping them to make the changes. So, you know, for example, I had a patient who's one of my most memorable health coaching patients. You know, he came in, but he was already quite motivated. He'd gained weight, he was worried about his, you know, risk of having heart disease because his dad had passed away from a heart attack. He was worried that, you know, he'd gained weight from, you know, sedentary lifestyle. So he said, I just don't really know where to start, but previously he was someone who used to go to the gym, he knew what to eat. He'd just lost his way because of family time. So I was asking him like, you know, what one change could you make say tomorrow in your daily routine? So he was coming up with the answers. So it was really such a fantastic way of putting the patient back in the driver's seat. And often as GPs, we're, you know, often we're doing the hard work, we're being paternalistic, saying, oh, you know, often we'll say, oh, you need to stop smoking. But actually, when you take a step back, give patients the opportunity to think about what they're doing in their daily life, they have the answers. They just need that extra sort of help to get there. So for me, health coaching has been quite transformative. And hopefully, you know, our future events will be doing a bit of group health coaching so people can think about what they've learned at our events and then take it forward because that's the key thing.
Dr Rupy: I have the same issue with my family. So I can, so I can, I can tell them what to do and I can tell them the evidence base and I can, you know, put forward a very nicely constructed argument, but unless they come up with the answers themselves, it's very hard for them to actually make that change. And I think it's the same with patients as well. So actually putting them in the driver's seat and actually getting them to come up with the answers and everything is the, is the ultimate.
Dr Sumi: It's the motivation for change, isn't it? Otherwise it's not going to happen.
Dr Punam: And I think one of the most powerful things as doctors actually, well certainly I I I bring this a lot to my consultations is just being transparent. And I think sometimes just connecting with your patient and saying, do you know what, I've been there, like I understand how hard it is. We form bad habits so easily, but it it really requires all your will and might to want to change and helping them understand that planting that seed. And I think as GPs, one of the core things that we have the ability to do is if in your 10 minutes, you can plant one seed for the patient to go away with. I think that every day is just the most satisfying part of my job.
Dr Rupy: Oh, I love it. I love planting seeds.
Dr Christy: And desk workouts.
Dr Chintal: And as GPs and guess as well, we see our patients multiple times. So we will see them again and we'll see how that seed has grown and we can plant another seed and you know, it continues. So I think, you know, we only see them for a 10-minute period, but if we can just put a small change in place and then the next time we see them, it can grow.
Dr Punam: I think this is why when the whole country is struggling as GPs, we're like, we love being GPs. We see change all the time. It's amazing.
Dr Rupy: Yeah, I think that's really, yeah, that's really unusual for sure because I I I mean a lot of my friends who are general practitioners who are perhaps not of this mindset are facing burnout. I mean, I faced burnout as well myself. And to go back to your point actually about vulnerability, there seems to be a common thread that a lot of doctors in particular who have experienced their own medical issues or have had close family members with medical issues, you understand the frustrations, you understand, you can empathize at another level. And I think that's something there's a common thread in this table as well. I mean, I know yourself, you've had your own issues, haven't you?
Dr Punam: I think that that's probably the turning point.
Dr Rupy: That sounds really bad. You've had your own issues. You know, you've had.
Dr Punam: My issues, if you've got all day. But no, absolutely. I think that what what particularly lifestyle medicine, it's come into many of our lives because we hit a crisis point at some point, whether it was with our own personal health and well-being or whether it was that of a loved one. And when you hit that, that's that's been your trigger to change. For me, certainly that was. I'd I've faced burnout also as a partner a few years ago, but my big sort of health problems happened after the birth of my son. And that's really when up until that point, I'd really taken my health for granted. And kind of some parallels with your health journey. But when we face a point where you think, oh my god, this can't continue, I have to change and you start looking for ways to really turn your own life around, you then have the platform to say to your patients, listen, don't wait for that car crash moment, which is what we often see. We see people coming in and they're getting that diagnosis of type two diabetes or they're post MI and that's when they're triggered to change. So I think just helping people prevent that point is quite valuable. So even if somebody comes in with a cold or a cough, you've got an opportunity if you've done your consultation in five minutes, you've got a few minutes just to explore their social history and say, look, tell me a little bit about your physical activity levels.
Dr Rupy: You actually opened up about your your own experiences post the birth of your child. I didn't know about that first of all. I don't I don't think we've had that conversation. Would you mind expanding a bit more on that and how you actually came into the understanding around lifestyle medicine through that?
Dr Punam: Yeah. So, like I said, up until I had my wee boy, I was perfectly healthy. I'd never had any issues, but then it was really after he was born, just post delivery, I ended up with a very big blood loss. And then in trying to kind of resuscitate that blood loss, I ended up having quite a severe reaction to the blood products, which then led to DIC. My heart stopped to kind of, I went into heart failure, overwhelming sepsis and just really everything kind of transcended into a point where I was in intensive care ventilated. So it was quite tragic. And then the aftermath of that was the healing took so long. I was not just physically depleted, but just emotionally and mentally was just completely drained. And everybody around me was just trying to medicalize it. And I think when you have that medical knowledge also, it's hard to switch off. And I guess it was the very first time I had experienced what that vulnerability of being on the other side of the consultation table feels like. I just wanted somebody to just listen to what my anxieties were and everyone was like, well, you're just anxious, you're just traumatized. Here's an antidepressant, this will fix it. And I'd never really felt the need to listen to my intuition until that point. And there was just lots of different things that happened that made me look not just at my own life, but really as to, it's kind of informed the kind of doctor I am now. But at that point, I had to kind of take my own health into my own hands. So I kind of started looking at meditation and mindfulness and really started working on my own physical activity levels and getting myself a bit more active, eating better, not just for me, but wanting to incorporate that into my son because I was like, well, we're Asian, so already he's doomed. Looking at my family history, gosh, we're all doomed. How what can I do to kind of prevent as much as I can some of the things that may happen to him when he's in his 30s, 40s. So really that was my big motivation to to start looking at wellness.
Dr Rupy: I think it's interesting though, isn't it? Because as medics, we're all taught, you know, what's the diagnosis, spot the diagnosis, what is the etiology, what is the treatment plan? And we're not taught that sometimes the treatment is just listening. And as general practitioners, as people in primary care, you're very well aware of how just the connection, just being listened to is treatment in itself. And you kind of have to sometimes, I mean, I've learned this throughout my GP training, is to withhold that prescription pad because you're like, oh, I'm meant to give an antidepressant in this case or the patient is wanting some sort of medical treatment as in a pharmaceutical, whereas actually the right treatment, in some cases, not all cases, but in a lot of cases that I see, is to not to, to not give a pill, to not give an intervention in that respect.
Dr Punam: I think we've gone too far the other way. I think that, I mean, definitely we all practice evidence-based medicine, but I think that in sort of traditional medicine, we're really taught to focus, like you say, on what is the diagnosis, what is the treatment, and it's usually in some sort of intervention. But actually, much of the intervention is holistic. There's so many other things involved. And most of us, it kind of took a moment in our life to kind of get to that point where we're like, actually, this prescription pad, we can put so much more on there. So I tend to prescribe, like I I give out gratitude journals to my patients. And I feel that patients sometimes just want something. So on a normal NHS prescription, I will write down sometimes, you know, I want you to just do some breathing exercises for seven days. And they love taking that away because we're living in a society that is so informed, people are clued up, but they want to be given the option. And sometimes when it comes from a doctor, they're like, yes, I'll listen to that.
Dr Christy: And sometimes I actually write on a piece of paper, I'm prescribing for you today, and I'll write 10 minutes out in nature, go for a walk at lunchtime, you know, and take some time for yourself. And they really love it, don't they? They like taking that piece of paper away and it's so satisfying.
Dr Vanita: But we underestimate how powerful our voice is and that interaction with the patient is often half of the management, the treatment. They go away feeling a different person.
Dr Sumi: Absolutely. The therapeutic consultation is just sitting and listening. I think Chintal and I were both GP trainers and I think we're I think the the way
Dr Rupy: For the listeners, can you explain what that actually means? I think I think we assume sometimes that everyone knows the NHS structure. I think a lot of people don't really know the difference between a doctor, someone who's fully qualified in a specialist position, someone who's a junior, like they just think, oh, all doctors are the same, you're all the same. But actually there are multiple levels of specialization and different specialties as well.
Dr Sumi: Yeah, sure. So just for anyone who doesn't know what it takes to say become a GP, we all have to do two years of foundation training. So you spend a couple of years in hospital training and GP training at the moment is three years long. So you spend two years rotating around different hospital specialties, you know, be pediatrics, obstetrics and gynecology, women's health, mental health, because as a GP, you're essentially expected to be a jack of all trades. So having experience in all those fields is, you know, really, really important. And a lot of the training by the time they come to you in primary care, which is what I do at the moment. So I'll have a final year GP trainee with me, is just learning the art of the consultation. So being able to, you know, sit with your patient for 10 minutes and go through that journey from symptom to diagnosis and a shared management strategy. So I think GP training has changed over the years because I think previously it was quite paternalistic. So from my dad was a GP and you know, in his day it was very much like, you would just tell your patient what to do and they'd say, yes, doctor.
Dr Rupy: I didn't realize your dad was a GP.
Dr Sumi: Yeah, my dad was a GP as well. Yeah. So, and it was interesting because I briefly worked with my dad and it was really, it was really interesting. So, and I'd have a lot of his regular patients like, you're quite different to the way your dad is. You're, you know, your dad would just tell us that, you know, you're carrying a bit of extra weight, you need to lose weight. So that was, you know, you know, that's how it used to be. Whereas I think now, I think particularly with my my health coaching hat, I think the direction and the way that we consult is quite different. I think we want to be shared with our patients. We want to empower them and all listen to them and not necessarily reach for a prescription pad because we know that's not necessarily the right thing. And actually, if you go back to medical school, first line often was lifestyle, but it's almost along the way we've forgotten because, you know, you know, pharmaceuticals have told us, you know, prescribe this medication. So I think things are changing. I think GP trainers now, the ones who are supervising are really trying to get that message through to trainees. And I'm certainly seeing that the appetite to learn that way of doing things is there, which is really refreshing because I can see the future GPs really sort of channeling that message that we're all really keen on.
Dr Chintal: I was just going to say that that our I found with the GP trainees that I have also usually ST3, so in their final year of GP training, they don't actually have that much training in lifestyle medicine during and when they come to us in general practice, it's really refreshing to actually, you know, put it into practice with patients because actually when you answer an exam, even then the first treatment plan is actually lifestyle changes, isn't it? That we're taught in medical school. But weirdly, when we put it into practice, it's always a prescription. So I think
Dr Sumi: Well, it's quicker, isn't it? It's it's always was quicker to say, I'll write this prescription, but if you can just sit back and pause and actually use the beauty of continuity and bring your patients back, it's quite interesting what can happen.
Dr Rupy: Do you think there's a a type of patient that actually wants to be told very directly?
Dr Sumi: Definitely. Yes.
Dr Rupy: How do you sift those out? I mean, we can be very honest here, but yeah, it doesn't yeah, it doesn't work for everyone. The soft approach sometimes doesn't work and sometimes people do want to be told, but that I suppose comes with a lot of experience. I mean, I'm learning every time I'm in general practice, every time I'm in, I mean, I do mostly emergency medicine these days, but I'm learning different consultation skills from peers as well as as my own interactions.
Dr Vanita: I think it comes, yeah, it comes after years, doesn't it? I mean, we sat and thought about how many years we have between us of medical experience.
Dr Rupy: Guess how many years there are between it. Between the five of us. Between the five of us. How many? Go on, how many? I don't know, you all look so young, so I'm going to say five. Very good answer. You've just qualified, you look so fresh faced, yeah.
Dr Vanita: So it's over 70 years of experience.
Dr Rupy: I wouldn't have guessed that.
Dr Vanita: Yep, there you go.
Dr Chintal: We have a lot of experience between us.
Dr Rupy: Must be the lifestyle.
Dr Vanita: Just being responsive to what the person in front of you seems to want.
Dr Christy: Absolutely.
Dr Punam: And I think that's what's beautiful is that you get to see all walks of life. You get to see humanity in all of its kind of ways. And I think that you really only get that when you are in general practice because you're not seeing the same type of person or the you're not or the same organ or the same disease every single day. You just never know what's coming through the door and you get really good at just reading not just the verbal cues, but reading the non-verbal cues and you get to know your patients over a lifetime. You get to learn about the intricacies and dynamics of families and you get to know like how is this person going to respond? And you get good at people reading.
Dr Christy: It's great though. That's what I love about it. I really do. And that's what's so exciting. It's the most exciting thing that's going to come in the door.
Dr Rupy: I think you have to be a bit nosy, don't you? You have to you have to be quite comfortable. I mean, I I I think I honed my skills of nosiness when I was doing sexual health in Brighton, which is a wonderful place to do sexual health. I mean, the stuff that I heard and you know, I had to Google a lot actually whilst I was there. Yeah, I had no idea what people were saying to me. Well, I don't think it's correct for the table. If this was in a dinner party, then I wouldn't mind, but maybe a bit later after I've had another one.
Dr Punam: You should come and do a gum clinic in Glasgow.
Dr Rupy: Oh, well, well. But um, no, it's I mean, you have to obviously ask them lots of questions. Are you heterosexual? Are you homosexual? Uh, are you bi? Uh, you know, do you use protection? How often? How many partners? You know, all these different things that I mean, I would go really red. Like my first time I started doing that. Yeah. But now, really off. And I think you can get anything off. Don't think anything off it. And I think you people can read the confidence that you have as a practitioner. And so it just definitely comes with experience. I mean, I probably, hopefully, will look at myself in 10 years time and think, you know, I was I was very, I mean, I still feel very junior if I'm honest. But uh, you know, I've learned so much in the next 10 years. So it's a it's a real like ongoing continuous journey.
Dr Punam: It's really funny when you say that about how you like talk to patients. Like just this morning, as well, you know, if you're especially as a female, I'd imagine it's the same when you see like female patients as a male. But you know, like just doing something like a digital examination, a digital rectal examination on a man, and I came out with, oh, don't don't an examination of the back passage for things like hemorrhoids and other things. And I came out with, oh, don't don't be worried. I do this all the time. I mean, not all the time, but like sometimes. And then it was just this kind of complete awkwardness and you're like, oh my god, I've just dug myself a hole.
Dr Sumi: But I think you're right. I think you're right though. You know about going in there confidently. I think if you take out the awkwardness for the patient, they really appreciate it. So I think if you can say, listen, for for like if you say actually, this part of your body is no different to another part to me. I know it is for you. I often find people just go, oh, okay, doctor. And also, because we're so short on time, we unfortunately, we don't have that time to say, actually, I'll give you a few minutes just to like, sorry, can you please undress and we can just carry on. But I think if you're confident, patients really feel that and it's important to give them that, you know, sense that, you know, it's it's no different to any other body part. Because I think you the work you did with the Eve appeal was really helpful because you were bringing, you know, for the importance of, you know, using terminology, talking about genitalia is no different to any other body part. And I think the more the public are seeing things like that, I think it makes it easier even in our GP consultations.
Dr Rupy: Absolutely, yeah. And for the Eve appeal, just for the listeners, is the charity that tries to raise awareness of the five gynecological cancers. I remember when they first asked me to do that because the CEO, Athena, who she saw me do a lecture, it was one of the first lectures I'd done. It was all about menstrual pain, heavy heavy bleeding and what sort of nutritional strategies we could advise patients based on the evidence that we have for for patients undergoing this alongside obviously treatments that we we all know of as general practitioners. And she said it was the first time that A, she's heard a man talk about this subject, but B, without really, you know, um, going red or like becoming embarrassed and stuff because I mean, as GPs, we do this all the time.
Dr Christy: But there's always a we you know, to be honest, our our jobs are quite hard and we see quite a lot of stuff. So obviously we don't want to make fun of anything, but actually to have a bit of humor in your in your life and your job is good, isn't it? You need to have that healthy balance, don't you?
Dr Vanita: We were talking about it today actually, resilience, particularly in pediatricians because apparently at the moment they're the highest number of doctors seeking help for mental health issues. So I've been working with one of the previous presidents of the Royal College to say, okay, how can we help our doctors? So obviously GPs, they do seek help, but pediatricians aren't that good. And we all need to know ways to build resilience and they were saying they're only just getting it into the medical student curriculum. And now they're going to put it in the pediatric.
Dr Rupy: Absolutely. I mean, they're probably as stressed as most specialties, but then they have to deal with children. I mean, that has got to be harrowing itself.
Dr Vanita: It's stressful and with all the high profile cases recently. Exactly, yeah. So the the Charlie Gard case and so many people have dropped out of training. We're really short of of.
Dr Punam: Well, my primary interest for was I wanted to be a neonatologist and throughout uni, that was like every SSM, so a special study module I did was geared towards that. That was all I ever wanted to do. And then I did my first job in peeds and we had a little baby that died and I just could not emotionally deal with that. And then it I think it just becomes worse. It's hard enough now as a GP sometimes when you have young babies coming in and they're sick and you just think how do I disconnect myself because you become really emotionally attached.
Dr Vanita: And you do change once you've had your own children. I'm a much better pediatrician. If somebody tells me they've been up all night with a vomiting child, I understood what that meant once I'd had my own child doing that. And then that's just a different dynamic with the mums and parents.
Dr Rupy: I feel like sometimes that hinders my ability to connect with someone because I've had that experience as well and even though I've assessed the child, they're safe to go home, they're tolerating some fluids, obviously they're not 100% better, obviously they'll still sick. Um, often the question comes up, well, if you had children, you would know. And they always ask me, do you have children? And I have to be honest, the only children I have are godsons and they live in Miami. And I do get worried phone calls from their their mother and father all the time. But um, yeah, that is something that I haven't experienced and then I can't I probably can't empathize as much. I mean, that isn't to say that everyone needs to have kids to be able to do their job, but you know, it is
Dr Vanita: Your own experience changes you, doesn't it?
Dr Chintal: I think for the patient as well, that immediately the way that their rapport with you changes and they open up and it's just it's just a very, I've noticed since I've had children when I see a patient with children that just the way they speak to me is very different and I think because they know you can relate and exactly.
Dr Punam: Yeah, like even sort of feeding difficulties, prior to having my little boy, if a mum came in and was anxious over colic, I'd be like, it's colic. Like, you didn't sleep, okay, baby's cry. You know, and then my little boy had silent reflux, which was undiagnosed and I wasn't taken seriously until he actually ended up really sick with it. But that sleep deprivation was horrific, probably worse than the birth. That dealing with a baby that is having severe colic and heartburn and it's helpless. Like, I would never want to go through that again. But now when mums come in or parents come in and they talk about sleeplessness or colic or reflux and you just completely empathize. And even though you can't necessarily, you can help them to a degree, but you you can reassure them that it does get better. I promise you your child will eat properly at some point. But um, but just being able to have that human connection, but equally, we've got aging parents at home. We've all had either siblings or friends who have been unwell. Like you can see narratives that are parallel to your own life as a GP with your patients. And I think if you bring that human element every day to work with you and promise to deliver that to your patients, um, but be able to also disconnect when you leave, I think that that is probably what makes a good doctor irrespective of what specialty you are.
Dr Rupy: I think everyone needs psychotherapy who's in medicine. I mean,
Dr Vanita: It would help.
Dr Rupy: I think it would definitely help. I mean, one of my friends in A&E doctor in Australia, and he's a registrar level now going towards consultancy, which is really weird because he's a little bit younger than me and we were working together in A&E at the same time. Um, but he's he's great. Um, he was telling me about a particularly traumatic night where he was in charge of the ED department. He had a whole bunch of juniors with him. Um, he had some really, really severe uh, casualties come in, young RTAs, road traffic accidents. Um, and at 7:00 in the morning at the end of this horrific night, there were three therapists running around the ward going and trying to pin down the juniors that were on over that night and just have a conversation with them. And the A&E consultant, even though he wasn't on, was calling the department at 7:00 in the morning to speak with him and all the other juniors one by one. It's something that's so lacking, I think, in the NHS, which is already overstretched. And I'm sure they are in Australia just as much or getting to that level anyway. Um, but certainly something I think that it needs to be in it almost needs to be mandated in the NHS, I feel, because it's not going to happen.
Dr Vanita: The good practice is that you have a debrief, but even that doesn't necessarily happen, but they're making sure it's happening now in Evelina with the children's hospital, but only just now.
Dr Christy: There is, there is access though for doctors to get therapy and it it is out there, you just have to access it.
Dr Chintal: I think within general practice training actually, we're quite good at that. Um, that is something that we have, we have the PSU, the professional support unit to support any trainees in difficulty. And while they're training, not afterwards actually, but during their training, the deanery actually has a lot in place to support um, and to help build resilience and to, yeah, but I think
Dr Christy: It should be, it should be mandatory for everybody. And all the specialties, yeah.
Dr Sumi: I think what's good, I think there is more help out there than there was before. And I think as trainers, I think and it's more acceptable to ask for help. I think before I don't think it was.
Dr Sumi: I think you're right. I think there's still an element of stigma associated with asking for help amongst the medical profession. I think it's shifting, but I think it's still there because of the professional responsibilities we have. Doctors worry if they, you know, ask for help, is their, you know, competency going to be questioned. So I think it needs to be normalized more like you said, I think the fact that in Australia that's actually had to be done, that would not happen in the UK, whether it's resource or culture, it's not quite there yet. But I am reassured that say for example, general practice in London, if there are any doctors listening, there's something called the practitioner health program. So you can self-refer, you can self-refer if you have any distressing issues in your life, regardless of whether it's to do with work or to do with, you know, you know, something that's happened outside of work. Support is there. So I think that's some some great work going on.
Dr Sumi: Well, I think the very fact that like we as GPs and primary care physicians all sat around the table speaking on a public podcast talking about these issues, I don't think would have happened like a few years ago. You know, the the openness to be vulnerable, I think is um, is something that yes, it's become quite fashionable if I'm honest. Um, but at the same time, it's something that would be very, very uh, looked down upon amongst medics themselves. I mean, I remember the the very first time I had atrial fibrillation episode, the reason why I took so long to even talk to my boss about it was because I I felt like I might be seen as a weakling. And I think that's just kind of endemic in the culture, but it is changing.
Dr Sumi: But it is changing. It is changing. But I think it's interesting because now, I think because of the high rates of burnout, say primary care physicians and now and pediatricians as well, people are adopting portfolio careers because they're recognizing that working, you know, the hours that people previously used to do, it's not sustainable. So I think doctors want to do other things using their medical backgrounds to deliver, you know, the message in a different way, work with patients in other ways, which is I think what a lot of us are doing now, particularly around this table. I think as a way to manage that.
Dr Rupy: Well, it's nice to have an outlet, isn't it?
Dr Sumi: Yes, creative outlets and things, yeah.
Dr Punam: One of the reason actually that I ended up in the whole portfolio route, I was previously a partner and was quite burnt out with it and I think I probably entered that quite early on in my career as a GP, but also there was quite a lot of pressure put on partners.
Dr Rupy: Can we just expand on that a bit actually? Because I don't think many people understand why GPs are burnt out in the first place because the perspective is, and perhaps amongst medics still as well, that GPs just see the patients in the morning, the afternoon, they go home, they're usually on the golf course by by 3:00 p.m. That was the traditional, honestly, people still think that about GPs. Oh, you're a GP, you must be on a load of money and you go to the golf course. No.
Dr Punam: It's absolutely not the case and I think if I was ever to redo a career based on money, I would definitely not have chosen general practice or doctor for stop. Um, but when I was a partner and I mean, Sumi, you're still, you're a partner. Um, but it wasn't just seeing the patients. So you'd have your usual GP day, so you'd be seeing something in excess of 30 face-to-face patients. You'd have your home visits, you'd have your usual admin, but then on top of that, you had all the business side to look at. So you had to see where you're meeting all your deadlines, meeting all the contract requirements. If you didn't have a staff member turn up for the day, how are you going to cope with that? You have internal politics and dynamics also. So it's kind of like entering a marriage with other partners. So you all really need to be connected and on the same wavelength, which is hard enough to actually find a soulmate in real life, let alone like be financially tied to other people who may not work like you or may not have the same outlook in terms of business. Um, so a lot of these things are quite stressful. If a partner goes off sick, for example, you've all got to kind of cover that. So the pressures are insane. And of course, you're managing and juggling your own personal life alongside that. And for me, I had my baby at the time was only one years old. So I was trying to juggle that. I was working four and a half days a week. But there was a time where I was sitting on holiday with like my friends in Turkey, a cocktail on one hand and ordering toilet roll on the other hand for the health center because we didn't have a practice manager. And I was like, is this my life? You know, like, do I want luxury toilet paper for like, you know, and um, it was little things like that that it got to a point I thought this is encroaching on everything. I was working late at night in order to get away at a reasonable time to spend time with my family. I was having remote access, which means GPs often take a lot of their paperwork home so that they can do it later on in their own personal time. But you can be up to all hours of the night, really never disconnecting. So I kind of felt that after three and a half years, I just couldn't stand that. But the light bulb moment for me in my portfolio journey was I work for the University of Glasgow, so um, I'm a lecturer and also a tutor. But I was interviewing a sixth year medical school students. And it was like every student was coming in and I was like, tell me why do you want to be a doctor? And they were like, I want to help people. But I'm also like grade eight cellist and I've just traveled to Uganda to do all this other like voluntary work and I'm, you know, amazing at sports. And I was like, once upon a time, this was like all of me. And now I literally sit and order toilet paper and see patients. And but it was just this complete diverse individual full of creative flair, but also academically successful. And I thought, why is it that we somewhere along the line give up all of that creativity when actually we're full of that. And for me going down my portfolio journey was that, hold on, I love writing. Um, I want to write more and since then I have kind of gone on to kind of do more in sort of journalism. But um, you know, there's lots more to me than just being a standard GP every single day. And that was my journey into portfolio. It was like young students that inspired that. And now as a teacher, I tend to say to them, never give up your other interests. You know, and medicine very much informs absolutely every one of my other passions, but it's not all of me.
Dr Rupy: I I I'm noticing that amongst different specialties as well. So I think it's not just GPs that have like these amazing outlets. It's a whole bunch of different specialties. I mean, you're one in pediatrics, but endocrinologists, a good friend of ours, Anita, who's a gynecologist, you know, there's so much that a lot of other medics can give. But one thing I did want to ask you guys about is is lifestyle medicine as a term under attack?
Dr Sumi: Yes.
Dr Rupy: Yes.
Dr Sumi: I would say so.
Dr Chintal: I guess it's how you view it. Lifestyle medicine for for me as a GP, as an NHS GP that practices NHS evidence-based medicine is an adjunct, is an adjunct to my everyday practice. So I wouldn't necessarily say that it's it's a replacement in every clinical scenario, but it's definitely going to be an adjunct and definitely help patients in a positive way, whichever aspect of it we use for particular conditions. And I think that's the whole point. Um, nothing in medicine is black and white and you know, lifestyle medicine isn't black and white. So it I think the way it's attacked is probably very black and white. And we perhaps need to see the the wider picture.
Dr Christy: I agree with Chintal. Sorry, I was just going to say at the end of the day, we're just empowering patients to take control of their own health, aren't we? So we're just trying to say, you've got the tools there to be able to optimize your health and we're just giving them the information and trying to motivate them to make some changes which will overall help their health physically and mentally. So it's just empowering, I think, to be able to offer them that opportunity.
Dr Sumi: And I think the term lifestyle medicine, I think doctors have been practicing lifestyle medicine for eons. It's just a different term. If you speak to a GP from 20, 30 years ago, it's like, oh yeah, we're talking about sleep, prevention, exercising, moving. This is not, this is not new. I think what's interesting is it's been given this new name, it's getting a focus, which I think is overall, despite any negative press, I think it's a fantastic thing because I think in many ways, if we focus on it, we're going to be giving our NHS, you know, a bit of a lift. We're going to be, you know, hopefully, you know, preventing chronic diseases and you know, the burden that comes with it both financially and in terms of quality of life and life expectancy. So I think it's just a a new term for something that doctors do anyway and they do it well, but I think it's bringing the focus back onto prevention and looking at yourself as, you know, someone who can help help themselves with their own health.
Dr Christy: And it's also, um, it's not replacing medicine, is it? It's just, as you said, it's an adjunct, isn't it? It's not replacing. We all prescribe, we all prescribe stuff. Everyone needs to be prescribed things in in certain conditions, but we're just saying also, alongside this, we can also give you the opportunity to improve your health in other ways. So it it all should melt together, shouldn't it? It should all work together.
Dr Sumi: And I think all of us are evidence-based. We all, you know, we read the journals, we know what's out there, we know our nice guidelines. And absolutely, we are so fortunate to have some of the medications and drugs that we have now that we didn't have yesterday. And it's about using them appropriately, but also giving patients a chance if they can go without medication to try the different areas of lifestyle medicine. And that's really, I think, the message that we want to put forward.
Dr Punam: And at the same time, they could have a drug for a particular condition, but they could be helped with lifestyle medicine in another way for another condition. So it's using it together with medicine.
Dr Punam: I think the traditional, yeah, I think the traditional role of the doctor was just to treat illness. But actually, I don't think that there was much focus historically on sort of health promotion and education, which actually is the traditional role of the doctor. We're not just there, especially as GPs, to just treat illness. We're there to actually educate our communities, which we've not done. Historically, we've never had the time. And right now, I think lifestyle medicine is seen as a threat to a lot of GPs that feel burnt out or feel that already there is so much on our plates. So here is another thing that we have to do. Um, I think that there's often an attack that lifestyle medicine is just a bit of woo woo and it's just quackery medicine. But actually, we're all doing it, we're all practicing it. But the facts are that society is getting sicker. We have more chronic disease today and we have more awareness of it than we've ever had. So clearly education is not getting out there. It's not got out there through the media, it's not got through all the other avenues and outlets. So maybe now doctors need to be at the forefront of this message and campaign to say, we want to actually start moving towards a healthier society. It starts with us. And that's what lifestyle medicine is.
Dr Chintal: And that's what prompted us really to start our workshops because actually we didn't have the time in our clinical hours to address these additional things that people could do to improve their life. And by having holding these workshops, which we deliberately promoted and targeted within the community, within our practices to actually reach people that didn't have access to social media that weren't already converted. We handed out flyers to the church halls and to the community. It was amazing. Schools. Yes, schools and our local GP practices and like, yeah, exactly. We wanted to reach that target audience that perhaps don't really understand it and educate them on different aspects of their health and how they can improve it.
Dr Rupy: What do you see as the future for the your lifestyle doctors? Have you done that like five-year forward sort of thinking or what do you envisage?
Dr Christy: No. Why don't we do it right now? It's a good idea.
Dr Rupy: Like how are you going to scale this? Because I think like a lot of people will look at what you guys are doing, and I'm playing devil's advocate and say that's all very nice, but how is that actually going to make a difference on a grander scale and how you're going to measure it as well so you can get this funded. I obviously am a big believer in it and I think there's a lot more in the way of how we can actually quantify benefits to human health. But um, I think that's one of the main criticisms that, you know, there isn't enough uh, infrastructure around our healthcare system to deal with, you know, the kind of things that you're doing, which are quite labor intensive. I mean, you you're giving up your own time to do this stuff and
Dr Christy: To be honest, I mean, at the moment, I think we're just focusing on trying to reach as many people as possible. So we want to do some more events. We're planning on doing an event in January, February. First of February. First of February. Brilliant. Okay. Yeah. So save the date because we're going to do, so we in the first event, we targeted families and that was really successful. This time we thought we would try and target more working professionals because pretty much all of us, I think, have experienced some form of burnout in our lives. And and we're all learning from it. And so we want to try and share some of our experiences to working professionals. So we thought our next event might be um, geared towards, yeah, the the young professionals of any age, to be honest. Any age, not exclusive, not inclusive, exclusive. And um, and so we want to try and give people the opportunity to um, improve their or optimize their health really through making some lifestyle changes. And we really want to be able to give people, let people leave with like a social prescription, like we were talking about before. We actually want people to take a piece of paper away and have written down tips and tricks that they've taken from our workshops because we've all, as we said at the beginning, like we've all got our own little niches. And so we'd hope that, you know, if people are already exercising and eating well, then maybe they need to look into stress and avoiding burnout. So they might take something away about mindfulness, for example, or routine. But if someone's already doing all of that and they don't know how to exercise, then hopefully they'll take something away from that and they'll be able to take it away on a piece of paper and have their own little social prescription for themselves. So that's what our aim is for our next event.
Dr Rupy: Awesome. That's super cool.
Dr Punam: But it's always about creating that ripple effect. If you can reach even like sort of on a on a day-to-day, we reach, you know, even individuals, they go away and if something has resonated, they tell their friends or their family members and people start that. So our focus is that if we can continue with through content making, through event organizing and through really just pushing forward our message that we can hopefully create a bit more of a ripple and a movement that, you know, we're just ordinary people that happen to have some information and knowledge and experience.
Dr Chintal: And I guess sort of scaling up where you say a long-term plan, you know, if other people were to be inspired by that and set up their own groups and set up similar things in other areas, that would be amazing. Which, you know, we would love. So if we can make this work and we can show that it works, maybe it will inspire others in other areas to do the same.
Dr Rupy: It could be like the park run model. Like if you had like a kind of structure to what you guys are doing and then people can come along and and start their own sort of lifestyle events up and down the country. That's really how you start a movement. So big fan of you guys. Of course, of course. I mean, I haven't cooked a massive meal like this for everyone.
Dr Christy: We are honored.
Dr Rupy: Do you often have five women over for dinner?
Dr Christy: I know, yeah.
Dr Rupy: This is going to look really bad on social media, isn't it? Rupy, Doctor's Kitchen, lures five women to his studio. Low lighting.
Dr Punam: This is where we put the PIMP in that. She hasn't even had a glass of wine.
Dr Rupy: But I must say your food is pure dead brilliant.
Dr Punam: Oh, thank you very much. That's very nice of you. I very much appreciate it.
Dr Rupy: If you're going to leave the listeners with one tip from your respective area of lifestyle, and I'm going to limit you guys to a sentence because we can all talk ages. Um, we'll start off with sporty lifestyle medicine spice.
Dr Christy: Thanks. So my main tip for everybody out there, um, and because I'm an advocate of exercise, I'm going to ask everyone to move more and sit less.
Dr Rupy: Like it.
Dr Christy: I will.
Dr Rupy: We should have been standing up for this. Sorry. Standing desk.
Dr Vanita: I think it's actually more important how you eat than what you're eating sometimes. And this sort of social sitting where we're all around a table, it's not there in many families and that's what we try and encourage people to go back to because whatever you're eating, you end up eating in a more mindful way. So that's really important.
Dr Rupy: I always say it's as important who's around the table as well as what's on the table.
Dr Chintal: Yes. Following on from what you've just said, um, my angle is that is the cooking and and putting things into practice. Um, I would say to try and do that as much as a family or with your partner or with other people and talk about what you're doing and encourage conversations around food, why you might be cooking a certain ingredient, perhaps go shopping together, perhaps cook meals together, encourage I'm as a mum, I'm a big advocate of including my children in everything we do and from the kind of choosing to the shopping, to the cooking process, you know, they're part of it all. And I really think that encourages really healthy conversations around food. So that would be my point.
Dr Punam: I love it. Um, so I would say that no matter how overwhelming your day gets, always remember to breathe, to focus on every breath, and the most important thing is to always enjoy every breath.
Dr Sumi: Wow, last but not least, no pressure here to come up with something really phenomenal. Are you posh lifestyle medicine spice? Of course. I'll take that. I'll take that. I don't know if that's a compliment or not, but thanks.
Dr Rupy: Well, you're very fashionable. You could start your own line, you know.
Dr Sumi: Thanks. So, uh, in terms of all the things we've said, I think for anyone who's listening who's inspired by what we've said or they're sitting at home thinking, you know, I really want to make a change in my lifestyle. Um, firstly, just, you know, don't be too hard on yourself if things are not going exactly the way you want it to. You're human, it's hard to get things exactly right. But maybe think about one area of your lifestyle that you'd like to improve that would have the most impact. Take something, maybe think about one small change you can make just that one, just for one day and then just try it out, you know, and if you can maintain that, you'll be surprised how far you'll get because I think often as human beings, we can have big ambitions, say for example, new year to make some massive changes and then when we don't succeed, we give up. So I think if you're thinking about making a change, you know, give yourself a, give yourself some time, give yourself an opportunity and then see how you go. And um, if you want some more support, you know, you can see your GP, enlist your friends and families, you know, come to workshops like ours and um, hopefully you'll be on a journey to better health.
Dr Rupy: That is the longest sentence ever.
Dr Rupy: I really, really enjoyed that and I can't wait to have more dinner parties, but I would love to know your opinion as to whether you enjoyed that or not. Please give us your honest opinion on Twitter, on Instagram, send us a DM as well across social media. I'll try and look out for them. You can send us an email too via the website. And if you want to have more of those, please do let us know. I'd love to know who you want on the podcast or who you think should be at the next Doctor's Kitchen dinner party. Love to know, please send us your comments. As always, you can find all of this information and more on the doctorskitchen.com. Please follow my guests on social media. They are at Your Lifestyle Doctors and you can find their individual social handles on the doctorskitchen.com podcast page as well. I'm really excited for them. I think they've got an incredible set of future goals and I can't wait to support them as much as possible. Please give us a five-star review. Over a thousand of you have already. I'm really, really appreciate all of them and I try and read all the comments. But if you haven't, we know thousands of you listen to this podcast every single week, so please consider giving us a five-star review. It really helps spread the message. Have a fantastic week and I'll see you next time.
