Do you need a digital detox?

Social media is the phenomenon of our time.

It has allowed each one of us to connect with new and old friends and companies like never before and it has become an integral part of our lives.

A couple of weeks ago, my wife took us both to Rome to celebrate my birthday.  This is me in the photo, caught in the act by my wife, checking social media in the middle of one of the world’s great historical sites – the Colosseum in Rome. Is this not addictive behaviour?

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There are pitfalls and dangers with social media as with any aspect of life and these are well documented. However, for the majority of people, social networks allow greater integration and sharing of our lives with friends and family than has ever been previously possible. From seeing family holiday photos to speaking to friends from years ago or miles away, connecting with people has never been easier. Suddenly the world is a much smaller place.

As a doctor, I have seen social media be a pathway to improving a patient’s health. One young patient had been quite social during their early years in school but had become more reclusive due to bullying. They rarely left the house and had no social interaction other than with their own family.

My patient’s one and only interest was sport. They continued to watch their favourite sport and over time, due to their enthusiasm, started a weekly iTunes podcast which proved quite successful. As part of the promotion for the podcast, they found they had to engage with social media including Instagram and Facebook. Slowly they found they were starting to talk to people online and, over the following months, started to form online friendships. This progressed into face to face friendships and attending sporting events together. From living their life alone in their bedroom to attending large sporting events with friends; the positive power of social networks is easy to see.

I think we engage with social media because as human beings we are inherently social animals. We like to keep up to date with what people are doing because by nature we are interested in what is happening in our surroundings.

Earlier this year, a study of 14-24 year olds found that Instagram was beneficial in terms of self-expression and self-indentity but that it could negatively impact their body image, sleep and lead to a fear of missing out.

Another study suggested that a Facebook addiction could be seen on brain scans of those reportedly affected – showing changes in the same parts of the brain that is affected by cocaine use.

Here are our top tips for spotting a social media addiction:

  1. As soon as you open your eyes in the morning you are already reaching for your phone to check out what has happened over night.
  2. You check in at the bus stop, the tube, your desk, at starbucks (with a selfie of you looking wistful with your coffee – or a boomerang of your coffee), you then update your status as you’re waiting for the work day to end and repeat the check in process on your way home before providing a running commentary in Instagram stories of you preparing your dinner.
  3. When someone tells you a joke you respond with lol instead of an actual laugh.
  4. You use the phrase “hashtag” in normal conversations. #fail.

So you’re worried you might be addicted, or you might need to take a step back from social media – how do you go about doing it? In truth in can be incredibly difficult to digitally detox your life.

  • Start by trying to set some limits – like not checking your phone in bed or after a certain time at night, not taking your phone to the bathroom etc.
  • Try turning off the push notifications – these little messengers of social activity constantly draw us back to our accounts.
  • Try having a device amnesty in your house eg for a few hours in the evening or even for a whole day, and spend time instead with your family

Sure, there are some people who live and die by the number of likes a post or picture gets, but the rest of us just enjoy looking at photos of our friends as they have too much to drink and falling over don’t we?
 

 

 

 

Wonder Woman/Super Man – what’s so great about them anyway?

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This post is inspired by a patient I have, we’ll call her Jane. In reality the patient I met today is like so many that I have, and your doctor has, met before. It could easily be John, or Jenny, or Jeff.

Jane is in a cycle of trying to care for family members and hold everyone together, but the cracks are starting to show. The strain of being everything to everyone is leaving little time to tend to her own needs. Her stress levels are through the roof, she isn’t sleeping well at the moment, her appetite is a little off, she is struggling to focus at work and feels like she is on the verge of tears or anger most of the time. Sound familiar?

It’s not Jane’s fault, she is doing what she knows best. She is trying to support her family whilst being a productive colleague, a good friend, a good spouse… She’s trying to be Wonder Woman and she’s mad at herself because she is struggling. She berates herself for not being “strong enough” and that she “needs to snap out of it” but try as she might, she doesn’t see how she can.

I talked with Jane about imagining ourselves in a house. For any house you need a solid foundation, and that foundation is our sense of self.  The walls of the house our are natural defences to protect us from the storms of life. Repeated adverse life events or stressors, just like a real storm, can chip away at the walls of the house, they might even break the windows.

If our house is built on solid foundations, and we have developed coping strategies that are effective for us then we can weather those storms. If our defences are low – perhaps we have lots of stressful things happening at the same time which are rocking the walls of our house, or our foundations are built on shallow ground, then our house is going to start tumbling down.

Without the house to protect us, we are exposed to the harsh realities in life.

This is where I found Jane today. Her walls are tumbling in, she is trying desperately to barricade the doors and windows but she cannot keep up with the demands that life is throwing at her. Simply put, she cannot be everything to everyone. She is not Wonder Woman.

Fortifying our proverbial houses is tough, especially as we often have to try and fight these fires whilst carrying on with our normal lives.
The first step is acceptance. Accept that you cannot do everything.

“Serenity is accepting the things we cannot change,

courage to change the things I can and

wisdom to know the difference”. 

Acceptance does not mean berating yourself for weakness. It is not a flaw to accept that you need help or that you are struggling. It takes strength of character to stand up and say to someone you need some support.

Next comes rebuilding. For those in caring roles this can be especially challenging. As a carer your focus is inherently on those your care for. Shifting your focus back to you can be unsettling, upsetting and hard to do. However to care for another in the way you want to, you have to be able to care for yourself.

One of my favourite analogies (and I have plenty) relates to a broken leg. If you have a broken leg, society at large knows how to react. They can see the plaster cast and the crutches, they can mentally apportion the right amount of sympathy and understanding. Bones heal, the injury is visible, and it’s much easier for people to get their head around.

Stress, burn-out, depression and anxiety all have few outwards signs. Unfortunately a stigma can still exist around these problems and society can sometimes feel unsure about how to ‘handle’ someone who is suffering. But just because it isn’t visible, and just because it isn’t physical, doesn’t make the problem any less real or relevant.

To rebuild takes time. Patience. Support. Effort. It isn’t easy. Remember that a difficult path can sometimes lead to beautiful destinations.

Talking therapies such as counselling and CBT should never be overlooked or dismissed. Having someone else, impartial to your situation, help you to talk through your current troubles can be a real life saver – and can help to set you up for your future.

Some patients might need medication from their GP. I would always encourage anyone who is facing difficulties in their life that are starting to overwhelm them to speak with their doctor.

Part of rebuilding is learning about yourself. Really understanding yourself is the key to your success. What are your warning signs that things are getting too much? What can you do when those signs start to appear? What strategies to do have to protect that proverbial house?

Whatever it might be, find what re-centers you. It might be yoga or meditation, it might be catching up with an old friend, watching a favourite film, reading a book, going for a run or taking the dog for a walk.  As long as its a positive action – that doesn’t mean opening a bottle of wine or similar.

Exercise can be an incredibly powerful tool at boosting how we’re feeling when we’re struggling. Physical activity is not only good for our physical health but for our mental health too. Not only does it increase endorphins that help promote good feelings, but it also can help with issues such as insomnia.

Being you is enough. You don’t need to be Super Man or Wonder Woman. Besides, they wore their pants over their clothes, and when you stop and think about it, what’s so great about that anyway?

 

 

 

Share Your Spare: Organ Donation

This week is Organ Donation Awareness week in the UK.

Transplanted organs save so many lives as medical science and surgical techniques advance, but the sad fact remains that that the number of people who need an organ outstrips the number of people who donate organs. It is thought that every day in the UK, three people die waiting for an organ.

 

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There have been some incredibly moving videos on social media lately – hearing the heartbeat of a deceased child beating strong in another person, meeting the recipient of your partners lung donation and so on. Emotive as they are, they do illustrate just how life changing organ donation can be to those who receive a transplant.

Talking about dying and organ donation can be really difficult, so it is understandable why we might shy away from thinking about it and talking to our loved ones about it. Somehow as if it’s almost tempting fate.

We can donate organs such as heart, lungs, kidneys, liver or pancreas, or we can donate tissues such as corneas (a clear layer of ‘skin’ at the front of the eye), heart valves, skin or bone.

Most people know about organ donation after death, however we can (in some circumstances) donate an organ whilst we are alive. The commonest situation would be to donate a kidney to another person in need, sometimes within our family. We have two kidneys but we can usually manage just fine with one. The brilliantly titled #ShareYourSpare is a social media campaign trying to raise awareness for living kidney donation.

Roughly 5000 people in the UK are waiting for a kidney transplant and as many as 250 patients died last year waiting for a kidney transplant – because they could not get a transplant in time.

Parts of the UK have different laws regarding consent for organ donation, and you should always check what the law is where you live.

In Wales there is an ‘opt-out’ system. This means that you can still voluntarily register to be an organ donor if you wish. However if you specifically do not want to be a donor, you need to register your intention not to donate. If you do nothing, it will be presumed that you do not object to donation.  For the rest of the UK, you still need to register your intention to donate your organs.

Regardless of your feelings or decisions about donation, it is important that you tell your next of kin or family. In the event that the worse happens, your family can help to share your wishes and make these known to the medical team looking after you. If they do not know you wanted to donate your organs, this could blind side them in an already very difficult time.

Talking about death and dying with our loved ones can be a difficult and painful process. As hard as these discussions are, having them sooner rather than later will ensure we’re all on the same page if the worse should happen. As we look to raise awareness of organ donation this week, try and take the opportunity to think about what you might want.

You can register as an organ donor or find out more about donation on the NHS donation website 

 

“All that I am, or ever hope to be, I owe to my Mother”

It’s Mother’s Day today in the UK and this gives us a chance to show our mums how much they mean to us – whether they are still with us or not. There is an undeniable connection to your mother, no matter what is going on in life.

As babies we are conditioned to bond to the person who provides us with the most care – this can be our mother, father or anyone that provides us the majority of our care. This bond is what psychologists call ‘Attachment Theory’. It’s a biological instinct where we equate our safety with being close to this person and that this person will take away our discomfort and protect us.

We don’t know about you, but that definitely describes our mums.

 

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In honour of our mums, we wanted to share some of the most valuable lessons we have learnt from them:

 

“Grant me serenity to accept the things I cannot change, courage to change the things I can and wisdom to know the difference”.

This was something we had on an ornament in our house growing up – and it followed us from house to house and has always stuck with me. Learning to let go and move on, or dig in and work hard are crucial life skills we all need.

 

“When driving, you don’t have to run a race”

When someone approaches in your rear view mirror, whether it be in the car or in life in general, you can choose to put your foot down or carry on at your own pace. Life is not a race or a competition. Enjoy the journey and don’t put your foot down and miss the beauty and opportunities around you.

 

“Never let the sun set on an argument”

A quote taken from Ephesians 4:26, in the heat of a disagreement it can be hard to reach resolution. Feelings of anger or resentment can be destructive if not handled properly, both to our physical and emotional health, but also can have a wide reaching impact on our relationships and careers.

 

“You are in charge of your own feelings”

This would often come during a typical teenage temper tantrum and mum would tell me that I was in charge of how I felt. At the time, I never understood it, but as I have got older it makes sense. Yes, a certain event or circumstance may trigger emotions e.g. an argument might make us angry, but we are in charge of how we deal with that anger. Do we bottle it up, or do we move on and resolve and forgive? You are in control of how you handle and react to your feelings.

 

“If you can’t do it, learn to do it”

If there was something I wasn’t able to do, mum would always work out if there was a way to learn it. She always believed education, in all it’s forms, was the way to improve oneself. As doctors, we are somewhat infamous for our poor handwriting, but even growing up my handwriting was questionable. So mum would keep buying me handwriting books to try and practice and improve. When we come up against something we struggle with, we are faced with two options: we can give up, or we can adapt and work through it, and it was my mum taught me that we didn’t give up.

 

“One day you’ll thank me”

They were right. We’re incredibly thankful for all they have done and taught us. Abraham Lincoln told us that “All that I am, or ever hope to be, I owe to my Mother”, and we’re inclined to agree.

 

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What makes you happy? Mindfulness, Hygge and beyond.

It’s International Day of Happiness, a good time to think about what makes us happy and steps we can take to improve.

Our emotional wellbeing can have an impact, both positive and negative, on our physical health. It’s a fact backed by countless studies including the annual World Happiness Report.

In 2017, Norway topped the polls of the World Happiness Report. They’re joined in the top four by Denmark, Iceland and Switzerland. The rankings look at the main factors that are considered to support happiness: caring, freedom, generosity, honesty, income and good governance.

The 2017 report also examined the social foundations of happiness and it’s importance and demonstrated how work is also a big part of our happiness with unemployment being linked to lower scores.

Within countries, differences in happiness appeared not to be explained by discrepancies in income, but by difference in mental health, physical health and personal relationships.

Patients with chronic illness and chronic pain have higher rates of depression and we know that depression can worsen our experiences of illness and pain – the physical and the psychological are intrinsically linked.

When faced with troubles – stress at work or home, financial worries or health worries, it can be easy to focus on these and lose sight of what keeps us happy. In psychiatry sometimes these are referred to as protective factors – unique facets our lives that keep us safe and happy. For some, it might their family, their spouse, pets – to be honest it can be anything, as long as it works for you. Imagine the scene from Harry Potter – where he has to visualise a happy memory that Harry Potter before he could fly a broom – it’s the same principle! By understanding those principles that truly make us happy, we can call on them in times of need.

Not losing sight of those factors, or the bigger picture, are similar to concepts explored by mindfulness. A Buddhist philosophy that promotes the focusing on the here and the now, and quietening our minds to the external stressors. Mindfulness is gaining popularity in and outside of medicine and it’s ability to help with problems such as anxiety are becoming more apparent. There are lots of really useful online tools for mindfulness and if you’re someone who has anxious tendencies, they are worth exploring.

One way to naturally boost those happy feelings are exercise. There is a unique sense of wellbeing that comes after a work out or after exerting yourself. The process itself promotes the release of endorphins that boost our mood. Not to mention the added benefits on the body, the heart, improved sleep etc.

In honour of International Happiness Day, I have been reading about Hygge.

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A cosy, bubble of good feelings that has come from our Danish cousins – it might not be that much of a coincidence that they made into the runner up position on the World Happiness Index after all.

Hygge, which has been open to some speculation, has saturated our media – newspapers, blogs, insta posts, of late. So popular, the Oxford Dictonary short-listed it as a word of the year in 2016 (it lost out to ‘post-truth’). But what is it all about? In short, it’s an approach to living that embraces the positive and enjoyment in everyday experiences which are thought to be core in the attitudes of Scandinavia.

Whether you choose to follow the teachings of mindfulness, the concepts of Hygge, you work it out in the gym or another path to happiness, remember this: your emotional health is as important as your physical health. We are well when we are holistically well, our body and mind working well together.

 

 

 

 

Your sense of self: the magic five.

Self Confidence.

Self Esteem.

Self Worth.

Self Belief.

Self Respect.

All priceless. All fragile. All unique.

Our sense of self is intricately tied to our personalities, experiences, belief systems and the bubble we find ourselves in. It can take a life time to build and a second to shatter.

 

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On the face of it, the five S’s may all seem similar concepts but each one is a like a snowflake – outwardly uniform but subtly different to the next.

In today’s society when we are so often judged on how well we do our job, how many exams we passed, how productive we are, what material possessions we have or don’t have, it can be easy to conflate our self-confidence by listing our many achievements. However to face and accept our flaws and weaknesses takes real strength. It’s our self-esteem that allows us to look at these facets of our character and not be lessened by them. A robust sense of self esteem enables to us own our flaws, learn from them, use them, grow from them.
Alexander Pope wrote An Essay on Criticism in 1709 and told us “To err is human, to forgive is devine”. Whether you have faith in a higher power is immaterial, and whilst Pope may have been talking about literary critics, his words ring true when considering self-esteem.

Mistakes, flaws and errors are part of what makes us human. Being able to forgive ourselves is part of our ongoing development. We need to acknowledge and accept these to be able to move forwards.

Valuing what we can offer our friends, our family, our colleagues, the wider community or, more importantly, ourselves helps to re-affirm our sense of worth and place in the world. We all have a place.

What we do with that place, to a greater or lesser extent, has much to do with our self-belief. Einstein said that insanity is doing the same thing over and over and expecting different results. If we never change what we put in to something, how can we ever expect a different result?

At a couple of stages in my professional life I have had attacks of “Imposter Syndrome”, a pervasive feeling that at some point I would be uncovered as a fraud. I lacked the confidence and belief in myself and my abilities. The first was immediately after medical school. For years as I rotated through my house officer (residency) jobs, I kept all my old med school notes and textbooks – just in case the university called to tell me they had made a mistake and I hadn’t actually passed my finals!

The second time was shortly after I qualified as a GP. I worried all the time that I would be “found out” and that I wasn’t really “good enough” to do my job. Thankfully with time, supportive colleagues and a helpful husband, I learned to settle in my work. I still have moments when doubt starts to creep in, but using strategies I have developed over time to refocus my self-belief and confidence, I can pick myself back up.

Having a goal – whether it be in your work, your home life, weight loss or fitness goals – and the effort and drive it takes to reach it – all relies on your self-belief. That intense faith you place in yourself that you will reach your target. This one (as they all are) is tricky. It’s vulnerable to knocks along the way and this can lead you to deviate from your goals.

An analogy I often use with patients when we talk about goal setting is to imagine climbing a mountain. When you are in the foothills looking at the summit, it can seem an awful long way up. It’s easy to think of at least ten reasons not to start the journey – it’s a long way, it’ll be hard, I’m not prepared… But if you think of that same journey as a series of shorter journeys, perhaps from the foothills to base camp. From base camp to the next rest stop, and then to the next and so on until you reach the summit. Then at each rest stop allowing time to gather yourself and evaluate your progress. Whilst the journey might still seem a challenge, breaking it down to smaller chunks makes it more manageable.

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A buzz phrase in medicine, and education generally, is SMART. A tool for setting goals, it tells us that goals should be:

Specific (what are you going to achieve)

Measurable (how will you know when you achieve it)

Achievable (is it within your ability – if your idea of art is drawing is limited to stick people it might not be achievable to think you’ll open at the Tate Modern or MOMA in twelve months time)

Realistic (perhaps you are a great artist but accept it might take ten years for an opening in prestigious galleries) and

Time Specific (when are you going to achieve it by)

Either way to get to our goal takes self-confidence to learn our strengths, self-esteem to accept our weaknesses, self -worth to believe we have value and the right to dream and self-belief to push on and achieve it.

Which leaves the toughest one of all, self-respect.

Underpinning all of these is the respect we have for ourselves. Our esteem, worth, belief and confidence are, in general, internal concepts. They are what we think. Our respect is generally what we do to ourselves in the physical sense. Self-respect doesn’t care what happened in the past, it’s about what you are doing right now.

If the other four S’s are talking the talk, your self-respect is walking the walk.

No one, in any shape or sphere can or should take your self-respect. The only person who has any right to your self-respect is you. If you have a bad day, or week, or even a bad month your esteem, confidence, worth or belief might take a beating, but it’s your self-respect that will build you back up.

Self-respect is lifetime work. There will always be critical voices and adverse life events ready to knock you. However if you can ensure you respect you for you, you’ll make it through. Imagine your self-respect as a small seed, planted in the ground. To grow, it needs to be nourished and fed to flourish, ignore it and it will risk withering and decaying.

Having respect for yourself means taking care of your body, your mind and your actions. Be proud of you. Don’t settle for something that is less than you deserve. Forgive yourself, we have all done things we are not proud of, but berating yourself for these for the rest of your life won’t get you anywhere. Surround yourself with positive people and influences. Take care of your body – you only get the one. Don’t compare yourselves to others. Theodore Roosevelt told us that “Comparison is the thief of joy”. Treat others with respect but do not allow others to disrespect you.

“Self-respect cannot be hunted. It cannot be purchased. It is never for sale. It cannot be fabricated out of public relations. It comes to us when we are alone, in quiet moments, in quiet places, when we suddenly realize that, knowing the good, we have done it; knowing the beautiful, we have served it; knowing the truth, we have spoken it” Alfred Whitney Grisworld

 

–Alex

 

 

A lost art?

All week it’s National Conversation Week. Sounds simple enough, do we really need to be reminded to put down our myriad of devices to have an actual conversation?

Sadly, we do.

In these days when we can communicate via 180 characters or by stringing emoji’s together, the art of the conversation is risking being lost.

As human beings we crave social connection. Like many mammals, we are social creatures.

 

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Are we hiding behind our devices and forgetting the importance of conversation?

Communication, and conversation, is so pivotal in medicine. Whether it be breaking bad news to a patient or relative, explaining the risks of treatments, or just allowing a patient to talk and unburden themselves. Conversations are two way streets. But it’s in the area of mental health where a conversation can be the most important.

A common feature of depression is withdrawal and social isolation. A patient who is battling depression actively seeks to be alone and will often close down to the outside world. It might seem trivial, but just asking how someone is can make a real difference to the one who is suffering.

It’s a common misconception that talking about suicide with someone who is depressed will ‘put ideas in their head’. Having a conversation, or letting a friend, colleague or loved one know you are willing to have that conversation, can go some way to shining a light in their darkest of hours.

As GP’s, we work within a geographical boundary and have responsibility for the health for patients within that area. Each GP will find their patients in that area can be slightly different – younger, older, rural, urban, higher or lower socioeconomic class, and sometimes a real mixture.

Our practice area contains a high number of elderly patients and loneliness is something we see often. It is not uncommon on a home visit to sit with someone and realise you might be the only person they see that week. As a professional, it’s heartbreaking. As a human, even more so. Unfortunately as a GP in my day to day life, we don’t always have enough time to sit and reminisce with our patients, providing them that social connection they crave. Just as the health service is stretched, so is our social care system. The number of isolated elderly people living in the U.K. will only increase as medicine advances and life expectancy increases. There are charities and organisations which try to help combat the loneliness by providing outreach programmes and day centres.

For me, I wish that we all took ten minutes out of our day to have a conversation with someone who might really need it. We exist in communities but live in our own bubbles. Say hello. Ask how they are. Listen. You don’t know if you are the only person they may speak to that day.

–Alex