Old dinosaurs – old problems needing new solutions. I have always been able to think “outside the box”, to think laterally, to look for alternative solutions. This must come from growing up in Zimbabwe (then Rhodesia), being the “rebels”, and having to think of creative ways to overcome political restrictions. Medicine is, by nature, a very conservative profession. We are governed by the dictum “first do no harm”. From this, evidence based medicine arises, at least in the Western context. So, it takes a brave soul to want to explore outside the known, and to be part of the solution, rather than part of the problem.
Change has to come from within. It has to come as a result of the tensions between wanting to find better solutions, and needing to remain safe.
One of the ways is to co-opt patient willingness and co-operation. To explain that everything that we normally do has been tried, and that (so far) nothing has worked. Ask them if they would be prepared to look at alternative solutions. Would they try herbs, meditative techniques, lifestyle changes, therapy of some kind. Perhaps a combination of more than one. From my experience, people are usually (a) very interested, (b) have often already started to think along these lines and are quite relieved to be able to share, and not operate in secret.
Does this mean that this is in the province of general practice alone? I don’t believe so. It is the topic of another blog about how to deal with the answers to these questions; here at least we are on common ground in just learning where the patient wants to go. So, are there these intractable problems in your practice? Are there problems which are crying out to be solved in a non-standardised way? This is what I have spent so much time on, learning, practising. There are real rewards here – it just takes a moment to stop, open your thinking, and ask the question. You may be surprised at the answer.
