World Voice Day Special pt 2 - Belief Systems & Diagnosis - with GP Dr Ayan Panja

For the second half of our World Voice Day Special edition, we're talking belief systems and diagnostics with one of the most influential GPs in the UK (Pulse Magazine), Dr Ayan Panja. 

Dr Panja is a GP (family doctor), podcaster, presenter on BBC World News and the bestselling author of "The Health Fix"

00:00 What motivates a working GP?
04:01 Putting health into context
06:25 Different cultures and body psychotherapy
08:13 The first lifestyle medicine course
11:11 Beliefs and diagnosis for singers
13:08 Beliefs and diet
15:55 There isn't a single balance
17:20 Stop chasing the symptom!
19:00 Jeremy rolls his eyes...
21:00 Singers, doctors and antibiotics
23:13 Sore throats, acid reflux and mucus
26:40 Rolling with resistance
28:30 Looking for the fix
31:19 Taking part in your own health


Get Dr Ayan Panja's book (highly recommended) The Health Fix here https://amzn.to/49xGTUL

Listen to Ayan's podcast Saving Lives In Slow Motion here https://open.spotify.com/show/3608nfD5nUcRyKtgAba6DT

ADHD for adults: https://www.healthline.com/health/adhd/adult-adhd#takeaway


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Transcript

This is A Voice, a podcast with Dr Gillyanne Kayes and Jeremy Fisher.

Hello and welcome to This Is A Voice series 9 episode 4. The podcast where we get vocal about voice. I'm Jeremy Fisher. And I'm Dr Gillyanne Kayes. And we are back with part 2 of our World Voice Day special with the excellent Dr Ayan Panja. Hi. Thank you so much for having me back. It's a pleasure and an honour.

I'm really looking forward to this. So let's just, let's jump straight in with the first thing.

Can you tell us a bit about your why? What is a working GP doing on Instagram? And also what motivates you? Gosh, they're tough questions. I guess, On that one, it goes back a long way. So both my parents were NHS doctors, and so it's in my DNA to some extent. This is a very common, slightly stereotype, story.

And so actually when I was growing up, I, they made it look very easy. They weren't GPs, they were based in hospitals and the community. And so that sort of ingrained in me this idea of, helping people and being able to be part of a community and doing something useful. And I could see that, they, just the thanks they got from people and, it was just a useful, you're a useful member of society, you know, a bit like being in teaching, or, or, something where you're doing something of service.

That was quite important to me. And so that's probably the why bit, because you're doing something in, and I, as on a tangent to this, I get so many patients over the years that work in journalism or in media and they suddenly at the age of 35, they go, Oh, you'll never guess what, Dr. Panja, I'm gonna, I've decided I want to become a nurse.

And I go, Oh my gosh, really? Do you know what's involved in that? I go, Yeah, well, I really want to give back, because my job's a bit vacuous. I've been a TV producer for ages and I just don't fancy it anymore. And they've got this signal that they, this sort of pang that they need to do something to help society.

And so we have that, almost de facto by doing the job that we do. And in a way it's, it's, it's a double edged sword because you can become burnt out from that. If you speak to any teacher, they'll tell you what their work's like. But the, the Instagram bit is because I think over the years, you know, I've done a lot of broadcast work in a previous life, as well as being a doctor alongside it, and once you enter that world, you're given notes, a bit like when you act in the theatre, and People tell you what you're good at and what you're not so good at can be quite brutal.

Sometimes that feedback, and I'm sure you get it with your students, but and so that a lot of the people that I'd worked with and worked for said, Oh, you're really good at explaining things. That's why we need you on this particular episode on whatever it was I was doing. And I'm like, really, and so that stuck.

And I think the reason I was good at explaining things is that at med school, I was Quite disengaged. I thought I'd done the wrong degree. I'm really an arts person trapped in a, in a scientific world. And so, it was really that that drove me towards doing what I'm doing because I, and you see so many people when you're training to become a doctor, when you're a medical student who do things badly, you're sitting in a clinic and you're watching some wise consultants hand over information to a patient in a terrible way and you think, gosh, I'm never doing that, and this thing about modeling behaviors.

And so, as you go through your career, you look at things that are being done well and things that are being done badly and you take a cue from that. And so I wanted some way of kind of collating all the stuff that I thought was good. And my strapline now is, when people say, Oh, what do you actually do?

Because it's quite confusing. If you look at my LinkedIn profile, it's, it's really confusing. It's like, what does he do? Is he like a, is he a TV doctor? Is he a lifestyle medicine guy? Does he run courses? Is he still a GP? Actually I do all of those. And I like that. I like the variety of it, but ultimately my role is to put health into context.

I think. And I have a keen interest in prevention and hacking. So you're not hacking, not biohacking, but just making life easier for all of us. Oh, you've said so many magic words in that. The last one you said was context. And for me, context is like the business, because why would you do anything unless you know what the context is?

And once you know what the context is, you know what to do. So a hundred percent. And also, I was wondering cause we were kind of riffing before we went on air about the importance of meeting people where they are, where they're coming from. And maybe, you're talking about being, well, I'm an arts person trapped in a science discipline.

Maybe part of that has allowed you to make that connection with people and given you this open mindedness that I've read about with you, that, you, are prepared to look at alternative health therapies and what they might mean and what they might mean to, uh, to the patient and why they're important.

And I would guess that you probably have quite a lot of colleagues who don't do that. It doesn't mean that they're, not good GPs, but. Absolutely. Yeah. And it, it buys, it buys into this whole ethos of, understand first, educate second. You can't tell people what to do, not that we do that anymore because that's so paternalistic, but you can't give advice unless you really know where someone's coming from.

And and I, I, I remember this happened years ago. I used to be in a really busy practice in Tottenham in North London and really amazing place to work. I mean, the demographic is just, not like anywhere else on the planet. You've got these people who are going to be the next Poet Laureate or whatever, but then you've also got people who are very transient, who are refugees, and they're only there for a while, really, really interesting.

And so you have to use your brain, it works really hard because one minute you're talking to someone who's you know, got an IQ much higher than you because they write for the Guardian or whatever, and, and so the next bit you've got someone who can barely speak English and you, and they're really unworried and unwell, so they don't understand that they need to go to the hospital now, and you're using a translator and all of that sort of stuff.

And so, That, that was where I realized I, I needed to understand more about a patient's sort of background, their culture and their beliefs, and, and I remember the first time I ever met someone who, who worked as a body psychotherapist. I'd never heard of it. I was a very green GP.

I'd just become a GP in the early sort of 2000s. And I was like, body psychotherapy, what, what does that mean? And he, he said to me, he goes, well. means that the words that you use in your vocabulary and your, your language and your linguistics affect how you, get physical symptoms.

And I thought that's interesting. And so then I went off and did a bit of reading on that. This was in the era where the internet wasn't quite as accessible. So, but I think that is really important. And the other thing, the reason it's so important is if you do that, then firstly, the patient knows that you want to help them and you're engaged and half the battle in in any kind of therapeutic relationship is that if you don't think the person sat opposite you wants to help it's not going to work it's just that's it you know and i'm sure you've we've all had bad doctor's appointments or nurse's appointments where they're not even looking at you and they're just It's just a terrible, the whole, the energy is just wrong.

But then you can also overdo it. And I remember when I was early on in my career, I was a bit of a people pleaser. I tried too hard and that's bad as well, because you think, what's wrong with you? You're a bit sort of sugar coated. I think it was because I'd struggled so much with, relatively bright person.

But I didn't really do a lot of work at med school because I, it was taught so badly, I thought, and gosh, cut that bit out in case Imperialists think that. Absolutely not, because I'm going to say the same about music college, it was taught so badly. Isn't that one of the reasons why you run a lifestyle medicine course for other medics along with other colleagues?

Yes, absolutely. And I think that, well, there was an, there was a gap in the sense that we were the first lifestyle medicine course in the UK and I run it with my friend Rangan Chatterjee. He's obviously very well known in that space. And it was interesting because we'd broken it down, you can do a lifestyle medicine diploma online, you can do lots of courses, but they're, they're not really how to courses. There's lots of theory and it's quite dry, a little, dare I say, a bit like GCSE music is these days. So it really suits the children that are grade eight cello or whatever, someone, like my son, for example, he's grade four guitar and, used and plays a bit of saxophone, but it's quite musical.

He's got a lot of musicality. It doesn't suit people like him because actually there's, it's all about. music theory, which isn't particularly interesting to everyone. And it's, it's very similar with medicine. You want to be able to know how to get someone better and enough science so that you know that you're in that arena of evidence based and not doing something that's dangerous.

And so that's what we've created. And it's exactly right. I wanted something that was not dumbed down because it's not dumbed down, but. Mm hmm. clear and well explained and well structured and that's one of the reasons I wrote the book because I thought you know what there's a way of getting this across to the public where they can do this themselves.

When we first started running the course it's funny because we had a lot of the first sort of tranche of people that came along included people like Rupi and Hazel Wallace, the food medic, Zoe Williams, lots of, there were lots of our friends. So the energy in, in at County Hall was amazing and we were like hey.

It's great. The second lot that came were all doctors who were very cynical and had, the people that had come to the first sitting had gone back and told all their colleagues how amazing this was. And actually, I remember Rangan and myself, Rangan goes to me is it just me? Or it's like the energy in this room, like really different to last time, because they were all sat there like this, like, what are they going to tell us about lifestyle medicine that we don't know?

Yeah. eat better and exercise a bit more is what they think it's about. And of course, it's not that. And so we, we, we really had to work hard, because we're all in sales, aren't we? In some sense, a doctor is selling a concept to you when they're trying to, and and I think Rangan and I, because we're relatively convincing.

We, I wanted to quell that bit of us thinking, hang on, look, this isn't about sales. This works. This is, we have to do this. And what I used to do was mockingly shame the audience. And I go, has anyone here actually read one of Rangan's books? And so about half the audience would put their hand up and I go, well, those of you that haven't got your hands up, you do realize if your patients have read them, they're going to know more about this stuff than you are.

You're just not going to be able to connect, uh, not in a sort of, patronizing way, but it was just the making the point that, we've got to know about this, and some people argue that it's not really any business of a doctor to know about lifestyle, but really that's what I thought we would be learning at medical school.

It was all about disease, and, drugs, which is also important, but, but, there's so much else, isn't there? 

I want to go back to the top of this This whole discussion and you were talking about what is essentially beliefs and beliefs, we, we, on our client profile, we do two types of diagnosis.

When we're listening to somebody sing, we do the client profile, which is what type of voice do you have? How does your voice work as an instrument? energy type, processing mode, age, level, and then the top one is Belief About Singing. And I always think of it as the top one because Belief About Singing infects everything that you do when you're a singer.

And I just want to unpick the whole belief thing. thing because it seems to be so important. It's not, doesn't just have to be belief. It's just the idea that you have about something. And it's exactly the same with the idea that you have about your health or ill health or what's wrong with you.

And I think you deal with it in a, in a certain way when you're doing your diagnosis. Do you want to talk about that? Yeah, no, that's a really good point. And it comes down to starting with the patient where they're at and meeting them where they're at and understanding what is going on there.

And it used to, It takes a while to learn to do that in medicine because I, when I see our new trainees and when I was a green GP, it's very much, you're desperate to get the diagnosis right, aren't you? And you think, oh gosh, what could this rash be? But, but, and, and actually when you hear experienced GPs, talk about whole person care.

It's like, well, how does that fit into their life? I'm like, I don't care, I just want to get this diagnosis right. And, and you realize as you mature and you zoom out and have a more of a global overview that that's only one piece of this much bigger puzzle. And the way I, I, I guess the, My methodology for that in terms of beliefs is I've been listening very carefully to what someone says.

I've got patients who, so the ones that are quite, You know have mystery symptoms or a little bit broken will often come to see me going I've heard that you know It's worth seeing you because one of your colleagues said to come and see you because I've got gut symptoms and this that and the Other and it's amazing diet is one of the ones where people have very fixed beliefs I've got patients who are on a carnivore diet.

I've got patients who are vegan And I will just say this one thing about diet while we're on it. It's completely individual It's completely individual. There are these, these sort of general signals about what foods are healthy and what aren't. And yes, of course, ultra processed foods are not good for us because, you keep eating that, eventually your immune system will get confused and react and you'll become ill.

But, Actually, there are these, if you're someone who's a type A person who lives on stress and you are go go go and you're on adrenaline and you're eating things like red meat and you're doing lots of aerobic stuff at the gym, That's not going to work for that person because they will just put their blood pressure up.

The red meat will increase their sympathetic drive. It will raise their heart rate. And I've seen this time and time again, these sort of executives who goes, well, why am I pre diabetic? I'm going to the gym even more. I'm already on a low carb diet. I go, because you need to be doing strength work and yoga and eating more vegetables.

He needs slowing down. Whereas. Another group of my patients who are, by and large, middle aged women who have sluggish thyroids. So they need speeding up, so actually they need more of that kind of, it's nuanced and that's the problem. And just like you were saying about your, your singing, it's not just, well, you need to, that old school well, you need to exercise more, just go and join the gym.

No, It's just not enough in this day and age. It's not enough, especially with digital technologies. We've got so much information. I get frustrated at the end. I'm not a digital techie person at all, but in the back, right at the end of the book, I'm like, I can't believe we don't have something on our wrists that tells us whether, you get on with a particular medication or whether you, what your gene propensity is for certain things.

I just can't believe in 2024, I used to look at 2000 AD comics when I was a kid thinking, wow, that's so far away. We'll have flying cars. Where are they? And it's the same in healthcare. We, we, we work in a very 1970s, eighties, nineties, way in, in, in, in some respects. Sorry, I went off on a tangent.

No, actually, you have to cut me off. You have to cut me off. Love it. No, it's super interesting. I mean, we've both done the Zoe program as it happens. Oh, right, yeah. Yeah. And, we have different digestive behaviours, and we have to somehow between the household, we have to balance, what works for us.

I want to go to balancing because everything that you're saying really resonates with me. What you're saying is that people, okay. Can you see, I'm desperate to interrupt. I want to talk about the gut and the immune system. Yes. Because it'll be helpful to our singer listeners. Yes. Okay. Before we go there, balancing.

What you're essentially saying is that there isn't a single balance that everyone is aiming for. There's a balance within each person. And again, I'm back on pattern recognition, which is what you're recognizing is that the balance of that person is off and you want to do something that will get them back into the balance for themselves.

This, I mean, I love this because this is, this is underneath diagnosis. You're, Because you are extra I mean, I talk about this a lot. You're extrapolating. You're taking that person and that lifestyle and their, their intentions and their desires and their wants to live in a certain way or to feel a certain way.

And you're extrapolating where they are now and where they want to be. And you're going here is the route to get you from where you are to where you want to be. It is not the route that I would give to the person next to you because they're heading in a different direction. I love that because that is really powerful, deep extrapolation, and I'm a big fan of it.

Well, thank you. That's exactly right, by the way. And it is exactly, it's not the same, and I think why we go wrong in medicine, and I've done it for years, is we start with the symptom and we're chasing the symptom to get to a diagnosis, not thinking of it as a signal, from that person's body.

And How to interpret it and whether it's part of something bigger and, and, and, I'm sure you've seen in the book, I, there's a, it sounds so simple. So I've, I've trademarked the health loop, which I call the symptom web in the, when I teach it, but the how, what, and when I couldn't trademark that, but that is so key because it's not about Eating better is how you eat, what you eat, when you eat.

And just by changing that, I think the reason the method works is, I might write down four or five things for someone to do, but even if they do one of them, they'll feel somewhat better. Do you know what I mean? It's because, Behaviour change can be quite difficult and some people can't get going.

We're so lucky we've got health coaches now because once I, if I set something and I think they're going to struggle with this, I'll book them in with one of our health coaches who will hold their hand, metaphorically, and work through the behaviour change. And they've had some amazing results that you wouldn't, 50 years ago, you wouldn't think about.

I think you could get without drugs or surgery. I mean, it's that impressive. Honestly. I'm with you. I think the pattern recognition is key and it's, it's, it's about individualizing as much as you can using an Occam's razor approach. No, it's fine. Just going back to the symptoms thing that not just fixing symptoms. And I, I'm just going to back refer a little bit, obviously for our singing voice community that there's a very well known and old fashioned book that I think may have been written in the 1950s called the diagnosis of vocal faults and it's right in that thing that you've got something wrong with you. And right now in the singing voice community although we've spoken several times in this podcast about diagnosis, we have to be very careful about the word diagnosis because of course it has the that paternalistic edge to it.

And really, sorry, I just rolled my eyes for those of you who are not watching on YouTube. I rolled my eyes. I do get annoyed with people who go, Oh no, you mustn't say that. And I'm going, don't do mustn't to me. It doesn't work. Yeah. But the way that we work, We're always giving the singer agency and we're looking at the singer as an individual.

So, that's the way that we work. But I think that, once upon a time, it was that you were looking at this list of things that weren't right, instead of really digging deeper and communication is key, that's one thing that I picked up from you in this conversation so far, that it's not just what you know, it's how you communicate with that person and to that person and how you work with that, that kind of loop, if you like. So they get a healthy health fix. Yes. Unhealthy health fix. I love health fix as your title. It's great because fix means so many different things. Yes. Yeah, it was, people use that as part of common parlance, don't they, like, I think I need a health fix. And amazingly, there was no book out there with that name.

And so, in part of my other world of things, I've often done bits of work with companies that need, advice on how to point products or message. And so I quite like that sort of, that, that branding thing. I couldn't think of a, I think I want, I wanted to call it saving lives in slow motion, but because I wasn't well known.

They needed something a lot catchier, I think. So, but it seems to work, and I think that infinity loop really captures the whole fact that it's it's a dynamic thing and it's, it's not permanent. It's constantly evolving. And then if you start to feel rubbish again, you just repeat it.

That's the thing. It's iterative. So it kind of keeps on giving. I'm sure you use the same method. With your, with your students, when they, you get someone from zero to one and they want to go from one to two, don't they? Mm. And then two to three mm-Hmm. . And after a while they fly on their own sort of thing, so, absolutely that's what we want for them to fly on their own. we have a challenge for you. Gosh. And the challenge is, we want you to sing. Nope. Did you see that nifty segue I did? Talking of people who sing for a living, when a singer comes into your surgery, if they're looking possibly for specialist medical help, usually they have to go through their GP.

So if you're thinking of your diagnostics and your systems and your, I'm going to call it the habit loop. A singer comes in and says, that they don't think their voice is working as it should. What sort of things are you listening for and looking for? Walk us through what systems you might be asking them about.

Yeah, it's a great question and I have had this over the years and the stereotype sort of argument, and it starts actually when you're a GP trainee, they often get actors in to play difficult patients, and the singer one is always like, oh hi there, yeah, I'm I sing in the West End, I'm a very important person, and I I've got a show tonight, and I've got a bit of a sore throat, I just need some antibiotics, and of course they don't need antibiotics, and it's all about how you negotiate that they don't need it, and, and and and I, and I, I'm no expert, although I love singing, I'm no, I'm no expert on, voice work and there's, there's lots of ENT experts in central London that look after those people like, but what I'm looking for and what I'm, what I'm interested in is, again, their belief, starting with why they think that, and often the very high level singers and, and vocal coaches who I've met actually, who coach a lot of the same people that you do, I'm sure, will kind of go, yeah, you know, I can't work, which I, I get that because that's their pressure.

It's like, I can't, I just can't do my work without my throat being right. And, and, and I get, and then I always say, well, what do you think's going on just to see where they're at. And they, often the antibiotic thing is quite high on the list. It's one that they go for because they think it's a quick fix.

Yes. Now, now often I'll. digging around, I'll go, well, tell me when you get the sore throat. And one that I can remember from years ago, it's much worse last thing at night and first thing in the morning. So that sort of sore throat is from acid reflux, it's nothing to do with tonsillitis or laryngitis or any of those things.

It will still affect the sound of your voice because essentially you know, for want of a better explanation, acid will sort of burn the back of your throat while you're asleep. And so there's this sort of valve between your gullet and stomach that becomes slightly floppier over the age of 40. And if you add into that some stress and, not great diet and eating dinner too late and all of those things, It's a very common thing.

So I tend to get it if I drink alcohol. The next morning, I've got a bit of a cough, but it's not a lung cough. It's a phlegmy throaty cough, build up of mucus that's migrated. Sorry, that sounds disgusting, that's what's going on. We're fine with mucus. Mucus is welcome in the singing world.

Yeah. And, and often they What I'm also interested in is what they've tried and often they'll, not to name brands and things, but they'll go, well, I tried these lozenges that are industry standard, and yeah, there's always, always industry standard things aren't there. And I'm like, right, okay.

And I look at what's in them and they're just, there's nothing spectacular. It's a mixture of honey and whatever. And and then I'll give them my explanation that I've just given you and they'll go, oh gosh, okay, hmm, that might, might be what's going on because I've been really stressed about my daughter or whatever, there's something going on, and then we'll deal with the acid problem and how we can work with that.

So, so, so it is a, it is about working out what else is going on some people, sometimes the person gets irritated if you, do go down that route because they go, what's, sorry, what's my, what's my cycling got to do with my voice, or, like you're asking about other things, but actually it has, once they get that it's a systemic, it could be a systemic thing, they're a bit more understanding.

So, yeah, it depends on the underlying cause. And sometimes there's something in the story. So for example, there was a guy who was having lots of building work done. He was a singer who's sings locally around, he's quite well known just in terms of the local area. But and that caused a lot of dust, and that was affecting his voice.

And again, it wasn't one that needed antibiotics. It was about, getting rid of, staying away from the thing that was triggering it, or maybe taking an antihistamine or whatever. But so it depends on the root cause, if you like, of what's going on. But I do understand that, that pressure though, because it's, if you're, if you're, and it's the same with voiceover artists, or it's the same with broadcasters, they get really panicky if they can't speak.

Their livelihoods are dependent on it, so it is something that needs looking after. So, so yeah, that's, that's my model is just really starting where they're at really and not saying no, because I think that's the thing that they often hear.

It's like, no, well, you're not getting antibiotics. As soon as you say that, the whole consultation's falling apart and they're not going to get better and they'll never come back. So, so it's just, it's being patient and trying to, Take them with you. And I have, some people have dug their heels in over the years, and there's this thing in motivational interviewing called rolling with resistance, which is where you kind of sound like you're agreeing with them.

So often, it's quite useful with smokers. They never, they've always, people have always got sort of money for fags, and they've always got, that's never the cause of it. of their sore throat, is it? And so, and so sometimes if you go, have you thought about giving up smoking? And they kind of go, no, no, I don't want to give up.

And you turn away and go, well, you may never give up, as in you're agreeing with them and it's like, oh, hang on, the doctor's given up on smoking. on me giving up. And so, and, and sometimes I'll, I'll say, do you know what, I can give you the antibiotics, that's easy, but they won't work.

And, and suddenly it's like, oh, okay, once you because they won't work if it's acid, it'll make it worse almost. And it sounds a bit mean, but that's really at the end of like, 15 minutes of having this sort of circular conversation where all they want is that. And I'll occasionally I have given in and go, look, just take the prescription.

That's fine. Take it, if you think it's going to work, good luck to you thing, but it's not. Very, that's really fascinating because that's another type of pattern interrupt. They have a pattern, they have a belief. And then you behave, and they expect you to behave in a particular way, and when you don't, it throws them.

That's really fascinating. And do you know what? I have to try that in the next singing lesson. I think this. It's easier for me to just give them that because it gets them out of the room within a minute, but it's not, it's bad medicine and it's not, not going to help them. And I think once they get that and they think actually, is this, is this guy lying to me or is he and of course I'm not, I'm trying to give them what's right, but anyway, yeah. Just on, on the idea of fix, do you think there's an issue in general with the, the patient community that we come in and we're looking for the fix? Because we've all been there, okay, the doctor will give me a pill and then this will all be sorted out.

I mean, how much does that culture need to change, do you think? Yeah, there very much is. And I think As we all know, there's no cure for the common cold, and it's You know, frankly, it's a total nightmare if you work in an industry where you're using your voice and you've got a cold. And I've been there, I've done it, we were filming something in the Lake District and, it was freezing anyway, and I, and the producer goes, hang on a minute, and he goes, hey, have you got a cold?

And I go, yes, there's nothing I can do about it, I'm sorry, I just, it sounded like this. And so, and it doesn't sound good on camera, but that's just the way it is. And I think, I think, People, I think one thing we haven't acknowledged is, is the effect of COVID. And, and one of the things that people have fundamentally changed a bit since then, it's it's weird.

I was watching Breathtaking, which is this, I don't know whether you've seen it, this this sort of film that was made by Rachel Clarke. And it's a dramatization of the COVID years in an NHS hospital. Brutal to watch. I've seen it. What was bizarre was how distant it felt, but how recent it felt as well.

It's sort of like, hang on a minute, that looks really familiar. And I, I remember it, and I remember being the only person on my road just driving to work because everyone was, and that's horrific. And when you think of that, people since then have become, much more right, I'm not going to waste time now because life is precious and all that sort of stuff.

And we've, we've all got for what, again, I don't mean this seriously, but mild PTSD, I think from those years that we haven't really processed and won't, we won't see the impact of it for another few years. As a result, people are much more. willing to kind of say, right, I, I never, I never bothered the GP during all those COVID years.

They did nothing anyway, which is not true. I'm going to, I'm going to get my, tuppence worth and I'm, you've got to sort this out. And it's all about locus of control and whether you, your illness is the doctor's fault and the doctor's job to sort out or whether you take responsibility for it.

And it's patients often fit. different categories and it's, it's often the ones that we don't hear from and the ones that have low self esteem who find it very hard to ask for help and they're the ones that you have to sort of hunt out really. It's the ones that sort of shout very loudly that get all the attention.

It's that 80 20 rule and it's a difficult one when you're trying to treat everyone equally because that, you have to. So, yeah, we actually did, we did, I think, four podcasts on COVID and long COVID and then and a couple on COPD as well.

I think what's fascinating is that if you are a patient who wants to take part in your own health. I'm going to recommend the book because it's such a great way of doing that, of actually taking control of what you do and also being informed. I mean, this is the big one for us, is that are you informed in what you want to do? 

And it's better than Dr. Google. Yes, it is. It's a lot better than Dr. Google. It's also about being your own agent, isn't it? Taking care of yourself. And personally, I've found from having read the book and listening to your podcast, I have more beneficial conversations with the GP about things that might be going on for me.

Because. I sort of understand more how she thinks now. Yes. I think that is really really precious for the average patient. I really do. And I want to thank you for that. Because there's a platform for communication then. Yeah, absolutely. Yeah. And it's it's, it's strange, isn't it? I love, and I'm, Chuffed that you say that, that's so nice to hear, but it's almost, um, that thing I was saying at the beginning about, jokingly shaming some doctors about not, not having read a book on lifestyle medicine.

This book isn't to, to out doctors that don't know it. I'm not any cleverer than any other doctor and, and all of us have areas of interest. It's just It's so simple, and I, what, what slightly irks me is that there's a whole bunch of doctors that don't believe in this model of medicine and they, they say, oh, it's all common sense anyway, but it's not really, unless you're shown the sort of the rubric of how it maps together.

It's not just about, eating healthier and exercising more. The other, the other thing is there's an accusation that this is all very middle class, and I understand, I've worked in very deprived areas and I do, I do understand some people don't have, enough money to eat, I get that.

And it's not aimed, you start with where you're at, for that person in, in primary care, we would we would activate our social prescriber and try and get them some help. Whether it's through food banks or whatever. It's not just for people who've, who've got the basics ticked.

It's for, it's for anyone, really, and I do try and nod to that in the book. I do understand that it's not just, the, and, and, in St. Albans where I live, great place to live, but, there are lots of people that want to go from eight to nine, and actually I'm not designed for that because I've got, I'm far too busy, if you want to do that, then, Go and see someone privately that's going to get you that last bit.

It's well, I can't get under two and a half hours for a marathon. I'm really need to break that. I'm not your guy for that, and you've got to know, how your cloth is cut in a way for as a practitioner. So, yeah. It has been such a pleasure to talk to you. And, and likewise, honestly, I feel like we could talk all day.

We could, we could. Happily go on all day. So, we just want to say thank you for coming to us, sharing everything that you've talked about. And, uh, again, we're going to reckon, uh, recommend that people get the book The Health Fix Absolutely and do listen to Dr. Ayan's podcast, which is called Saving Lives in Slow Motion.

Thank you so much. It's been an absolute pleasure. We must connect again. Yeah, brilliant. Thank you. Lovely, lovely. We love that. See ya. Thank you. Take care. 

This is a Voice, a podcast with Dr Gillyanne Kayes and Jeremy Fisher.