Rangan Chatterjee is a GP who works in the Oldham area of Greater Manchester. He is featured in a rather unique series of TV programmes on the BBC entitled “Doctor in the House”. Dr Chatterjee lives with a family for a period so that he can get to know and understand individual members in order to gain insight the root causes of any illnesses they have. His approach has stemmed from the fact that in his early days as a GP he soon realised that he was only helping about 20% of his patients. The problem was that his training had not prepared him for the majority of issues raised by his patients which include headaches, joint pain, gut problems, indigestion, weight gain, stress, diabetes and skin complaints. As a consequence, he undertook an extensive programme of additional training to obtain the expertise needed to deal with the wide range of conditions he encountered.
In the first TV programme one of the people Dr Chatterjee met was Sandip, the step-dad who was aged 49 years and had been suffering from T2D for about 10 years (1). It was evident that the condition was potentially very serious because the HbA1c was about 9, there was nerve damage in his fingers which could result in amputation and he was on 3 different drugs. He and the rest of the family were persuaded to make drastic changes to their diet. All the foods and drinks that contained sugar and carbohydrates were dumped. The focus was on plenty of fresh foods, especially vegetables. Despite a certain amount of difficulty the family eventually managed to adjust to the challenge. Because of his T2D, Sandip agreed to starve completely for one day a week on a regular basis as it has been established that this can help to overcome the T2D.
Sandeep was encouraged to take up exercise and was shown how he could apply High Interval Intensity Training (HIIT) techniques to his walks. This involves setting targets which enable him to achieve continuous improvement in his fitness.
The impact of all the measures was extremely successful. The HbA1c came down to about 7 and he was able to stop taking 2 of the 3 drugs he had been prescribed. Although not ideal, it was clear that he had made incredible progress and that further improvement would be expected.
In the second programme Dr Chatterjee met Ray, who worked in the NHS as an IT manager and also owned his a fitness centre so he led a busy stressful life (2). He had been suffering from severe back pain for many years and was taking incredible amounts of painkillers and other drugs to deal with his condition. To cut a long story short, Dr Chatterjee was able to find the right kind of support. He was shown exercises that were beneficial and as a consequence he achieved a complete recovery. Drugs were no longer required and Ray reckoned that he was a “new” man.
These results are extremely encouraging and demonstrate the huge potential for dealing with the many forms of ill-health that are so common today.
On the other hand, they also highlight the serious inadequacies of the modern health care system. Those who featured in the programmes are the lucky ones. Without the help and support from Dr Chatterjee they would still be struggling to cope with their poor health which in all probability would continue to deteriorate. The reality is that there are millions of people who will not benefit in the same way because the treatments provided are not working.
There are a number of reasons to explain why this is happening.
- It is evident from the experience of Dr Chatterjee that the training of doctors is far too limited. Hence they simply do not have the expertise or the awareness of most of the conditions they encounter.
- The usual time allowed for a consultation with a GP is about 10 minutes, which is simply not long enough to get to know enough about the patient and their lifestyle to understand the fundamental causes of their ill-health.
- The almost universal mantra on the part of patients and medical professionals that the answer is some form of medication. It is notable that in both the cases mentioned above once the root cause had been identified and addressed that the need for medication was drastically reduced or eliminated completely.
The insight gained from these programmes only serves to reinforce the conclusion that our healthcare services are not fit for purpose. Despite the continued increase in expenditure all the indications are that public health standards are getting worse. The incidence of diabetes has doubled in the past 15 years and all the prognostications are it will continue to increase. Obesity, kidney disease and Alzheimer’s Disease (AD) also have similar trends. The same pattern is evident in most other countries.
If things continue along the same lines it is predicted that the NHS faces a funding shortfall of £30 billion by 2020/21.
There is only one possible conclusion: the strategy is fundamentally flawed. It is absolute madness to carry on in the same old way, throwing money into the system and expecting a different result. The brutal truth is that the existing approach is not sustainable in the long run because there is a limit on how much can be spent. Eventually events will dictate that there has to be a complete overhaul.
The lesson from “Doctor in the House” is that there are ways and means of successfully overcoming many common chronic conditions. Clearly it is not feasible to provide the resources deployed in making these TV programmes to everyone with similar health problems. However the knowledge and insight gained from this type of exercise is extremely valuable. This must be used to develop completely new strategies for the mainstream health professionals.
I have no illusions about the major difficulties which will be encountered in any attempt to make radical changes. It would be a terrific start if only there was a more widespread recognition that maintaining the status quo cannot be the right option. There is huge potential for a totally new approach which provides individuals with appropriate accurate information and enables them to take on a much greater degree of personal responsibility. Self-empowerment will go a long towards increased efficiency in the utilization of resources.
Above all, Dr Chatterjee deserves to be congratulated for his own personal initiatives to extend his expertise and the amazing success he has achieved.