Wellbeing For Real Life - Connections

In this episode of the Wellbeing for Real Life podcast Dr Richard Pile and Dr Wendy Molefi talk about connections.  Human beings are social animals who need connections if we are to thrive.   Richard and Wendy discuss the challenges we face as a society, the problems of loneliness, the benefits of having meaningful relationships and give their top tips for building strong connections with others.   A video version of this episode is available  on YouTube.

Richard is a GP specialising in Cardiology and Lifestyle Medicine, and author of "Fit For Purpose: your guide to health, wellbeing and living a meaningful life".  Wendy is a GP specialising in Mindfulness.   You can find out more about Richard here and Wendy here.

Fit For Purpose is available from Harper Inspire in paperback, e-book and audiobook format, with Richard reading the audio himself.  Find out more here.  This podcast has been produced the brilliant team at  Monkeynut Audiobooks. 

Transcript

Richard Pile  0:11 
Welcome to the wellbeing for real life podcast. Have you ever wanted to live life better, but found yourself baffled bewildered and bored by complicated, confusing and condescending advice? This podcast is the antidote. I'm Dr. Richard Pile. GP, lifestyle medicine specialist, and author of Fit for Purpose. Each episode, I'm joined by leading experts as we explore different areas that affect our everyday lives. This is the Wellbeing For Real Life podcast.

Hello and welcome to wellbeing for real life. In this episode of the podcast we're talking about connections.  I'm Dr. Richard Pile, GP with a special interest in cardiovascular medicine and lifestyle medicine, and author of the book, Fit for Purpose. My guest in the studio today once again is Dr. Wendy Molefi.

Wendy Molefi  1:00 
Hi Richard, thank you for having me again.

Richard Pile  1:02 
It is lovely to have you back. Wendy for those who haven't listened to this podcast before, can you just tell us a little bit about yourself?

Wendy Molefi  1:08 
I'm a GP as well. In fact, Richard and I have worked together worked together many years ago. And over time, I've also trained as a wellness coach as well as a mindfulness teacher; really disciplines that I feel kind of compliment my consultation style. I like to just bring in the whole picture when I consult.

Richard Pile  1:32 
Thank you, Wendy, and the thing we're talking about today is connections, and I know that you and I both believe that that's one of the really important pillars of well being. We can talk about sleep and movement and nutrition and those are quite obvious physical things where I think connections with others is, for me, probably one of the most important pillars of well being. And I wanted to start by asking you, particularly in the context of the pandemic about loneliness really.  Do you ever have patients come up to you in the surgery and say "Doctor, I'm lonely. That's why I'm here, that's why I'm coming to talk to you today".

Wendy Molefi  2:06 
That's really interesting.  Not often, you know, not often.  Some patients you get a sense of it, you know.  I guess as GP's we're in that privileged position of really knowing our patients, and we know their social circumstances, and we can tell sometimes when perhaps when they're presenting frequently or when they come and the story just doesn't quite fit. And it's really through digging, and asking the right kind of intuitive questions to find out a little bit more about what is the story here that you can have a sense of, there might be loneliness. Yeah. So, the answer really is that it doesn't often drop on your lap, like "Doc I'm lonely".  I don't know what your experience is Richard, in your practice?

Richard Pile  2:52 
I agree with you, I think, usually the people that admit to being lonely tend to be the ones that you've actually spent a bit of time with so they know you and when they're talking to you, it's an ongoing conversation isn't the first time they've ever met you.  People don't tend to open with "the problem is that I'm lonely". Those patients that we see at the surgery a lot, the frequent attenders, whether they come to our surgery or to the A&E department, sometimes the underlying reason really is that they're essentially lonely, and I think for me, loneliness, I think it's been defined as the difference between the quality of the relationships that you have, and the quality of the relationships that you'd like to have, and if you've got that mismatch. I think what people don't realise is that actually, it can have real consequences for their physical health. Is that something that you talk to patients about?

Wendy Molefi  3:42 
Yes, absolutely, it's something to think about and something that you also mentioned: some of the patients who come that you know very well and they might allude to the fact that they're lonely and loneliness is not only the sense of living alone.  You can be with people or be in a crowd and still feel quite lonely so there's that, to think about as well in terms of what does loneliness mean to you, and it means different things to different people. And in itself loneliness has, you know, mental repercussions, and that in turn, will cause other kind of physical problems. So sometimes you have to find a way in. If it's through some physical condition and exploring that a little bit more, but ultimately you really do have to try and explore the whole story because if you don't address it, or if you take the shortcut and just give them a painkiller or something because they complained about a headache, then you're really doing them a disservice.  You're not to really taking a bit more time to just try and figure out what the problem is because it's it's a pandemic waiting to happen. I think that data shows something that we might not be aware of - that loneliness has lots and lots of other manifestations.

Richard Pile  5:02 
It does remind me of the story of how not to do it. One of the senior doctors in my practice whom you and I both know but I won't name, this was not actually his issue but it was his trainers issue so going back a very long time. When this particular friend of mine was a trainee GP. He once sat in with his trainer GP, and a lady came in, and her presenting complaint or opening gambit or whatever the term is that you use, was about a headache. And they spent a long time talking about her headache, and my friend who was a junior GP was sitting at the back of the room thinking, "I don't think the headaches, really the problem" and she kept doing what we call "dropping cues" in the consultation, and she would refer to her relationship, her marriage, the difficulty, she was having with her husband, and the GP, that was my friend's trainer seem to ignore every single mention that she made of that, got the consultation over with very quickly and the patient left the room with a prescription of a painkillers for her headache.  My friend was thinking "I've got the world's worst GP as my trainer, how terrible".  This doctor then turned around him and said "What do you think that person wanted to talk about?", and my friend said " I think she wanted to talk about her marriage!" to which the other doctor replied "Yes , so did I but I wasn't going to open that can of worms!"  I know that we are joking about it but it illustrates your point perfectly - that if we're not careful what we end up with is effectively palliating our patients and by that, you know, in the medical world we use that term as you and I know to describe people for whom no further curative treatment is available, and when we're trying to ease their passing. We can't cure them we can't fix them, but we're just going to make life a bit less uncomfortable for them. And we're comfortable doing that with people who are dying from cancer or heart failure or dementia or just very old age but the risk if we don't pick up on those cues and have a way to respond to it in primary care and in my view is that what we're effectively saying to them,  to a 20, 30 or 40 year old is "I'm sorry that your life is a bit rubbish and that you feel lonely and that your relationships aren't great, but because I'm a doctor who's been trained to look after people with diseases, all I can really offer you are painkillers or antidepressants, and good luck".  And I think that's a, that's a real challenge to us,

Wendy Molefi  7:18 
It is a real challenge, but I'm just sitting here thinking, how can we change it then, as a profession I guess? How can we start approaching loneliness or such difficulties, challenges that present in that sort of way?

Richard Pile  7:32 
I think that's a really important question and we have seen some acknowledgments of that now.  The government has a minister for loneliness.  It's not a job I'd be queuing up for but I guess they get up before they move on to a bigger job, but it is an important statement of intent, I think, and we know also that the NHS has invested money in primary care networks. These are collections of GP practices so that someone can be employed, who is a social prescriber, they have different names: community navigators social prescribers, health coaches, key workers. But as you and I are used to having these people, of course, are there for when this situation arises. As a doctor I might think that I can't really help you with the fact that actually you don't have any close friendships or that you've been bereaved or that you've had a breakdown of your relationship, but I know someone who can. And in our practice we can refer people into the social prescribers, and I explain to them and say look, you know, sometimes in life there are things which aren't directly what you might call health-related there are things that maybe as a doctor, am not necessarily the best person to help you with. But actually, this person either can, or they can point you in the right direction. And I don't know whether you've seen that in action, seen the benefits of that in your practice?

Wendy Molefi  8:50 
I think, certainly the conversations are being had.  We're beginning to realise that it's something that we need to address. And as you and I are aware how time poor we can be as GP's in consultations. It's just about having that, at the back of one's mind and thinking a little bit more about it, and setting the conversation and signposting, and that's something that we haven't really mentioned, I guess, is communities, tribes:  how we can encourage people to just be a bit more involved in, I guess, faith based communities in other aspects of community where they can be less lonely.  Just to explore a different aspect of life. And signposting and you've mentioned to me the social prescribing.  I think I saw something the other day on Gardeners World.  Do you do any gardening?

Richard Pile  9:49 
Not if I can possibly avoid it.

Wendy Molefi  9:51 
Oh, Richard!

Richard Pile  9:53 
Sorry, that's a shameful admission.

Wendy Molefi  9:54 
Anyway, never mind. Another conversation for another day. But yeah on Gardeners World essentially there was a whole programme dedicated to wellbeing. And part of this social prescribing involved, recommending gardening, you know, people going, and spending some time gardening with others. It was really life changing for a lot of people the testimonials that were coming out of there just because gardening is just about so much more than just putting seeds in the ground.  You're going to cultivate that seed without any outcome any known outcome from that point of view.  The social aspect of things - you're going to meet other people, you're outdoors you're connecting with the earth. There's so much more. So, I'm trying to convince you to be a gardener

Richard Pile  10:42 
I would enjoy it if I did it more with other people.

Wendy Molefi  10:45 
But you know social prescribing enables them to be able to advocate for that as well so things like that. Definitely.

Richard Pile  10:53 
I think that's, that's a really good point.  Parkrun for example.  The director of Parkrun whose name I forget, was interviewed once about why Parkrun was set up and what it was. And I think he said that Parkrun is a social enterprise, dressed up as a sports event. Something like that.  And I've seen, I don't go every week and obviously we haven't been able to go at all sadly for the last year,  but I've been a few times in the past and you can see just how much people enjoy it and there were those who were just walking around, as well as those who are trying to smash their personal best. I stay well clear of those people because I don't want to get in their way!  And you mentioned faith and you know there are lots of examples of great community action that are often provided by faith groups and groups that are obviously not faith based. The church has been involved in lots of things like, well, food banks for example during the pandemic and just giving people somewhere, a place to go and talk

Wendy Molefi  11:50 
Yeah absolutely and other voluntary organisations certainly like the Samaritans.  That's something that I remember especially because I also work for an out of our service whereby you've never met a patient, and yet you sense that turmoil really, and it can be difficult in an out-of-hours setting to recommend where people should go in terms of mental health/loneliness, that aspect of things. So the Samaritans have been very kind of useful in that sort of sense.   I guess it's a faith element to that but equally they are available from that point of view. So, really approaching this in that psychosocial and cultural aspect, respecting those.

Richard Pile  12:33 
I think just to go back around the houses slightly...we started off talking about seeing patients in our consultations and loneliness is a real issue because there is good evidence to show that it could knock a significant number of years off your life expectancy in terms of death from all causes simply through loneliness. So if a patient does end up in front of you, whilst you may not have hours to spend with them, and the correct answer ultimately may be some signposting and some encouragement, if we were talking about some tips for for managing loneliness and building connections, what are the kinds of things that you might suggest they could consider in terms of building or pruning, their relationships and their connections?

Wendy Molefi  13:15 
Well certainly it's just about making that investment, especially if loneliness is not necessarily because somebody is alone. It's just because they're feeling a little bit isolated , a bit unwanted a bitt misunderstood. It's about knowing that if you cultivate , invest a bit more in your relationships, it can be fruitful. So making time for that. And one of the things that I was thinking about is that so often when,  I don't know if you've seen it when you're out there, you'll be out in a restaurant, and people are on the phones.  They're not really together.  We're all guilty of it,  I'm not gonna lie, but it's something that I'm very mindful of.  It's just that sort of awareness, yet again, of being mindful of making an effort. We are social beings and just having the courage to connect with other people and talking , it's really important that we talk about these things.  And seeking help.  If you are feeling lonely, not dressing it up as anything else just seeking help.

Richard Pile  14:26 
I think that's particularly valid advice at the moment as well in the pandemic. We know that, as you say we are social animals and people who say that they don't need people. This doesn't really make a lot of sense. It's like someone who has a small appetite saying that they don't need food. We need people in different doses. And we need different qualities and quantities of relationships, and I think we've had to be quite deliberate about it because in the pandemic we've unwittingly conducted the world's largest experiment ever into loneliness.  We didn't submit a protocol we didn't get ethics approval for this dreadful experiment. We just had no choice but we did it. And I think going back to your comments about digital technology, it certainly has its place. I did take part in a few Facebook pubquizzes for the first few months before I got really bored of them.  I have done zoom calls with groups of friends and family. But I think now that we're able to do a bit more face to face, even if it's just outdoors at the moment, there's really no substitute for that.  Our brain knows the difference between a picture on a screen and a person in front of us, as we're sitting talking now. And I think we shouldn't underestimate that. So your comments about the digital, I think is really valid because we need to be intentional and where we can still only see people over a screen because they live too far away, or they're not able to travel because they're poorly or whatever that's valuable, but we shouldn't substitute our our real networks for with the social network instead. That's one of my tips for making connections  as well.

Wendy Molefi  15:58 
Absolutely, I agree with all of that.  It actually makes sense in that throughout the last 18 months or so we have been deconditioned and so that had set that sort of narrative.  In a sense, so it's about following on, and it's about starting to explore a little bit more safely, obviously, but it is about making that concerted effort in terms of connecting with others.

Richard Pile  16:33 
Just a simple conversation can be so nice.  I caught up with Ned the florist, who works in St Albans and we hadn't seen each other for months, because florists are not an essential business (I don't know whether my wife would agree with that) but for a while, he wasn't able to open.  We caught up the other day, and we were chatting away for 10-15 minutes, having not spoken for ages.  Just starting the day with a walk into town in the fresh air and connecting with this guy, and having a chat, a real meaningful exchange, really, from a selfish perspective it's set me up for the day and actually that's one of the tips I give to people in that it's good for you, obviously, but to connect with other people, you know it's good for them and it's good for you.  It's a mutually beneficial thing.  Everybody wins. I've learned that over the last year, I've had some conversations with members of staff and I realised how little I knew about their lives, because my standard thing was "Hi, how are you?  I'm fine. Yeah?  I'm fine too". And you know you've exchanged the required pleasantries and that's job done. And you can't, you can't have a half hour conversation with everyone, but when you do just every now and again, take a moment to think "Did they drop the cue there?" When they said "I'm fine" did they sort of roll their eyes slightly or look a bit resigned? Maybe that's a chance for me just.  to have that extra conversation with them and maybe not be something else and that connection that it builds between you can be a really powerful thing.

Wendy Molefi  17:59 
 Yeah, changing the culture and the environments that we live in, that we work in, because we spend so much time in this environment so if we start to just initiate these one might sound like a little bit of inane conversation, you're talking, and you know makes you feel happy and it makes life not so stressful. We've talked about stress in other podcasts, but physiologically, there is that boost in our brains that improves those, the dopamine receptors and so it's I think it's it's important that we do that.

Richard Pile  18:34 
I think Wendy it feels to me like, as we come to the end of the podcast, that we've finished on a very positive note.  We started by talking about how dreadfully lonely we all are, but hopefully we've come up with some good ideas for people and and shared our experiences of that as well. And so it's been lovely to have this conversation with you. I hope our listeners have got as much out of it as I have, and I look forward to speaking to you again soon.

Wendy Molefi  18:57 
Thank you. It's been lovely to connect with you.

Richard Pile  19:01 
And with you Wendy, thank you.

You've been listening to Wellbeing For Real Life with me, Dr Richard Pile. If you've enjoyed this episode, please give it a nice review and tell other people about it. If you'd like to learn more, my book Fit for Purpose is out now, published by Harper inspire and available in paperback ebook and audiobook. You can also follow me on Twitter, YouTube, and my website Wellbeingforreal.life. This podcast was recorded at Monkeynut audio books. Until next time, take care of yourself.