The Root Cause of Ill Health
In today's guest article, Dr William Bird MBE explores a transformative approach to healthcare that redefines the traditional model. With nearly four decades of experience and having seen over 300,000 patients, Dr. Bird brings a wealth of knowledge and insight. His innovative perspective centres on shifting from the conventional Healthcare Matrix to what he terms the Resilience Matrix.
Last week, I treated a woman called Lorraine (not her real name) who came to the Out of Hours GP Clinic where I work. She had chest pain that started 3 days ago. She was 42 years old with a diagnosis of fibromyalgia, Irritable Bowel Disease, high blood pressure and arthritis with some acid reflux. She was overweight with long term depression. She had a history of self-harm in the past. She is taking eight different medications on a repeat prescription.
She thought she was having a heart attack. She works for a large organisation in the Finance department. She has used up all her sick leave but told me she never feels well at work due to her anxiety and pain.
Any GP will relate to Lorraine as one of many patients who have a cluster of symptoms that modern healthcare can’t cure. While the medication may offer temporary relief, it fails to enhance her overall quality of life, and the pain relief has minimal impact on Fibromyalgia. She is now stuck in the healthcare system and her life is now defined by her visits to doctors, counsellors and the occasional hospital consultant. The five diagnoses Lorraine has are simply symptoms of her chronic stress brought on by low resilience. We dutifully follow protocols for each problem, resulting in a list of medications, but we are blinded to the miserable life that she is living right now.
Lorraine felt unsafe as a child but never told me why in such a short consultation. As a result, her stress system is hyper-vigilant to protect herself, leading to panic attacks, which, as a teenager, she used to relieve by self-harm. She complains that doctors don’t care about her pain and everything she takes doesn’t work, so she is a victim of an uncaring healthcare system.
She likes her work and has a supportive and understanding manager but worries that she will lose her job if she takes more time off. She admits that she is working at half her full potential because of anxiety, pain and constant tiredness.
After examining her and getting an ECG and some bloods I diagnosed costochondritis. Joint pain in the ribs. She was relieved it wasn’t a heart attack.
After seeing over 300,000 patients in my career of nearly 40 years, I now believe that if we take Lorraine out of the Healthcare Matrix and put her into the Resilience Matrix, we will start to make progress. Social prescribing is a start of this process for the NHS. The Resilience Matrix is based on neuroscience that has shown that there are three main drivers that determine our survival. Being safe, feeling valued and having a sense of belonging . There are also three domains in our life which give us our support. The people around us the place we live and work in and our purpose i.e the reason we exist.
So let’s start with the domain of PEOPLE.
The first priority is for Lorraine to feel safe at work and home. This involves trusting others to allow them to help her. Lorraine has been let down so many times that regaining trust in people is tough but she realises that she needs help and therefore needs to build trust. By developing trust she can allow people to come closer and help her. Despite never feeling compassion she understands that she can lower her guard and rewire her brain to allow herself to feel loved.
The second area in the people column is feeling valued. Healthcare staff increasingly deal with patients by filling in online forms rather than actively listening to the patient with good eye contact. For Lorraine I needed to give her the time and focus she deserves so that she feels valued. She is still deeply affected by the attitude of NHS staff when she attended A&E with self-harm. “They used to look at each other and roll their eyes, which I took to mean that I was of no value, simply an unwanted burden to their busy department.”
The third area is belonging to a groups and communities and this is where social prescribing can be so helpful for those who need to build relationships within a neighbourhood. Lorraine stays indoors after work because of her anxiety and pushes people away due to a poorly functioning parasympathetic system (Vagus nerve).
The second domain is PURPOSE which is where Lorraine really struggles.
The first area is feeling safe with purpose. The most important attribute is to learn to have hope. Lorraine has constantly been let down so has never allowed herself to be hopeful. She therefore becomes a victim of circumstances with everything against her. Being thankful for the small wins each day can very quickly rewire the brain to shift from pessimism to being more optimistic. Having autonomy and responsibility for her health allows her to take more control of her symptoms and become more of a partner than a patient in her treatment.
The second area is feeling valued with Purpose. It’s about wanting to discover, being creative, learning and taking on new skills to build self-confidence and fulfilment. It’s also about self-awareness where Lorraine can understand and control her emotions and how to be more in-tune with her body and symptoms.. Being more self-aware means the symptoms and unwanted emotions become less overwhelming so she can take greater control. This is the area that includes mindfulness that can be taught.
The third area is Lorraine giving her time to a good cause through volunteering. The more she gives the more value she will feel, the more people she meets in a common cause and the more she may be able to benchmark herself against others in less fortunate situations such as poverty and disability or poor mental health.
Finally the domain of PLACE
Lorraine had mentioned that she had just come out of a controlling relationship so she is staying with a friend where she feels safe and secure. She walks down to the river which has become her sanctuary particularly when she is feeling anxious.
Wonder and beauty describe a place which we value and helps us put things in perspective. Where we feel more connected to something much bigger than ourselves and where the inequalities of our human world even out, making us all feel valued. Green and blue spaces offer this in abundance.
Familiarity of a place is where we feel we belong as we create routines and rituals when we walk the children to school or go to the shop passing familiar landmarks. This familiarity creates structure and certainty and this deep sense of belonging makes us feel more secure.
ROOTS
Lorraine has poor resilience brought on by past trauma and perpetuated by the chronic stress. This has lead to a cluster of stress related diagnoses. At Intelligent Health we have created a solution for workplaces so that their employees can strengthen their resilience. We call the programme Roots of Resilience as we are treating the root cause.
It is designed as a modular course that helps employees understand the mechanisms that lead to their stress and negative emotions. By going through the Resilience Matrix, we help employees build their resilience. For example, we help them understand how to build positive relationships and the difference between chronic and acute stress. We then move onto secondary causes of poor resilience, such as poor sleep, inactivity and poor diet, leading to an unhealthy gut biome and chronic inflammation.
Not only would Lorraine understand the reasons she has these debilitating symptoms but through her workplace we could help her treat them by shifting from healthcare to the resilience matrix.
Dr William Bird MBE is a practicing GP, CEO of Intelligent Health and Honorary Professor at the University of Exeter. He has been passionate about engaging communities to create healthier neighbourhoods and workforces by promoting resilience. You can follow William here on LinkedIn and if you are interested to know more, please email workplacewellbeing@intelligenthealth.co.uk