Blog

BLOG.

This blog is a space for Health and Libraries collaborations and a source for links to videos, websites books and ideas.

Dr Malcolm Rigler   M.B.Ch.B. Associate FPH, FRSPH,

Member  CILIP  Health Group

The Sound Agents Arts/Health/Heritage

The GP, The Artist and Uncertainty

Having grown up in Poole by the sea, I was fascinated by the story of the container ship that shed its load of toys which have now led to some re-thinking by oceanographers about previously unknown ocean currents.

Matt Finch is a librarian who seems to work in many places around the globe. If you can find the time to read his”long read” I think you will find it fascinating. Click on link below.

Matt Finch ends with the words

The future will always be uncertain. No-one can gather data or evidence from an event that hasn’t happened yet. Forecasts are merely bets on the power of a given predictive model. And if anyone could bottle the future, they would have done so and made a fortune.

Uncertainty suggests an anxiety about “what happens next” that can never fully be assuaged. But it also implies opportunity: to change, to respond, to propose something new; to transform and be transformed.

When it comes to the future, we may always be reduced to listening for footsteps in the dark; but perhaps we will also be able to choose how best we dance to that haunting tune. Lispitz’s work of pop-cultural history helps to show us the way”

Malcolm

Can Public Libraries help to revive the practice of Humane Medicine?

In his book , “The Death of Humane Medicine” Petr Skrabanek   makes it clear that doctors these days  now seem to  worry more and more about the risk factors of specific diseases such as cardiovascular disease  , stroke and diabetes  – treating such risk  factors as enemies to be  battled against. They   seem to  worry less and less about the anxieties and worries that  patients bring with them into the GP consultations. Skrabanek calls this approach to medical practice “coercive  healthism”. 

Prof Stephen Pattison  – who holds  a Fellowship  of the College of GPs   – puts the matter cogently in his short paper ( attached) tilted  “Redundant Subjectivity ”  suggesting that “the ambition seems to be to make humans redundant in medical encounters” .

This sad state of affairs was predicted by Rick Carlson in the 1970s  in his book “The End of Medicine”  in which as a lawyer he  finds that 

modern  medicine has little or nothing to do with health  and well being but has become pre -occupied with dysfunction and the failure of the organs within the human body. 

Another  writer Dr Michael Wilson  in his book “Health is for People” and in other writings    makes the  point that “our era is one of 

enormous pols of loneliness in densely populated cities , and alienation between races ; our diseases are 

psycho-social , such as stress , heart attacks, blood pressure , anxiety , violence , divorce, abortion , ulcers and 

the effects of substance abuse such as alcohol and tobacco  , plus the consequence of  our lifestyle , obesity  , car accidents ,delinquency , pollution and unemployment.” He writes” Medicine has little to do with such things”. He concludes that we are lumbered with a style of hospital medicine which is misfitted to the disease pattern of post-industrial society. 

Finally Prof Ken Judge  writes:  “the main causes of disease in our society are unemployment, lack of social support and poor education”. It was as a result of my study of these texts and these issues over past decades that some time ago I came to the conclusion in my own mind that :

“The GP within the NHS has no enjoyable or creative future until the  partnership work that  needs to develop  between Public Libraries and GP practices comes to be fully understood  and well supported  financially and in every possible way by both GPs, Librarians, Govt  and all the funding and commissioning bodies within the UK”. Malcolm

Why should  Libraries work with GPs ? 

1.   Libraries can offer safe , neutral spaces and places for  GPs, Teachers, Social workers , Librarians , Artists and  Policy  Officers from all agencies to meet and  share ideas for creative change and to develop practical ideas for  the work of “salutogenesis” ( the promotion of health) that must now be developed in every Village, Town and City in the UK. 

2.   Only Libraries can adequately respond to “the learning needs of patients and carers” in any language under the sun”. Often Patients have  “learning  needs” for digital skills, or  building social capital, and  many  would  benefit from  “guided web surfing” about medical conditions and treatment options. 

Work in the library can also help to   secure  truly  “informed consent”  from patients  for planned treatments  and procedures. 


3.   The few books   mentioned in this piece – and many others –  are available through Public  Libraries not from  any   GP Practice. Many other books and texts supporting  change from a  “disease eradication ,  treatment  focused -medical model” to a  “salutogenic model ” of health and social care services  can also be found in Public Libraries. Malcolm

BUT IS IT ART?

Moira Kenny The Sound Agents

Art is not what you see, but what you make others see.” ~ Degas

Before the Medical Profession came in to being and gentrification bulldozed streets in favour of retail parks and student accommodation, people would turn to women in their family or neighborhood, who came together to aid the sick, deliver babies, look after children and the infirm, lay out the dead and organise funerals.

Since the creation of the NHS General Practitioner Service in England in 1948 many changes have occurred, Doctors working in densely packed urban areas were committed to their patients running GP practices and caring for patients who had no money to pay for their services. Dr William Duncan became the first Medical Officer of Health as some GP’s employed debt collectors, some lived in poverty committed to helping the sick but constantly struggled to make ends meet.

Somerset GP, Dr Malcolm Rigler argues ‘in 2017, we have arrived at just such a point in the development of medical / health practice whereby we need a new kind of “medical officer of health” devoted not to infectious diseases but to our modern epidemics of loneliness, obesity, dementia, heart disease and community development’.

Dr Rigler and Liverpool based artists John Campbell and Moira Kenny: The Sound Agents, founded Health/Arts/Libraries Project (H.A.L) in 2015.

Action is the foundational key to all success”. Pablo Picasso

In 2020 the work has developed in Liverpool working in collaboration with Crosby and Bootle Libraries to work with retired Liverpool Dockers to capture their stories of life on the docks and at home. Sefton Council are pleased with the progress of the project as historically it has been difficult to engage with retired men as participants or volunteers in Sefton.

Funded by Awards for All THE DOCKERS CLUB: Jobs for life will start once it is safe after Lockdown. The Dockers will meet weekly in Crosby Library and will learn film making skills to share their stories on YouTube and will hold an exhibition of images and stories in Liverpool Central and Bootle Libraries

 The aim of the Health and Libraries project is to work with librarians across the UK to design and deliver a series of Arts Projects, Events, Publications, Workshops and Training Sessions to offer help to patients and carers in their search for information and understanding about health, social care and life changes working along the theme of “Libraries on Prescription” and Salutogenesis.

Aaron Antonovsky (19 December 1923 – 7 July 1994) a professor of medical sociology, specialised in the relationship between stress, health and well-being. Antonovsky developed the Salutogenesis theory ‘sense of coherence’ to describe human health rather than factors that cause disease. The salutogenisis model was derived from interviews of Israeli women who were concentration camp survivors, despite experiencing inhumane conditions stayed healthy. Antonovsky’s wife Helen developed an ‘Orientation to life questionnaire’ in 1987 to provide people with a ‘sense of coherence’ about life and challenges. (https://academic.oup.com/heapro/article/21/3/238/559289/Contextualizing-salutogenesis-and-Antonovsky-in)

 “The key elements in the salutogenic development are, firstly, the orientation towards problem solving and, secondly, the capacity to use the resources available. Over the years the Salutogenesis has become an established concept in public health and health promotion’.  B. Lindström, M. Eriksson, BMJ, Volume 59 Issue 6

Dr Rigler states ‘Scientists and health professionals must work with librarians and colleagues who have a background in education and information to introduce the salutogenic framework to the public in an accessible way, focussing on people’s resources and capacity to create health than the classic focus on risks, ill health and disease’.

He goes on to explain the way these patients view their lives has a positive influence on their health. These characteristics are a key concept to ‘The Salutogenisis Model’ a theory concerning how specific personal dispositions make certain individuals more resilient. This theory needs to be the key focus of a transformation of both GP practice and community library service.

“Information, fully understood, is a key part of care. Patients need such help to give clear consent to treatment and investigation. This project enables patients and families to grasp the essence of the issues and play a full part in the decision-making process” Sir Kenneth Calman, Chair of the National Library of Scotland, one-time CMOH.

Libraries need to be the centre for computer assisted learning for patients and carers once the doctor has given a “prescription for learning”. Computer Assisted Diagnosis ‘Person Centred Epidemiology Practice’ is a learning opportunity that can be accessed in any language using computers in libraries led by librarians and GP’s working together.

In 2013 The Sound Agents were invited to work with Dr Simon Abram’s, GP and senior partner at Great Homer Street medical centre in Everton. Dr Abrams was Medical Director at UC24 for 7 years and was Medical Director at UHUK from 2008-2014. He took up position of UHUK Chair in July 2014.

Dr Abrams introduced the artists to a group of patients who together founded The Greaty Arts Group. The group led by Dr Abrams and The Sound Agents met every week in the surgery waiting room and discussed the relationship between the GP and the patient and how it could be improved. The arts group was based on arts on prescription and Salutogenesis rather than traditional painting or dance the art forms organically developed into developing short films and writing scripts using story boards. Their story, the patient’s personal life story was key to the meetings.  The group discussed social capital and continuity, gentrification of their neighbourhood leading to a depopulating area, deprivation, depression and loneliness.

Health is more about people than diseases, the issues in Liverpool are more about the “social side of life”. “We have inter-generational problems here about the lack of work. We have a depopulating area. You cannot treat these problems in the conventional way.” Dr Simon Abrams

The Sound Agents working as artist in residence in Great Homer Street Surgery aimed to help the patients set up The Greaty Arts Group as a social enterprise and teach the group skills to run a not for profit organisation.

In 2013 Awards for All funded us with a grant of £10,000 to work with patients in the waiting room and teach them how to set up a blog or website to write stories about their illness and treatment to help others. Dr Abram’s works with zero tolerance patients. Computers were installed in the waiting room, funded by the NHS and Liverpool City Council. 

When new patients arrived at the waiting room to join the group, we were surprised to learn that they had no previous experience of using a PC. We spent time showing them the most basic steps, starting with how to turn the computer on and built up a relationship with a small group of people who were interested in joining us each week while the project lasted. Continuity is key, the funding ended and the surgery was demolished. Dr Abrams has now moved along with his patients to a surgery ‘up the hill’ and has taken the computers with him, they are used every day by his patients who call in to the waiting room not to see the doctor but to job hunt and enjoy having access to the internet”. The Sound Agents

A symposium event was held at FACT in 2014 to bring people together to discuss the project and find a way forward to carry on working in the waiting room and later when Dr Rigler became involved, the ideas developed for artists to work not only in GP waiting rooms but also in libraries. 

For more information and to view short films made by The Sound Agents with Dr Abrams and some of his patients who set up The Greaty Arts Group discussing social capital and continuity.                                       

Redundant subjectivity?

Professor Stephen Pattison, Hon. Fellow  RCGP October 2016

I am ashamed to admit I have learned to dread going to my GP.  Indeed, I positively avoid going, even when I think it might be useful or even essential.  Letters inviting me for health check-ups lurk unopened on the kitchen table and eventually find their way into the bin 

Thinking about this lamentable situation, as one who ‘should know better’, I guess my phobia has grown over the years and led to a fundamental lack of trust in those over-burdened, hard-working souls charged with my primary care.  And I think at the heart of this it feels as if my subjectivity is now more or less completely disregarded. 

I go to the GP with a small agenda of, usually minor, problems that are important to me, but insignificant in the great scheme of things.  And instead of attending to my concerns, the GP, attending in the first place to a computer screen, and then pushed no doubt by prompts and advice from government and other health bodies, insists on taking my blood pressure and interrogating me on my lifestyle before giving me unasked for advice about how I could live a healthier and better life (as if I didn’t know that I could do that, and were not ashamed of the fact that I don’t). I leave the surgery edified but effectively deafed out, both guilty and demoralised.My partner has had worse experiences.  An experienced psychotherapist, she has lately become hypothyroid, a condition she was warned years ago that she might develop.  The condition became so serious that she thought she would have to give up her flourishing practice as she could not think properly.  The GP’s response: the blood tests show that you are within normal range so we are not going to do anything about it.  But you seem rather depressed, so why don’t we give you a mental health plan and refer you to psychiatric services?

My partner has quite a good sense of the difference between depression and physical depletion, but this seemed to count for nothing in the face of the statistics and the external guidance that appeared to have captured the GP’s mind, judgment and prescription pad. 

We later talked about how if you actually go to the doctor saying you feel low, you can be administered heavy-duty psychoactive drugs without recourse to any physical tests whatsoever.  It appears, then, that the subjective experience of patients sometimes ‘trumps’ all other information, and is sometimes irrelevant, however lousy the patient feels, however close to some statistical border line they may be, and however cheap the treatment that might be prescribed for them (a daily dose of levothyroxine is very cheap, I understand).

I write in a spirit of perplexed solidarity with GPs.  My perplexity revolves around the changing value of subjectivity in illness and clinical encounters, the value of different kinds of evidence and the nature of the role of doctors in a world that is served by more and better information and testing than ever before.

Trainee doctors should study impact of arts on health, inquiry says

A cross-party parliamentary report says it is “time to recognise the powerful contribution the arts can make to health and well-being”

READ MORE BELOW

https://www.artsprofessional.co.uk/news/trainee-doctors-should-study-impact-arts-health-inquiry-says

BEYOND RETAIL

Redefining the shape and purpose of town centres

“Town centres have become too reliant upon retailing. The town centre function needs to be re-balanced to provide a broader range of alternative functions, including employment, commercial, leisure, community, residential, healthcare and education. Local authorities and public sector agencies have a key role to play in ensuring towns and cities do not lose public and private sector jobs to out-of-town locations, leaving a rotten and decaying core. Independent research organisation Centre for Cities Beyond the High Street: Why our city centres really matter report clearly demonstrates that where jobs are located can affect how well a city’s economy performs. For example, for retail if a city has more jobs in out-of-town locations, it reduces the number of people who have to come to the city centre” Mark Williams Taskforce Chairman Partner, Hark Group 2013

READ MORE BELOW:

BOOKS FOR DISSIDENT DOCTORS

REVIEW: RESPECTABLE

https://www.theguardian.com/books/2016/apr/14/respectable-by-lynsey-hanley-review-class

THE DEATH OF HUMANE MEDICINE

The Death of Humane Medicine and the Rise of Coercive Healthism by Petr Skrabanek

BODY SPACE IMAGE NOTES ON IMPROVISATION AND PERFORMANCE by Chris Crickmay and Miranda Tufnell

LIFELINES THE BEATING HEART OF LIBRARIES

CLICK ON LINK https://www.stirling.gov.uk/media/7191/libraries.pdf

BURNOUT RATES HAVE REACHED EPIDEMIC LEVELS

Experts are calling for an internationally coordinated research effort to identify evidence-based strategies to reverse the rising tide of burnout within the medical profession. READ MORE BELOW

https://www.univadis.co.uk/viewarticle/burnout-rates-have-reached-epidemic-levels-539622

HUMANISING HEALTHCARE

Developing Partnerships

The inaugural meeting to discuss the potential development of a new SIG titled HEALTH AND LIBRARIES took place in Liverpool January 2016 in the John Lennon Art & Design building Liverpool John Moores University LJMU. 

Attendees included: Dr Malcolm Rigler, Dr Simon Abrams, John Campbell, Moira Kenny, Dr Robert MacDonald, Andy Wright, Susan J. Thomas, Jill Beswick, Liz Stafford, Rachel Byron, Jayne Plant, Cath Shea, Matthew Wheeler, Sue Cook, Anna NBDT. The meeting was organised by Dr Malcolm Rigler and facilitated by The Sound Agents.

Background

One of the most important responsibilities of the GP and the GP paractice is to ensure that patients are given: “information in language and terms that they can understand.

In fact this is one of the key responsibilities listed by the GMC in the document “duties of a doctor” Over recent decades the Health Education Authority (HEA), the Pharmaceutical Industry, some NHS GP’s and Hospital Consultants and NHS Trusts, writers of health and social care books, health charities and self help organisations and many others have all been writing leaflets, booklets and books to support the GP in his/her attempt to share health and social care information with patients and carers

There is now such a profusion of leaflets, books, video, films, CDs, sound tapes and websites that no GP or GP practice could possibly hold all of this material together or even know of its existence

As a result patients and carers continue  to complain more and more loudly that ’the doctor did not explain anything to me’ or quite often ‘the doctor tried to explain things to me but I did not understand a word that he said’. 

There is now such a   profusion of information sources and learning materials that  many people believe that  the development of a “Libraries and Health” partnership is long overdue. Only libraries and librarians can ensure that up-to-date , good  quality health and social care information can be brought together and made available to patients and carers when it is needed. The  librarians professionalism, their  skills in archiving material and the use of ICT are crucial in this regard. At  present making  sure that “the right information” reaches “the right patient or carer” at the “right time” continues to be just an   aspiration within the GP community.

It now seems clear that with  careful planning and political commitment  the development of “Health and Social Care  library services”, including Health and Social Care  ICT services, within libraries  could soon become a reality.  It is also possible, using the new technologies , to make sure that health and social care information is available in  many different languages. 

Many people are now seeing this development to be just  as important as the provision of clean water to every household in the UK.  Ensuring that the “Health and Libraries” partnership  really does lead to the changes needed will require change and development both within UK Hospital and GP practice and within the Library Service.  We shall also need the support of  the Legal Profession to secure “statutory standards of library provision” as already exists in Wales

Changes needed  in the Medical Practice.  

  • Doctors  to become aware of,  and respond to  their patients learning needs. 
  • Doctors  to alter consultation style to signpost patients to better information sources and to write:
  •  “prescriptions  for information”   
  • Doctors  waiting rooms to be the start of the journey towards learning.  The  environment of the GP practice needs to encourage questioning whilst at the same time signposting patients to the library  service that can respond to questions. This will need to be a joint “medical/nursing/community education” development.  
  • Development of  CCG Commissioning   to support the above i.e. patient and carer learning and self  management.   

Changes needed in the Community Library Service.  

Libraries need  to learn  from the “exercise on prescription scheme”  and the need to focus on “meeting and greeting” patients and carers who may not have ever  entered a  library before and who did not enjoy their school days.  

Library developments to be in close partnership with education professionals: 

Libraries need  to learn  from the “exercise on prescription scheme”  and the need to focus on “meeting and greeting” patients and carers who may not have ever  entered a  library before and who did not enjoy their school days.

Library developments to be in close partnership with education professionals:  

  • Need to alter the  environment  both outside and inside the library to be more welcoming of NHS service users.
  • Need to employ  “explainers”  – usually nurses skilled in “guided web-surfing” as is now being offered at  Maggies Cancer Care Centres. 
  • Need for crèche and rooms/venues for group meetings / place for tea/coffee /toilets / free car parking  
  • Development of online  “Libraries and Health”  website for each administrative area with  links to  all  or most languages  spoken and read in the UK . 
  • Need to develop international links with Libraries Eg: Harare led by Pettina Gappah  Chief Librarian and former Civil Rights Lawyer in Geneva.  Dr Malcolm Rigler 2020      

MAKE IT BETTER FILMS

AND THE ART OF LIVING STORIES

The Sound Agents Limited

Artist/Oral Historians John J. Campbell and Moira Kenny

We are a new production company travelling around Britain to capture the amazing health and wellbeing work being done in cities, villages and parishes by not for profit organisations, small groups and funded organisations. We want to share the ethnic and social economic diversity of work being done behind the scenes. 

We are offering an exclusive opportunity for you to tell your story and be heard. Target your audience by grabbing their attention, show them the work you are doing. We know you have a sense of pride in your community and we want to help you share it to show other people the importance of health and wellbeing and improving lives. 

A Short film will help you share your good work with others and show your work to future funders and sponsors.

We offer:

Pre- production research and planning

We can chat over the phone and on line to learn about you and your work and decide on a theme or project you are working on.

Production

We will travel to your place of work wherever that might be and shoot footage for a short film during the course of one day.

We will capture the visual and sounds for the content we need to capture your vision and innovative stories that are shaping the future.

Post production

We will edit the film and upload it for you on to YouTube and on to this website and send you a link for you to share it.

Voice Over 

We can provide a voice for you if you do not want to speak on camera. We can deliver your powerful message and emotion

Creative Concepts

We are storytellers and will capture high quality footage to share your work using creative concepts.

Make it better and Inspire others

Edited Video duration of up to 10 minutes  Competitive Rates
– 1 Days Filming on Location 
– 2 days Post-Production
– Basic Motion Graphics
– Single Music Track/Voice Over if required

THE ART OF LIVING STORIES CAPTURE SELDOM HEARD VOICES FOR RADIO AND THEATRE PRODUCTION

Contact us today for a quote 07923925379 Thesoundagents@gmx.co.uk

Dr Robin Youngson TEDxTauranga

Perfectly Broken and Ready to Heal

SIR KENNETH CALMAN, UNIVERSITY OF GLASGOW CHANCELLOR

SLIC Ambition & Opportunity One Year On Scottish Libraries 2016

Asking the Way – Mike White

Directions and Mis-directions in Arts in Health 2014

CLICK ON THE LINK BELOW

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