Metaphors and analogies have long been used to turn complex medical concepts into everyday ones, albeit with fancy terminology. Having been involved with many 3D animations on the topics of Blood Pressure, arteriosclerosis, cholesterol and the like, we find that often a metaphor goes a long way to building understanding, credibility and even compliance with patients. One of my favorite analogies is what we call the arterial highway. Much like their tarmacked counterparts, arteries act as conduits for all the parts that make your body go. A city typically uses highways, gas lines, water pipes, railways and other infrastructure to distribute important materials to its people. Your body is much the same, except that it does it all in one system, the cardiovascular system. This is used to deliver nutrients, extract waste, transport and deliver oxygen and even to maintain the temperature!
The arteries can do all these things because of their smart three-layered structure. Our arteries consist of a muscular tube lined by smooth tissue. They have three layers named – the Adventitia, Media and Intima. Each is designed with a specific function and through the magic of evolution has developed to perform its function perfectly.
The first is the Tunica Adventitia, or just adventitia. It is a strong outer covering over the arteries and veins. It has special tissues that are fibrous. The fibers let the arteries flex, expanding and contracting to accommodate changes in blood pressure as the blood flows past it. Unlike a steel pipe, arteries pulsate and so must be at once be flexible, and strong.
Tunica Media - the middle layer of the walls of arteries and veins is made up of a smooth muscle with some elasticity built in. This layer expands and contracts in a rhythmic fashion, much like a Wave at a baseball game, as blood moves along it.
The media layer is thicker in arteries than in veins, and importantly so, as arteries carry blood at a higher pressure than veins.
The innermost layer of arteries and veins is the Tunica Intima. In arteries, this layer is composed of an elastic lining and smooth endothelium - a thin sheet of cells that form a type of skin over the surface. The elastic tissue present in the artery can stretch and return, allowing the arteries to adapt to changes in flow and blood pressure. The intima is also a very smoothe, slick layer so that blood can easily flow past it.
Every layer of the artery has developed evolutionary traits that help your arterial system to maintain flexibility, strength and promote blood flow. Diseases and conditions like high cholesterol or high blood pressure, diabetes and others prevent the arteries from doing their function well by creating blockages or increasing the stress on one or more of the layers. For example, high blood pressure causes rips in the smooth lining of the Intima. Anybody who has experienced a pipe burst in a house knows that the damage can be extreme and can never fully be restored.
Understanding the delicate functions of the arterial structure gives good incentive to treat them better. Conditions like high blood pressure, high cholesterol and lifestyle diseases such as diabetes create tears, holes, blockages, and can disrupt the functions of one or more layers. Getting patients to visualize the effect of bad eating habits on their anatomy helps to increase patient compliance. In modern society, the concept of highways goes hand in hand with the concept of traffic jams. Patients understand that the arterial highway is one that can never be jammed.
Hypo-politicosis = A behavioral condition where political thought and action is dangerously below an optimal range. Leading to the ostrich phenomenon of delusionary belief that there is nothing outside of medicine.
In an age of ever great openness, communication and democratic rights, the population of the western world is disengaging with political ideology, political debate and political engagement.
This disengagement is nowhere more prevalent than in the UK. The total membership of all the political parties are at the lowest since they were formed. There are less trade unionist today than a century ago. And most importantly the proportion of people that vote regularly is at an all-time low. Surely, this is a sign of a dysfunctional democracy? Can we truly call it a democracy if the state’s citizens have no interest or control over how the state is run?
What worries me even more than this dire situation, is the lack of interest in politics from fellow medical students. If you were to sit in a bar in a medical school city, I am sure you would be able to hear groups of medical students unwinding over a pint and discussing some political issues. But those political issues almost always evolve around medicine, such as abortion laws, public health initiatives, doctor’s pay and the re-structuring of the NHS.
This insular mind set worries me because there is more to life than medicine! And while so much of our lives may be taken up with the learning and practice of medicine, our lives will be affected by so much more, and before medical school we all had to take an interest in so much more just to get an interview. Do you remember having the time and inclination to take an interest in something that wasn’t medicine? Like reading history or poetry?
This insular mindset is detrimental because it means that as a demographic group we may not engage as fully as we should do with the rest of society, this could be bad for us but more importantly bad for the greater society. If medics become too disengaged in the greater political debates then we may find that society decides that doctors are easy targets and easy scapegoats. We may find our working lives extended, our social lives curtailed, our pensions decimated and our earning power diminished because we did not engage with the public and discuss these issues openly. We may also lose influence with the government if medics don’t vote for their local MPs, question their local party officials and fight our corner over important issues via the BMA.
The other side of this coin is that medics are selected from some of the brightest in the country, educated at great expense by the state, trained and employed by the state and pay a huge amount of tax to the state. If we engage in politics less then society as a whole may suffer from a lack of highly intelligent, highly educated individuals, who should hopefully have a strong social conscience and interest in well run state, from putting their thinking skills to good use on societal problems.
Dr Liam Fox is a conservative back-bench MP and use to be in the shadow cabinet. He has used the skills he developed as a doctor to try and follow an evidence based political career. He recently released a book called “Rising tides” (http://www.amazon.co.uk/Rising-Tides-Facing-Challenges-New-ebook/dp/B00CUE0DKQ) which analyses many of the world’s current political issues and I would highly recommend as many people as possible read it. I also hope that in future I can walk into a bar, meet some medical colleagues and talk about an issue that affects more of society than just medics! How about using a scientific approach to discuss how Britain’s education system could be improved? Or how Britain could use its welfare resources better to decreased homelessness (which would also reduce a burden on A and E’s)?
“There is nothing new under the sun” - Ecclesiastes 1:4-11.
If any of you have read one of my blogs before you will have realised that I am a huge fan of books.
The blog I am writing today is also about a book, but more than that, it is about an idea. The idea is simple, practical and nothing especially new. It is an idea that many call common sense but few call common practice. It is an idea that has been used in every sort of organisation for over 20 years. It is an idea that needs to be applied on a greater scale to the health service.
The idea is not new. How the book is written is not new. But how the book explains the idea and applies it to healthcare is new and it will change how you view the health service. It is a revolutionary book.
The book is called “Pride and Joy” by Alex Knight view here.
How I came to read this book is a classic story of a Brownian motion (a chance encounter), leading to an altered life trajectory. The summer before starting medical school I was working as a labourer cleaning out a chaps guttering. During a tea break in the hot summer sun he asked me what I was going to study at Uni. As soon as I said “Medicine”, he said “then you need to come see this”.
He took me into his office and showed me a presentation he had given the year before about a hospital in Ireland. He was a management consultant and had been applying a management theory he had learned while working in industry. With his help the hospital had managed to reduce waiting times by a huge amount. The management theory he was applying is called "The Theory of Constraints" (TOC).
I thought that his presentation was fascinating and I could not understand why it was not more widely applied. I went away and read the books he suggested and promised that I would stay in touch.
Four years later and I had been exposed to enough of the clinical environment to realise that something needs to change in how the health service is run. To this end, a couple of colleagues and myself founded the Birmingham Medical Leadership society (BMLS) with help from the Faculty of Medical Leadership and Management (FMLM). The aim of which is to help healthcare students and professionals understand the systems they are working in.
The first thing I did after founding the society was contact that friendly management consultant and ask him for his advice on what we should cover. He immediately put me in contact with QFI consulting, @QFIConsulting.
This small firm has been working with hospitals all over the world to implement this simple theory called the Theory of Constraints. They were absolutely fantastic and within 2 emails had promised to come to Birmingham to run a completely free workshop for our society’s members.
The workshop was on March 8th at Birmingham Medical School. Through our society’s contacts we managed to encourage 15 local students to take a revision break to attend the workshop on a sunny Saturday. We were also able to find 11 local registrars/ consultants who wanted to improve their management knowledge. It just so happens that the chap leading this workshop was Mr Alex Knight. The workshop sparked all of our interests and when he mentioned that he had just written a book, pretty much the whole crowd asked for a copy.
When I got my copy, I thought I would leave it to read for after my end of year exams. However, I got very bored a few days before the first written paper and needed a revision break – so I decided that reading a few pages here and there wouldn't hurt. Trouble was that this book was a page turner and I soon couldn't put it down.
I won’t spoil the book for all of you out there, who I hope will read it. I shall just say that if you are interested in healthcare, training to work in healthcare, already work in healthcare or just want a riveting book to read by the pool then you really should read it. The basic premise is that healthcare is getting more expensive and yet there appears to be an increase in the number of healthcare crises'. So if more money isn't making healthcare better, then maybe it is time to try a different approach.
“Marketing is what you do when your product is no good” – Edward Land, inventor of the Polaroid Camera.
Mr Land was a wise man and I can happily say that I have no conflict of interest in writing this blog. I have not been promised anything in return for this glowing review. The only reason that I have written this is because I believe it is important for people to have a greater understanding of how the health service works and what we can do to make it even better!
As a very junior healthcare professional, there is not much that we can do on a practical level but that does not mean we are impotent. We can still share best practice and show our enthusiasm for new approaches.
Healthcare students and professionals, if you care about how your service works and you want to help make it better. Please find a copy of this book and read it. It won’t take you long and I promise that it will have an impact on you.
NB - Note all of the folded down corners. These pages have something insightful that I want to read again... there are a lot of folded pages!