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Interview: Richard Pile, general practitioner

11 June 2021

‘For too long we’ve paid lip-service to the need for preventative medicine. Now we need to put our money where our mouth is’

Work is now the busiest it has been in my 20 years as a GP: consulting with patients face to face, over the phone, and via video calls. The pandemic has taken its toll on all of us — patients and medical professionals.

I had ten years of training, and 20 years in the job, and what you learn from your life outside medicine also informs how you practise. I’d have been a very different person without the challenge of having a disabled child. Luke taught us that what we assumed about life — careers, schools, marriage, and so on — wasn’t necessarily so. It’s made me more rounded, a better doctor, and a better person — though, of course, I’d never have asked for it. It’s difficult to resist surrounding yourself with people just like you. Having that variety in personal experience and within the surgery does ground you a bit more.

I don’t find it hard to switch off from work, but the length and intensity of the working day is hard, with very high expectations at national and patient level. I have more flexible commissioning roles, and work as clinical lead for Thrive Tribe, one of the healthy-lifestyle providers used by the NHS to provide support services for primary-care practices. These roles don’t have defined hours — as I’m talking to you, I’m looking at The Ruthless Elimination of Hurry, by John Mark Comer, on my shelf.

We’re meant to know all about the sabbath as Christians, but, sometimes, overwork creeps up on you before you know it.

I thought I’d serve patients best with advances in drugs and technology; but, actually, it’s the basic things that are most important when it comes to a sense of well-being: sleep, movement, nutrition, managing stress, relationships, and knowing your purpose in life. You don’t hear so much about the last in the secular sphere; so that’s why I wrote Fit for Purpose.

I felt that I wasn’t helping my patients as much as I’d like. Between 25 and 75 per cent of consultations were ultimately about life-related issues that were not strictly medical, and beyond my control. People have problems with relationships, their environment, their sense of meaning and purpose in life.

It’s surprisingly hard to practise in this way, and sometimes to convince patients and colleagues that it’s right; but the NHS is an expensive, disease-based model, which can be a blunt tool when it comes to dealing with the causes of patients’ distress.

We know that, for every pound we spend on preventing disease, you save £10; but we’re always playing catch-up. The biggest bills are for hospital care and social care, and we have to pay them, obviously; but now some primary-care networks are employing social prescribers, community navigators, mental-health workers, and health coaches.

We also have to act further upstream. It requires courage from the Government, investment, and a degree of paternalism. I’m very happy with the nanny state. Things that improved health historically were the broad-brush environmental things: clean water, employment laws, seatbelt laws, clean air. They weren’t about individual effort, but government commitment.

The definition of lunacy is doing the same thing over and over again and expecting a different result. For too long, as individuals and society, we’ve paid lip-service to the need for preventative medicine. Now we need to put our money where our mouth is.

Yes, there’s a huge mismatch between what I can do, what patients want, and what they really need. Practising a disease-based medical model which pushes patients into a passive, sick role and makes others responsible for their well-being creates huge demand — and isn’t ultimately satisfying for patients or doctors.

Giving more control and responsibility to patients is important, and providing education and being consistent is the only way of gradually harmonising expectations.

So much lifestyle advice is confusing. Look at the credentials of the person who is advocating a particular lifestyle. Why should you believe them? What’s their track record? Do they have any reputational or financial interests that might be influencing them? Be wary of anything that flies absolutely in the face of current evidence and standard medical practice — for example, having mistletoe injections instead of surgery for cancer. Don’t just read one piece of evidence, but take a deeper and wider look in that area.

Common sense is hugely underrated. We all know the “what”: that an apple is better than a Mars bar, that a walk is better than sitting on the couch or being stuck at a desk, that it’s important to get a good night’s sleep, and that being lonely or without direction will make you unhappy. It’s the “how” we struggle with. If information was all that was required, then the internet would have made us all healthy, and we wouldn’t need doctors.

My colleagues are generally positive about my holistic approach. GPs are true generalists, and of all physicians they’re best placed to understand the importance of a holistic approach to life, including medical practice. But it’s hard to practise it within the limited time of a consultation, and you risk feeling uncomfortable or being misunderstood.

I was raised in a middle-class Mancunian Christian family. We all still get on with each other; so I guess it must have been pretty good as upbringings go. I’m married with four children. Life was particularly challenging when my oldest son, Luke, was still at home with us. He has severe complex epilepsy and learning difficulties. It was tough being on call and on high alert 24 hours a day, but it made us close as a family. I’m particularly proud of how my boys have grown up and looked after each other. Luke lives a wonderful life, now that he’s grown up and left home. Two of my boys are still at home, and we still all see each other regularly.

Faith has always been a part of my life, and I made a conscious decision to embrace it for myself at the age of ten. It was after the Children’s Christian Crusade came to our church. I knelt down by my bed and prayed their prayer.

As I’ve experienced life, I’ve had to think about what I accepted as fact when I was younger. I saw the world in black and white, and was quite dogmatic. Now, I appreciate there are shades of grey, and there isn’t a specific, absolutely correct answer to everything in the Bible or in Christian teaching. My faith shapes how I live my life, and my life-experience has shaped what I believe, and the way I practise my faith.

One specific goal I have is to get to the top of Mount Kilimanjaro on my mountain bike, with my best mate Al, when I turn 50. I’ve warned my wife about this.

Ignorance, demonstrated loudly, makes me angry — though not as much as dishonesty.

I’m happiest spending time with my tribe — my family and friends; running and riding; having time to think and reflect, ideally listening to ambient music or jazz.

In the pandemic, I’ve enjoyed spending time with my wife and my boys and with others, when it’s been possible. I wasted less time on travelling to meetings. I said no to stuff I wasn’t interested in. I wrote a book. I’ll try to continue doing more from home.

As humans, we are made in God’s image, whether we recognise it or not. I’d like to think that, given the right incentives and tools, we can work together to avoid self-destruction. How likely I believe this is to occur depends on what sort of day I’m having.

I pray for my children, the NHS, for fairness in society, that the church will become the heart of our local communities, loving our neighbours as ourselves in whatever way we can, without agenda.

I’d like to be locked a church with Sir Alex Ferguson. He shares certain qualities with our Lord Jesus Christ, being a good conversationalist, deep thinker, inspirational speaker, miracle worker, and a personal hero of mine.


Richard Pile was talking to Terence Handley MacMath.

Fit for Purpose is published by HarperCollins at £14.99 (CT Bookshop £13.49); 978-0-3101247-4-0.

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