GP Dr Rangan Chatterjee returns to BBC1 tonight at 9pm for a second series of Doctor in the House – the show in which he spends two months with patients suffering from chronic, and seemingly untreatable, health conditions and hopes, that by observing their daily routines, he can get to the bottom of their problems.
“Our NHS is fantastic,” he says, “There are certain things that we’re really good at – like acute problems. But with chronic conditions that aren’t life-threatening but make your life miserable, some of the time we’re not as good as we could be.”
“Going into people’s homes, I lost the security of my surgery walls. You never really see your patients in their own environment, suffering. If I saw someone having a heart attack in the street I’d know what to do, but being in a patient’s house, you see their pain happening day in, day out. I felt powerless – it was very uncomfortable.”
In the first episode, Chatterjee treats Gemma Bullivent-Hughes, 35, who has suffered from cluster headaches, or ‘suicide headaches’, for 15 years. Already treated by her GP and a specialist consultant, Gemma (below) was having up to 100 agonising headaches a week, had tried every conventional and unconventional method imaginable to alleviate the pain, and was struggling to cope with how they were impeding her family life. Rangan’s assessment of her lifestyle led her to a neurologist, and a lifestyle overhaul, which eventually reduced the number of headaches to a manageable handful a week. “It was one of the hardest cases of my career, and I’ve been practicing for nearly 16 years,” he says. “Next time I see someone with a cluster headache in my practice, I’ll be able to put the illness in the context of their life, and think about how it affects their relationships, their home life, their children.”
At a time when television is brimming with series documenting the stretched state of the NHS and the pressures on GPs’ time, Chatterjee insists that his method in the show is achievable for other doctors. “Spending intense amounts of time with a patient is clearly impractical outside of the show – but there are principles that I’ve learned that I can apply to my patients.
“It’s not just about more time – it’s a completely different approach. Ours is a drug-based approach in the UK – pills that suppress symptoms, it’s like putting a sticking plaster on. I try to get to the root cause – but we’re not trained to, and that’s a huge problem. I didn’t become a doctor just to give people painkillers, and after the first series, I’ve changed the way I practice medicine. I think the age of the ten-minute consultation is over – it simply cannot deal with the complexity of the problems we see today. That was set up when patients came to GPs with acute problems that lent themselves to quick fixes. The NHS is going bankrupt, so we have to think outside the box. Even if we pour money into it, it’s going into a broken system. We need a framework for primary care that works in the 21st century.”
One of the major things that Chatterjee mentions that could revolutionise treatment is what he calls “lifestyle medicine” – and can start with us making small changes ourselves.
“I think there are four big pillars of health: what we eat, how we move, how we sleep, and how we switch off. Paying attention to nutrition is critical. Do you have to be perfect? No – but if you eat a diet full of processed food and sugar, you’ve got to accept there will be a consequence on your health. If you’re sat in an office for eight hours a day, that’s going to have an impact too – get up every hour, put an alarm on your phone, walk to the water machine, go to the toilet. Do what you need to do, but keep moving.
“As for sleep, we are chronically deprived. I think the reason is we have so many things in the evening that compete for our attention. We’re all tempted by another episode on Netflix, and we think sleep is something we can sacrifice, but we can’t get away with it. You must prioritise it or you’ll suffer. We’ve lost the ability to switch off – there’s so much noise coming into our lives from the start of the day until we go to bed. Whether it’s meditation, yoga, or just listening to some music that you love, chill out and do it, but don’t be scrolling through Facebook at the same time.
“When I get stuck with a complicated problem, I take a step back and assess which of these four areas the patient needs the most work in. I’ve seen tens of thousands of patients and the more experience I get, the more I realise just how much comes down to these four basics.”
Doctor in the House begins tonight at 9pm on BBC1