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Tag Archives: GP

Five Blogs in Five Days…I Can Relate to That

15 Friday Jun 2018

Posted by Burning Manager in Uncategorized

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accidental manager, General practitioner, GP, Harvard Business Review Press, Institute of Managers and Leaders, Jeffey Pfeffer, RACGP, Rasmus Hougaard, Stanford Graduate School of Business, The Mind of the Leader, The Potential project

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Well I got to day five of my blog-a-day for Men’s Health Week. There’s lots of areas I could cover in the last episode but I wanted to make some linkages to what I have covered this week, so am going to discuss relationships. We know from research that relationships are important in our lives. Good relationships are instrumental to our physical, emotional and mental well-being. The ‘big four’ relationships (in no particular order for reasons you will discover in a minute) are:

Our relationship with:

1)     Our self;

2)     Our family and intimate friends;

3)     Our manager at work; and

4)     Our GP.

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I was going to concentrate on the relationship with your General Practitioner (GP) – and I will get to that – but I went to a master class this morning and it broadened my horizons like all good master classes should. It was conducted by Rasmus Hougaard of The Potential Project. Rasmus has just co-authored a best-selling book, published by Harvard Business Review Press no less, entitled ‘The Mind of the Leader’. Based on extensive research across many countries, where senior executives were interviewed, (open disclosure – I was one) Rasmus found that there are three key components to extraordinary leaders who get extraordinary results. These can be summarised as:

1)     Being mindful;

2)     Being selfless ; and

3)     Being compassionate.

I would strongly recommend getting a copy because it really does provide great insight into how to be a better leader of people and thereby improving business performance. In chatting with Rasmus after the masterclass, I mentioned my blog and he emphasised the point that THE key relationship in terms of  our physical and mental well-being is in fact our relationship with our boss. Clearly I had to touch on that in my blog!

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Given the amount of time we spend at work, our boss can have a direct impact on our mental and physical health. This certainly aligns with what noted management writer and Stanford Business School academic Jeffrey Pfeffer talks about in his recent book called ‘Dying for a Paycheck’. A toxic workplace he argues comes at a huge cost in terms of morbidity and mortality and is a clear work health and safety issue. Managers as leaders in their respective areas have a very strong bearing on the level of toxicity in the workplace, given the culture is either set by them, or allowed to flourish by them. Clearly it’s an area where more focus is needed min addressing men’s health concerns.

The ‘accidental manager’ is often the problem. Frequently technically gifted, they lack the insight to realise that the skills that make an effective leader and manager are not technical at all, but rather the ‘soft ‘ issues like emotional intelligence, insight, reflection , calm, poise, diplomacy etc. Quite often these new managers don’t want to reveal their vulnerability, so fall back on the ego that gave them great succor as content and technical experts. Humility is the key here and the insight to know that it’s good to ask for help. No-one can drive a car without getting driving lessons. Believe me you can do way more damage in charge of people than you can in charge of a vehicle. Learning is paramount and it should be lifelong. Like for me today…I learned new stuff and I do every time I am in the company of people like Rasmus.

The second relationship I want to give some focus to is our relationship with our GP. This is particularly important to us blokes because we under use this incredibly important service. We will get our car serviced within a week of its due date but will put off regular health check-ups. Let’s face it, most of us have less knowledge about what’s going on beneath our skin than we do about what’s going on under our car’s bonnet. Seems the wrong way around somehow.

What if we had a GP with whom we shared a good rapport? I suspect we would be willing to engage with them on a more frequent and earlier basis if they would engage better with us. This is an issue I raised recently with the peak body for General Practitioners, the Royal Australian College of GPs. They have been advertising a lot lately promoting themselves as ‘your specialists in life’, quite possibly mindful of the fact that Ai is already out performing them in terms of diagnosis and treatment choices. So far I haven’t heard ‘boo’ back. A shame really because they must have conducted research in terms of how to engage effectively with their customers, especially men who are a business opportunity just waiting to happen? Before a GP has a practice, first and foremost they have a business. I would encourage all GPs that they need to think long and hard about how they engage with their customers, particularly men to avoid disruption. Ai and machine learning is here and if lawyers’ days are numbered, GPs can’t be far behind.

This would be a great shame because it strikes me rapport with a robot will be much harder to establish than with a human. This got me thinking as to how you might build rapport and get to a level where you have a friendly and trusting engagement with ‘your specialist in life’. Unless you are a contestant on ‘Married at First Sight’ you don’t get married without first building a relationship with your partner. The first step on this journey starts with rapport. If you can’t build this, the marriage is doomed. So it seems counter-intuitive to me to end up with a GP without having some sort of selection process. Otherwise it’s no better than those faux relationship experts who put the MAFS contestants together – and we all know their success rate! I think the best approach if you need a new GP is to draw up a list of what’s important:

  • Would you be more comfortable with a male or female doctor?
  • What age demographic would you feel more comfortable with?
  • Do you need a specialism? e.g. asthma or diabetes – many practices have a sub specialists who cover particular areas in greater depth.

Armed with this list of requirements then, I think the next step is to shop around a few local practices identifying those who might fit your criteria. Asking who specialises in Men’s Health is the next action to be taken. Once you know this you can see whether that GP or those GPs meet your earlier criteria i.e. age, gender etc. Most likely some will.

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The next step, I believe, will be some of the best money you can spend to live a longer, more active and fulfilled life. Book appointments to meet with your shortlist and simply chat with them. This will quickly identify whether they are someone you could establish a long-term trusting relationship with. If you need help narrowing the field, tell them what you are there for i.e. you are interviewing them to see if they will make your short-list. Those interested and understanding of what you are doing should make the list. Those who take umbrage should not. There is no place for ego or power gradient differences with your GP.

If you really want to turn the heat up in the interview, move the patient chair from next to the Doctor’s desk to the middle of the room and get them to swivel their chair towards you. This changes the power dynamic and disrupts what is known as the ‘sociology of illness’ where the patient feels like the child in a parent-child relationship. If they can get through this without batting an eye, they might just be the one for you.

Next you should really dive deep into what does their self-professed interest in men’s health mean for you and what does it look like? If I’m having a GP who specialises in men’s health I need to ‘feel and touch’ the difference. In my experience quite often there is no appreciable difference between a GP who is a men’s health specialist and one who isn’t. This surely can’t be right.

The final clincher is can you see yourself liking this person? Will you build rapport and trust such that you can will be able to tell them anything that may be bothering you no matter how squeamish or embarrassed you might feel? If you can get all these issues covered in an appointment then you are building a key cornerstone into your long-term well being. Be prepared to book a double appointment (GPs love those) and don’t be worried about not finding your ideal match on the first ‘date’.

We know that relationships are key to good health. They can help us avoid anxiety and depression. They can intervene before issues build to a point where suicide might be considered an option. They help us build resilience and nurture us through times of hardship and suffering. Relationships at work can help us flourish or flounder depending on culture and how good the manager is. Relationships play a pivotal role in our physical and mental health. As humans  we want to live longer and be healthy and happy. We can all relate to that!

 

That Pesky Prostate

12 Tuesday Jun 2018

Posted by Burning Manager in Uncategorized

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BPH, digital rectal examination, Dr Dre, DRE, GP, MP-MRI, multi parametric MRI, prostate cancer, PSA

DRE-dr-homi-zargar

Second in my Men’s Health blogs this week is a discussion about the prostate.  This walnut sized gland seems to have more mystery and myth surrounding it than any other part of the male anatomy or perhaps for that matter the human anatomy. Part of the reason might be it’s hard to get to  located in a pretty crowded spot down there. It’s our semen producer which is the transporter of our sperm and it’s alkaline assisting our swimmers to survive in the acidic environment of the vagina. Clever huh! As a possible ‘pub quiz question’ the base of the prostate is located at the top of the gland and the apex at the bottom. That is by no means the end of its quirkiness.

Let’s first look at the stats. In 2018 it is estimated there will be just under 18,000 new cases of diagnosed prostate cancer which constitutes around 23% of all new male cancer cases. Regrettably around 3,500 men will succumb to the disease this year. New diagnoses of prostate cancer in men and breast cancer in women are roughly the same each year, but more men will die this year from prostate than women of breast cancer.

Where the disparity really kicks in though is the spending on research. While broadly speaking death rates are similar between the sexes for prostate and breast, the research spend does not reflect this  ratio. In fact according to Business Week there is a huge and statistically significant disparity in both research dollars by two to one. In other words, around twice the number of dollars goes to breast research than prostate. It is reported that for every prostate cancer drug on the market, there are seven used to treat breast cancer (US figures in both cases).

We all know about lies, damn lies and statistics so it is worth pointing out that the mean age of deaths from breast cancer and prostate cancer are different with the latter being a more late-onset disease thereby being responsible for deaths in older men rather than younger men when compared to breast cancer. Also worth pointing out is the agreed efficacy of testing for both types of cancer. It is fair to say that there are now well-established protocols for testing breast lumps that may be breast cancers and some exciting genetic therapies are on the horizon. Not so much for prostate cancer where the Prostate Specific Antigen (PSA) test is acknowledged as a pretty blunt instrument for indicating the presence of cancer, plus the actual diagnostic tool – a prostate biopsy – is still somewhat mired in controversy with how many holes to drill. The higher the number the more likely cancer that is present will be found, but so too the possibility of septicaemia and potentially death.  That said, there is good news on the horizon according to Harvard Medical School with multi-parametric MRI (MP-MRI) being a preferred substitute in place of some biopsies

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We could sit here and bemoan how men have drawn the short straw, or do something about it. Perhaps the key factor in the larger research dollars for breast cancer is the activism of women who decided something needed to be done and just got on and raised awareness and money along the way. There are seemingly no end of runs and walks for breast cancer. There are even breast cancer rounds of our national rugby league where the teams wear pink. There is a pink day for the McGrath Foundation supporting breast cancer nurses at the cricket test in Sydney each year. These red-letter days are in men’s sport no less. And yet, confusingly, there are no prostate rounds or prostate days at the cricket. Time that imbalance was righted methinks. Plenty of people are sticking up for the breast, but I cannot recall many advocating for that little old walnut thingy.  Perhaps Ray ‘Rabbits’ Warren or Darryl ‘the big marne’ Brohman at one time, but nothing much appears to have come of it. Happy wearing those beanies for brain cancer though! Time we took a stand!!

So here are some helpful hints about what to do. I’ve used the Harvard Medical School as a guide but, as always, seek medical advice as required.

Not surprisingly the advice to reduce the risk of prostate cancer is pretty much the same advice for good health:

  • Improve your diet;
  • Watch your weight;
  • Become physically active; and
  • Have regular check-ups with your GP.

I’ve always thought it was a good idea (all flaws aside) to have a baseline PSA done quite early. This means over the years you will be able to track how your PSA score is going. Always ask for the score from the GP and get them to describe the details of it so that you know what’s what. They can explain the difference and meaning of PSA and the free-t-total PSA ratio. This way you have your own record. Early 40s is my suggestion, but be guided by your GP. If there is family history then earlier testing may be wise.

prostate

What if your PSA level is raised? Well first off you should have ensured that your bloods were taken some time (24-48 hours) after anything that could have caused an elevation e.g. sexual activity, digital rectal examination (DRE), aggressive bike riding etc. Once this criteria is met then the doctor may then suggest a DRE. I am always reminded of Andre Romelle Young (aka Dr Dre) when I see DRE written down. Believe me it’s no scarier! Quite possibly this is where the squeamishness associated with the prostate comes in. I’ve been at plenty of prostate related functions where there is a schoolyard titter when DREs are mentioned. Compared to what women go through for PAP smears, the occasional rectal examination is nothing to write home about. Lying on your side, knees brought to chest to allow the doctor to enter your back passage with a finger to feel the shape of your prostate gland, it is a slight discomfort for a very short space of time. You’ll be a lot more prodded and probed if you choose not to get tested and then find out later you have prostate cancer. A change in your sexual orientation after being administered this procedure has never happened ever. You can relax.

A DRE does not happen each time you ask to check your PSA score, in fact there is evidence to suggest that it is not helpful outside of those practiced in knowing what the various enlargements or normal prostate mean. You really do need to know what you are doing, so an occasional DRE by a GP may not be that well-informed an examination. An enlarged prostate does not necessarily mean prostate cancer and especially in older men may be benign prostatic hyperplasia (BPH). After 50, guys, our prostates are growing regardless of cancer. By 80, over 80% of us will have BPH. That’s a lot more trips to the toilet to look forward to!

Our best chances of avoiding death by prostate cancer are by leading a healthy lifestyle and ‘man-up’ and get tested on a regular basis, as agreed with your health care professional. That doesn’t mean you can leave it to your GP. You should at least co-manage your own health and medical care and being on top of things like prostate health is just a part of that. Later in the week I will blog about one of the most important relationships in your life – you with your GP. So lay back now – prostrate – and absorb all the wonders and marvels of your prostate.

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