Flourishing together – lifestyle medicine.

Richard Pile is a GP partner specialising in Cardiovascular & Lifestyle Medicine.  His other NHS roles include appraising, mentoring, and leading on wellbeing, prevention & urgent care as a CCG board GP.  Outside of my NHS day jobs, he’s the clinical lead GP for Thrive Tribe and co-founder of Living Life Better    and does a bit of blogging (including for the British Society Of Lifestyle Medicine), wellbeing updates for the Royal College of GP’s, writing for the British Medical Journal and national press, and podcasting (Wellbeing For Real Life, Series 1 is out now).  His first book, Fit For Purpose (“Your guide to better health, wellbeing and living a meaningful life”) , was published by Harper Collins. 

Richard believes that our modern medical disease-based model is not fit for most of what actually ails us in life.  We need to practise lifestyle medicine as individuals and as a society if we are to lead fulfilling lives.  Personal responsibility is an important part of this but to make the biggest difference to our health and wellbeing as a society we need societal-level changes to the default environments in which we live and work. 

He doesn’t believe in work/life balance as a meaningful concept.  Instead he does his best to lead a balanced life and enjoys mountain biking, running, listening to a ridiculous amount of music, spending time with my tribes, pondering the meaning of life and graciously allowing his dog to take him to the pub.  You can follow Richard on Twitter @DrRichardPile and Instagram dr_richard_pile and LinkedIndrrichardpile. 

What if medicine started with lifestyle solutions rather than seeking solutions to sickness? Listen to Dr Richard Pile’s hard won wisdom in the area of lifestyle medicine in this inspiring and challenging conversation with Gillian Straine.

Trigger warning – there is a mention of suicide towards the end of this episode. 

Find Richard’s full biography and the transcript of this conversation here. 

• Richard’s extensive biography and multiple jobs 
• Richard describes how he came to faith as a child and how his journey of faith has taken him to a variety of church expressions over the years 
• Lifestyle medicine described and explained – moving away from a sickness model to a health model 
• What is health? Physical, spiritual 
• The importance of talking about how you are feeling. 
• Hard won wisdom from adversity and how Richard got involved with life-style medicine 
• The role of churches and medicine in holding the conversation about purpose. 
• The healing we receive when helping others. 
• Dealing with death – how the church can really serve the community. 
• A different way of doing church 
• The importance of connection 
• Doing what we have influence over and finding meaning in what we do.  
• Richards starting pointers for wellbeing 

Links:
Richard’s book – Fit for purpose 

Thrive Tribe 

Zero Three

Headspace 
GoHealth Community

Follow GoHealth on Twitter, Instagram and Facebook @guildofhealth  

I am Gillian Straine and welcome to the GoHealth podcast. The GoHealth podcast is run by the team here at the Guild of Health and St. Raphael, which is a charity that’s been around for over 100 years, promoting and resourcing the Healing Ministry of the Christian Faith. 
 

We are in season three of the podcast where we’re exploring the topic – ‘together, we flourish’. So in this season, we are looking at all the positive ways that people combine health and faith. And we have a fantastic lineup of really interesting people and we’ve chosen this topic, ‘together, we flourish’ because it’s at the heart of the GoHealth Community and indeed all the work of the Guild, because our vision is to see flourishing communities made up of flourishing individuals. 
 

And the GoHealth community is a place, the place of nurture, sharing, learning and practice, where we actively tend to our journeys towards health and healing with the faith of Jesus Christ at the centre.  

So in this episode, I’m delighted to say we are exploring the theme of Together We Flourish with Dr. Richard Pile. Now Richard is a GP with over 20 years of medical experience. He was raised in Manchester, he went to medical school in Nottingham and completed his GP training in Oxfordshire. He has specialised in cardiology and lifestyle medicine. We’ll hear a lot about that in the episode. And he’s also involved in training and appraising and supporting other doctors. He’s married with four children, the oldest of whom has a learning disability and severe epilepsy. 

As a result of his professional but also his personal life experience, Richard is a passionate advocate of lifestyle medicine because he believes that our conventional medical model, which is disease based, is broken. So he advocates for a health based model which offers us the chance to take control of and improve our lives. He’s a blogger, he’s a podcaster, and he’s been published in the British Medical Journal and across the national media. 

He also presents at conferences on the subject of wellbeing and lifestyle medicine. And outside of his work he also enjoys running, biking, dog walking, listening to music, practicing mindfulness. His bio also says drinking proper beer, which I’m very much in favour of, and spending time with his friends and family. So it’s an absolute delight to chat with Richard on our podcast, not least because he’s also the Guild’s new clinical lead, which is really exciting for the Guild because throughout our history we have always sought to talk about faith, to talk about health and healing, in conversation with medicine and science. So we can offer that holistic understanding of human health. So on with the episode. 

[MUSIC] 

Gillian: So Richard, thank you so much for being on the GoHealth podcast. How are you this week? How’s your week going? 

Richard: I’m very well, thank you Gillian. It’s, it’s the NHS, so you always have to qualify your comments don’t you, but not bad, thank you. Life is very full and interesting at the moment. Are you okay? 

Gillian: Yeah, Yeah. Similarly, I’ve had a really busy week so this is sort of a really nice way to come towards the end of the week and have a conversation with you. Always busy, but kind of really – trying to find all the good bits and the moments to have a laugh and keep going even despite the busyness.  

So you mentioned there your work for the NHS. Can you tell us a bit about your day? Well, I’ve written down day job, but it’s actually a day jobs, isn’t it? You’ve got a couple of roles going on, so can you just tell us about that and what you’re up to? 

Richard: Yeah, sure. So you could you could probably say that my my biggest day job is, is being a GP and I’ve been a GP for 22 years, at my surgery in St Albans, where I’m a partner. In that time I’ve worked four/five days a week. I’m currently on three days a week. Probably dropping down a little bit in the next few weeks. So that’s one of my day jobs and that’s, you know, core general practice. I’m seeing people because, believe it or not, we do still see people face to face, despite what the Daily Mail and The Telegraph say. 

Gillian:  You’ve heard it here. It’s true. Great. 

Richard: Yeah, it’s actually true. Just yesterday I had the surgery that was mainly seeing people – there you go – I’m sorry, the day before, to be accurate. So that’s seeing people, speaking to people, lot of, lot of urgent care and worries but also trying to do – am long term condition management, and sort of ongoing relationship stuff.  

And then a day and a half a week I work for Integrated Care System, the ICS for Hertfordshire in West Essex and I am the clinical lead for lifestyle medicine, prevention and inequalities, which I know is a little bit of a mouthful. So that’s not a hands on patient facing role. That’s a sort of strategic kind of board or sub…sub board level, clinical role. And we’re trying to work together to in those areas I’ve mentioned, lifestyle medicine, prevention and inequalities. And then another, at my third job, a week, I work for an organisation called Thrive Tribe and they are not an NHS organisation, they are a healthy lifestyle provider. 

And so for example, if you get referred for help with giving up smoking or losing weight or because you’re pre-diabetic and depending on which part of the country you live in, you may well be referred to a service that’s provided by Thrive Tribe.  

So that’s most of my jobs and there are other bits and pieces. 

Gillian: And just to be clear, you have the same numbers of days in your week than the rest of us. This seems like a lot, but… 

Richard: Disappointingly so…at the moment it is spilling over into weekends, which is why I’m stepping back a bit from one of the roles because my wife and kids have got something to say about that as well. 

Gillian: Okay, cool. So I really want to get into the lifestyle medicine stuff and pick you up on the inequality stuff as well. But tell us more about your non-work bits of life. What’s the rest of it like for you? 

Richard: Ah non-work bits of life. So what do I do in the non-work bit of life. That is, I guess, spending time with family, my wife and four children, although only two of them still live at home. So it’s become a little bit less complicated in the last few years. And my over large dog and physical activity –  so running, cycling, I enjoy going to the pub, spending time with my mates, doing pub quizzes, reading, bit of X-Box gaming, those kind of things. 

Gillian: I think you might be the first person, on the podcast who’s mentioned the Xbox and gaming. This is a whole world that I’m now very nervous…I know nothing about it Richard. Oh no – have to ask you a question about that. That’s not my work. And tell us a bit about your faith background as well, you know, this your…what you were brought up with in terms of faith matters what you what you believe and how you practice your faith these days. 

Richard: Yes. So you would say I was, I was raised in a Christian family. We went to a Brethren church when I was younger. That was that was my childhood memories of church. I became a Christian. I made a conscious decision to do that for myself at the age of nine, after going to a week long campaign at our church run by the ‘Children’s Christian Crusade’ with Ralph Chambers and Irene Ward. I remember he played an accordion and they had they had a song, which I’m not going to sing to you. 

Gillian: Was it the accordion that turned you to Christ? 
 

Richard: It was, very much the accordion. Yes. Yes. And so, I became a Christian then. And then in the next 40 years, I suppose I would describe my faith as being kind of a journey. I know that’s an overused word, but I would say I’ve always had faith, but I’ve done that in a number of different ways – I’ve had periods of time where we weren’t in church very much, periods of time where we’ve been in church more consistently. I’ve been an Anglican, a Baptist, a methodist, I’ve been to Pentecostal churches – at the moment we’re in a largish Anglican church in St. Albans and over time, it’s give me a lot, time and life experiences meant that I’ve thought a lot about my faith. It’s been challenged by life circumstances, which I think we’re probably going to talk about today. And it’s meant that I’ve questioned some of the things that I took as well, Gospel, in quotes, when I was younger. And I guess that’s just part of life. And now, now I try to to integrate it meaningfully into my work and my life. And I try not to distinguish where I can between those different areas because I think that’s a mistake that many of us make. 

Gillian: Yeah. The more holistic approach to it all, I definitely think we’re going to get into that holistic understandings of human being and health and how to live. But I think journey, I mean, it is overused, but I just think one of the best words to describe, you know, the past and where we’re going as well – it includes our openness to what might happen in the future, too, and that sort of always learning approach to the faith rather than set in stone and too much tribalism, I guess. 

Richard: Absolutely. 

Gillian:  So I really want to understand more from you about this thing, Lifestyle Medicine. What…it’s not on your book title, you’ve published a book, a fantastic book called ‘Fit for Purpose – Your Guide to Health, Wellbeing and Living a Meaningful Life’. And that comes from your experience as a human being, but also as a doctor and that sort of lifestyle medicine isn’t it? So, what is this thing, Lifestyle Medicine. It sounds like what you might get at the, you know, the beauty counter in John Lewis or something like that – it’s sort of something you can buy into. But that’s probably wrong.  

 Richard: Yeah, it sounds a bit luxurious, doesn’t it? And possibly something that’s practiced by people who grow their own sandals as well, which I can confirm, I don’t. So no one can actually even agree on how to spell lifestyle medicine – certainly things like wellbeing, whether it should be hyphenated or not. But if I was to put it very simply, I would say it’s looking at the basic natural principles of what determines how well we feel in life. And you could crudely divide those up, say, for example, into a sense of purpose and meaning, relationships with others, our sleep and nutrition, our movements, how we manage stress and relaxation. And I, I think all of those things together, looking at the, the evidence behind those things and how implementing those things in your life can really help you feel well, whatever your circumstances may be. 

So it’s applying it scientifically. It’s helping people to understand that it’s not woo woo – it’s proper medicine and my big argument is that actually we’ve known for a long time what’s good for us, probably for thousands, hundreds of thousands of years perhaps. But we’ve deviated away from that with our modern medical model, which is a disease based, sickness based model. The National Health Service is really a national sickness service. And my view is, instead of regarding lifestyle medicine as slightly quirky and alternative, we should say actually lifestyle medicine is – just you could just also call it real medicine if you don’t like the term lifestyle, because some people have a bit of an issue about that being, you know, not accessible to everyone and shaming other people and saying it’s all about choice when not everyone has choice –  just call it real medicine. We we need to get back to that and perhaps move away from our fixation on drugs and technologies, which can be life transforming and life saving for some people, it also can do a lot more harm than good. And it’s a medical model which doesn’t encourage us to to look at the bigger picture. 

Gillian:  Because it sounds very sensible and down to earth. And I wonder why, why it might be controversial among doctors to take a holistic approach. What’s that about? Isn’t this just being a being a doctor, wanting to help people find health and healing? Are you up against some big kind of cultural change when you’re introducing what basically sounds like common sense? 

Richard: That’s an excellent question. How can I put it? I think on many levels what I’m talking about, it’s not rocket science, Gillian, I haven’t invented this. People have been writing about this for a long time and they’ve been some real trailblazers and some giants who shoulders I’m standing on and I’m not putting myself up as one of them. 

But I think and I think most doctors most, probably not all, would say, would even though, again, it’s a bit of a trendy word. Yes, holistic – that’s how it should be. I think the problem is not so much that we don’t believe in that as a concept, but the question is how we actually practice it in real life within the constraints of a system which is very burdensome and has had so much apparatus bolted onto it, you know, take primary care, for example, because that’s what I’m best qualified to talk about – all these different guidelines that we have, all these different targets to hit, many of which are about patient care, many of which are also financial. The evidence base behind some of these guidelines is questionable. The more time goes by, the more we realise, perhaps the flaws in research that have led to the guidelines about the drugs that we now commonly prescribed, which maybe aren’t quite as good as we once thought. And in fact, doing things more naturally in a lifestyle medicine kind of way would work better for most people. 

But there are there are competing interests there. Some have I got half an hour to spend with someone talking about their relationships and their sense of meaning of purpose in life. When you’ve got a full surgery, they’ve come in with a sore throat. There’s an ambulance being called downstairs. You’ve got a meeting in half an hour about something to do with admin and finance. And if I said to one of my partners, ‘what I’d really love is half an hour with every patient to talk to them about this’. Well, I don’t need to say I can imagine what they would say – I’ve heard what they say. And these are all good people who totally get the concept, but practicing it is a real challenge. 

Gillian: But I wonder also, is there a question around risk? I’m thinking about conditions and I’m of course, no medic at all. So this comes with the zero medical training, but things like IBS, irritable bowel syndrome, which is what many people suffer from. And the symptoms are very, some of the symptoms are very much like the symptoms for bowel cancer and really terrible illnesses – but are also the symptoms for just being a bit stressed and overwhelmed by life – there must be some risk – you’re sitting there with your stethoscope and your neck, with insurance policies and so on. There must be risks for you to say ‘well, actually, you look really frazzled. And and you said something about a divorce. I bet there’s a lot of stress in your life’, but the risk of doing that again the risk that this person might actually have a really serious illness that doesn’t need lifestyle medicine, it needs radiation and surgery. 

Richard: You make a really good point. So it takes guts to be a GP generally because you’re used to practicing autonomously. You bear the brunt of all the decisions that you make, and that’s whether you refer someone in for an appointment in a managed way or whether you treat someone in an emergency situation. Lifestyle medicine is another layer on top of that. And you picked a beautiful example and I can reassure your listeners, this was not rehearsed, but you talked about IBS. So me, ten years ago, a young woman presenting with IBS symptoms, irritable bowel syndrome, for those who aren’t medical – would present with things like bloating, slightly altered bowel habits, discomfort would probably be a history of stress related stuff in their life. And me ten years ago, I would probably have given her anti-spasm drugs, sent her away. Maybe if the symptoms kept on bothering her and she kept on coming back to bother me, I might have preferred it to a gastroenterologist so that they could stick a telescope up a bowels, which basically gets me off the hook because then we don’t need to worry that  that she’s got bowel cancer. 

But actually I had just such a conversation with someone within the last couple of years, where actually we did talk, I was, I immediately reassured myself she didn’t have red flags, so she wasn’t losing weight, she wasn’t passing blood, she didn’t have altered bowel habits as such. We talked about her life and the job that she hated and living with her parents and university. And we didn’t do drugs. We didn’t do referral. And when I spoke to her six months later, she had completely transformed her life. She, she quit her job. She told her parents what she wanted to do with the life, her IBS symptoms disappeared. No drugs, no referrals. Now, that’s a relatively – that’s a kind of low hanging fruit example. It’s not that risky, but you make a really excellent point. This is -we always have to consider that. And I think that’s the reason also in this current culture, there’s a pathway for everything. There’s a test for everything. So when do we have that conversation about lifestyle medicine? Is it right at the beginning or perhaps might we sometimes say, well, look, I’m going to have to rule a few things out first and then if those things are okay, maybe we could talk about those other lifestyle aspects. 

So so it is it is complex. It does make, I would say, practicing lifestyle medicine some ways to make your life harder as a clinician because if you want to be lazy in quotes or just straightforward, you just tick the box and get them out of the consulting room. But in the long term, it’s got to be for the benefit of the patient and ultimately for you. You’ll practice in the system because then you don’t end up with people with this much chronic disease and you end up with people who understand that they have a autonomy, that they have power, and that the answer to that concerns may rest with them, not the medical profession. 
 

Gillian: Yeah. It’s almost like there’s a two tier. Is there like a two tier thing? So do the the red flags – that’s like signs that somebody might have something serious and you must act and get further tests in the system. You know, that’s kind of one system and thank God for the NHS and other interventions and science that can help cure so many more diseases than we used to be and like a second one, once you started all that thought out right, we could then look at the bigger things because you’ve reduced the risk. 

Because, I remember when I had cancer, I was getting treatment for cancer. Somebody once referred to me as ‘the lymphoma case’. So I was referred to within a group of health professionals, doctors and other people. As the disease. And I remember it really clearly. And actually I remember. Yeah. So it was a doctor and he was at a group of medical students and because it was – my case was fairly sort of straightforward – he was giving the students the opportunity to have a good feel, to see what was going on so they could…I was in a room very vulnerable, I’d just been diagnosed. I hadn’t started treatment so I was really fearful of what was coming. And then they all trotted in with their white coats on. And here is the lymphoma, right? 

Not even the lymphoma patient. It was a doctor. It was the kind of the disease was who I am – so often with serious illness – and, you know, I’m not I’m very, very glad to have got the treatment, of course. But you’ve sort of become the illness and there’s a scraping away of identity within serious illness as well – it almost seems like, you know, that’s like – there’s probably better ways to have a consultation, I’m sure. But sort of a rescuing of the whole person is needed even in serious conditions. 

Richard: I agree. I like your phrase there, ‘the rescuing of the whole person’. Yes. And I’m sorry, by your experience, you know that ‘the liver in bed three’ is kind of one of those things that people still talk about. Thankfully, I hope we’re a bit better nowadays. Certainly in hospital, not as many people in white coats, but yes, the rescuing the person. So I think that’s the benefit of lifestyle medicine. You can look at someone and you instead of saying you’re a diabetic, your asthmatic, you’re, you’re obese, you could say I’m I’m a person who’s currently struggling with this, that or the other. You know, it’s got issues to deal with. But there’s a plan and I’m part of that plan, and I am the key to, in some of these conditions, to getting better and actually lifestyle medicine has a role to play even in the treatment of cancer. There is good evidence that nutrition, for example and physical activity can, can reduce the risk both of getting cancer and improve your chances of recovering from it and not getting a recurrence. 

Gillian: I came across a lovely phrase recently, but something like this, ‘the silence of good health’. So we don’t, we’re not aware of health when it’s good, so we just carry on living our lives, getting on with it. So it’s only when health goes wrong that you realise that it’s important and there’s something like that. In your book, I mean, you talk about lifestyle medicine, all the things to do – in your book and in your work do you, in what way do you think of as health? Is health just something that goes wrong and we go to the doctor to get it fixed or is it much broader? And is that part of then the sort of the practice of lifestyle medicine? So what is health? 

Richard: I think health has different dimensions and I do talk about this in the book. So I would say physical, mental, spiritual, all of those things, you know, you could be in great physical health, you could be a fit specimen, but your personal life could be a disaster and you could be having a crisis of faith. So do we say that is a healthy person? – probably not.  

I, I made the point in the book that we shouldn’t attempt to artificially separate those things. And just as the medical profession increasingly nowadays accepts that we shouldn’t try to distinguish physical from mental health, because there isn’t a wall that somewhere across your neck that separates the head for the rest of your body, then we should include the spiritual in that as well. 

And one of the challenges therefore for me is how I bring that into an NHS consultation, because there are clear, quite right guidance about you not promoting your personal philosophies and belief systems to patients and certainly not allowing what you believe to affect the services that they can access, etc., but spirituality doesn’t necessarily mean religious belief. And so there is that opportunity then to have that conversation with someone about the physical side of their life, their mental health. And now more and more, though not every consultation for a sore throat, etc., but more and more I will ask people about purpose and meaning in life, which I think is quite a good, a good way in and I think is particularly relevant when they’re presenting with mental health concerns. I think that’s a big, a big way in – when they’re presenting with, you know, appendicitis, it’s probably, you know, not quite so relevant. 

But yeah, health must be in the round and if we attempt to compartmentalise it, then it’ll never work. It’s like I’m having three bits in a tripod or a stool, isn’t it? And then you kick one of them away and then you just fall over. 

Gillian: Absolutely – I read an interesting paper on cancer survivorship, if that’s a word, after first remission. And it was across all sort of socioeconomic groups, lots of ages and ranges and economic backgrounds and so on. It was a huge study. And they found that the group most likely to get cancer again and die were middle aged men. And then the conclusion of the paper was that they thought this was because that group of middle aged men were less likely to talk about their experiences. And there was some importance about recovery in storytelling. So trauma recovery, working out meaning and purpose in life, despite what they’ve gone through, as well, and how how healing that could be. And I remember a doctor’s consultation when I was in treatment for cancer, a really, I had a really good GP and I was really confused because everyone was so positive Richard, and they kept saying, ‘Oh, you’ll be fine’. ‘And there’s good statistics’ and and I was like, ‘Well, that’s great. But it does say cancer on the front of the notes and I’m pretty sure that’s bad’. And no one was really telling the truth. And I had a very wise GP and he obviously saw I was struggling and he said, ‘you know, you are really ill and it’s okay if you want to have a cry or talk about’ and it was the first time anyone had said that to me, okay, I was that good old repressed Presbyterian Scot at the time so emotions weren’t high on our things to do list, but it was incredibly healing and important for somebody, and that as a GP, to say that to us, so there’s something about the storytelling which that it transcends any particular denomination because the storytelling we do the meaning making, don’t we. 

Richard: Absolutely, and being able to talk about how you’re feeling is not just good for you, but it gives other people permission to realise, Ah, that’s okay, I can do that too. So it helps other people. And going back on your comments about cancer in remission, one of the things I write about is the evidence for purpose and meaning of life, because when I was writing all of this, I thought, well, everybody knows the evidence for being moving and sleeping better and not drinking as much alcohol. Where is the evidence for this? And actually to to whip through it briefly, if you look at purpose in life as a score, you can have two scores for this. It is associated – causation hasn’t been proved – but it’s associated with people being less likely to have a heart attack if they’ve previously had a heart attack, less likely to have a first stroke, better recovery from cancer, improved longevity and coping mechanisms in HIV and probably equivalent to something like taking a cholesterol lowering tablet or eating your 5 a day. So again, those those are associations, not causation studies – not really designed to prove that kind of thing. But it’s absolutely valid. It’s a really important conversation to have. 

Gillian:  And can I just bring into this conversation, because I do want to go down the meeting purpose bit and talk more about that. But just bring into this conversation about meaning and purpose and health the other bits of your job title – so you said your lead on lifestyle, medicine and health inequalities. Tell us a bit about health inequalities as well and how then there is a link through to the impact on our health of meaning and purpose. If we’re living with health external challenges, I guess that might be impacting on our health 

Richard: We’ve got 3 hours for this podcast, is that right?  

[LAUGHTER] 

Gillian: The Twitter answer, right? 
 

Richard: So, so what we were thinking about what clinical roles or leads we would need moving from Clinical Commissioning Groups, CCG, into ICS, Integrated Care Systems. I was very strongly advocating that we needed to look at lifestyle medicine, prevention and obviously have a vested interest because I ended up getting a job in it and it was very universally agreed fairly early on – inequalities must be part of that because life is not a level playing field. You know, some of us start 100 yards behind everybody else with one arm or one leg tied behind their back. And clearly that presents significant challenges in life. Take two children who are genetically identical, but then raise them in completely different environments. You know, one in poverty, one in affluence, one with a secure and loving family and one in an unstable and abusive environment. One who gets a good education, one he doesn’t. All, all of these things will clearly shape their life chances. They say, don’t they, give me that child at the age of seven and I’ll show you the man or whatever. And I hope that’s not true or we can maybe tweak it a bit, but I still think it makes an important point. So inequalities, therefore, thinking about the built environment, the place you live, whether or not you’ve got access to healthy food, your transport links, what sort of school you go to, those things are fundamental. And if we just talk about sleep and whether high intensity interval training is good for you, well, that’s an incredibly privileged conversation to have isn’t it – that is such a first world, first world problem, I mean, really. So we can’t, we, it’s good it’s fine to do that for people who need it, but we need to do the other bit as well. So for example, we had a meeting yesterday, I’m trying to remember what it was called – it was the integrated care partnership, strategic care integration meeting or something, and it was all about what our priorities are. And we whittled them down from one number to another number. I can’t say how many because I don’t think it’s officially been agreed yet. And we talked about different areas of priority and one of them was about whether you call it leveling up or creating equity as opposed to addressing inequalities. And we said, well, two examples of that would be, children getting good input at schools so that they have healthy meals and that with their families they learn how to cook and eat healthy meals together. When we talk about things like physical activity, that becomes part of school too. And again, families are involved, looking at how do we help prepare people for education further and further life, because certainly, depending on what part of the world you live in, you know, if you’re privileged enough, your kids probably go to a school where they get lectures from professors about how to get the best possible GCSE marks, three A stars, Russell Group University and the usual career track. 

What happens if that’s not for you? And you mentioned something about meaning and purpose. If you were more neurodiverse or less able or something like that, that’s really important because we won’t all – having a happy and fulfilling life will look differently, look different to all of us. And so the real question is, what does that mean? You know, if we only preach that you can be happy if you tick some middle class box then a lot of people are going to be unhappy. So that’s really important as well because I think if you have meaning and purpose, it makes a huge difference. Have you seen a film called Happy? I think it’s on Netflix or Prime. 

Gillian:  Yes, I did. 

Richard: And there was a guy in it who, was he the rickshaw driver or something like that? He basically did an awful job on the face of it, which meant leaving his mud hut and his family, walking a massive distance to a city every day, being abused by tourists all day for not very much money, walking home at the end of the day in the pouring rain back to his family. And he was, as far as you can judge it, as happy as the average American. So I think that, that’s a really important issue to discuss, because you can be happy, you can be fulfilled, you can have meaning and purpose, even if you’re sick, even if you’re poor. It just depends what it looks like. 

Gillian: So true, because each of us also, from the Christian point of view, have a particular vocation – we’re each wrought in our mother’s womb by the design of God and held in God’s hand. We’re each individual as well as our individuality is really important as well when it comes to vocation, how we might live out our life, and I hear what you’re saying about everyone can flourish no matter. Everyone should be able to flourish no matter where they are. And that’s going to look different for everybody. 

Richard: And my son is s a good example of that. So my eldest son, Luke, who’s 25, he has severe, complex epilepsy and a moderate learning disability. We had people telling us all his life that he wouldn’t amount to very much. He might not talk. He wouldn’t be able to go to mainstream primary school. He wouldn’t be able to get to mainstream secondary school. 

He did all of those things. He lives with a wonderful organisation, called zero three, who look after him. He’s funded by the NHS and he has a tremendous life and his life has meaning and purpose and he because he has things like a choir that he sings in, a garden centre place called growing places where he goes to do meaningful work, other community projects he’s involved with, physical activities that he takes part in, and even he, with his learning disability, was able to express at one stage when he was unhappy after COVID and lockdown had taken its toll, he said, to be, said something like, I don’t have a job – so even he who wouldn’t probably, would not be capable of having many of the jobs that we, most of us would consider ourselves capable of doing. He recognised the need for purpose in his in his life so everyone could experience that. 

Gillian: With the lifestyle medicine, you’re obviously driven by your medical training and and your work and your skills and everything, and what you see outside the window. But you’re also sounds very much driven by what you said, your life circumstances. You talk…and lovely to hear about Luke and and his example of the ways in which he finds wellbeing and flourishing. 

Richard, in terms of lifestyle medicine, are you very much a…you’ve always done this or has this been hard won for you personally, about how to find balance and wellbeing in your own life? 
 

Richard: Yes, very much that the latter, I would say. So, whilst I have started life with many advantages because I was raised in a loving Christian family as a middle class child, went to a good school, went to university, became a doctor, met a lovely person that I married and had children. I was kind of on a sort of bog standard, old fashioned medical track, quite unsympathetic about a lot of things in life and pretty no nonsense. 
 

And then Luke, and then having Luke made a real difference to our lives, because at the age of six, he had his first collapse and what turned out to be a seizure. An ambulance was called. He went to hospital. That was just the beginning of the journey. And his, as I said, he has complex and severe epilepsy, which meant that when he was living at home with us, which he did until he was 18, life was essentially 24 hours on call. So no matter what I was doing at work, we were all on call as a family, my wife, his brothers. And that was intense. I mean, I talk to people about fight or flight and overdrive of sympathetic nervous system. We were doing that pretty much 24 hours a day. Nights were disturbed, ambulances were called. We were familiar with the local A+E department and recuss and in fact, the A+E department of a number of hospitals, depending on where we were. And things were getting really tough for all of us physically, mentally. So I just asked myself some questions about how I could sustain myself in order to sustain our family as well. And although I was already physically active, I wasn’t getting enough sleep. I probably drank a bit more than was good for me. Just a common coping mechanism. My diet probably wasn’t optimal. I didn’t really have, I’ve always looked after myself in terms of sort of, I suppose relaxation, hobbies and things, but I hadn’t really focused on mental health. So then I because of all of those things, I started simply with a bit more reading. I learned about mindfulness and did about 18 months of headspace, which was very helpful, loads more reading, lots of podcasts, like your podcast and other podcasts, and gradually just built up a practice over time, a personal practice which I shared as best I could with my family and friends and some bits they may have found helpful, some bits perhaps they haven’t. And then inevitably, it found its way into my into my job. Because you can’t have, you can’t practice that in one bit of your life and completely ignore it in the next. So I then had no choice but to do that, which led to diploma in lifestyle medicine, which led to writing the book, which led to doing the role I do with the ICS and the Thrive Tribe, and with and with other colleagues in other ventures as well. So yeah, one thing led to another. It was, it was, I liked what you said, I think you said hard won, hard fought, I haven’t thought of it in that way, but it very much grew out of that. 

Gillian:  And it seems to me that having run this podcast for a while and had the privilege to work with a lot of amazing leaders, in fact, if I took a moment to think, you know, all the, if I can name the top ten people that I think are…that model good wellbeing and live a connected, flourishing life, who are open every single one person in my mind right now has been through something major, whether that is coping with the inability to have children or severe mental health breakdown or serious illness, or there’s always been something. And it’s not like, it’s like, I don’t know, a weird qualification, but it’s some kind of bit of the journey that helps you be more open, I think, and not just open and wise and ‘oh I have some pearls of wisdom to dispense’ it’s just an openness to – aw life just really hard and I’m going to be honest and open about that and therefore and that’s attractive to those who are going through it. There’s some almost like innate, oh, you’ve been there. I remember that scene in the West. You have. Did you have you seen The West Wing? 

Richard: I used to watch it regularly. Yeah. Yeah. 

Gillian: Remember that episode where one of the characters has a breakdown and, you know, he’s not listening to any advice. Somebody saying, go to the doctor, he’s telling his therapist where to go. You know, the woman in love with him is trying, but nobody’s rescuing him, until somebody comes along and tells the story about the man who’s stuck down the hole and they throw him a lifeline, he doesn’t want to climb. It can’t work out. Eventually the person jumps down the hole and he says ‘what are you doing down here?’  And then he says, ‘well, I’ve been down here too, and I know the way out.’ You know, that kind of company that comes with the life experience, don’t you think? 

Richard: I agree completely. And I think most people that I know of who’ve led in on this, including some of the most well-known names in lifestyle medicine, all have personal stories, whether it’s bereavement, coping with illness, etc.. And one of my colleagues, once disparagingly, I remember he once said of someone who had a particular interest in Cognitive Behaviour Therapy, this person said, oh, you know, all those people, if you’re into CBT and whatever, they’ve all had mental health problems. 

And I was thinking, yeah, that’s kind of the point really – in that it is often what wakes you up to the most important stuff. What I would like to do as part of my role is to be able to talk to people who maybe don’t feel they’re at crisis point yet, whether it’s to church leaders, to leaders in the NHS, to my patients, whoever, It’s about being a bit more proactive so that rather than wait until the wheels fell off, as so many of us have done, actually, you know, keeping the car in bad condition to start with. And that that’s the challenge because we are not logical creatures. We assume that past performance predicts future. And therefore, when we get into our forties and fifties or when we get diagnosed with cancer at a young age, it completely knocks us for six because we were never expecting that. We thought we were going to be, live forever. And that nothing bad would ever happen to us. 

Gillian: Bit surprising isn’t it, given the evidence. 
 

Richard: The rude shock, yeah. 

Gillian: But yeah, but maybe that’s the, you know, survival evolution. We’re sort of preprogramed to survive. I mean, even at the cellular level, we’re preprogramed just to reproduce the whole time as well. So there is that huge clash. And you mentioned church and faith communities as well. And I’d love to get into all that side a bit too, because now that’s the tagline of your book ‘Living a Meaningful Life’. 

But it’s not it’s not what we learn at church, I guess. I wonder, has it been any pushback? I mean, why –  you know, that’s what you do in the doctors. We shouldn’t be doing it at church, now hang on a second. Why are GP surgeries and wherever they take lifestyle medicine practices, hang on, aren’t they treading on our toes here. We are the ones that talk about meaningfulness and purposefulness. 
 

Richard: I would say that no, whatever people have thought in the privacy of their own head obviously the only feedback I’ve had is from people who spoke to me directly, so that probably is a skewed audience, but actually there’s a real appreciation for this Gillian I think, because the point I make in the book as well is that just as we shouldn’t separate the physical from the spiritual, we need to…and just as the secular world has historically neglected perhaps the spiritual and or not wanted to acknowledge, steadfastly refused to acknowledge, the importance of spirituality to truly live well wherever that means to a person. I think the opposite is also true of faith world, unfortunately, at times, which is that we’re so heavenly minded that we’re of no earthly use. And people turn up every morning, you know, no matter how knackered and burnt out, broken they are in their shiny Sunday best, whether that’s the person at the front preaching or the people sitting in the audience putting on their best face for an hour and a half. And then we exchanged pleasantries and we listened to the sermon. And and there is it goes further than that. There is almost a…I’ve seen a culture certainly in our church. I would say historically, I’m not speaking about the current church leadership, but I’ve seen a cultures historically at a number of churches where almost a badge of honor, a martyrdom, martyring yourself on the steps of the altar to serve faith. It doesn’t matter if your marriage is falling apart, if you’re drinking too much, if you’re grossly obese and you’re stressed to the eyeballs, as long as you can preach a good sermon on a Sunday morning, that’s that’s fine. And that’s not fine. And that’s why I think just as we need to move spirituality into the conversation in a GP surgery, we need to move wellbeing and physical health into a conversation in churches, which is what I’m working on. 

Gillian: Absolutely. I couldn’t agree more. I saw some stats recently of obesity and church leadership, and statistically the research showed that you’re statistically more likely to be overweight compared to your peers if you were a leader of a church by a couple of percent. But it was sort of notable, and there is that kind of false conversation that goes on – ‘How are you? I’m fine. How are you? I’m find too’  – don’t mention the breakdown or depression. And it just seemed bizarre of all the places that we might go  Monday to Sunday – coffee shop, the workplace, anywhere, the queue in the dentist, whatever, the one place we should be honest about that ‘how are you question’ should be church. And we do still have kind of keeping up keeping up appearances when it comes to church, don’t we? 

Richard: Absolutely. I find it bizarre and I’m going to try not to get too political or controversial here, but I it bizarre the amount of time and energy that the church, you know, with a big C or whatever, collectively spends on talking about some fairly specific or even esoteric subjects which which affect a small proportion of our of our faith, they account for a very small number of words in the Bible and yet we don’t do the basics well about looking after ourselves and each other. That’s where I think a community approach is really important, because you do need to be able to both ask for help and have others ask you for help. And sometimes, even if you feel you’re a bit broken yourself, you can still help other people. And actually helping other people can be part of you helping yourself as well. So I think that’s, I think that’s really important and we could do with more of the basics on a regular basis than some of the stuff I have to listen to on a Sunday morning. 

Gillian: 

That God made us mind, body and soul, didn’t he – to be ignoring the body bit, and the mind, just to concentrate on the spirit bit. And I love that painting, that picture you’re painting there, that when we reach out to others, it can can also be part of our own health and healing. I keep dropping references, not giving them, but I read this other study that somebody studied what happened at Lourdes, you know, that shrine in France where people go expecting a miracle. A psychologist went to study what healing happened there. Didn’t come with a faith perspective, proper, straight psychology and all the rest of it. And what – having spent time there he then wrote a paper instead on the healing of the volunteers who helped. Those who went and pushed wheelchairs, wiped bottoms, did all the…and actually what they found themselves, and they actually got diverted from doing all these interviews. They were the people that were finding healing, as well as the miracles – let’s not get onto miracles today – but it was in going to others that people were finding their own health and wholeness as well in almost unexpected ways. So churches are places that we are, we are, for the last two thousand years, could have been proclaim a whole person approach to health. It seems to me obvious that we shouldn’t be ignoring body, but we also we also tackle the elephant in the room, don’t we? We tackle meaning and purpose. We tackled death. That’s what we that’s kind of the thing, I would argue, the you know, if you if you break your leg, go to hospital don’t come to church. But, but what do we offer? We offer people an explanation of the thing we think is never going to happen, death. And that in itself could be really healing. So we could do lifestyle medicine and we could have lifestyle medicine clinics in churches, couldn’t we? But we could also do the ‘this is what happens when there is no cure, or this chronic, or there’s neurodiversity or there’s death. 

Richard: Absolutely. And I think now more than ever, church has an important part to play in that if we think about what it means to really serve the community and we’re  think about the challenges that we’re all going to be facing. But some people, particularly over the next couple of years with cost of living, etc., you know, whilst the church may not have got everything right in COVID, I’m sure there was some things it did and being a community hub, helping people with warm spaces, places they can eat, places they’ve got someone to come and talk to and listen to them is is really important. And we’ve we’ve got a rough idea of something we might do in our church where we’re doing a Sunday evening event, we’re not calling it a service anymore because we we think not as many people want to come to a service, particularly not two on a Sunday, and it’s more about conversations. So more workshop type stuff, some bits of church service, but other bits not. And we’ve talked about trying to put something together that I might lead on the importance of connections and relationships and from a sort of spiritual but a secular perspective as well. I mean, maybe in that session really trailing widely amongst the community and have people there with stands like social prescribers, the people from Christians Against Poverty, people who you know are working on the food-bank, people who are just available to listen to, to people who need someone to talk to and have a chat and then and then say, right, you can talk among yourselves but now also, you know, go around the room and introduce yourself to some of these people and learn about what you can do to help each other. And I think, I think that’s what church is for. I think was it Rob Bell, who wrote in Velvet Elvis, it might have been him who said something like Churches exist for the benefit of non, a club that exists for the benefit of non members and that’s what it should be. And I’m afraid that some people, including people in my congregation, I say mine – I’m not a vicar –  the congregation I go to – seem a little bit too stuck on it, on the member club, on the benefits of membership bit. And for me that’s not what it’s about. And if they carry on doing that, then we’re just going to see churches continue to shrink and be less and less relevant. And I suppose the definition of lunacy, which is doing the same thing over and over again and expecting a different result. 

Gillian: Yeah. Oh, man. This is another podcast episode, Richard. Yeah, I think we’re in a really significant moment for the church as we shift from a membership organization that nobody wants to join, to a movement that makes a difference in the world. Jesus movement was always a movement, it was always trying to change the world, it’s become really clubby. Not to denigrate what’s happened in the past. But I don’t think it’s what people want now.  And that event, that sounds… can we keep in contact about it? I think is sounds really important, and the word that you said and…and the the the event screams out is that word connection. And when we’re doing teaching about the healing ministry in the Guild, the word connection comes up so much because when we talk about health and healing, I talk about it broadly based on the miracles of Jesus is that healing is connection with self, connection with community, and connection with God – ultimately about reconciliation with all three and our churches…you know, I saw another stat recently, there’s more churches in our country than GP surgeries. We’ve got buildings, we’ve got space for these connections and events like, like what you’re describing. 

Richard: Absolutely. 

Gillian: And I want to talk a bit about the mental health, the problems our country is facing at the moment. I, I try not to listen to the news more than once a day because it just seems like every single item on the news is, you know, as terrible as the one before it. You know, it’s just so bad list of things happening in the world right now that is really, really tough. 

And just the other week at the cathedral, somebody came to kill himself, Richard. He had taken a massive overdose. And myself, my husband and luckily a passing nurse were first there and we found the suicide note and and it was the suicide note – there was one for the police and there’s one for the priests at the cathedral. And, and it was just awfully, awfully sad. 
 

And we kept, we had to wait an hour for emergency services. And we sat with him. And it was incredibly intimate, was the word that I was using about it. We just held him and we laid hands on him and we prayed for him, the nurse made sure he was breathing and all the rest, all the first aid stuff – he was amazing. But we sort of surrounded him and held him and it felt like he’d come. I mean, he wrote that he came to the cathedral because he was seeking, you know, seeking something. 

Richard:  Yes. 

Gillian: And, and I think there is this memory in our gut maybe or in our past, that the churches, our churches are places that you can come to maybe right at the last when there’s no other hope. These are places for forgiveness and for connection into something bigger than ourselves. And that’s a really extreme example of it, of what is going on. But my, my feeling is that we’re going to see more of this as times get much worse. We need to and we need to equip ourselves to deal with people in real distress. 

Richard: I agree. The example you gave you were giving kind of spiritual first aid whilst the nurse was giving the physical first aid. And it is likely to just get more, more difficult. And as you say, people are people are searching for meaning. And I get probably another podcast episode, but that that message about where you get meaning from over the years it’s become it’s become quite complicated and it’s almost unacceptable culturally in some respects to to bring up the issue of meaning and certainly any form of organised religion. People kind of instinctively assume that that’s a bad thing because of all the terrible things they heard about it. But it is a real comfort to, to a lot of people. And even if a person doesn’t share the specifics of someone’s faith, you can still have that conversation about what you know, what what is life all about? What what gets you up in the morning? What does happiness mean to you? How could you, know all the things you’d like to change in your life that make you would make you happier or less unhappy, even dealing with your chronic disease. And all those are the bits and pieces. And we should be having those conversations without agenda. And if people end up wanting to learn more about Christianity, then great. If Jesus says, you know, love your neighbour as yourself? And then he didn’t go into great detail about exactly what that would involve and under what circumstances that would be considered acceptable. So that’s kind of how my thinking has shifted from my teenage years when I believe that almost every conversation I had to have with a nonbeliever was ultimately with the alternative motive, at some point asking them whether they wanted to be friends with Jesus. And you know that there may still be a point where that’s relevant. But yeah, that’s that’s, I think it’s a different it’s a more nuanced conversation for me nowadays as a, as a doctor and as a Christian. 

Gillian: Yeah, absolutely. And it’s kind of that whole I mean, holding space is the phrase that I keep using more and more. And and I imagine in lifestyle medicine, it is what you’re doing for that, your educating but holding space for those conversations – it’s what we might do as pastoral counsellors, I do this in trauma training as well. So that’s very much about holding space and creating safety for somebody. Also what we do in our church spaces, we hold space for people. And, and I’m, I’m sure there are opportunities to talk about our Lord and Saviour Jesus Christ. That is really appropriate. But, you know, God, God’s pretty big and he might be all over us. 

And just trusting that we don’t have to get into those details ourselves, you know, the resurrection is our founding hope. And if anybody asks me to stand up and say otherwise, I would say a whole bunch of stuff about holistic approach to health but ultimately, I want to talk about the resurrection of Jesus as being a core to my, to us being able to connect with God and God connecting with our suffering, the God kind of hand a lot of it himself. I don’t think it’s up to us to always have to spell out for people. 

Richard: Yeah, we could probably give him a bit of credit to maybe some of the heavy lifting. Yeah. It’s not all down to you or me. 
 

Gillian: And that’s great for our mental health, right, that’s how you sleep at night. 

Richard: Absolutely. Because we can only do so much. You know, we talk about the locus of control and having autonomy. And I think one of the problems going back to your comment about not watching the news too often and I’ve canceled two of my newspaper subscriptions and I’ve just come off Twitter, we need to think about what we can meaningfully do to help ourselves and others without getting too bogged down in things that we have absolutely no influence over. 

Gillian: So, Richard, we have to draw the conversation to a close now I’m afraid, although I definitely earmarked at least three other episodes about things we can talk about, plus covering your event back there at your church. Just to finish, can you – if somebody is listening today, they might be a little triggered by something we’ve said or having a hard time and, you know, or cold or worried or things like that. Give us one bit of advice about how we can flourish just a little bit in all the messiness and all the craziness. 

Richard: Well, see, I always, at the end of every podcast I ever listen to, I know, I know this is coming because that’s what the podcast host always does to the, to the guest. We haven’t rehearsed this have we so, I’m thinking what am I going to say to that!? 

I would say of all the pillars of well-being that I talk to my patients, to my friends, to my clients about whatever, the one that I think is the most important is purpose and meaning in life. I know that doesn’t necessarily pay the bills, and it might not necessarily put food on the table. But I think that, going back to our earlier conversation about the person whose life on the face of it seemed much tougher, but they were actually not unhappy. Understanding what matters to you in life, where you get your your sense of meaning from and are you happy with where you are now and what could you potentially do to change or ask for help to change from others? That can be the beginning of a lot of other more detailed sort of conversations as well. And clearly we can’t address everything in one go but I would say I would say start there. And then when you, if you regard that as the foundations for life, then you know, you can work on the other stuff as well. 

Gillian:  Wow – off the top of your head, that’s brilliant. That’s brilliant. Thank you so much Richard Pile, for being on our podcast. Thank you. I give thanks to God for your vocations as doctor, lifestyle medicine guru, lay person involved in the the church -obviously doing amazing things and living honestly and openly and helping us all learn a little bit more about how to flourish. 

Richard:  

Thank you and it’s been great to talk to you. 

Gillian:  So that was my conversation with Richard. Thank you so much for listening. What did you think? Podcast is freely available to everyone, but we pick up the conversation in the Go Health Community and explore the topics of the podcast within our monthly bundle that we send out to all our Go Health Community members – so join us there to pick up the conversation. 

Because if today’s theme resonated with you, why not share it with someone who you also think would enjoy the episode? Perhaps someone who needs a boost, someone who needs to know that health is something that we can all get involved in. That we all have stories to tell, that we all have wisdom to share. Thank you, Wendy for producing  this podcast, please do rate and subscribe to it. Why not share it on your social media streams? We want as many people as possible to experience these conversations. That would be amazing. So in the meantime, God bless. Let’s connect and chat because together we flourish.