In 2011, Cromwell-based doctor David Beaumont was giving a talk at the Goodfellow Symposium in Auckland about the importance of work – particularly good work – for people’s health.
The symposium, which is held annually, is attended by about 1000 people working in primary health care, and as a first-time presenter he was feeling a little apprehensive.
At that time, Beaumont, who trained in Britain and moved to New Zealand in 2006, was just starting to formulate his thoughts about a new way of practising medicine that he now calls positive medicine.
At its heart is the belief that good health is about more than just the absence of disease. It’s based on Te Whare Tapa Whā, a model of health developed in 1984 by leading Māori health advocate Sir Mason Durie, which takes the view that good health is broader than just its physical aspects. It also incorporates psychological, emotional and spiritual health.
For Beaumont, good health is best achieved when doctors (or other health professionals) and patients work together as equal partners to make sure all these four things are properly attended to.
This may seem a relatively uncontroversial idea now that concepts such as “wellbeing” have become mainstream and there’s a greater recognition of how closely the mind and the body are connected. But it certainly didn’t seem uncontroversial to one GP at the symposium in 2011.
“Halfway through my talk, a hand shot up at the back and this woman said, ‘Could you finish off the point you’re making and summarise the rest? This is a complete waste of my time.’”
Not surprisingly, Beaumont was demoralised by this damning reaction to what was, for him, a tentative exploration of a still evolving idea. Like most doctors of his age (he is in his early 60s) he had been trained in what he calls the “science of medicine”, in which the doctor is seen as the expert whose role is to diagnose an illness then come up with a way of treating it.
“We as consumers of healthcare have been educated to expect doctors to fix it, or to expect the healthcare system to fix us. And then we’re really disappointed when the healthcare system lets people down, and we’re losing the battle against chronic disease.”
That was certainly how he practised medicine in the first part of his career. “I was a very traditional GP, very good at what I did. But what I did was diagnose and prescribe and treat and aim for a cure.”
His views started to change when he left general practice after training as an occupational physician. His new job supporting people with work-related injuries and illness helped him realise that there is more to medicine than writing prescriptions.
“The focus in occupational medicine is on preventing disease, it’s on keeping workers healthy and able to work, and also fulfilling their potential in life, not just at work.”
What was missing in primary healthcare, he decided, was a focus on what people can do themselves to find health and healing – what he calls self-efficacy or being in charge of your own life.
His own experience as a patient helped cement these early insights into the importance of patients taking an active role in their health rather than ceding control to their doctors. At the age of 42, he had a heart attack, and later had two hip replacements. He also experienced a period of depression.
While Beaumont continues to take the medication that will keep his heart in good shape and has regular medical checkups, he started to take more responsibility for his own health. He embarked on an exercise programme and improved his diet, which led to him losing 13.5kg. He also took steps to address his psychological, emotional and spiritual health through things such as counselling, making a conscious effort to spend quality time with friends and family, and being careful to get 7-8 hours of sleep every night.
And despite the reaction to his talk in 2011, he continued to develop his ideas about positive medicine. His 2021 book, Positive Medicine: Disrupting the Future of Medical Practice, won the primary care category at the 2022 British Medical Association medical book awards, and in October last year, he launched the Positive Medicine website, where people can access online courses with names such as The Journey to Self and The Road to Recovery.
“I see myself as teaching people how to create the circumstances in their life to optimise the chance for health to emerge.”
One of the online courses available on the website is called Project Me. It was originally developed as a workplace-based programme in partnership with staff at Fulton Hogan Central Otago. It is now also being offered to Fulton Hogan Canterbury staff in Christchurch, Timaru, Ashburton and the West Coast. Further south, the Invercargill City Council recently finished a pilot programme of Project Me with about 20 staff. The organisation is now looking at how to roll it out to all staff.
The purpose of Project Me is to help people identify what matters to them and how they can achieve those things. Its goal is to have not just better physical health but also better psychological, emotional and spiritual health.
Roseanne McLaughlan, employee support manager at Fulton Hogan Canterbury’s Hornby office, says Project Me isn’t for everyone. But for those staff who are receptive to the ideas behind it, doing the programme has been a really valuable experience.
“They’ve gone through it and come back and said, ‘I can’t believe how clear my head is. I have just refocused and found my purpose again.’ It helps them identify what they want to be and what direction they want to go, and it kind of pulls them back to their original plan.”
GP scepticism
The ideas behind positive medicine still don’t strike a chord with all doctors. In November, Beaumont gave a presentation to 50 members of the Royal Australian College of GPs in Adelaide. The feedback afterwards fell into three basic camps: a third of attendees were enthusiastic, a third were interested to find out more and the remaining third were sceptical about the whole thing. “When I read the feedback saying it sounded like quackery, I felt despondent. But then I thought, ‘You know what? This is at least two-thirds who are either positive or neutral.’ That’s a big shift from where I was before.”
Among those who fall into the enthusiastic camp is Tauranga GP Andrew Corin. He had already been on a similar path in his own practice, so when he heard about Beaumont’s work, he was keen to get involved.
“I’ve been on a journey for a number of years of being somewhat frustrated and a bit disillusioned with the current models of care and the dissonance that exists in the patient-doctor relationship, and I was exploring ways of doing that better.”
He is now running a pilot programme of Project Me with eight patients to see how the concept might work in a primary care setting. The aim is to eventually run a larger study.
Corin started the 12-month pilot with four, once-weekly facilitated group sessions with the eight participants, who have a range of health conditions. These group sessions were followed by 45-minute individual sessions to help each participant set their health and wellbeing goals. He will have two more individual sessions with each participant to check their progress and measure things such as their blood pressure, cholesterol levels and blood glucose control.
Among those taking part are Simon and Sarah Smith (not their real names). Both are in their late 60s and still working. Simon has had prostate cancer for almost 20 years and Sarah is on medication for stress cardiomyopathy, a heart condition that can be brought on by emotional or, in Sarah’s case, physical stress.
They have both chosen to set goals around their physical health, particularly diet and exercise. But others in the group are focusing on their psychological or emotional health. Their goals include taking up meditation, going for walks in the bush, spending time surfing or doing charitable work.
It’s still early days, but the Smiths say taking part in Project Me has helped motivate them to make some much-needed lifestyle changes. “I feel I’ve been challenged,” says Simon. “I suppose what it did was I put a marker in the sand and asked myself, ‘Where do I want to be in six months?’”
For Sarah, it has been a good opportunity to have some “me-time” and reflect on what is important to her so she can stay as healthy as possible as she ages. “You don’t often sit down over a period of weeks and actually focus in on that.”
Time pressure
Running the pilot has taken up a lot of Corin’s time and, like most GPs, he is normally restricted to 15-minute appointments with his patients. Thanks to the support of the practice he works with, he has had the luxury of being able to spend much longer than 15 minutes with the eight participants. Ultimately, though, he believes that Project Me (or a similar positive medicine programme) could be delivered by other health professionals within a medical practice, such as health coaches or nurse practitioners.
“The intent would be that most of this would be delivered by non-GP staff, with us providing oversight and endorsement of the process.”
He hopes that the long-term outcome of taking part in the pilot will be fewer visits to the doctor. “The goal would be that once patients start looking after their health needs in a more proactive way than most do now, they might not need to see their doctor more than once or twice a year because we’ve resourced them to take care of themselves outside of the consultation.”
He has already noticed a growing sense of enthusiasm among the participants about the possibility that they can take charge of their health and set themselves meaningful goals.
Being involved in the pilot is proving to be very satisfying for him, too, and he would like his medical colleagues to be able to have a similar experience. “The reality is we’re all exhausted, and some of us are burnt out. We’d love to do things better but it’s often hard just doing what we’re doing. If we can demonstrate that there is something new that delivers really meaningful change, I think it’s an exciting opportunity to recover some of the joy in our working roles.”
Watch and learn
When Wānaka videographer and photographer Brodie Reed started shooting videos for David Beaumont three years ago, it was just another job.
But slowly, Beaumont’s positive medicine message – that you can take control of your own health – started to strike more and more of a chord. For Reed, the result has been transformational.
When he first started filming, the 22-year-old weighed 110kg and was experiencing a lot of anxiety. He is now 30kg lighter, goes to the gym every day, his anxiety is pretty much gone and his whole mindset has shifted.
“At the beginning, I thought this is just going to be a job – I’ll film and edit, get paid and call it a day,” he says. “But because I was spending six hours on just one project I’d be having the same messages ingrained into my mind. My whole mindset shifted from being more go-with-the-flow to taking control of literally my entire life, curating everything within it.”
For Reed, Beaumont’s views about the links between the mind and the body struck a particular chord.
“I realised that everything is interconnected and combined – your physical health adjusts your mental health and your mental health adjusts your emotional health. I try to live to the values and the concept that is positive medicine, which is the whole control of your own life.”
Eventually, he’d like to be able to help others achieve a similar transformation. But at the moment he’s happy to pass on some of the things he’s learnt from Beaumont, such as his suggestion to take three conscious breaths to deal with anxiety.
“I’ve used that many, many times to control my anxiety and I’ve suggested it to other people, too.”