The clock is ticking.
It was put to me that a milestone (do we ever see them nowadays?) had been reached as I step down from the BSLM Chair after eight years at the ‘helm’. And would I write a reflective piece on my LM journey? My first reaction was ‘who on earth would be remotely interested’. My second reaction was ‘it would be rude not to’’. And anyway, it might be interesting for me to look over my shoulder, as I spend all my time in the present and thinking of the future. And the clock is ticking at so many levels……
So, my friends, here goes. I decided I would interview myself and see where it went. I might learn something. Maybe.
Rob, you qualified in Medicine in 1975, undertook a self-constructed GP training programme in the UK and abroad and ended up as a partner for thirty years in a semirural Practice in your home country of Scotland. What was it that drew you to what is now known as Lifestyle Medicine (LM)?.
Good question, thank you. I picture my grandmother, sitting in her upstairs flat in Paisley, knitting away, and between her mouthfuls of chocolate she would talk to me – a small boy visiting from abroad. So why would I remember, as if it had been seared into my brain, her expression “a stitch in time saves nine”? It set me on a course for the rest of my working life. “Prevention is better than cure” intoned my grandfather as he added fresh lemon juice to his glass of water. Such wise words! One lived into her late 80’s the other to 101.
So, as you went through medical school prevention loomed large?
Not exactly. Actually, not at all. The concepts of holism, wellness, primary prevention of disease, salutogenesis, were never on the agenda. Pharmacology did loom large though.
Emerging from medical school and eventually after a circuitous route to General Practice were you able to bring these concepts into your practice?
You know, although it was a monumental privilege being a GP in those days, it was extremely hard work in a small practice with no night cover or locums. It took 6 years, and a newbuild surgery, before I set up a Lifestyle Active Management Programme run by our first Practice Nurse. She had the time with patients I never had. Looking back, the only pillar I missed out was sleep. Who knew how important that was! That was in 1986.
The first time the words Lifestyle Medicine appeared in print was a paper by Ernst Wynder in 1989. (Wynder EL. Cancer control and lifestyle medicine. Present and future of indoor air quality: proceedings of the Brussels Conference.; 1989. pp. 3–13.)
How did this experience change your practice?
It led to me setting up a local cardiac rehab service for my county in 1989. Ok, secondary prevention, but since the 1960s it was a recognised intervention to prevent hospital readmission. It was not widely available and was a great opportunity to bring the wider determinants of health into the conversation. Over the last 30+ years and thousands of hours of interventions, including gentle activity, relaxation and social connectedness, people living with chronic disease, frailty, (or none) have had continual access to 13 ‘classes’ a week. One such class was in a pub but don’t tell anyone!
Nowadays I suspect that would be difficult to set up without significant funding and resources. Did you have access to any?
No. Fundraising in my spare time was the order of the day but you know what? If there were ever any low points, a visit to any of the classes would inspire and re-energise me. Smiling, happy faces, full of joy. That is what Lifestyle Medicine brings. But you know that already.
Indeed. So fast forward to 2016 how did you make the leap to setting up another charity called BSLM?
Well actually it was a painful leap in one sense. On retiring from NHS practice, I was determined to keep working and use the holistic approach to set up what I eventually called a LM Centre. My optimism was unbound, and I saw a thriving business funding the other charity and repaying my debts. Oops! 18 months and it closed BUT it was the most satisfying time in my working career, bringing to people what mattered to them and in an approach which is now called Lifestyle Medicine.
That must have been hard for you and rather dispiriting.
Hard yes, dispiriting no. Because by now I had made great friends with Prof Garry Egger in Australia who had just published his second edition of Lifestyle Medicine: Managing diseases of lifestyle in the 21st century. The third edition came along in 2017 with environment and upstream determinants of health prominent.
He had set up with Prof John Stevens the Australian Lifestyle Medicine Association. During one visit to Sydney, he suddenly stopped while we were walking along Manly beach, turned to me and said “Rob, you must organise a LM conference in Englishland”. I did bristle ever so slightly, so he changed it to ‘Scottishland”! “Don’t be ridiculous”, I replied.
In 2017 we held our first BSLM conference in ‘Englishland’. Engineers House in Bristol with 75 early adopters. BSLM Newcastle 2024 had 1200 wonderful delegates.
You may have seen the video about leadership and the lone nut dancing on the hillside. Was that how you saw yourself?
No, but others might have! Actually, Laurence Stewart and Michael Boyle came to join me although I cannot attest to the quality of their dancing. Thanks guys, you know not how much your support meant to me and the BSLM. Great job, and we all owe you a great deal.
OK you have gone on a bit about the back story. People come up to you and say you must be really proud of what you have achieved with BSLM.
And I say to them that my pride is entirely in the membership, staff, trustees and so many people who understand what altruism and good will really means. It has been an awesome journey. With inevitable challenges along the way, but rather like my visit to the classes mentioned above, a visit to our annual conference is the biggest boost anyone could have. LM attracts the loveliest of people and I know that thousands, if not millions of their ‘patients’ have had their lives enriched by committed and inspiring healthcare practitioners.
Well, thanks Rob, one or two readers may still be awake. Any final thoughts? Would you change anything?
Thanks for the vote of confidence in the interest! And no, I would not change a thing. Just don’t ask my wife!
The clock is ticking at so many levels in this uncertain world, there are lots of questions to be answered, but whichever way we turn LM is there to offer up solutions. As a graffito tells us on a rock in Alicante, Spain, ‘Together we are invincible’.
Rob Lawson
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