Posted by: ayrshirehealth | January 16, 2013

The best for every patient, every time by @docandrewmurray

Is it due to the midges?

Dr. Andrew Murray running in the Antarctic, Union Glacier.  Nov. 2012.We have put a man on the moon, but we can’t stop death. 100% of people die worldwide- despite medical advances.  But how can we persuade the Grim Reaper to defer his visit as long as possible, and how can we help Scots have healthier, happier lives.

In Scotland life expectancy continues to get better, but at a rate slower than our Western European neighbours. Despite all efforts, and very significant achievements within NHS Scotland, health inequalities continue to widen.

Are Scotland’s genetics responsible for our problems, do we have a poor health care system, or is it due to the midgies or the economy?

The truth is that a profound cultural change is what is required if we are to achieve the massive step change in Scotland’s health that we aspire to.

The Problem

AM-MoveeattreatWe can help tackle excess early death,  and illness in Scotland by addressing

1)    Unhealthy lifestyle choices, including low levels of physical activity, an unbalanced diet, excessive alcohol consumption, and smoking.

2)    A loss of purpose, and sense of control in large population groups


Consistent approaches are being applied to address excess alcohol, and smoking, with considerable success- we can continue these. The Lancet suggests that 16% of the UK population dies due to a lack of physical activity. I’ll repeat that.


Physical Inactivity costs the Scottish economy about £660M according to CMO Harry Burns, whilst getting people active can help prevent and treat over 20 diseases.

Getting Scots more active, and helping improve what we eat will achieve enormous benefits for the patient and the system.

Sense of Control/ Purpose

AM-RunlikeustolesomethingHumans work best, and remain healthier when they have a sense of purpose. It doesn’t seem to matter what this is, as long as there is one.

Without a sense of purpose we lack direction and meaning in life, and also lose our sense of control and self worth.

Programs that provide people and communities with a purpose and sense of control achieve better health results.

Is it just Scotland?

The same problems are being recognised internationally. Lifestyle factors are contributing to an epidemic of Non-communicable diseases. For example more people die of eating too much worldwide, than too little. The WHO, the World Health Assembly and the Lancet have urged countries, systems, and practitioners to continue treating disease, but also to help patients address physical inactivity, unhealthy diets, and other factors, that can help create health as well as treat disease.

A Fresh Approach – Health Creation

Healthcare leaders in Scotland like Derek Feeley, Harry Burns, and Jason Leitch are making the bold changes that will integrate health and social care, helping tackle the factors that lead to a loss of purpose and control, and unhealthy lifestyle choices.

The clear intention is to produce world class health care, and to do the best for EVERY patient EVERY time. I want to be a part of that.

Initiatives such as the Early Years Collaborative gives opportunities for us all to make a difference, and to get it right for our patients and communities.

Increasing Physical Activity

Dr. Andrew Murray running in the Antarctic, Union Glacier.  Nov. 2012.Health promotion in general is good medicine. Evidence is mounting internationally that physical inactivity is one of the biggest causes of death and illness worldwide, but more importantly we can do something about it.

There is bullet-proof evidence that we can make a difference in healthcare, and Scotland can lead the way in this regard.

Worldwide, it’s the new show in town, with the scale of the problem only now appreciated.

And the world does a bad job on physical activity- fewer than 15% of GP’s practice nurses and health visitors in Scotland know the guidelines, compared to 97% of medical students knowing the alcohol guidelines.

What can we do?

I’ll just focus on physical activity- but health promotion in relation to many risk factors can achieve results.  Something that we can all do to make a difference to our patients. If we are to do the best for every patient, every time, that will often involve health promotion. There are competing priorities, and we are all busy, but either we are serious about doing what will most benefit our patients, or we are not.

1)    We can spread the word about the guidelines- the basics are

a)    ADULTS- 30 mins 5x a week (150 mins/ week)

b)    CHILDREN 5-18- an hour a day, are minimum recommendations, and everything counts, walking, cycling, swimming, dancing, gardening, and as a starter, something is better than nothing.

AM-23 and a half

2)    Ask the questions, How often do you do physical acivity (EVERYTHING COUNTS) and for how long, followed by sensible brief advice on integrating it into daily life, and walking more.

Where possible offering Brief Interventions, and signposting to the likes of local resources, Active Scotland, Paths for All, Jog Scotland, Tribesports etc can help.  And it’s clinically and cost effective- almost ridiculously so in primary care studies show, and probably in secondary care.

3)    Build Physical Activity for health into admissions forms, clerking sheets, guidelines. If this kills more than obesity, suicide and MRSA combined, we should be asking about it.

4) Watch which is the most popular health video on the internet- and share on Facebook, Twitter etc.

AM-Sahara@docandrewmurray is a GP and Sports and Exercise Medicine doctor. He works as the Scottish Government’s physical activity champion.

As a runner he’s won races in jungles, deserts, in the Arctic, and has run from John O’ Groats to the Sahara desert and last month ran 7 Ultra Marathons on 7 continents in 5 and a half days – to raise awareness of the benefits of exercise.


  1. Great blog…. Your enthusiasm and energy to tackle physical activity uptake in Scotland is inspirational. It’s a huge agenda with so many factors to consider – improvement methodology could be really useful for this.

    • Thanks for commenting and for your part in taking the agenda forward 50×50 challenge

  2. I’m a practice nurse and I give physical activity advice to most of the patients I see every day. I’ve even taken a foundation level course on exercise. The message is out there, but many people have to break years of bad habits. You are right it has to be mentioned EVERY time they are in contact with a health care professional. The patients of mine that are in good health for their age are the ones that eat healthily and stay active.

    • I think the thrust of the blog is we need more like you, HCPs who talk about the individuals contribution to their own health, a responsibility each of us share for our own wellbeing. Thanks for commenting.

  3. is Ramblers Scotland guide to walking for health and fitness and a useful resource to direct patients to, to help them get active and stay active.

    • Thank you – I’m sure this will be a useful resource for readers.

  4. […] have quite a few health themed posts this week. ‘The best for every patient every time‘ by Andrew Murray looks at how we can help people to live healthier lives for longer. Andrew […]

  5. […] The best for every patient every time on the Ayreshire Health Blog by Andrew Murray. […]

  6. […] Doctor Andrew Murray then took up the baton of blogging on Ayrshirehealth as he shared his own experience as an ultra-marathon runner hghlighting the need for every one of us to take responsibility for elements of our own health.  He signed of his blog encouraging us to keep our sedentary approach to 23.5 hours per day. […]

  7. Good to see the so much discussion around what health is and how to get it, and noticing a positive change in language. Great to see words like wellbeing, resilience, compassion, empathy, assets, local, networks, co design creeping into same sentences as deprivation, activity, fitness, running, sport, exercise. Maybe it’s just what I’m reading, but language around health might at last be getting less preachy and smug and more understanding of each person and individual circumstance and upbringing? Professional’s contact with people is fantastic opportunity to encourage change, but only if they have an idea how to approach it and choose their words to suit – this isn’t easy. What words / phrases are you all using to talk about activity?

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