‘I worked from 8am until 8.30pm and still think I’d done a bad job’
A Welsh GP who felt she was ‘constantly failing’ has opened a baking school and now treats patients from her kitchen table. Jonathon Hill reports
WHEN Rachael Watson suggested a patient’s pain could be due to their home life, she was soon on the end of a barrage of abuse.
She was told she was a “f*****g useless GP” and that other patients would be wasting their time in seeing her.
For Rachael, who has now had 30 years’ experience as a GP, the words hurt, but also got her thinking about our relationship with pain, and whether more can be done for patients than a 10-minute appointment and a prescription.
Two years later she was introduced to Professor Lorimer Moseley, a world-leading physiotherapist and neuroscientist. It was the lightbulb moment she needed, and she has gone on to think more deeply about the neuroscience behind pain.
Ten years on, and months after her last shift as a GP, she has just opened her own baking school in Abergavenny, where – as well as teaching people how to bake – she has also opened the Physician’s Kitchen, intended to allow her to spend more time with patients experiencing chronic discomfort including things like back pain, fibromyalgia and arthritis.
According to the National Institute for Health and Care Excellence (NICE), pain that lasts for more than three months – also known as chronic pain – affects around one-third to one-half of the population. It is estimated that more than 40% of people who walk into GP surgeries annually have experiences of chronic pain.
With GPs under increasing pressure due to the strains of the pandemic and ahead of what is expected to be one of the worst winters on record for the NHS, Rachael hopes patients can become more aware of the possibility that a GP surgery might not be the answer.
“I’ve been doing baking classes since 2015 from home and only did one or two classes a week, and it was like the antidote to a GP surgery,” she said, chatting at the head of her long table in a kitchen which is the epitome of homeliness.
“I wanted to make it feel like a proper house so people would just come in and relax,” she said proudly.
“I have domestic ovens and not too much gear. For now with the baking classes it’s just a place where people can come and bake some nice bread and show it off to their friends and family. Something might collapse but it’s only going to be bread.
“And then there’s the Physician’s Kitchen, which I’m excited by.”
Last month the Community Health Council revealed the intense pressures on GPs across Wales, and Rachael said the need to give answers quickly was, if anything, increasing.
“In a practice everything is so timelimited, there are so many quick decisions, it’s about getting through the day,” she said. “But medicine is an art and it is often grey.
“We have been taught that pain comes after tissue damage, but in reality you can experience pain with no underlying structural damage at all. Chronic pain is often to do with neural circuits in our brain which tie in our pain processing pathways. It’s not really that something has happened to your body, but more to do with danger signals from your brain which alert you that something dangerous might be going on.”
She uses an example of shark attack victims, who have repeatedly said that at the time they were attacked they didn’t feel pain
“That’s because the subconscious brain where pain is initiated and processed decides that the most useful thing to do is to not send pain signals,” she explained. “Once we realise that, then we realise that asking someone how sore their knee is is like asking someone how sad a film is. It’s important to ask about someone’s life, because you need to understand someone’s life to understand the pain they are feeling.”
These ideas are not new. Two and a half thousand years ago Hippocrates said: “It is more important to know what person the disease has than what disease the person has.”
Rachael continued: “When you read how 45% of those who walk through a GP’s door do so with medically unexplained symptoms, like pelvic pain or non-cardiac chest pain, and you’ve only got a 10-minute appointment and a prescription pad, it is very hard to be a GP.
“I used to work from 8am until 8.30 in the evening and I would still drive home thinking I’d done a bad job. I was probably making decisions on 120 patients daily – sometimes more. But there is something about the system that makes you feel like you are constantly failing if you’re the sort of person that I am. And I think there are a lot of GPs who are like me. You train as a GP because you care about people.
“We’ve gone down a very biomedical model of medicine. We’ve sort of put the person to the side, but actually that’s counterproductive for so many medical problems. But with a 10-minute appointment there is so little else that can be done, and yet there’s such a high expectation of prescriptions.”
As she prepares a sourdough class for the following day, Rachael thinks hard when asked if she has lost faith in a healthcare system which she has wanted to be a part of since she was 13.
“No, I haven’t lost faith in it,” she said decisively. “I think being a GP is fantastic and I think the NHS is fantastic for emergencies. I just couldn’t enjoy it. In old-fashioned practices you would be able to get to know the patient and their family, you would know all sorts about them. Now there isn’t that continuity of care because it’s so difficult to get appointments.
“I’d like to think I’m not turning my back on it. Rather I’m making plans to run towards something that could be really valuable.
“I want to be able to offer patients long appointments in my kitchen which doesn’t involve a prescription pad. For millennia human beings have sat at the campfire or the hearth or the kitchen table to discuss life and bash out their problems over a cup of tea. There is something about sitting in a kitchen and talking about life which just takes away from it being a medical problem, because it often isn’t.
“Getting chronic pain better is about rewiring those neural circuits in your brain. Every sensation which gives messages of safety and trust will help someone’s subconscious brain to process new ideas.
“I understand for most people that if they have pain and someone is telling them it is to do with an oversensitive pain processing system, that’s a big thing to take on board. When you’re in pain it’s much more difficult to take on that information anyway.
“My hope is I will be able to see patients and then with time start doing some sessions that involve baking. By doing something lovely like baking you can take on information more easily. The baking isn’t therapy, but baking allows people’s minds to wander – and that’s half the battle.”