Remote Lifestyle Medicine

Dane catches up with Dr Alex Maxwell, a GP and a Director of the British Society of Lifestyle Medicine.

Dane catches up with Dr Alex Maxwell, a GP and a Director of the British Society of Lifestyle Medicine. They discuss lifestyle medicine, social prescribing and how to deliver both remotely.

Produced by Arc Health in collaboration with Doctors.net.uk.

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Episode
5
37 mins

Dane: Hi there, Dane here from Arc Health. Welcome to the Remote Consultation Masterclass. This is a podcast where we catch up with leading healthcare professionals to discuss tips and tricks for carrying out remote consultations, as well as bringing you key nuggets of information for your CPD. Now you can listen to us on Apple Podcasts, Youtube or Spotify or wherever you get your podcasts from.

Dane: So today I'm joined by Alex Maxwell. He's a GP and a director of the British Society of Lifestyle Medicine. So, Alex, welcome to the podcast.

Alex: Yeah. Thanks very much. Thanks for having me. 

Dane: So I guess before we get started - because maybe some people know you, some people might not know you - it might be just nice to know a little bit more about how you got to this place and what you're kind of currently doing around particularly lifestyle medicine and social prescribing. 

Alex: Mm-hmm. Thanks. Yeah. I mean, so I'm a GP. I am a sports doctor and a lifestyle medic as kind of a background. I'm lucky enough to be the clinical director for Social P, which is Croydon's Social Prescribing Endeavour. I am a GP who regularly does group consulting although COVID has affected that. And actually, I have recently moved jobs, something that is a little bit less now with my new job - I have just taken a job to be Harrow's school doctor, which is very exciting. So I will embed some of the lessons learnt from being a GP into that. But at the moment I haven't set up the infrastructure there yet. And then also, I am the London director or one of the London directors for the British Society of Lifestyle Medicine, and also the national director for social prescribing. And I've set up a special interest group for that as well. So really, I think the main things I love are being a GP, lifestyle medicine and social prescribing. 

Dane: And those are the topics that we are going to be talking about today. So, spot on. 

Alex: Yeah, what are the chances? 

Dane: Okay. So I guess to start with and this is probably a question that comes up a lot. What really is lifestyle medicine? Because it's a term that's been banded around a lot over the last few years. But, you know, it isn't a medical speciality in terms of GMC or specialist training. So I think it'd be great to start with that question. What is lifestyle medicine?

Alex: Yeah. So lifestyle medicine, the first component of lifestyle medicine, is attempting to support people to improve their health and wellbeing. And I think that is something that's important because you can lose sight of things and look at the wood for the trees a little bit too much and think that it's a bit reductionist. But actually it isn't. It's got a lot of behavioural change, motivational interviewing and human psychology in there. It's first and foremost to support the person in front of you. The way through which it does that is attempting to support someone's lifestyle factors. So that's the sleep, what they eat, their relationships, helping them destress and avoid harmful substances. For example, drugs, smoking and too much alcohol. So it's very much an adjunct to medicine. It is evidence-based, it is not the throwaway phrase, "oh, just eat better". It is an individualised and person-centred way of helping someone. Supporting someone to change in the ways that they would want to and also the ways that they hadn't imagined they might. So I find it very satisfying and it is very useful. And that's what it is in a nutshell. 

Dane: So if you are a doctor who is listening to this, that wants to get into lifestyle medicine, you know, what would you advise is their next steps in terms of their career path towards learning and then doing more of it? 

Alex: So I think educating and inspiring our upcoming doctors is so important. And I guess it starts before you even qualify. So there's the undergraduate lifestyle medicine society that you can find. There's also the British Society of Lifestyle Medicine, and they have a website you can find very easily if you Google BSLM - British Society of Lifestyle Medicine. If you want to get more involved, then you're always welcome to come to conferences. There's also a certification, which is like a diploma, which is quite an endeavour. And if you're interested in that, just let me know. And we're also working on a slightly easier or more accessible qualification, which we would call the certification, which is something that you can kind of use to get a little foothold into it - some evidence-based - and put some time to learning the principles and the evidence base a little bit more formally. 

Dane: So I guess moving on from that, lifestyle medicine is obviously really in the media spotlight at the moment, I think COVID has brought it to light. And particularly we know that obesity or being obese gives you a worse determinant if you were to get COVID or the severity of illness. And I guess, well, what do we do next here? What's the advice that doctors should be giving to patients who are obese that we know are already at high risk and many illnesses, but now also COVID, potentially as well? What's the kind of advice you’d give them on how to tell patients to lose weight really? 

Alex:  Yeah, and it's such an important topic at the moment. And I think the first thing to say is, unfortunately, because of COVID, sometimes people have been quite reactionary to obesity and therefore have tended to be a little bit too close to judgement or fat-shaming and not through any fault of their own necessarily but just because of the concern that we hold within ourselves as clinicians and we understand its importance. But if you kind of zoom out a little bit, you realise that a behaviour change doesn't happen through being didactic. Behaviour change happens through kindness. It happens through understanding and it happens through empowerment and education. So my advice is that to effectively counsel someone, to help them with their health, you have to first put yourself in their shoes. And it's quite easy to say, well, lose weight, you just eat less. You know, for example, we absolutely know that that isn't the whole story. Yes, calories in and calories out matters. But to be honest, understanding why someone's eating what they are, what their family situation is, what their heritage is, what their stresses are, and all those - what we call upstream determinants of health and disease, so all the things that are really not in their control and very challenging for them. So I guess in summary - it’s a little bit of a cop-out but I would suggest that really first, you have to absolutely understand the person that is standing in front or sitting in front of you. And then what you do is you empower them to make the decisions that they really want to make. Because everyone wants to be more healthy. And actually, that's the challenge. It's supporting them to make the changes in their diet, in their sleep and their de-stressing and their relationships that then impacts on their health and wellbeing. 

Dane: And as you point out, it's far more complex and it's about knowing that individual really well. So no, I can completely get that. I think that's one of our challenges, because actually it's not a skill that - we don't learn behaviour change or I don't think we do in undergraduate or postgraduate education formally. And maybe that's something we should be doing across the board, regardless of speciality. 

Alex: Yeah, I would agree. And one of the problems is that - I don't like to use the word arrogance so much as I think we're just a little bit blinkered. We focus so much on learning the information, we almost forget how important it is to convey that effectively. And we’re taught communication skills, but it's almost as if we're taught how to communicate effectively but not necessarily how that person would perceive that and then change their behaviour. So you can't change one's behaviour unless you're on board with him. Most people know they should eat more vegetables, and that's a pretty unarguable thing. But why? Why aren't they? And it's a lot more complicated than explaining that they need to. So, yeah, for me, 100%. Some of the, you know, the psychology behind behaviour change and motivational interviewing and, you know, that sort of thing is very undersold in medical school. 

Dane: So I guess moving on from the kind of undergraduate, postgraduate challenges around education. And, you know, clearly, there's lots of things that can be put in place and there’s already opportunity there. If we move on to kind of ideas for medics in terms of what could be put in place in your role, you'll have seen a lot of innovative practice, I assume. Are there any things that you're happy to kind of share with us around practises that were quite innovative in embedding lifestyle medicine into practice?

Alex: Yeah. I mean, I guess there are two main things that I really enjoyed delivering, you know, apart from my day to day clinic. I think the first thing is group consulting. It's fantastic to get a room of people with a theme of something that they all want to to work towards. And some of them less want to work actually. They don't all have to be wanting to change, although it does self select a little bit for them. And actually being able to impart what everyone is wanting to hear once, well, and take your time over each single part of it. So that's one thing. Group consulting has been a really, really enjoyable part of my career. Delivering healthy lifestyle group consults has been something I've done for the last kind of two or three years and it's been really enjoyable. So that's one thing. And then we can talk a bit more about that in a bit I guess, the other thing is social prescribing. And I know, you know, that in itself is not just lifestyle medicine, neither one comes under the other. If anything, I'd probably say lifestyle medicine comes under social prescribing, actually, but that's because I feel like social prescribing is greater than what it previously was defined as. I mean, to me, social prescribing is the recreation of the community, the empowerment as a community to care for itself, not just socially, but health and well-being, physically, domestically, financially, throughout every avenue of your life. It's kind of linking all those resources that we either wish we had or knew was available to be able to support everyone throughout their, you know, from childhood all the way through till their adulthood. And actually health and well-being comes underneath that. Doesn't it? The community and its social infrastructure is bigger than that.  

Dane: Yeah. Okay. So before we move on there's a couple of points I want to pick up on there with you, which is so we'll come back to group consulting, because I think there's a lot we want to know more about that. 

Alex: Yeah.  

Dane: And just before we move on to social prescribing to kind of finish off the lifestyle bit on its own, I guess. Given that quite a few the doctors who'll be listening to this, but also given what we are as an entity here. How would you deliver lifestyle medicine remotely? Any kind of thoughts around that, whether that's telephone or video? And given that's the direction of some of healthcare travel now.

Alex: Yeah. And I'm going to slightly answer a very slightly different question, but it definitely encompasses what you're saying. Essentially, moving back a bit, I feel that having a robust infrastructure of social prescribing within our CCG, i.e. having groups who met regularly to support vulnerable people and less vulnerable, to have avenues of communication created, supporting and mentoring and directing structure really created significant social resilience in the area towards COVID. So actually, I'm convinced and I am working with a few research organisations at the moment into how social prescribing creates social resilience. And then to go back into what you were saying,it's absolutely - it is very easy because everyone already knows each other. You've got people who can mentor people who can mentor people. You've got, you know, very well understood hierarchies of support. So, you know, Doris, who was really struggling to get out to get her food. She was, you know, involved with the local town hall. She was involved with a dance class. She was involved with a coffee group. She had multiple people, each of whom had multiple mentors, who understood how to support her individually, get her support from the way that she needed in terms of getting medicines, in terms of getting medical reviews, in terms of getting calls from me, from link workers. So actually, it's not necessarily how social prescribing can contact people, although, as you say, it absolutely can through multiple avenues - email, letter, video consults, calls, whatsapp. There's loads of ways through which we contacted people. It's more about demonstrating how much more powerfully people are able to be supported because it has those tendrils in the community that can just so easily go and identify people. So as a GP and as the clinical director for our social prescribing endeavour, I've found it so incredibly powerful because I could, with my team, create a list of people who I felt were important to contact support. And we could within a few days find and support and create a way of using what resources we had effectively to look after them. I could not have done that without it. It would have been extremely difficult. So actually, I feel like social prescribing allowed us to do what we needed to do.  

Dane: Okay. And that also then had the knock-on effects of lifestyle medicine, which you feel really is kind of underneath that because it's just on its own, it’s all the elements around it.  

Alex:  Yeah. And I practice social prescribing; effective social prescribing, for example, the link workers, I support them with evidence-based assessments, ways of identifying needs, and that then allows me to support them effectively through the principles of lifestyle medicine, through the principles of medicine itself, and also through the principles of good social structure and support community, which we know is good for you. 

Dane: So, Alex, based on what you're saying, you know, we've covered a range of things and you've started to talk more about social prescribing and as you've already quite rightly pointed out, encompasses lots of things. But I think there will be some people that aren't really, truly aware of how social prescribing works. And I wonder if you could just give us that kind of overview of exactly what is social prescribing, who's involved in and you know, how does it all work?

Alex: Yeah, I mean, social prescribing is, I think one of the most powerful concepts that I've really encountered as a GP. A lot of people would have probably encountered it possibly as this is, you know, you prescribe that people go to the cycling class, to the dance class and things like that. And it is that but it's so much more. I mean, social prescribing is the recreation of the community. It's identifying, supporting and enabling the community to look after itself. It creates resilience within the community. It allows you to socially support someone, rather than medically support someone. As part of my role as the clinical director, whatI end up doing is I end up supporting the people who support the people who deliver interventions. So there are people who are doing the classes, who are doing the, you know, doing the breastfeeding classes, doing the debt advice. They're then mentored by myself a little bit and also supported by link workers and link workers are now funded by the local PCN, which is fantastic, and they are incredibly powerful. And what I'm trying to do is identify areas that need to be supported. So, for example, oh, we need a homeless person's drugs counsellor or someone who can support people with some lunchtime interventions or an over 50s dance class or a choir or, you know, something that I think would benefit the group. And also they identify that. We then create it, link it with the hospital and the GP practices and the council and make sure that's easily accessible. And I then support them to make it evidence-based and effective, to the principles of good medicine and good science and also lifestyle medicine. So social prescribing is the re-enablement of the community. It's the creation of social resilience. And it's so incredibly powerful and exciting. I really enjoyed it.  

Dane: Yeah, I can tell that as well from the way you talk about it, and that's good. So I mean, just to kind of summarise for the average person that doesn't know. So let's say you're a GP, you can refer or signpost into the social prescribing service and there's a link worker and they will then basically decide what types of services that they could go to or utilise. Now, what does that link worker's training or background look like?  

Alex: Yeah. And so there's a lot of ways in which you can access it. So what I'm trying to do is take it away from GP practices because although it's a resource for us, we're busy and we're not great at social issues. We understand them, but we're quite medical. We don't understand a lot of those things so we would defer to social workers and now to link workers and to social prescribing, people who deliver social prescribing interventions. So link workers - they are often people who have been integrated with the community and understand their community. First and foremost, they are a part of the community. So they will be often trained in social care or have previously been in the healthcare sphere. Don't have to have been. They have skills in communication in support and understand the fringes of their jobs of medical and social interaction with the council, often with debt, and have some skills in the kind of medical field as well with nutrition sometimes or with, you know, health and well-being on a more basic level than a doctor would have often, but they are generally the community hubs as people, I would put them, and I generally don't need to refer to them. I would refer to them if I needed more intense intervention socially. The point is, I want people to be able to refer themselves. I want people instead of feeling, “oh, I need the securest route, I need to go see my GP” - I actually want GP to be more of a community specialist again and actually to get rid of and offload some of those things that we've accumulated over the years through being the generalists but actually that we're not that good at necessarily. Nutrition advice, exercise advice, you know, often GPs are - that's not our speciality. I mean, it happens to be mine. But that's an irrelevance. We're talking about the group. Most people want to be doing medicine and end up trying to give, you know, advice for a hurt knee and they kind of have got used to doing that or debt advice or here's how you manage your social or get care - all those things. But it's actually something that we've just generally accepted that we should do. And although we can, we're not experts in those areas. So I'm keen to make us a bit more specialist community physicians and offload those social societal poverty, deprivation, you know, health and wellbeing things a little bit more to these other areas, which I think would be more effective.

Dane: Yeah. So it's about getting that person to the right person who can help the most, but also then opening up GP time or other clinician time to do what they do best. So it's efficiency as well, isn't it? 

Alex: Yeah. And you know, we do love those things. We're community doctors. To be a good doctor, to be a good GP, you have to understand your community. So it works together. But I just feel a lot of the things that we're not so skilled at, it's almost like an orthopaedic surgeon classically can't read an ECG. They laugh at that and they think it's funny because of what they're very good at. And I think we should be happier to say what we are very good at and actually draw some barriers around what we're not so good at.  

Dane: Yeah, that makes sense. So I guess moving on from the kind of more social prescribing elements. While you've talked about it, maybe this is something you've already kind of said now, but where do you think social prescribing is moving to? Given all the opportunities and the media attention from it, there's definitely a lot of potential to expand and grow in this kind of area. Where do you think it's heading and what should GPs be doing as part of that to help? 

Alex: So where it's headed is a very interesting question. I think it's power to me has really been, you know, a bit like any discrepancy in Black, Asian and minority groups with COVID. Sometimes challenging situations expose what we kind of already knew. And it doesn't make the problem, it just identifies or highlights the problem. So social prescribing for me has really highlighted its importance. Because before we could have even predicted COVID, it was already useful for COVID. So that's the first thing. I think social prescribing needs to be made more unified. I think it needs to have a robust national infrastructure. I think it has to be less of a postcode lottery. I think there has to be better communication between leads. So, for example, clinical leads in each borough, in each county need to be regularly in contact to share lessons learnt. I'm attempting to do that in the best ways I possibly can, though you know, I'm still quite a junior GP, but I am very frustrated through such discrepancies postcode-wise. Some areas are doing phenomenally well, you know Merton with Mohan Sekaram and I'd say Croydon, are doing fantastically well. And those mayors up in the north, are doing incredible work. And then there are some that just have barely anything. So I think we need to you know -  you have the bottom up, and you have the top down and they need to meet. And the people in the middle, like me, need to be able to talk to each other and share lessons learnt. And one of the things I'm trying to do is create a paradigm for social prescribing. So the structure that we have with an operational director, clinical director, people who mentor and direct localities and then link workers and then the people giving the interventions with the council and with the CCG, kind of on either side, I think we need to be creating the gold standard. And I think we need to be rolling that out, not in a pre-packaged -  here's something that we're just gonna take funding away from - because it needs to be personal to the community. But I think we do need to put more top-down infrastructure on it. It's the time to do it. To find the right people and to create a good, solid way of delivering it. Because I think it is very, very cost-effective. You know, very cost-effective. It's very efficient. And we’re just proving that at the moment. NHS England, well, we'll see. I won't share, but there are plans. You know, it's not been fully decided, but there are plans to do a really good, strong three-year research projects into it and actually, get some good data. And I've been trying to do that locally, and I'm quite convinced it's far more effective than utilising a GP's time, for example.  

Dane: That makes sense.  

Alex: So yeah, that's where I see it going.  

Dane: No, perfect. So there's lots of potential. It's a bit of a watch and wait as well. And obviously, now's an interesting time politically with lots of different movements happening. So we shall see. So you also mentioned group consultations. So I want to bring you back to this and this is something we started on at the RCGP conference actually, didn't we? So this is something you've done quite a bit of, which actually many of us haven't. So I wanted you to hopefully get started by just telling us a bit about group consultations - what you've kind of been using, how you set it all up where you were? 

Alex: Yeah. So I've done group consultations for nearly three years. So like I said, I've just left my previous practice where I did it for nearly three years. So not currently delivering them in the same way. But, you know, again, this is the way of careers isn't it? I love group consultations. I really enjoyed it. It came up through Emily Symington, who was the Darsey fellow and introduced group consulting to the CCG in Croydon roughly 8, 10 years ago. I then, with her support and with groupconsultation.com, Alison Manson's support, set it up in healthy lifestyles with my interest in lifestyle medicine. So you can do it for your annual review, asthma, diabetes, COPD groups. And that did happen in our practice. And I delivered it for healthy lifestyle, which was prediabetic, BMI of over 30, started out as 35 but also 30. And then also I added in hypertriglyceridemia as well. With the premise of attempting to be more proactive and preventative, as we are often saying in the NHS fourth year etc but not necessarily always delivering. So trying to predict the people that would get metabolic disease, for example, before they did. And the set up basically is, you have a facilitator. Well, you identify your group and you invite them, you get confidentiality agreements and you set up them with the rules of the day, as it were. They come in, sign all the pamphlets and bits that they need to do to understand the session and the confidentiality side of things and what's going to happen. The facilitator then gets a question off them that is specific to their desires and wants and what they're hoping to get out of it. Bearing in mind it's not so rigid as that, they've always got a couple more questions, but they always get one that they always get answered. And then once that's all set up, that takes about half an hour or so. Then I come in. I'm in for about an hour, consulting with each one of them individually and then all of them as a group, you answer their questions. It's much more effective. It is efficient. It's just much more enjoyable. 

Dane: When you say you consult individually when they're in the groups. How does that work, sorry?  

Alex: They're all around the table and you consult with them and most of them are very happy - well, they're all very happy to talk about it because they've been asked that already.  

Dane: Fine, so the others will listen in on the consultation?

Alex: Right, right. 

Dane: Yeah, OK.

Alex: And sometimes people baulk at that but generally, they don't. And actually, it's about how you manage that group, isn't it? Because a lot of them are quite happy to share and it's almost empowering. It's almost off-loading, isn't it? To kind of get stuff off your chest. And multiple times people have cried and have had breakthroughs and have been supported by the group and actually made real progress emotionally - which is often what's holding people back because they've identified something that they're doing. Emotionally eating, you know, they're eating  because they miss their ex-partner or you know, their husband died and they gained loads of weight. And it's because they're replacing the intimacy, for example. And, you know, there are so many breakthroughs through it. It's such a positive environment, and it's so much more uplifting than a clinic, I must admit. I actually quite enjoy clinics to be honest and I don't generally get too pressured during them but group consults is a really refreshing thing to do once or twice a week. It's very invigorating, and a much more uplifting type of experience.  

Dane: So how many would you get in a consultation on the whole? What would the max capacity be realistically?  

Alex: I would advise anything over about ten gets a bit hard to manage. And it does depend on the group. So if it's COPD and they're all well behaved, it can be 15, 18, 20, you know? And I know that some of the guys who do them regularly for, you know, for rheumatological conditions, for example, they are all very well drilled. You know, they're good patients and they just smash through it as part of their review. They're much quicker so it can be, much more effective up to 30, 25, 30, it depends on the setup. But for me, more like ten. And I would then consult with them. I would leave. And then the facilitator will take the last questions and get some feedback because you're always looking at quality improvement. And then debrief after everyone's left.  

Dane: So. OK. So that's quite interesting. So in many ways, because you were saying that you're also using them for actual reviews. So actually, it's a way to practise - I mean, it's not just the efficiency side we're looking at but actually practises can be quite efficient in terms of getting through reviews, but also you've now got this group approach where they've actually got each other for support as well. With chronic disease, you know, mental health issues, amongst other things that are more rife aren't they? 

Alex: Yeah, for sure. And you know, the amount of times we talk about pain during it. You know, if we if we've selected people who are obese, the likelihood of them having knee pain or back pain or any pain, as you know, is a little bit higher. And all their pain is likely to be greater. And talking about that, when you're on a one and one, people will go, “oh, my knee hurts.” Yeah, but it's because of X, Y, Z and actually losing weight would help. They look at you like, "Yeah, okay but I'm special, my knee hurts." But then if someone says that in a group consult, four other people going, "oh yeah, me too". Well, actually, what do you all share? None of you have any injury. It's actually because of a lack of joint control. And if you know, if you lost a few kilos... And they look at each other and go, "Ohh ok. Actually, maybe that is something". And they form WhatsApp groups and they go off and start doing walking groups together or they are mates and just go out for coffee. Accountability and support is a huge part of behavioural change, and there is data. I mean, you know, I've seen probably a hundred twenty people over that time. And I have data now about ninety or 100, and blood pressure didn't go down, to be honest it didn't change, but HBA1C and weight definitely did. And then if you go on groupconsulting.com there is a list of - and also on the app - support and ways to set it up yourself. And also - or you can contact me, I’m very happy to support you as well. And also a lot of the evidence-base, Fraser Berrel is one of the chaps who would be good to get in contact with as well. He'll support you as well.  

Dane: Perfect, so I guess the kind of final questions to you really are more about just bringing this back to more remote video consultations. So as an individual, any kind of final parting advice or tips really around video or remote consultation? But, trying to do these lifestyle bits, are there any things that you should consider? That's quite a broad question I appreciate. 

Alex: Yeah, I mean, so the first thing I'd say is it's actually not as different as you'd expect. Unless people are very elderly or vulnerable or not fully-able, if they're disabled, that can be difficult. And one of the things that I am a little bit upset about, you know, we have to be very mindful of self-selecting people who are less needing of it. So group consults virtually are biased towards people who have phones, who can use them, who aren't so isolated. So we just have to be mindful of the people that we're excluding when we do that. But actually zooming out a little bit. The majority of elderly people now have smartphones. In fact, I know loads and loads of people who are very okay with WhatsApp, Zoom and Skype and actually not to be ageist, I think is an important part of it as well. The second thing is, if you're able to deliver a consult, you can deliver a group consult. You just have to have your barriers and make sure you're being firm with people about boundaries. And actually doing it virtually is very, very similar, to be honest. The only thing that is the thing that people worry about is the technological "oh, are you there?", "oh, the Internet's gone", and all of that stuff is the thing that people worry about. Whereas actually, to be honest, if that happens, all you need is a fallback and not to stress about it. Tell people in the email that you send them or in the letter that you send them or on the first call, guys, if you drop out, try and join back in. And if you can't, it doesn't matter, we'll do another one next week or I'll give you a buzz later in the day. And just don't stress about it, because actually 80 percent of people won't have any problem at all. One of them might have a little bit and start shouting when she thinks she's muted but apart from that, you know, Grandpa Joe is shouting at, you know, the TV or you know, that's... you can't get rid of that. But generally, it actually works very well. Yeah. So being less scared of it I think is the main thing. And actually it's a lot more normal. We're all very okay with technology. 

Dane: Yeah, that makes sense. Perfect. Well, I guess on that note, just kind of summing up some of the things we've been talking about. So, again, guys have a look at social prescribing to see what's available in your area. Clearly, with the British Society of Lifestyle Medicine, this is a network for those interested in lots of medicines, so do have a look at their site if you're interested in a career down that pathway. In terms of group consults, you know, these are innovations to some extent so if they're not being done in your practice, have a look at how you might do them. Obviously Alex just talked and shared about how he set up some of these things. That's everything from reviews to actual lifestyle factors. So again,  have a look at the opportunities in your area. Clearly, you know, get in touch. And there's a range of people around who, it sounds like, are keen to help here. So I think on that note, really just a massive thank you to you Alex, for joining us. Appreciate you sharing your experience and knowledge around this area.  

Alex: Thank you so much for having me. Dane. It's been a really enjoyable chat actually. Really enjoyed it.  

Dane: Pleasure. So on that note, we'll see you guys on the next podcast. Take care.

Dane: As always, do keep in touch with us for future episodes by clicking the subscribe button on Apple Podcasts, YouTube or Spotify. See you on the next one.

00:00 Episode introduction

01:05 Introduction to Alex Maxwell

2:20 What is lifestyle medicine?

04:14 Career advice on learning / doing more lifestyle medicine?

05:44 Courses & resources for lifestyle medicine

06:44 How to tell patients to make lifestyle changes

10:50 Innovative practices that helped embed lifestyle medicine into practice

13:01 How to deliver lifestyle medicine remotely?

16:21 What is social prescribing?

22:08 How do you see social prescribing evolving?

25:16 How to set up group consultations?

31:18 What have been the outcomes of group consultations?

33:54 Advice and tips around video or remote consultations?

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