I have strong memories of being taught by Keith Macleod when I was studying medicine at the University of Otago in the 1970s. He had a unique approach to teaching in action. I recall him, for example, discussing the profession of medicine in a tutorial. He challenged our shared view that medicine is all about curing and healing. He mooted that people are dying from the minute that they are born, that every second of every day people are treating their terminal condition by taking their next breath. Only when people fail in their self-treatment and when their friends and families are unable to help them, do people eventually seek help from doctors. On this basis, medicine is a failure-based system and ultimately all people must die, so we must fail with every single patient.
Here he was taking our “healing/cure/success” loading and tipping it upside down, replacing it with the view that our whole medical system is failure·loaded, taking our view that we are quite simply alive and turning it on its head: we are all dying and with every breath we take we are treating our terminal condition. The juxtaposition of opposites is used to challenge, free up and expand our thinking. The way in which Keith presented his views also introduced the element of surprise, and that, for me, provided such an anchor for everything he taught: I think it was my emotional reaction to the unexpected content of his lessons that has embedded my early experience of his teaching in my memory.
Finally, Keith focused us on people’s experience. Even more than that, he was putting the power firmly with the people who seek our help, and challenging the prevailing view of the doctor as the authority in charge of treatment. He reminded us that people are actually responsible for managing their own health and treating themselves, and that doctors play only a small role in regard to this.
Keith had a remarkable ability to challenge conventional thinking, though his views were not widely supported at the time. With hindsight, I see that Keith’s early teaching and our subsequent conversations have profoundly shaped my working life: I can see in my interactions with Keith the seeds of my life-long passion for ensuring that mental health services focus on the experience of the people they serve and that they support people to take the lead in addressing their own health issues.
Looking beyond my own work, it is heartening to see over recent years an increasing focus on the experience of patients, both to drive improved healthcare delivery and to enable people to make informed choices about treatments within the context of their own lives and aspirations. Although Keith’s teaching on these subjects was unconventional over thirty years ago, recent changes in clinical practice provide evidence of the relevance of Keith’s ideas today. The importance of each person’s experience of their condition and the central role we all play in managing our own wellbeing are concepts of Keith’s that, with the passage of time, are becoming increasingly widely accepted and incorporated into day-to-day clinical practice, illustrating just how far ahead of its time Keith’s thinking was, all those years ago.
Sue Hallwright has worked for many years to change health systems so that they enable people seeking help for mental health challenges to take the lead in their own recovery and to support each other. Conversations with Keith McLeod about his ideas over many years have had a profound influence on her thinking and her work.
This is part two of an edited extract from The Next Patient in the Waiting Room: Essays on Edwin Keith Macleod. Physician, Poet, Thinker. Versal Press, 2016. Read part one here and read more about Keith Macleod here.