An interview with Mateusz Pucek, GP

Can you introduce yourself and tell us about your role in Primary Care at the moment?

My name is Mateusz Pucek, I’m a GP, I live and work in London. I primarily work in the NHS doing locum shifts in practices around Balham. And also work for 111, the out of hours service. I also have my own private preventative and functional medicine clinic called 360 Health Clinic.

How has your practice coped over 2020?

It has been a roller coaster ride really. Originally, I was planning to locum full time, which I was doing. I also work for a private Polish practice when the pandemic stated. Then all the work just dried up within a few weeks. In the time of the pandemic, I almost faced unemployment as a doctor which was a bizarre experience!

I joined 111 and worked for them, for almost a year now. And have been working on developing the clinic. Private work was non-existent throughout the pandemic. I think people had different priorities, but its all picking up right now. I want to see what happens in the summer and throughout next year. We’re still not out of the woods yet, and don’t think we will be until next spring. A lot of things have changed.

What do you see, or hope for, for the future of primary care?

I don’t see primary care ever going back to what we used to do in the past. That model of primary care has gone. Whether that’s a good thing or bad thing, I’m not entirely sure. The reason why we’re not going back is because I don’t think anybody remembers what it was like. Patients have changed their habits, they know they can call and get a telephone appointment. Same with doctors, I think they see the advantages of having a telephone triage system, seeing people that they only really need to see.

That system needs to be tweaked because I see a lot of people who complain that they cannot get an appointment with their GP, or that they are only able to be seen online or on the phone. And for a lot of people, that’s not enough.

I think online medicine is here to stay and it will be developing, definitely. I think this model actually created a fertile ground for automation being developed much quicker than it was before the pandemic.

Health seeking behaviour has changed already. People are used to online consultations and now its just a matter of creating a technical infrastructure to capture more data and data processing. There will be companies working on hardware. For example, if everybody had a thermometer, blood pressure machine and oxygen meter at home; especially if they were able to connect it to the internet so I can see the results live, or ECG machine. That will give me far more information as a doctor.

I’m sure things like AI and machine learning and the companies that deal with it, will enter the market and will automate some GPs out of existence really. At least as people whose sole job is to make diagonals as they implement treatment as according to an algorithm. How long it will take, I don’t know. It will take much less time than I previously thought it would.

I saw you have a background in neuroscience, can you tell us a bit more about the work you did with that?

I was a researcher at Imperial College for about 4 years. We were working on stroke research. We were working on stroke rehabilitation for patients on renal dialysis. Then later we worked on automation of stroke rehab. Automating the disability assessment and automated stroke rehab.

There was a company I was involved with called Grippable, which is a start up at the moment. They already have a product, which aims at gamification of stroke disability assessment and rehab.

Can you tell us about the work you have done with preventable conditions?

I finished training at the Institute of Functional Medicine. Ever since that I was more interested in prevention and lifestyle intervention in chronic medical conditions. As an individualised approach at the moment. And because the approach I have is individualised, it takes into account far more data concerning patients’ lives and history, than what I would normally do as a GP. It’s a time consuming process and therefore its more costly. So, I am doing this mostly privately.

I work with people with anything from irritable bowel, fibromyalgia, dementia and cardiovascular disease. What I’m looking to do in the future is to create a model that is more financially accessible.

How do you think primary care will cope with the impact COVID has had on peoples mental health?

I think the main advice is we are not alone. There are a lot of people struggling and going through a difficult time. If I can suggest something, it’s to support each other. It’s unprecedented what we are living through. We are told to socially isolate, which I think is a bad word in itself, because what does it mean to be socially isolated? Physical isolation has a different meaning to me than social isolation. We are being told to socially isolate and it goes against us as social animals really. We’re a heard animal. We thrive on physical contact with others and we are all deprived of that at the moment.

The first thing is to recognise that this is what it is. This is why we all feel anxious and depressed. Try to mitigate that, whether that’s through maintaining online contact with loved ones. Or using the allowances that we have within current regulations. So, if you’re allowed to meet one person and go for a walk, do it. Talk about anything else other than the pandemic! The words and language around the pandemic are everywhere, its permeated everything. It’s difficult to get out of this stress that it creates. It’s a language that activates stress responses and we’re bombarded with it constantly.

I’m lucky that I don’t have a TV, but sometimes I do watch it during breaks at work and its just constant news about COVID. And this creates the atmosphere of dread and stress. Don’t watch TV! Talk to other people who are going through the same thing, but not necessarily about COVID, talk about something else.

Contact with nature is important, physical exercise. All these things that we would normally do at times of stress. So, movement, nutrition, sleep maintenance and maintaining relationships with others. That will help.

Keeping the end in sight

Let’s keep the end in sight and learn from this as well. Let’s treat this as a learning experience. What I learned in particular, was I thought I was a loner and preferred to be left alone most of the time. But actually, I need human contact so that’s important for me.

Let’s also appreciate that as much as we like order in life, COVID has revealed that there is a lot of chaos that sometimes takes over. There is nothing wrong with chaos and there are things we can control within that chaos. Just concentrate on things we can control. But we shouldn’t be obsessed with getting total control over everything in nature because its impossible. And that leads to frustrations and anxiety. I think that’s a good lesson to carry forward beyond the pandemic.

The way I see it, is it has been a delusion of control. We assume we have far more control in our lives and what’s going on around us, than we really do. What COVID has shown, is that this delusion of control is everywhere. In reality no one knows what’s going on, its far more complex and far more chaotic and far many more variables that are beyond control. It’s like weather, we cannot predict weather beyond the next three to four days, and with our lives it’s the same.

The best option is to just live in the moment. Control the things that you can control, but don’t get too obsessed about controlling every single variable that you can think of. Because that’s anxiety and will drain you of all the vitality and leave you leading a life full of misery and worry. We have a choice. If you use COVID to realise that, that’s great.

Looking after your mental Health

If you’re looking for advice and support with your mental health, speak to your GP who will offer you help and advice. You can also visit websites like Mind that offer support and guidance.

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