Lucinda Sykes brings a retired Canadian physician’s perspective on healthcare to the Perspectives on Healthcare podcast with Rob Oliver. Lucinda Sykes has many years of practice in public and private healthcare as well as experience in the academic world. Her initial work was in family medicine and then moved to psychotherapy and eventually transitioned to mindfulness and sleep coaching for women over 50. It is interesting to hear Lucinda Sykes’ comments about her experiences throughout her career. She is a member of the Baby Boomer generation and joined the podcast from Toronto, Ontario, Canada.
Here are 3 things that stood out as Lucinda Sykes shared a retired Canadian physician’s perspective on healthcare:
- Quality healthcare does not require a prescription pad.
- Two of the essential descriptors of quality healthcare are effective and accessible
- Good healthcare includes addressing mental health issues
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Here is my conversation with Lucinda Sykes as she shared a retired Canadian physician’s perspective on healthcare:
Introduction to Lucinda Sykes
Rob Oliver: Thank you and welcome to Perspectives on Healthcare. Today’s perspective comes from Lucinda Sykes. She is a retired physician. She has a journey in which she has done family medicine, she has done psychotherapy, she has been an instructor. I’m sure that we will get into more of that as we go through the conversation. She is a member of the Baby Boomer Generation. She joins us from Toronto, Ontario, Canada, one of the one of the it is our wonderful neighbors to the north. Lucinda welcome to the podcast.
Lucinda Sykes: Ah, gosh, thank you for that summary. Yes, yes.
Tell me a little bit about yourself and your role in healthcare
Rob Oliver: Absolutely. So I gave a brief introduction, but can you talk a little bit about your role in healthcare? Please.
Lucinda Sykes: Okay. Okay. Well, in part, it’s the journey you just outlined there. I began in family medicine back in the 1980s, and then as I secured further training through the years, I specialized or focused on psychotherapy in the family medicine contact and began to get more and more referrals. Eventually for 24 years, I was teaching medical programs of mindfulness, Rob, to… patients who were referred to me by other physicians in the community to learn mindfulness. So that’s, that was the case up until a couple of years ago with COVID coming through. I did have to close my clinic, Meditation for Health. We closed the clinic because our in-person groups were ended and now I have an informal practice of sleep coaching for women over 50.
Rob Oliver: Okay, so. Talk to me, you’ve got a unique set of views there because when you’re dealing with family medicine, you’re dealing with medications, you’re dealing with diagnoses and prescriptions. When you’re doing psychotherapy, again, you are dealing with diagnoses, but the treatments are not quite the same when it comes to medication, I would assume. And then when you’re getting into mindfulness, and even into sleep coaching, once again, you’re looking at things from a different perspective and the tools of treatment, so to speak, are different. Can you talk a little bit about the different views that you’ve experienced over the course of your journey?
Lucinda Sykes: Thank you for those very perceptive questions. It’s been on my mind since I accepted your invitation to speak with you. Yes, I did begin in very traditional family medicine, prescription pad, clinic and community-based. And then with my interest in psychotherapy, in 1985, long time ago, I gave up my prescription pad and I have not prescribed since then, although I have been practicing medicine wholeheartedly for decades since then. And I have, I would say, in all modesty, I have a lot of patients who would say that they got good medical care from me. It wasn’t by way of prescriptions. But I have been providing, I would say, psychological care.
What does quality healthcare mean to you?
Rob Oliver: Yeah, okay, and that leads me into this question, which is what does quality healthcare mean to you? And I don’t wanna put words in your mouth, but it sounds to me like quality healthcare doesn’t necessarily need a prescription pad.
Lucinda Sykes: Yes, yes, you’re… Really reading my mind here, Rob, I was reflecting on what really do I have to contribute to the conversation and that’s right at the at the heart of it. First off, as a Canadian, I would really toot the horn of our wonderful Canadian system. I know we’re under strain these days with COVID, but we are accessible and you know people who are ill are treated in a pretty timely fashion. and so on and they aren’t put into bankruptcy. So for me, that’s quality health care. And also we want health care that is effective. That almost goes without saying, but being effective, I believe, requires that you be integrative in your approach. And that, of course, includes all of the wide, vast field of mental health and social care too. So effective and accessible.
Rob Oliver: Talk to me about that range that you’ve just brought up. So there is the medical side of things, but then there also is the psychological side of things.
Lucinda Sykes: Yes, oh yes. And you know, I’m not being controversial. Someone as mainstream as Tom Insull, who until recently was the head of your national institute of psychiatry and mental health in the States. He has also been speaking to the little bit of an imbalance between the medical model and mental health, the concerns that mental health has to encompass and then trying to address it through the traditional medical model, which is diagnosis and treatment. And there’s a little bit of tension between those two aspects of medicine. But with good-hearted medicine, you can deal with it. You can deal with it. The principal problem is diagnostic labels. In much of medicine, the diagnosis is central. Treatment is determined by the diagnosis, just in a nutshell. But when you get into the field of mental health, the diagnostic labels, in part, are simply consensus definitions. And they don’t have necessarily the scientific validity that you might see in infectious diseases, for example. And because the diagnostic labels in mental health, in psychiatry, are a little bit, well, they can be open to dispute. It’s difficult to be absolute in the type of treatment that you render. It’s a very interesting topic, Rob, but we don’t have that much time.
Rob Oliver: No, understood. Well, okay, but I remember 10 to 15 years ago, the World Health Organization, was moving more towards functional diagnosis rather than diagnostic labels, as you’ve put them. And to me, I thought it was very important because I’m a C5-6 quadriplegic, okay? But not every C5-6 quadriplegic is going to need exactly what I do. However, in our system here in the United States, and I think in most healthcare systems, you need a diagnostic code to justify a plan of treatment. So do you have thoughts as to how we, is there a systemic change that can come to move us from diagnostic codes into a more functional viewpoint on folks?
Lucinda Sykes: What an enormous question that one is for just a few minutes. Well, look at it from my perspective. I have been teaching programs of mindfulness to every patient who was sent to me. And mindfulness can be helpful to patients who are suffering from chronic pain, who are suffering from anxiety, some forms of depression. And really the list goes on and on. Heart disease, fibromyalgia, arthritis, many different conditions can benefit from patients learning the practice of mindfulness. So my dear referring physicians, they all sent their patients to my program. And I taught the very same program to everyone who walked through the door.
Can you give me an example of quality healthcare?
Rob Oliver: Got it. So you’re looking at something that’s, something that is not necessarily diagnostically related. It’s actually a life skill that you’re sharing that’s going to have an impact on people’s quality of life and on the way that they are dealing with whatever the situation is that they’ve got. So, okay, can you give me… an example of quality healthcare?
Lucinda Sykes: Well, in a way I just did. I think it’s quality healthcare where someone like myself trains in mindfulness, teaching mindfulness and so on. And then I set up a clinic, God bless the Canadians, is to let me set up my own independent clinic in downtown Toronto. And I just took all comers. And I was funded by the healthcare system. They trusted me to render the services. And then I built a referral practice, and my colleague sent me patients that, patients that in their estimation could benefit from my services, and then I dutifully provided that. I think that’s quality healthcare.
Rob Oliver: Got it. Can you just give me a short thumbnail version of what is your definition of mindfulness?
Lucinda Sykes: Well, as I was trained down in the University of Massachusetts at the Center for Mindfulness, four bulleted points to define mindfulness. Mindfulness is something you do on purpose. And mindfulness means that you are paying attention in the present moment. You’re paying attention to what’s happening in your experience right now. And crucially, number four bulleted point, you’re doing so with an attitude that is non-judgmental. You’re not trying to make things be a certain way. You’re not trying to change things. You don’t even need to judge the judging. You have open awareness on purpose, witnessing your experience from moment to moment. That’s mindfulness.
What do you wish people understood about your role in healthcare?
Rob Oliver: Got it, thank you for that explanation. What do you wish people understood about your role in healthcare?
Lucinda Sykes: Well, I am an example of practicing quality medicine without a prescription pad. That pharmaceuticals are not essential for good medical care. And in some cases, pharmaceuticals have toxic side effects and eminent colleagues now recommending that we use a whole lot less of them, especially in the mental health field. That for sleep medicine, for example, we could use a whole lot less of those chemicals called sleeping pills. Those sleeping pills, they don’t induce natural sleep. And by gosh, my patients can get dependent on sleeping pills years go by. And the research showing now that they can have very toxic side effects. For example, a higher incidence of dementia and Alzheimer’s disease if you’ve been taking sleeping pills even for a while.
Rob Oliver: Wow. I think it’s a very powerful thing that you’re saying that, and let me just read between the lines a little bit, okay? And that is sometimes what happens is prescriptions are given to address symptoms rather than to address underlying problems.
Lucinda Sykes: Yes, well put.
Rob Oliver: I would say that with sleeping pills, you take the pill and it gets you to sleep, but there is, figure out what is it that’s keeping you from falling asleep or what is it that’s keeping you from staying asleep? and if you can fix those problems, then the need for the sleeping pills goes away. What’s your reaction to that?
Lucinda Sykes: Well, first off, it doesn’t even induce sleep. They’re called sleeping pills, but what it does is it induces unconsciousness. But you can drink yourself a bottle of wine and maybe you’ll go unconscious too. But you’re not sleeping. You know, when we sleep, the mind goes to sleep, but the brain does not. During sleep, your brain is very busy rebalancing itself and crucially, it is cleansing itself. And these chemicals that induce the unconsciousness that we call sleeping pills, they can impair and the evidence seems to be accumulating, they do impair this crucial sleep function of the brain. And you know, I know practitioners are well-meaning. But now the research is, there’s no question. The research is that these sleeping pills are potentially dangerous and they should not be taken for more than two to four weeks. And the clinical guidelines stipulate that, but by gosh, my colleagues, you know, kindly, they keep filling their prescriptions. And the patients who believe that, dear doctor, thinks these things are okay, keeps dishing it out and the months and dare I say, even the years go by.
Rob Oliver: Okay, and I will say this as well, we are having somewhat of a paradigm shift in medicine where the patients are becoming stronger advocates for themselves and because of the proliferation of knowledge that’s out there, where you can go on Google and you can search for things and you can learn. You sometimes have patients who are coming in to the doctor’s office with a full expectation of, doctor, I need this particular medication. And so, there needs to be there needs to be from what I’m hearing you say, an educational process across the board, both for the practitioners and for the patients to say, Okay, if you take this medication, be aware that there are these side effects that there are these limitations that need to be placed on it. And there needs to be more understanding and education that goes with that, too, than just the willingness to kind of keep people happy by prescribing them what they ask for. What’s your reaction to that?
Lucinda Sykes: Well, my reaction is bravo. I agree entirely with this. And the well-informed patient can protect themselves, but it’s hard to be well-informed about all these things. And even the name sleeping pills is a misnomer, but it’s easy to slip into that rather than to talk about sedative hypnotics. Yeah, it’s pretty tricky. And that’s in part why I am on your program, because now that I am retired, I have the time to speak out. And I can do so. My dear grandmother died of dementia far too young, and she took sleeping pills every day of her adult life so far as I could see. And it’s only in the last couple of years that I really woke up to the fact of, you know, my grandmother’s health was likely affected by those pills.
What excites you about the future of healthcare?
Rob Oliver: Got it. OK. What excites you about the future of healthcare?
Lucinda Sykes: Yes, yes. There is a move now to expand the family doctor’s office to include other practitioners and I salute that. Were I to be in family medicine now, I would embrace it. I would have, and I believe it’s beginning to happen, but I don’t have the details. In my family medicine practice, I would have maybe a social worker or another colleague lead groups to help patients who are having trouble sleeping so that they could be assisted with sleep hygiene and other concerns rather than immediately given a prescription. I would also have another group for patients who are grieving and having sad episodes in their life so that they don’t immediately start on antidepressant pills, which then they have to withdraw from. later and go through a lot of suffering in many cases. And this is happening, that family medicine, and that’s really the foundation of medicine in my view, family medicine is becoming more collaborative, and there is space now for these types of groups.
Rob Oliver: Okay, and I think that your recommendation really fits the model of what your journey has been, right? Because you’re talking about family medicine, typically has looked at your physical wellbeing, and you’re taking it to the next level to talk about addressing your psychological wellbeing at the same time so that you have both elements of the individual being cared for at the same time in the same location. Is that accurately reflecting?
Lucinda Sykes: Well, that’s good medicine because you see at base, there is no separation between your psychological self and your physical self. The cardiologists know that if you’ve had a very difficult childhood, you’re more likely to have heart disease. If you’re under emotional stress, your immune system and even your cancer care can be affected. They are not in separate worlds. And this is again the teaching of integrative medicine. And that’s where I fit into the healthcare system all those years, teaching mindfulness to everybody else who could benefit.
What is one thing medical professionals can start doing today to improve healthcare quality for their patients?
Rob Oliver: Got it. All right, last question for you. What is one thing medical professionals can start doing today to improve the quality of healthcare?
Lucinda Sykes: Well, I would encourage my colleagues who are prescribing sleeping pills and antidepressants to think twice before they do so and to just ponder in collaboration with the patient, is there another way of addressing these concerns before we go the pharmaceutical route? And further, my colleagues who are prescribing, especially I’m thinking sleeping pills, When it gets to that two week, four week cutoff point, maybe don’t venture past it. Alert your patient to the fact that there are other ways of addressing sleep concerns and that it’s not to their benefit to continue to ingest these chemicals.
Rob Oliver: I had a former guest who mentioned that when antidepressants are prescribed, that they should be prescribed with, in combination with counseling, so that that there needs to be both modalities being employed at the same time. So I think it’s an interesting concept. And I think that what you’re talking about is very similar. So listen, Lucinda, thank you so much for being with me today. I appreciate you being here. I appreciate your willingness to share to all my listeners. Thank you for being here. I will remind you if you are subscribed to the podcast on iTunes, please go to the website and make sure that you are prescribed or subscribed to the correct feed because there are two and I would hate for you to be pers… I keep saying prescribed. You’ve got me thinking about the prescription pad. I would hate for you to be subscribed to the wrong feed because that feed will be closing at the end of the year. In the meantime, Lucinda, thank you. I appreciate you and I respect your perspective on healthcare.
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Disclaimer: All opinions expressed by guests on the Perspectives on Healthcare Podcast are solely the opinion of the guest. They are not to be misconstrued as medical diagnoses or medical advice. Please consult with a licensed medical professional before attempting any of the treatments suggested.