At the Melting Pot on 20 February my head found itself drifting to the complexity of general practice where I have worked for 25 years.
With individual patients, trying to deal with obesity is often unfruitful. It’s easy to talk about lifestyle, especially when GPs, among others, have been paid to measure and advise. But as a practitioner, all I felt I could do was impart some fairly obvious advice, offer drugs (now mostly withdrawn or ineffective), or refer for drastic surgery. Unsurprisingly, I’d be left wondering if any of this was helpful.
Surely, if there was a simple answer, there wouldn’t be such a thriving diet industry? When an obese person tips into diabetes, the health consequences are significant. However, diabetes, at least in the early years, is reversible if a healthy weight can be regained. So, given the limited tools at my disposal, was there anything I could do to make a difference?
The most important issue in health is, of course, to recognise that there is no most important issue in health. How could one possibly choose between the evisceration of the NHS, the abandonment of social care, grotesquely widening health inequalities, the looming nightmare of antimicrobial resistance, or the incipient planetary catastrophe of climate change?
So I’m not going to try and define any single, most important problem, because that’s a mug's game. What I would like to do instead is explore why it is that we are so often drawn back to trying to rank issues by importance, and why we find the complexity of these problems so challenging. What I’d like to propose is a set of approaches that can be used to conceptualise them in ways that may help us to achieve better outcomes.