Full Transcript
[00:00:11] Dr Monika Wieliczko: Welcome to Guide to Afterlife, your go to pod Wieliczko, a psychologist and your fellow widow. Each episode brings you insights from world renowned grief experts and authors discussing complex grief issues and their personal experiences of loss. My aim is to challenge the way you think, empower you to face your feelings, and help you develop resilient ways to grieve. Move beyond surviving each day and visit guidetoafterlife.com to take part in the Grief MOT, your first aid program for grief. Welcome to a Guide to Afterlife. I'm your host, Doctor. Monika Wieliczko, clinical psychologist and a widow. Today, we're diving into a topic that so many grieving people struggle with, grief related physical symptoms. The exhaustion, brain fog, heart palpitations, digestive issue, even chronic pain. Grief isn't just emotional reaction. It takes a toll on the body too. But how do we know when these symptoms are just grief and when they might be something else? And more importantly, how do you talk to your GP about them? What can they actually help with and what might be outside of their role? To help us navigate this, I'm joined today by Doctor. Lynsey Bennett, a GP with a special interest in grief and bereavement care. Lynsey is here to talk about the two way process between patient and doctor, what makes GP good at their role working with grief, and what responsibilities are for us as patients and what practical steps we can take to manage the physical aspects of loss. But first, let's start with Lindsay's own journey. So welcome, Lindsay, to the podcast. I'm really excited to have you here today.
[00:02:13] Dr Lynsey Bennett: Thank you, Monica. I'm very excited to be here with you.
[00:02:16] Dr Monika Wieliczko: Oh, nice to hear that. And I was really looking forward to having this conversation, and it comes in such a timely way. Well, we've met in November at the grief conference in Dublin and, stayed in touch. And I've recently also recorded an episode with Mary Frances O'Connor about her new book, Grieving Body. And we we got to talk about that a bit a few weeks ago, and we thought it will be such a nice way of, I suppose, putting the practical aspects of the research findings and everything we've heard from from Mary Frances O'Connor into real life examples and what it's like to be working with people who are grieving from the physical point of view, from the physical health point of view, but also emotionally, you know, what that brings up for you, what kind of challenges GPs might be facing. So I'm hoping that this episode will be helpful, not just for general public, but also for GP practitioners, anyone kind of who who's working with with people who are presenting with grief. But where I would like you to start and maybe introducing yourself a bit and telling us about your personal journey into this field of grief because there's always a story, isn't there?
[00:03:34] Dr Lynsey Bennett: Isn't there? Isn't there just? It's all about the stories. And we love the stories, don't we, Monica? That's why we're here. Yes. So, yes. So I'm a GP in Oxford. I've lived in Oxford since 2012. We moved during the London Olympics from London. So I've been a GP for about eighteen years, and I'm also a GP trainer, which means I work closely to help train other qualified doctors to become GPs. And last year, I was in a role, a sort of slightly academic role funded by the, primary care school in Thames Valley, developing an educational resource for GPs to help us better understand the grieving process and also therefore help us to be better at providing bereavement care. And why bereavement for me? Well, it's something I've thought about such a lot because I'm normally someone who plans things quite carefully but actually this particular role I applied for very, very short notice. I found out found out about it on the Friday, application deadline on the Monika, couple of weeks later, had an interview. So that was kind of out of character for me, but I did feel really struck very, very drawn to working on bereavement. Mhmm. And I think why is that? I think there are several reasons. I think I'm a I'm a people person. I find the human narrative, the stories, everyone's stories really interesting. And early on in my career, I worked in cancer care and I worked in a hospice. Mhmm. And I really enjoyed that sort of really holistic way of of providing care, but also the privilege of meeting people in a very vulnerable stage in their life and, you know, being able to walk alongside them for a while during that process. I think I've always enjoyed it and then there is a lot of scope for that sort of work in general practice, particularly once, one is established in a permanent role. You know, I've been in my current workplace for ten years. It's the longest I've ever worked anywhere in my life. But I that means that there are people I've known now that I look after. I've known I've known them for ten years. So that gives me the enormous privilege again of of seeing people walk through all these different life stages. So I think that's sort of the background, but also probably not coincidentally, my stepdad was elderly and frail, and I think I knew that he was I'd I'd certainly thought about his death quite a bit in the couple of years before applying for this role. And in fact, he he died not long after I came into the role. So then I found myself in a really unusual position of reading about other people's grief, trying to think sort of quite critically and analytically about the grieving process and also grieving myself. Mhmm. Which was I I can say now I think that there was a reason for this happening for me at this time. It gave me such a profound insight into into work that I was doing. Of course there were times when it was quite hard.
[00:07:13] Dr Monika Wieliczko: Yes. I mean I can imagine just just anything that touches you on a such a personal level having both family member dying and and trying to make sense of this whole experience that you're thrown into from that kind of more academic level, you know, your professional side kind of coming in, but also, you know, grieving yourself, which, as you're saying, it gives us an incredible insight into what it's like to be on the other side. Completely. Yeah. Something that you can't really learn until you experience it.
[00:07:49] Dr Lynsey Bennett: Yeah. It's not yes. No. And I mean, my dad died about, I think, about thirteen years ago. I've lost grandparents. In fact, my parents separated when I was very small so in a way I kind of I think I thought I knew grief.
[00:08:07] Dr Monika Wieliczko: Mhmm.
[00:08:07] Dr Lynsey Bennett: I thought oh grief you have done that done that. I can definitely do an educational resource on grief because I know all about it but of course this bereavement experience the most recent bereavement experience for me was really different to previous experiences I've had which again you know such a profound lesson to learn for me is to realize how different that could feel.
[00:08:33] Dr Monika Wieliczko: Would you mind saying a bit more of what was different or what surprised you in your own response to your stepfather's death?
[00:08:42] Dr Lynsey Bennett: I think I think the main thing that surprised me was the intensity of emotion that I experienced. I wouldn't necessarily say that we were that close but he had been my stepdad for thirty seven years. So, you know, Lynsey I was a child he had been in my life. And I also I sort of sort of thought, okay. Well, of course, I'll be sad and, you know, I'll be worrying about my mom and my siblings, particularly my younger sister. He he was her dad. But I didn't feel I didn't expect to personally feel so affected by it. Mhmm. Yeah. Is the main the main thing. And funnily enough, a lot of my symptoms were really physical.
[00:09:32] Dr Monika Wieliczko: Right.
[00:09:33] Dr Lynsey Bennett: Which again, surprised me. And I had to just sort of keep saying to myself, it's grief, Lindsay. The reason you feel like that is grief. Otherwise, I really would have been in my doctor's surgery a lot of the time, you know, I felt physically unwell in in a range of different ways as well. And the physical experience I had was I can remember saying to someone, it sort of felt like it kind of started at my head. And then as time went by, the different symptoms seemed to go move down through my body over the weeks and months. I mean, it you know, it was fascinating to experience, but, you know, also relatively unpleasant. So yes. So as luck would have it, I'm I'm probably your girl for for this sort of question.
[00:10:24] Dr Monika Wieliczko: Seems like it. It's not cold with you. But it's so interesting because obviously, you're you're a GP, so you know how body works. I mean, you've got general knowledge of probably everything that could go wrong within our bodies. That's that's my
[00:10:43] Dr Lynsey Bennett: A blessing of the coast.
[00:10:45] Dr Monika Wieliczko: Yeah. Yes. I can see that now. But it's it's this kind of, you know, widespread knowledge that you can obviously apply to yourself in a similar way as, me as a psychologist. I can I can psychologize everything out of anyone, not necessarily in a helpful way, but it's that kind of tool that you've had of like you're saying, you know, talking to yourself, you know, noticing what's going on, scanning your body, noticing those different waves, starting with your head going through presumably heart and stomach and all of that? Anything that can go wrong, because it's usually what what happens. It's such a visceral experience, grief is, and something we don't really talk about.
[00:11:31] Dr Lynsey Bennett: The term that I really like is embodied. Mhmm. I think that explains it really well in a way that people can understand. And when I'm talking about it, I say, you know, the term we sometimes use in grief is that grief is embodied. And by that, I mean, we feel it in our bodies. Our bodies grieve and you know that's why we don't feel well, that's why we feel sick, that's why we can't eat, that's why our heart races, that's why we have pain, that's why our legs twitch so much at night that we can't get to sleep. And it's it's a very I mean, I keep using the word profound, but I think it's that's the best way of describing it. And I also I like the word visceral. You and I can use that word as as as clinicians to each other, can't we? But I think I would be a little bit more careful when I'm talking to someone that doesn't have sort of a scientific education. And, yeah, that's why I like the word embodied.
[00:12:25] Dr Monika Wieliczko: That's a really good phrase, actually, because I think you're referring to the range of processes that are going on internally as much as physiologically, like, and psychologically there are written interlinked. And I think it's so important that we name it and kind of talk a bit more about that with people, because I think there's often a misunderstanding around what grieving looks like. And as you said, it might be very different depending on who died. And and as you said, you'd never quite know how you're going to react to the loss and not every response to loss is different, which is what you're saying. You know? There have been there have been few people you've lost in in your life before your stepfather died, but this was something very unique about that loss that, you know, brought up so many symptoms. And it's fascinating really because we can't really put grief into one category and say, well, this is this is what you should expect. It's it's just so unpredictable. Remember when before my husband died, there was this kind of period of time when we knew it would happen, but we didn't know when. And and and obviously one of the things I was talking to my psychoanalyst in my sessions was about, you know, we don't know how I'm going to react, how I'm going to feel. You can't possibly predict that experience before it's going to happen. So there's always an element of surprise. But you said something very interesting about the knowledge, which I wanted to kind of circle back to. So knowing that looking at your physical responses to loss and noticing all those symptoms, what's going on in your head and your in your heart and your stomach, all those kind of twitching and and not being able to sleep, not being able to eat. And you said, I've been telling myself it's grief. It's almost like this kind of processing going on in your mind around what is happening to me and some kind of giving reassurance because he said, if I didn't do that, I would end up going to see my GP every every week or so. And and I think that is really something I would like to think with you about. What kind of things people bring to you as a as a practitioner once once they come through the door, meaning that is something that the GP is usually the first person you contact when something goes wrong, when you have a pain or, you know, that's the kind of the floodgate to the NHS system and and the kind of the first person who would normally see you. So it only makes sense to be talking about what goes on in the consulting room between a GP and a patient who's coming in complaining about certain symptoms or talking about something that's, upsetting them, what would you normally see? What do people bring when they when they come to see you?
[00:15:31] Dr Lynsey Bennett: I guess one thing I would say is that being a GP, my job is all about pattern recognition. Okay? So someone comes into my consulting room. I may know them already or most of the time, they maybe I don't. I don't know. Maybe fifty fifty. I've got no idea what the split is. Sometimes I know people, sometimes I don't. But I will always have looked at their notes as long as the computer system is working that day. So I will always have looked at their notes to see what problems they have in the past recorded in their notes, what medications they're taking, if any. And I will look back to see the last few contacts that they've had with us at the surgery or if they've been recently to the hospital, to the emergency department, or a Lynsey, or whatever, I will quickly look at that. So I will already have oh, and then and then the the final piece of information that's really important is that our receptionists, receptionists, who do an incredible job always try and get a little bit of information when someone's booking an appointment about what the problem is that they want to talk to us about. And I know some people don't always want to give very much information away over the phone to a receptionist that they don't know, but that piece of information can be really, really important to me. It can be a really important part of that sort of pre pre appointment planning that I do, which, of course, that's before I even call the person into the room. So I'm doing that by myself. Mhmm. And then I invite the person into my room and, you know, I might I I normally, I have to get out of my seat. I open the door. I go into the waiting room, and I call them, and I will watch them walk across the room. And that also is giving me information. How how do they look? How are they walking? Do they look at me in the eye? Are they having a sad hunched posture? Do they look like they're in pain? I will watch them walk. I observe whether or not they have someone in the waiting room with them. They might want to bring that person in. So all of this is part of the appointment. The patient probably doesn't think about this at all, but this is a really important part of information gathering that I'm doing. And then, of course, once the person is in the room with me, we'll begin with something like, you know, I introduce myself. How can I help today? And I then aim to let that person tell me I aim to let them speak fairly freely for maybe a Bennett. And I hope that in that minute, they will give me a lot of information if I can be really good and try not to interrupt them too much. There's a lot of lot of research that's been done, to show that most people say everything they want to say within that first minute. Sometimes that first minute may include someone coming into my room, sitting down and just bursting into tears and crying for a Bennett, which is completely fine. And that that happens to me, you know, not not infrequently. And I always say to the person, you know, this is fine. And they they usually a bit embarrassed. Oh, I'm sorry. I'm crying. And I say, listen. If you're the only person in my room that cries today, I'm having a good day. So, you know, sometimes sometimes that's what happens. But all the time that I'm having this interaction, I'm also really watching the person, watching the way they behave, and I'm looking for all kinds of nonverbal cues as to what's going on. And, you know, people would be amazed if they videoed themselves to see how much they give away with their with their bodies and and how much I I know what they're going to say because they put their hand here. I think, okay. You're gonna tell me about your heart. And, yeah, it's just the way we communicate, isn't it? So I'm looking for all of this time as a GP. What I am looking for is serious illness that I think needs to be seen by a secondary care, specialist. So I'm looking for something that that I can't that I can't manage. You know, is this a problem that I can manage with simple, you know, a a prescription for something, maybe a few blood tests or a a scan routinely, or is this person significantly unwell? Do I need to send them up to hospital today? Do I need to send them up, you know, routinely? What what's going on here? So those are the sorts of things I'm looking for. And most of the time, someone who is bereaved doesn't come in to the room saying, oh, good morning, doctor. I'm grieving. This is this is what I would like to discuss with you. Because, of course, of course, we don't. Of course, we don't do that, do we? Because if we're that together with our grief, we probably don't need to be in the doctor's surgery because we're probably probably relatively speaking, coping with our grief. So people come in in all sorts of different ways, people come in sad, angry, convinced that something awful is going to happen to them And and the sorts of physical symptoms, I think, are relatively stereotyped if you like. So again, it's going back to this thing of pattern recognition. And I would say that women tend to feel their grief in their body sort of from the belly button upwards. Men tend more to feel it below the belly button. So women will tend to experience their physical symptoms in their head, their throat, sore throat, losing your voice, coughing, throat clearing all the time, you know, migraines, headache, can't sleep, racing thoughts. These are all the sort of head things and then you can sort of go down the body. Neck pain, shoulder pain, chest pain, heartburn, indigestion, can't eat, stomach not working, bowels not working. And then mainly for women, I think it kind of stops around about the belly button. And men tend to tend to have their symptoms below the belly button. So again, bowel problems, pelvic pain, testicular pain, sexual dysfunction, pain in the legs, twitching legs, restless legs, those sorts of things. So I find it quite helpful to all the sort of pattern recognition work that I do as a GP to have in my head this idea of grief being able to present in any organ in the body, but there being a sort of a little bit of a agenda divide as to how that might present.
[00:22:29] Dr Monika Wieliczko: Yes, it does, actually. And that's a really good way of putting it, Lindsay, in terms of the the differences. But also, you know, I'm I'm just struck how much work is being done before the person comes through the door and how much you're able to notice without really someone communicating it verbally. So it's nonverbal cues that, as you said, the walking, but also how they present to you and the rapport. And, you know, it's it's really not that different to what we do as psychologists, really, in terms of picking up on the the mood and the atmosphere and how people relate to to us in the room. I I suppose the difference is that I've got I usually have fifteen minutes to do that. You you feel lucky you've got 15, but often you've got at least 70.
[00:23:20] Dr Lynsey Bennett: Yes. So the, yeah, taking in information very quickly becomes the GP's superpower.
[00:23:26] Dr Monika Wieliczko: Mhmm.
[00:23:26] Dr Lynsey Bennett: And it's one of the reasons that I really like to call my patients into the room myself is so that I have that little bit of time where I can watch them walk across the room. Or sometimes we we work over two floors. So, you know, sometimes if I have to call someone from the downstairs waiting room, then I get to watch them walk all the way upstairs, which again can be super revealing, especially if they are have a companion with them. You know, you can tell a lot about the dynamic with that person and and all sorts of other things as well. So
[00:23:57] Dr Monika Wieliczko: Another thing you said is this kind of often the lack of awareness in the person who's coming through the door that they're actually talking about grief. And and I wonder, you know, reflecting on all the experiences I've had personally, but also, I suppose, thinking about what I'm hearing on social media in in widows groups on Facebook, for example, or just in in in general, the the difficulty that people are having with understanding that connection between mind and body. And and I think what you're saying is that the the really important role of GP is to help someone put those bits into a wider perspective of what really happened to them or what what happened or what is the kind of the trajectory of I suspect that you might not always see that straight away or it might take time to get to the bottom of it because as you're saying, people present very differently. So you might have someone who's, you know, having very classical symptoms of grief, like you described as stomach pain and restlessness, not being able to sleep, not being able to eat, heart palpitations and all that. And you might have someone who's just kind of in a very different place, like going into hyperactivity mode where, you know, maybe the crash comes much later on in their grief journey. It might not be the first six months or a year, but it could be, you know, through work related overwhelm or, you know, it might not necessarily be as easy to try trace it down to, okay, I think you're grieving. But I think you're saying is that such an important piece of a puzzle is to bring those elements together. And and I suppose knowing how to do that, it's a real skill and and and obviously not something that could be easily taught. It's not just knowledge. I think what you're describing is this years of experience of seeing people, seeing those patterns It is. And relating to them. Yeah.
[00:26:01] Dr Lynsey Bennett: Yes. Yeah. And understanding that there's something more going on. You know, you using my intuition, if you like, to think, this doesn't quite fit with the pattern that I would expect. Why is that? And another phrase that I've come across during my work in the last year, which I think is is really, really relevant, is this this idea that, you know, sometimes often, I think, when we're grieving, the pain of the loss is so overwhelming that we cannot put it into words. And that's when it comes into our bodies. There's something that is so alien and overwhelming to us that we just don't have a word and you know lots of people don't have words we all have really different personalities don't we? Some people use lots of metaphor and that can be a real clue. So, you know, people say things like, oh, I I feel like I'm I feel like I'm my world is turned upside down. I feel like a ship that's gone off course or, you know, those sorts of things and what they're saying is, I'm lost. I don't know where I am. Some people use metaphor, but I think it's just as common for people to feel the pain of loss somewhere in their body. And it's when the it's when the loss is just it's overwhelming us. It's easier to say my foot hurts, isn't it? And, actually, my heart is breaking. I'm I'm lost and I'm in
[00:27:50] Dr Monika Wieliczko: pain. That's a really helpful way of putting it is that, you know, when when we experience loss, we losing also part of ourselves, which is what you're describing and how that manifests in the body is used is often through pain, like you said, but also malfunctioning of different systems. You know, we often think of our bodies, organs as separate entities, aren't they? It's impossible that if your heart is affected, for example, that the the rest of your cardiovascular system is in effect. And if your cardiovascular system is affected, it could affect, you know, all the things. You you know, your hormonal imbalance and all those kind of things. And so it's a massive complicated chain of reactions that I can only imagine with my limited knowledge of physical health, what what that could do and and how long standing the implications of grief can be on on your body. And then, obviously, there's there's also the reality that some of it is, you know, some of it is is grief trying to manifest through body. But, you know, coming back to the previous episodes, episode six of season two with Mary Frances O'Connor, we talked a lot about the research that suggests that it's not just in your head, meaning kind of in a rather dismissive way how grief is also often being seen in the society as something psychological that needs to be worked through. But actually, we do know that there are some significant processes going on in in the body around, you know, think about the broken heart syndrome and, you know, and Yeah. For sure. Autoimmune diseases. And there's just the the actual increased risk of mortality within the first few years after losing someone significant. So so so it's it's, I think, something that we I'm I'm really annoyed that we don't talk about it enough. It's not to say that, you know, you should be worried you're gonna die because someone else died. But, you know, I can only imagine that if the if these symptoms are being ignored or not being given enough attention and someone has preexisting conditions or, you know, something that can kind of put them at increased risk, this is the heart the the time when they're most vulnerable to experience something very difficult. And and I wonder what you think about it. What how does that work in your practice? How does that inform your work? And what what can we think about it in terms of when should we see a GP? When we notice those symptoms? Like, I'm really kind of curious what you what you think about that.
[00:30:30] Dr Lynsey Bennett: I'm interested in that phrase you used right at the the beginning of what you just said, Monica, about the idea that this is in your head. It's something that I just wouldn't say because because of the kind of dismissive sort of feeling that that sort of phrase gives. And I would more try and say we feel grief in our bodies, grief is in every part of our body. And another phrase I use is to say, you know, sometimes when something really difficult happens to us or we're we're very upset, very distressed, we feel a pain or we feel something in our body as well as knowing that that unpleasant thing has happened. So that that's how I really try and help people to understand that the whole system is integrated, that the brain doesn't work without the body, and, you know, with obviously highly variable success rates. Because when people keep coming and they still have a pain, and I say to them, I think that your pain is about this grief or this loss that you've experienced. Sometimes they say no. That's not that's not it's not. I'm telling you it's not. This is a pain that has some there is something wrong with my body. And, you know, it it can it can be really difficult because I want to continue to have a good therapeutic relationship with that person. So there can then begin a, you know, a very delicate and long lasting period of negotiation where we Mhmm. Where we try and and unpick things slowly. And that's one of the wonderful things about general practice is is the fact that, yes, I I each appointment that I have is short, but I can have many appointments relatively frequently. And, you know, if someone is is feeling really unwell in any way, that's something that I would want to provide for them. And sometimes it's sort of, you know, trying to draw someone's attention to the loss doesn't work the first time you say it or the second, but it might work on the twenty third time. And yeah. I mean, I I think it's really difficult because I think, you know, particularly since probably since the second world war, there's just this huge brain body disconnect in Western medicine, isn't there? Mhmm. And it's, you know, it's something that we have to fight really hard against.
[00:33:08] Dr Monika Wieliczko: Yeah. And I think I think what you're describing is this the kind of the this division between the mind and body and this kind of concentration that we often have, especially, I think it's common in the NHS as if, you know, we suddenly just treating what one organ or one symptom or one condition without actually having the space to bring it all together, which in itself is, you know, is problematic when we're talking about any kind of more complex presentations, but also, you know, grief in itself because the the idea of of working with grief is about integrating that. And as you're saying, translating the body language into an emotional language. So I really appreciate what you're saying about just kind of having giving space for to someone because I think that's what you're suggesting is that it might take time. But it it is about creating the the this space for someone to be able to notice and hear a different kind of narrative that isn't about dismissing. Because often I think people do feel dismissed with their symptoms and and unfortunately still, which is why, you know, we need to talk about how grief can manifest. But still people do feel dismissed and and not taken their experience not taken seriously. It doesn't mean you have to order hundreds of tests and investigate every single symptom, but there's something about acknowledging that this is a real embodied experience that someone is having. It's a very different narrative to the to them coming to a GP surgery and your GP saying, oh, nothing serious. It will get better with time or, you you know, because often I I definitely had that from from someone before about my stomach. Oh, it's just it's probably nothing. But but how do you know it's nothing? I mean, it's not a response you wanna hear. Like, this is very dismissive. And I think that's, obviously, that's one side of the spectrum is when these symptoms are not being recognized. They're not being put in a context of what happened to you and how that manifests throughout your body. But the other aspect is obviously when things actually do go wrong, meaning that we develop those conditions. Not necessarily that grief is causing them as such. It's the fact that that's contributing. So if we've got certain kind of propensity to response to loss or or to kind of to stress in general, like it was for me with my stomach. Like, I always respond with my stomach problems when there's something stressful going on. But then there's, obviously, the context of, you know, what if something does develop like an ulcer or autoimmune disease or cardiovascular problem? How do we know or how do we separate them out? Because, you know, there's there's it's it's a real risk factor grief, in terms of, you know, this kind of chain effect, especially as we get older. You know, the risks of certain conditions like cancer or, you know, things that just develop, don't they?
[00:36:12] Dr Lynsey Bennett: Yeah. Yeah. Absolutely. And we know that, you know, all cause mortality increases for twelve months after you lose a spouse. You know, this is well proven, isn't it? And, you know, you've talked about things like broken heart syndrome. It's rare, but it it it definitely happens. And, of course, there is, you know, there's a period of such enormous stress associated with with grief. And I'm sure this is I haven't read Mary Frances O'Connor's books. I think it's only just been released in The UK. Yes. But I'm I'm sure this is probably what she looks at is the, you know, the the massive hormonal changes that we experience, the the way our stress hormones are just going, you know, really racing around our bodies when we're grieving. And then that puts our organs under stress. Perhaps we're not sleeping, we're not eating, we're not taking good care of ourselves, and then, of course, we can fall physically ill as well. And I guess what I would say is, you know, I am a generalist. I am a general practitioner. So that means that one thing that I'm really highly trained in is looking at, you know, body, mind, everything altogether and practicing in what we call a holistic way to try and identify if there is a serious emerging physical or perhaps mental illness, alongside grief. And that's that's where I think the bereavement care that we can provide in primary care is really unique because I'm not just a bereavement counsellor. I'm not someone that is is only trained in one, you know, in in I'm not a psychologist, so really good at at looking at at cognitive techniques. I am trying to look at the whole person, And I am of course, I've got in my mind the possibility of of serious underlying illness. That that's kind of what I'm always looking for. So I would I'm I'm always a bit sad to hear how people don't really think that they can bring grief to their GP. And I think that's probably because of the the way that, you know, bereavement and end of life care has sort of, you know, very vigorously Bennett taken on by the charity sector by organizations like Marie Curie, like Cruise, like Sue Ryder, and they do the most incredible work. And our hospices, they do the most wonderful work. But I think in a way, I think it mean it means people think that that's the only place you can you can do grief, that that's not really you shouldn't really bring that into your doctor's surgery. And funnily enough, I gave a a talk to some local colleagues this week. It was about a hundred people. And as part of it, I asked them how often do you have a conversation that includes bereavement? And there are people in a in that audience who put their hand up and say never. I never talk about it. So
[00:39:12] Dr Monika Wieliczko: That says a lot.
[00:39:13] Dr Lynsey Bennett: I don't know who those people are. And, you know, we we're all different, aren't we? And there may be all sorts of reasons that people don't feel it's their job to talk about grief. But I would say that we have really highly developed skills in this arena because we're highly trained in communication skills. We're looking to screen out serious underlying illness. And we've we might have known people for such a long time as well. So we might know the person that's died. We might know all sorts of different family members, give you the sort of a bit of a background about the dynamic and the pressures that that person might be under. Sometimes we even live in our local communities, so we know people outside work as well, and we can Lynsey sort of know them in a slightly different way, know their families in a different way. So I think we're ideally placed.
[00:40:01] Dr Monika Wieliczko: Yeah. Obviously, the reality of the pressure that NHS is under in terms of, you know, the the time, the the numbers of, you know, patients you need to see in a day. I mean, that that in itself, I can see how that could be a very challenging rule to be in touch with your own, I suppose what I'm trying to say, your your own kind of limitations to what you can do. Because I think that that often the the response you're still getting because of the system, I I don't think it's because people are just dismissive that the system kind of imposes certain structures and certain ways of dealing with it is, I think, often my kind of maybe not critique, but kind of the difficulty I think that the system is facing is that there's such a pressure to fix things, to give something to someone, whether that's an investigation, like a test or a a a kind of a a prescription, like an antidepressant or or something, which we know kind of shuts everything down, a conversation and an understanding of where that person is. And it's not to say that the GP should be able to do it all, but how can we start to shift this dynamic in our society that empowers people to speak about their difficulties in a kind of more they they become more aware of what's going on with them. So they are better at communicating their needs to GPs, So empowering the community, which is a big role of education around grief, starting from schools to universities and workplaces and family structures, you know, and not just third sector organizations that, you know, you can go to a hospice when someone died. I mean, that that is a really poor way of almost like rejecting the role of grief services into this kind of, I don't know, a small number of people who had the unpleasant event of someone dying was actually it's a business to for all of us involved. You know, living in society, grief touches us all at some point sooner or later. But I think what you're also saying that that there's there's a role of a GPs, the way they're kind of trained, that if we empower them with certain knowledge and and and tools that they are best positioned to actually to have these conversations at the very beginning and to signpost to kind of help someone understand and pull those things together these all these details together, which is such a crucial role. But, you know, it's also about how do we support DPs and and being able to deliver that. And this is part of your role in creating this, initiative, this training.
[00:42:44] Dr Lynsey Bennett: Consultation. Yeah. It's sort of an educational resource, but it's a consult based around a consultation model.
[00:42:49] Dr Monika Wieliczko: Could you tell us a bit more about that? You know, how that works in practice?
[00:42:53] Dr Lynsey Bennett: I've developed an educational resource, which which I've been delivering. I've done a lot of online delivery and I've delivered to all sorts of different audiences. So some GP trainees, some GPs, some non GP primary care clinicians, so nurses pharmacists that kind of thing and, also our admin team at work. And I've developed this this really sort of easy, really simple memorable and really easily applicable mnemonic if you like or a way of of thinking about what's happening, when someone is grieving and in describing that my aim is to describe how someone who's grieving might present to us in our rooms in primary care and what what our response might be to that so it's just about trying to make something really sort of simple and easy, easily, easily applicable and I identify these three different points in a grief journey one of which is the acute grief you know the overwhelming intense experiences that we've been talking about so far the storytelling which is a massive part of how we adjust to change and how we make sense of the loss that we've experienced, and also the parts of grief when we're allowing ourselves to look forward to see the future emerging. And the work I'm doing is, educate, try to educate as many people as I possibly can that work in primary care that these are three different aspects of grief, if you like, and how we might recognize that someone is experiencing one of those points, if you like, and what we can then say and do in a short ten or fifteen minute appointment. So, you know, it's not about me becoming a bereavement counselor. It's not about me only seeing people are, that are grieving. It's about me feeling empowered to recognize that someone is grieving and to be able to a lot of the work that I have been encouraging people to do is just to tolerate that, is to tolerate the discomfort that we feel when someone is experiencing loss. It's an uncomfortable place, isn't it? And, you know, sometimes we don't know what to say. We don't we're worried we might get upset. We're scared that we'll say the wrong thing we feel embarrassed helpless all sorts of different emotions that we have and you know this is a human thing but this is also evidence based there have been some good studies that have have shown that some GPs have all of those kind of emotions as well when we're confronted with loss in our consulting room and it's just just saying to people you know it's okay it's okay to feel uncomfortable everyone feels a bit uncomfortable with loss Let's talk about how we deal with that and make it something that we can all live with. So, you know, it's just, it's just really about acknowledging discomfort and and being able to sit with it which is something that as a psychologist you'll be highly familiar with because it's very much part of your training but, ironically it's something that I think quite a lot of doctors find quite difficult because we're problem solvers. We like to make people feel better. And you can't. There's there's no solution to grief, is there? Do you know what? All you have to do sometimes is say to someone, I am so sorry. This is so hard. And just let them cry. Mhmm. Make them feel safe. You don't you don't actually have to do anything.
[00:46:45] Dr Monika Wieliczko: That's the hardest bit.
[00:46:47] Dr Lynsey Bennett: Paradox paradoxically paradoxically, you don't have to do anything. And, you know, of course, I can't know, can I, if this is definitely thinking about this has really changed the way that I practice? I can't know if it's having a beneficial effect because you can't put that in kind of a randomized controlled trial.
[00:47:06] Dr Monika Wieliczko: I mean, we could do research on that actually. You know, you you could follow-up the longitudinal study, how people react and what is the outcome of the intervention. But they but I really liked what you were saying about just first of all, giving permission and normalizing the response and not being and in some ways, giving reassurance and kind of an experience of being heard. What I'm hearing, that's the main role of the GP facing grief. But, also, I think you you're saying something much more profound, which is if the GP, who's the first person that the person sees for for those kind of symptoms, is able to take it and hold it, the likelihood is that that person leaves the room feeling like it's possible to survive having that feeling and having the experience, you know, crying for a few minutes. I mean, people usually cry. They release the emotion, and the the emotion shifts into something else. And I think it's this experience of someone else containing that distress, which is very difficult. I think we you know, in some ways, when you think about having the whole caseload in that day, seeing 20 people like that in one day probably will be quite a lot.
[00:48:23] Dr Lynsey Bennett: Break me. Yes. Doing that doing that 20 times in a row would break me.
[00:48:27] Dr Monika Wieliczko: Yeah. Yeah. Absolutely. Yeah. But the likelihood is that the next person coming through the door will have a different experience. So you are going through a wave of your own reaction to someone else becoming overwhelmed, but that also ends. And I think it's it's really simple as a rule. It's just just sit with it. Just just let it go through your body, the wave of an emotion that you're experiencing. And then and then something shifts. And and I see it a lot in my work with with with my clients where that's the whole point of just sometimes it's all about surviving. It's all about kind of just being in touch with that. And that has a tremendous shift for these people who are there might be the first time that someone's coming through and expressing their feelings. They might not know why they feel like that, But in a way, that doesn't matter because if they are contained and there's space for that feeling, the likelihood that is that if they go and see their family member and some they're more likely to have the same experience. So you're kind of actually modeling a different way of dealing with the stress, which is so fundamentally transformative. And it puts grief in the middle of, you know, primary care because that's where it should belong, I think, amongst other places. Grief should be something you can bring to your workplace, to your family, to your GP, everywhere. So I really like how you phrase it, Lindsay, but also, you know, how much work still needs to be done with educating GPs, but also the the general public into kind of thinking about how that works and what you can do, what you can get from your GP. And it doesn't always necessarily mean you're gonna leave with a prescription, and it might be actually more beneficial if you don't in some cases. So that's a really strong message, you know, prescribing antidepressants for someone's pain. It's kind of invalidating in some way saying, well, it's too much or you can't handle it. Look at you. Although for some people, it's not just grief we're talking about. There might be something much more complex going on that grief just was the kind of trigger to release. And in those cases, obviously, people might need a prescription. But knowing which one which way to go, obviously, needs a bit of time and understanding. And giving that prescription on the first visit is probably difficult to assess if it's correct. I mean, it's not for me to say that, but, you know, I think it what I'm saying is these processes take time. Yeah. And
[00:50:57] Dr Lynsey Bennett: and that's a really important thing that I would ask people to always give us is time because you're absolutely right I cannot do this one after another in a row I would very quickly be very exhausted which means that sometimes I may think to myself I think this is probably grief I don't know that I can do grief right now I'm Monika ask this person to come back next week when I feel less tired, when my child is not at home with a fever, when I'm I will bring them back for a longer appointment next week. We we will talk about it more fully and that, that that will give me an opportunity to between those two conversations reflect what what I might bring to this conversation may maybe do a little bit more information gathering, maybe talk to my colleagues. Oh, I I I saw missus so and so, and I felt I was I I'm I'm struggling a little bit with this. What do you think? Because, you know, we were we work in a big team in primary care, and we do rely on each other.
[00:52:12] Dr Monika Wieliczko: There's all
[00:52:13] Dr Lynsey Bennett: kinds of secret things going on behind
[00:52:15] Dr Monika Wieliczko: the scenes that nobody
[00:52:16] Dr Lynsey Bennett: knows about. And yeah so I think and when I'm presenting on on this issue in another capacity, something I always say is give me a second chance. I might not get it right the first time, but don't never come back to me. Or if you really don't like me, go and see one of my colleagues because they might get it right. And it's okay it's okay to bring your problem back more than once if you don't feel that you're getting the solution or you you don't feel you're hearing what you think you need to hear, then it, you know, it's really it's okay to bring it back.
[00:53:00] Dr Monika Wieliczko: And I'm so glad you said it because it's so important, I think, for our listeners to hear that from a GP, has so much compassion and passion for working with grief and and and supporting people that you know, and also giving g other GPs permission to say, oh, actually, I might not know the answer, and that's okay. You've you know, a lot of the time in my practice, I also don't know. And and I think sitting with not knowing with uncertainty is one of the hardest things. But once you kind of put it out there, it's quite a relief that you don't have to know everything and you might want to see someone again and that's okay.
[00:53:37] Dr Lynsey Bennett: And, yeah, you know, sitting on sitting with uncertainty again is one of the, like, the daily chat things that I do every single day. I'm always weighing up how much uncertainty can I tolerate in this situation? Mhmm. What do I do? Uncertainty can I tolerate in this situation? Mhmm. What do I do? Do I make myself feel better by doing a blood test? Do I Mhmm. Do I ask a friend? What am I gonna do? Yeah. Yeah.
[00:53:57] Dr Monika Wieliczko: Yeah. And having that support system around you, someone you can talk to after the visit, if that that you've seen someone, is also really important. So a lot of kind of really interesting and valuable tips from you, Lynsey. I'm really grateful for this conversation and just thinking how much there's still to be done around educating the public and educate well, empowering GPs to do their job and providing them with the tools and resources to be able to do that essential work. And one thing I always kind of encourage people to do who are listening to the podcast who haven't done that already is to go and check the free resource that I've got on my website, which has got the grief Monika. And it's something that anyone can use to assess where they are on their grief journey. And it's it's you know, if you've experienced loss, it's a good place to start. And it might be a really good tool to use before you go to see your GP because it kind of highlights the areas that you're not functioning very well. And showing the results might be a good, you know, way of kind of facilitating conversation. The these are the things I'm struggling with because that could be a a good basis of starting a conversation around what do I need, what am I struggling with, and how can I boost kind of more resilient ways of dealing with grief, which often involves just being able to reach out to people and gaining the support that we need and and advocating for ourselves because this is really important that, you know, as a as a patient that you you have the courage and the right to say, well, I don't feel like this this conversation addressed all my needs, which probably never does because in fifteen minutes, you can't possibly address everything? But kind of having that kind of feeling of being empowered to say that, hearing that from from from yourself, Lindsay, is really important and really humbling that we can have those conversations. So I thank you so much for today. It's been absolutely great to learn from your experience and to hear about the amazing work you're doing. We will put some links to your article, but also if people wants to reach out to you anywhere we can we can reach you, that that will be in the show notes. So anyone interested in finding out or asking me questions, feel free to do that through the show notes. And, I don't know if there's any kind of takeaway message you wanted to share with our listeners, anything that kind of is the kind of obviously, there's so much that you've shared already, but takeaway one takeaway message for anyone who's struggling with grief.
[00:56:32] Dr Lynsey Bennett: Yes. Monica, you're putting me on the spot here, aren't you? I mean, I think I I think just don't try to find some words to to say what's what's going on. Try and try and talk try and talk to people. Don't give up. Don't give up. And sometimes support comes from very surprising places. So yeah and we know what it feels like you know we've been there haven't we?
[00:57:04] Dr Monika Wieliczko: Yeah thank you so much that's really quite a nice place to stop and to give some power back to our communities, but also, yes, a low a low bit of hope as well. So thank you so much for speaking.
[00:57:18] Dr Lynsey Bennett: Thank you so much. Thank you for having me.
[00:57:20] Dr Monika Wieliczko: Thank you for joining us. I hope you found it useful. Connect with me on Facebook and Instagram under Guide to Afterlife for more grief tips and resources. Visit GuidetoAfterlife.com to send me your questions and to take part in the Grief MOT, your free first aid program for grief. See you next Tuesday for yet another stimulating conversation.
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