15th June 2026

Newsletter Monday

Hello Reader,

How often have you been carried along by momentum?

We usually think of momentum as a good thing.

This week, I started wondering whether that’s always true.

I was visiting some patients in the community hospital to oversee their move there from the main hospital.

While I was in the office, an emergency buzzer sounded and without giving it a second thought, I ran, like everyone else, to the emergency.

Afterwards I kept reflecting on how automatic this response was even though I hadn’t run to a buzzer in a hospital for over 19 years. My brain clearly still had a map for it.

Anyway, this isn’t about my brain.

It’s about the man who collapsed.

He hadn’t had a cardiac arrest.

He’d fainted and I was of the opinion it was due to his blood pressure medication no longer being appropriate for him.

This can happen when you get to 88.

What you need for your health at 88 is no longer what you needed at 78, or 68.

The seesaw has tipped the other way.

This is a challenge in healthcare because we are hard wired for prevention.

We spend years trying to reduce future risks, but at what point should the “prevent future risk of X, Y or Z” conversation change course?

It’s a delicate conversation and one we are not as skilled at as I would like.

What was also interesting about this patient was that, in his own words, he was just totally fed up.

How do you really feel?

I sat and chatted to him for a while once he was back in bed and recovered. He described being thoroughly fed up with his body not responding the way it used to.

He missed his wife, who was in hospital elsewhere receiving end-of-life care, and it felt to him as though he was being carried along by momentum when he wasn’t entirely sure this was what he wanted.

That word stayed with me.

Momentum.

Because I suspect he’d been feeling like this long before he fainted.

His blood pressure that day was around 65/50.

One of his “preventative” medications had ruined his morning and now he was facing a weekend in bed because everyone was worried he might collapse again.

I stopped his blood pressure medication with immediate effect because high blood pressure was no longer the risk to this man that it once was.

The opposite was now true.

The medication hadn’t changed.

The man had.

And that’s where I think healthcare sometimes struggles.

We are generally very good at starting things.

Less good at stopping them.

A tablet gets prescribed for a good reason.

A test gets organised.

A supplement gets recommended.

A treatment plan gets put in place.

Then momentum takes over.

Years pass.

Circumstances change. People change.

But nobody quite gets around to asking whether the original problem is still the problem we are trying to solve.

I see this outside medicine too.

People often send me reels, adverts or supplements and ask:

“What are your thoughts on this?”

My first question is usually:

“What problem are you hoping it will solve?”

Because without a clear answer, almost anything can sound appealing.

“I want to feel better” sounds reasonable enough, but it’s surprisingly difficult to work with.

Better than what?

Better in what way?

How would you know if you’d achieved it?

The clearer we are about the problem, the easier it becomes to judge whether a treatment, supplement, scan, blood test or lifestyle change is actually helping.

Managing health is often less like following a straight line and more like balancing a seesaw.

As we age, the balance shifts.

What mattered at 60 may not matter at 80.

What carried more benefit than harm ten years ago may not do so now.

The thing I’ve thought about most since that day isn’t his blood pressure.

It’s the word “fed up”.

At 88, separated from his wife, frustrated by his body and stuck in a hospital bed, I doubt his greatest concern was whether his blood pressure was a few points higher than ideal.

Yet that was the problem healthcare had spent years trying to solve.

Perhaps one of the most important questions in healthcare isn’t:

“What can we add?”

It’s:

“What problem matters most right now?”

Because problems change.

People change.

The seesaw moves.

And good healthcare should move with it too.