Long Covid in Adults

I think from the moment you’ve got Covid, then information about Long Covid should be given to you, and even if you’ve had the vaccination, you must also be informed that Long Covid could be something what you develop after the vaccination. When you go into, like, your GP offices, you’ve got things like sepsis and stroke notices and things like that all over, you need to start getting this information out there as well, you know, notices out.
 
Long Covid: it, I think it’s something which everyone tries to keep quiet; it needs to be shouted out. But you don’t need to feel guilty about having Long Covid because it’s something beyond your control. They should make it more of a one-stop, so if you’ve got Long Covid, everything’s under one umbrella. How do you know I can afford to go to this place and then tomorrow to that place, and then to the other place? How do you know I can afford that? How do you know how it’s affected my employment? How does my employer know how to treat someone with Long Covid? Yes, it might be documented, it’s you know, the equal the Equality Act, disabled act, but how do you literally know what to do for that person? How do you know-? I was stood in a queue for a few minutes last week to get my medication, I don’t know if I remember saying this or not, and within a few minutes I realised I couldn’t stand, I started, the symptoms started as you’ve seen before.
 

Is there anything that you’ve sort of noticed about the way the current healthcare system is operating that you think could be improved or needs to change specifically in response to caring for and treating people who’ve got ongoing symptoms?

Yeah, I think it is so widespread that I think it does justify creating some specialist services for them. Because it turns up in slightly different forms and we’re…you know, we’re going to need to do research, we’re going to need to look at drug treatments, we’re going to need to look at finding a way of reliably, if such a thing is possible, reliably sifting out of things that people like me might think are Long Covid and actually they’re not, they’re this thing over there, so let’s focus on things that we can track it back, we can sequence it back to something that happened during Covid. And…and I think, you know, both hospitals and primary care need to think about having, you know, either clinics or services that are specifically about that.

Because there’s going to be…there are so many people coming in under that umbrella, you know, they need to think about that. And…and they need to…particularly in primary care, where for a lot of people it’s probably just reassuring them and monitoring them, they need to do a bit of that, not just make people leave… they’re left to fend for themselves… 

Well, that’s Covid, we don’t really understand that. That…give it time, it might clear up. 

Which is sort of been one level of response, or hang on, I can’t nail this down with a diagnosis and a drug that I then have to give you, so either it doesn’t exist or it must be something else, you know? Let’s…let’s be free enough to say you have to be professionally curious about this, it’s something we don’t know a lot about, we probably need to construct some services trying…to try and understand it better and to cope with the number of people who’ve got it.

And the second thing, again, and from the GP perspective, I absolutely get the fact that, you know, I am not dying, and that there are more people, with more serious conditions than me that the kind of medical profession needs to give its time to. But my life has been completely turned upside down.

And the lack of support has been galling. so if there were, a way that, you know, in Scotland, we could look to replicate, you know, the concept of the Long Covid clinic, or create something that allows people with this condition to get help, rather than adding yet another thing onto the big, long list of things that GPs need to think about, then I would have thought, that has to be a better, more effective, more efficient way of supporting, kind of this condition, and, you know, sort of what I've experienced so far.

And going back to my kind of qualification about the medical context. It’s, well the Health Service is obviously quite strained, just now, Long Covid is obviously something that’s all brand new. So, I don’t, you know, I'm not casting any kind of note of complaint or anything, kind of, at my GP. My GP has been pretty useless.

That’s not, I don’t for a second think that’s their fault, you know, they’re put in a very unfortunate situation of, kind of, too much to do, and this new Long Covid thing, they don’t know what it is, and they just, you know, I'm not dying, so they don’t seem to have the time to spend with me you know, I'm aware of the Long Covid clinics that exist in England and that we don’t have the equivalent up here [Scotland], which is a real shame. so, you know, I got to see a respiratory specialist, because I pushed to see a respiratory specialist. I got to see the neurologist specialist, because I pushed to see a neurologist. My, you know, the…as I say, other than writing a, physically writing the referrals, and physically writing the sick line for me, back in September, I've had nothing from my GP. 

So no advice, no information…

Nothing at all. If, if I…

…no follow-up to see how you are…?

No, not a thing.

So, without your medical insurance at work, and the, being able to go for tests, you would probably have felt quite abandoned by the Health…

Absolutely.

I think, one thing I guess I haven’t said is, one of the most important things that you could do, if you encountered someone who has Long Covid, is just be compassionate and understanding, believe what they say. It’s all very real, it sounds preposterous, and wild, and unbelievable, but it’s very, very real, it’s happening. And it’s really scary, and difficult. So just, you know, the kindness from other people has really helped me. And when there have been moments…no, no one’s been particularly unkind…but there have been moments when people maybe haven’t believed the symptoms, or have dismissed symptoms, and it’s really had a profound effect on me, and put me back the way.

So, what happened was…I mean, my GP’s quite… the surgery’s quite small…so there’s basically one…one full-time doctor and a couple of part time doctors. So, …I think just because I was phoning up on the day that I required a sicknote to start with…I spoke to the same GP so by the time I’ve, kind of, needed them, you know, they already had, kind of three months’ contact with him.
 
And I decided just to always ask for him so, you know, I found him very supportive. He was very good…there was a…I think a local… another local [area] GP became the lead because of the…her effects…you know, the effect it had on her with the Long Covid. So, he read up on a lot of her studies because, you know, he was quite good I think at looking at the, sort of, professional, sort of guidelines on that. And there was…there was various, kind of, flowcharts and stuff that came out to help with the diagnosis, so he did very quickly diagnose me with Long Covid, despite never having a test. You know, I was in it… you know, before the test and everything. So, he very quickly I think, correctly diagnosed me. Whereas that doesn’t always seem to be the case.
 
When would that have been roughly? What point of time would he have given you that diagnosis?
 
About three months in.
 
Three months in.
 
Yeah. He got…he got a flowchart but… and he was mulling over…he’d be mulling over, you know, the, sort of…what’s the other condition that’s chronic tiredness? You know…
 
ME?
 
ME type of thing…yeah. Then I think some guidance came out and he was able to work…he worked through…he actually worked through the flowchart with me…So that…you know, if you’re looking for what I think…what was…for me it was keeping the contact with the same GP.
 

I ended up phoning my GP at the end of January, about the twenty fourth of January, somewhere around then, and I was in floods of tears [Laughs].
 
And I said, I don’t know what’s wrong, but I can’t get back to me, I’ve lost me [laughs]. And they [laughs]…they were amazing. I mean, the GP that’s here in…I live in [place in county], and hats off to the GP and everything there, they were immediately…they were amazing. 
 
They immediately knew…could see the signs of Long Covid. And they set a treatment plan up there and then and said don’t worry.
 
They put a treatment plan in place immediately got me signed up to the Long Covid clinic here in the [region]. And regularly the GP was supportive, so I think I spoke to her probably every week at this point in time and it was having that support that was crucial.
 

If we take the healthcare profession…first of all, I was fortunate…that I was already in a system, and I was fortunate with the GP, who was a young GP, whether that’s any relation to it, I don’t know, but they listened. And I think just listen. It’s quite obvious when you talk to somebody what they’re feeling and what the symptoms are, and I think a lot of people will have…were different, probably. I mean, the symptoms for Long Covid, as I say, I mean, I never had the shortness of breath or the cough, fortunately, or the lung problems that seem to be with so many people, I was fortunate, but I had other symptoms that were, just the chest pains and the head, so I think everyone’s individual, but everyone’s probably, as well we’re under the same banner, and if you don’t just tick a box, think that it’s…it probably has been related. It’s not one size fits all, but I think, just be aware that Long Covid is out there with lots of people, and I think lots of people take a long time to go and see somebody.

And why do you think that is? Why do you think we do that?

I think a lot of us are professionally as well, we’re probably quite stoical and we kind of just think it’ll go away, it’ll be okay, and probably we’ve been in society with Covid, that some people have been okay and some people haven’t, and you kind of think, oh, I don’t want to make a fuss, maybe it’ll go, but then when you get so poorly, you have no choice.

You’ve got to go and get the help, because there is help there, it’s just getting the right GP to talk and help and support you as well, but I think…and I think the GPs need to listen just to, you know, if you don’t have one that does, or the healthcare professions themselves should be reading the research out there, they should be looking at the research everywhere and being up to date, ‘cause things are changing all the time.

I mean, I can just say that our profession academically, keep looking around and what’s happening and be up to date with it, because there’s probably lots of people out there that don’t want to go in and say it, and by the time they build up the courage to say it, like I did, and be in tears, which is not me…then you…come on, we’re not saying it for nothing, listen to them.

So how about any messages that you might have for a range of healthcare professionals, so that could include GP or hospital specialists or it could include pharmacists or physios or…?
 
Yeah, so these are…I’ve got, I’ve got a few but there’s, I think there’s a few other kind of points to discuss around it as well, so my first one is don’t allow this to be the same as what’s happened with, with ME or chronic fatigue syndrome, that took far too long to be agreed as, as a concept and even now the diagnosis is still a challenge for a lot of people to, to get diagnosed with that, so learn the lessons that we’ve learned with ME, and get to a, an agreed this is the condition, this is the prerequisites, this is the treatment, and this is the prognosis. I think we’re getting there with Long Covid, and I hope the timeline is far less than it was for ME but learn those lessons that we learned there.
 
Remember as well when you’re looking at somebody with a condition, remember the person that’s in front of you, even though the textbooks may say that it’s generally eighty per cent of cases are in this group or in this group, try to take that out of the discussion and think are these symptoms matching it? Because I think that’s been occasionally with the Long Covid side of it, there’s been a couple of times when you think I know I’ve got this, I’ve got all these symptoms but the other person I’m speaking to doesn’t think that’s possible because I don’t fit into the, the risk group or the risk category. So, remember you’re dealing with an individual in front of you with those, those symptoms.
 
And then I think the other one is just being connected, to make sure that notes are being updated on, on the page of notes, make sure that anything that’s discussed is on there. I myself have had a few experiences where there’s been kind of miscommunications between what’s written in the notes and what’s dispensed and it’s caused challenges with either getting sufficient medicine or getting it quick enough. The pharmacy thinks we’ve issued that recently based on his, his prescription, he shouldn’t have used all of that. Actually, it was changed two weeks ago, I’ve probably used half the medicine by the end of that week. So, it’s that kind of just make sure that we’re more connected than usual. This is a longer-term condition, and as I said yesterday, my pillbox makes quite a rattle every day. There is a lot going on. Just make sure that we’re… when we’re making decisions about pain relief how much to give, understand for certainly for me and for other people with my condition, for us to come to a GP, for us to come and explain our symptoms can be draining enough.
 
But then having to deal with having not enough medicine, to try and argue is not the right word… try and discuss with as much energy as we can to those that are either on reception or in the pharmacy that we need this medicine, this is what’s keeping us from being in quite intolerable pain can take quite a lot of effort, so just understand in terms of when you decide how much of a medicine to give or if you’re declining, why you can’t give, for example, codeine, you can’t give a huge amount of that, just so you don’t have to visit a pharmacy every month.
 
I understand the reason for that because it’s a controlled drug but it’s just making sure that you’re informing the individual and I think it’s that kind of making sure that we see the person that you’re dealing with there and you’re helping them, because that’s, I think, as I mentioned in the, the messages to the individual side, also on the, the kind of medical professional side, be aware that these are people that have probably never had a long-term condition. This isn’t someone that is familiar with having to get referrals or getting appointments and a prescription too, so just help us understand the process. If something’s going to be a while, help us understand why you have to go down that, that route or why a medicine that has worked for so many other people can’t be considered for, for you. And just understand these aren’t people that are used to having that kind of discussion or, or terminology. I think that’s all of those, I can come back if I come up with any others.
 

I suppose just relating to that whether there was any advice or message that you would want to give to healthcare professionals who might be supporting patients who have experience of Long Covid?
 
I would think, I would say that the healthcare people, whether they are already supportive or they’re not, you know, they’re kind of those people who are a bit hm about it, I would say they all need to have a very open mind about Long Covid. And these other, things like ME as well I’m sure are going to benefit from this, because it is not a normal thing, it doesn’t fit into their boxes. And that’s the trouble with, you know, when you see someone and they want you to fit into this box and you don’t because it’s not…it’s a multi-systemic thing. And I think we need to have an open mind. And they also have to have a very open mind about other therapies and other treatments, so like the supplements or like meditation and the benefits of acupuncture or, you know, other complementary therapies.
 
The people that have done maybe done the best are people that have gone to see functional medical practitioners who are more, you know, open to all sorts of things, so. And they’ve been given dietary supplements, alternative therapies and things, and they seem to have done the best. So, like in China apparently, they use qigong because that’s part of their thing, you know, qigong and tai chi. And that helps your system, that helps the body, and it’s a very gentle exercise. And, but here, you know, it’s not…you wouldn’t be told to go and do qigong or tai chi or have acupuncture; it isn’t something you would have.
 
So, I think we need to open our minds to these other things. And look at other countries and see what they’re doing and see what is beneficial to people. Because it’s not all just give you the pill, because there isn’t a pill at the moment.
 
 

And they have an occupational therapist and a pulmonary rehab physio so I saw, I spoke to both of those people over the ’phone so it must have been ’phone appointments they have. And that’s been really good, particularly the occupational therapist because she calls me up every month or something like that and, and you just talk through what’s happening and they talk about…she’s been teaching me about pacing and things like that. And it’s just really nice to have someone, the same person, talk to you and have enough time to talk to you. She might spend about half an hour, forty-five minutes on the ’phone with me. So that’s good because she remembers who I am and she remembers what I [laughs] told her last time. And she’s unfailingly kind and helpful and positive. So that, that’s been a really good thing.

And I think one of the good things about the occupational therapist there is that she’s quite happy to admit that she doesn’t know yet. That, you know, there’s lots of things that nobody knows. But she has got enough other patients with Long Covid that she’s beginning to kind of…she says that she learns a lot from them and she can listen and try and give advice to the other patients based on, on what people have told her. Or reassurance, or even just to know…well, for example, she said some people have found that the vaccinations helped them, and some people haven’t. So, you know, she…it’s not at the point where we have good clinical evidence but she’s able to kind of share other experiences.

And you indicated there that you, you appreciate the honesty about uncertainty. Could you just say a bit more about why that’s helpful or important?

I think it’s important because it’s not patronising. It’s, it’s helpful because it’s not patronising. it’s a kind of well “okay we’re going through this together what you tell me is important”. And it’s important, I think, that that honesty is accompanied by an earnest wish to help me with it and keep helping me with it. As opposed to, you know, if I went along to somebody and they went, “I don’t know. Nobody knows. See you later.” Then that would be incredibly frustrating. But I’ve always felt with the occupational therapist that she doesn’t know but she’s very willing to learn and she’s not going to abandon me halfway through.

So, then I started getting worse again. So, December, I really crashed my energy levels disappeared, my coughing was non-stop. I was coughing all the time. I went for another, I went for a Covid test on Christmas day, it’s how I roll, and [laughs] came back negative again and then this time my GP asked me again, I called my GP, I was very distressed because I just couldn’t understand what was going on. So, I explained to him, “I’ve had a Covid test”, gone through all the symptoms again. He asked me to come back for some more blood tests, so I went through the blood tests and then he sent me to hospital for a chest X-ray and then I had an ECG. I had a, and then basically in January, I was told by my GP that I had post-infectious Covid, and I was relieved to finally have a diagnosis and I was, he said to me there was no way of determining how long I’ve had Covid, but he believes I’ve had it for a very long time.
 
Because he’s a good GP he listens to his patients so I, we went through the timeline again and he said, “It’s very likely that that’s when, February’s when you started developing it,” and he said that “Covid has a way of, it infects everybody differently and, you know, but the body masks Covid in different ways.”
 
So, I was extremely relieved to finally have a diagnosis and I did ask him, “What does post-infectious Covid mean? I know what the words post-infectious are, I know what the word Covid is,” but I said, “put these two words together, what does this mean for me?” And he said, “Well it’s too difficult and impossible almost to determine because everybody’s an individual and everyone’s impacted differently but he said to me that, you know, “You need some time off work. You need, you know, the fatigue is extreme, and it will be for a while, and you need to take care of yourself.” He was very compassionate and very caring and like I said, I know a lot of people do not have that relationship with their GPs, I’m very lucky that I do. He referred me to a Long Covid clinic. He explained to me that it’s very hard to get access to one. He said, “I’ve referred you.” He said, “I can’t tell you how long it’s gonna be.” I still have not received a referral from the Long Covid clinic. This is now, we’re now in June. I was diagnosed in January.

What about advice for health professionals, people working in health services that are dealing with people with Long Covid?
 
Hmm, first of all, take them seriously [laughs]. You know, I think, I think, I think people generally are, now. There’s a difficult balance. I don’t know, kind of, how best to approach it. Because, obviously you’ve got to, you’ve got to strike a balance between being realistic, and offering hope to people.
 
And, so the realism is that, you know, the realistic response, or a realistic response has to include, “well we don’t know what’s causing this, and we don’t really know how best to deal with it, or, or make it go away. But here’s some things you can do to look after yourself.” So, and I think that’s the sort of advice that I've been getting, which is good.
 
It’s frustrating, because it doesn’t sort it out, but it’s nice and sensible, and it’s, I think, you know, absolutely the best that can be done in the current situation. And, you know, I'm very grateful to have received it.
 

So, if I could tell the medical community one thing, it’s keep everything to your, to what you’re good at, don’t suddenly become an expert at something that you’re not an expert at and the other thing is, I saw cardiology two weeks ago and one thing that really impressed me with him was that he said, “Look,” he said, “this thing is two years old, we don’t know. You’re not gonna like what I’m gonna tell you but I can’t tell you. I don’t have answers for you.”
 
This is about my heart palpitations, and I actually turned to him, and I said, “Thank you so much, you’re the first doctor that is not telling me, most doctors say, ‘Look there is a solution’, I just, you know, ‘the good news there is a solution. The bad news is I can’t tell you when you’re gonna get better.’” Don’t tell me that. I don’t wanna hear that because guess what, how do you know there was a solution? Maybe I am gonna be like this the rest of my life. Don’t promise me something you don’t know.
 
Just because you’ve seen a million people get better from what I have, maybe I’m part of the other million that won’t actually get my lung capacity back or whatever it is. So, I said, to him, “Actually I’m really happy to hear what you have to say,” and he didn’t ask me about my mental health. First time, the first time I saw a doctor who didn’t say anything about my mental health.

I think that primarily it’s believing that what the patients are saying is how they’re feeling. But it’s also believing that there’s a cause a biomedical cause to it that you just don’t know about. I think that’s really important. It’s not enough to say I believe you’re feeling that way. You have to say, “I believe you’re feeling that way and I believe there’s a cause. I just don’t have the answers."
 
And very, very few doctors have said “I don’t know” to me. And even though I know that they don’t know, they still don’t seem to be able to say that. And that seems very strange, but it seems like such a simple thing to do and it’s not a failure. It would actually be a, it would be helpful for someone to, I know that. It would be helpful for doctors to have the confidence to say, “I don't know what’s wrong.” But here’s a number of things from the limited evidence you can try and it’s, you know, safe by their own clinical judgement. But I think the main thing is, I believe you and there’s something wrong, I just don’t know what it is.
 
I think that’s the main message I can give. But also, that you know, improving symptoms and all these things. Trying things, that’s what gives me hope, personally. I think if I was kind of stuck at home and I wasn’t trying things and I was just waiting for time to make me better, which I was for the first year and a half, I thought, oh I’ll be better in a couple of months because that’s what I’ve been told. But the belief that you will get better will not make you better. I think that’s really important. It gives you hope and hope is really important in every illness. But I think that being realistic and honest to patients and not trying to trick them into kind of making themselves better by some strange, psychological mechanism that hasn’t, that’s completely unproven. That’s very unhelpful. And I think unfair to patients.

I think the most important thing is recognition. It’s real, it's a physical illness not like - I don't want to like insult or in any way discriminate against people with psychological illness but it just isn't one. That's the issue. Many researchers and doctors who claim it's a psychological illness claim they will get harassed by activists when they make these claims and it's just simply not true. Like I would wish you know, like it would be great, it would be treatable. You know I just would go to mental health clinic in four weeks, I will be fine, I would win. But it's not true. I'm sorry.
 
I met a 39-year-old father for like two-year-old daughter and he was like mentally really, really depressed but he felt anxious to actually be honest, to upcycle to like psychologist because he feared if he is honest, they will think it is a psychological illness and he won't get recognition, which is like really, really low. He probably needs that mental health support, but he's afraid of getting it because he doesn't want to get like put into this issue and don't get other treatments ever again.
 
That's I think another big issue for doctors. That they need to understand of course many people are just depressed. Also, many people are high suicides, so they’re suicidal. There are many - it's really because of the depressing condition. You know, you have bad illness, no one can treat it, no one wants to take it seriously. Of course, many people have some really bad feelings and may kill themselves so doctors also should screen for that. But they should know it's not the issue, like Long Covid is the issue for those psychological issues and they're not the only good psychological issue.
 
A big problem in this are those like multiple choice boxes tests they give you. Because if you check those like depression tests, you usually get a positive result if you have like Long Covid because you have fatigue and you have pain, but it isn't because for example, you feel like because you don't want to do things you want to do, but you can't. You know that's the main difference. And most like schedules which are used for like depression screening, they aren't good enough to filter these kind of things out. So, I don't blame doctors, without any further information for coming to those. That’s a psychological issue, they don’t need psychological treatment, but it won't help them you know.

And then I, then I asked in the surgery because there’s been a whole big thing come through the last few months about histamine being a factor in Long Covid and this anti-inflammatory. And I have a history of high histamine, so I asked my normal GP about this link, and she didn’t really seem to know about it, she didn’t say. So, I thought well, it’s out there and people are sharing BMJ blog posts and articles about it, so if she’s not reading them then she’s not keeping up with the Long Covid news. So, that’s fine, that’s not her area but I need to speak to someone who is keeping up with these things.
 
So, I asked at the surgery at the reception if any of the GPs were particularly interested and they said one of them was, so I spoke to her. And she was definitely much more up to date with what was going on and…But she said, “There’s nothing we can do for you until somehow there’s something set up in Scotland. There’s nothing here just now.”
 
So, it’s kind of like some of the doctors are sort of they do their tests and their tests come out okay, so they don’t know what to do with you, so they just put you away sort of thing. So, that’s why there needs to be people who are interested enough and informed enough about Long Covid to understand how it’s affected people. So, that’s why some of the clinics in England are really good because that’s what they’ve got: they’ve got people who are up to date and following the research and interested, or maybe doing research themselves, and can then see the sort of slightly bigger picture.
 
Not just, your heart’s fine, I don’t know what to do with you. But there’s something going on with your heart, there’s something going on with your lungs, so yeah. So, that’s why we can’t just rely on, we don’t think, the sort of normal people that you would go to see because they…it’s not their area of interest or expertise.
 
So for you I suppose one of the big kind of final questions is actually just about what you think should be changed to improve supporting treatment for people with Long Covid. It sounds like access to specialists with up to date…
 
Yeah, and…
 
…interests.
 
…GPs to be…GPs to have enough knowledge about it to not dismiss people, because some people have been dismissed. There’s a GP in our group who said it’s called diagnostic bias, because like if I go, and you’re a woman of a certain age, you’re having this, so it must be menopause. Some of the men have gone… I mean, my GP didn’t say that but that’s what’s happened to other people. Some men have gone and it’s been like, well it’s just anxiety, stop watching the news, stop being in these groups, you know, you’re not going to make yourself better with that. But it’s not anxiety. I mean, they may well have anxiety. A lot of people with Long Covid have anxiety and depression and all sorts of issues, but that’s because they’ve got Long Covid and they’re not being listened to and there’s nobody helping us.

Sometimes health professionals feel a bit useless when it comes to Long Covid. A feeling of “What can I do I don’t have a cure for this,” but there is actually quite a lot you can do. The first thing you can do is be your patients ally. Be on their side with them through what might be a long illness we don’t know at this stage. And the patient needs to know that you believe them.

And there maybe all sorts of practical things you can do like if they are not able to work or go to college or attend school, they may need documents that enable them to claim benefits or not be punished for that inability. I think some people do find the world quite punitive when they are disabled by Long Covid.

I think the other thing that you can do is to refer, because there are clinics available and there is a growing knowledge, it is growing slowly, but there is growing knowledge of what we can do to help with people who have got Long Covid, so it is very much worthwhile sending your patient, if they want to go, to someone who has expertise.

And I guess the third thing I’d like to say is just “be there”, “be available to your patient” who will have difficult times, may have crisis, may need to know there is someone, even if you can’t do anything, there is someone who will listen.

Are there particular messages or advice that you would give to healthcare professionals, particularly those who are working with people who have ongoing symptoms, post-Covid infection?
 
I think to be professionally curious. A doctor’s normal instinct is to analyse and diagnose, and…or rule things out, and say, well, it’s not that, it’s not that, it’s not that, and I think what… we’re into relatively uncharted territory, I think it’s really important for health professionals to be humble enough to say they don’t know and say that’s really interesting, we need to keep an eye on that.
 
And not feel they have to solve everyone’s problem by saying, well, the solution to that is take this drug or do this exercise or do this treatment, because actually they don’t know [laughs]. And… and it’s okay to say you don’t know.