Work day

Today I saw a dozen alcoholics/drug addicts or so.

I usually briefly wrestle with why they're failing themselves, why our system has failed them, why their GP hasn't made any progress (apparently) and in particular what the bloody hell we all going to do about it.

I get occasional positive encouragement from people who can still find an imagination of a better future that I can reach, tease, taunt, provoke or stimulate to reawaken.

Like healing a zit that won't go away. It doesn't matter whether you poke around with liquid nitrogen, a scalpel blade, the points of a compass (sorry Mr Armstrong, pair of compasses) - if you agitate it successfully you just might be lucky enough to allow healing process to begin.

The final patient tonight has been rushed into a famous local hospital and actively detoxed from his alcohol but I wondered at the stupidity of an emergency detox. The likelihood of success of this process in someone who had not been ready with his motivation and with whom they had failed to engage in any psychological manner. In dark circumstances like this, if you're not prepped for success you are doomed to failure. In the end he drank secretly all the way through the detox and left hospital early to drink some more.

But he recognised me.

He recognised me from the last time I presumably tried some similar weak, wordy intervention.

Some might call the need for this repetition failure. Not me. I'm comfy with it.

Failure is to give up trying. That's all. Just to give up trying. That's what I say and I say it because I genuinely think it's true.

If you do nothing else than to make a positive influence on the room that you happen to be in the time, that's still a damn good way to play.

He decided to pay me a compliment. 'I like your attitude' he told me and he went out of his way to do so. And.... I know what you're thinking, you cheeky sod, but I can tell you he meant it in a good way. And while you don't do this job for compliments, (god knows there are rare enough), it was a sign of a connection - a genuine piece of well meant appreciation.

A sign of a seed sown.

A result, okay that's too big a word but I live in hope. A result that, of course, would never show up on your appraisal report.

And that's the thing - surely a success is should be a quiet one. Better, surely they should be silent... the medic stepping into the background as the patient steps forward and takes the applause. Isn't that what the bloody hell this is all about? Channel 4, are you listening? Do you hear this, BBC3?

Or am I wrong?

As ever I took the compliment in a manner that left much to be desired by punching him in the face. I don't like people me thinking of me as a soft touch.

The fact is that the whole negotiation is more complicated than that.

The drug services who overprescribed are missing the point. If they wanted to know what's actually going on, they could ask the patient. That's what I do. They'll tell you the answers if you bother to ask the right questions, in the right way, and be sensitive to the nuances of the responses.

It's called the consultation. And the art form became endangered when checkboxes, NHS Direct, the pharmacist-as-clinician and the nurse prescriber stepped into the spotlight.

Ask the questions if you dare.

But you have to be to able to deal with the answers.

Or disregard these when you find you have nothing to offer.

I say ask the questions anyway and deal with your lack when you find it.

But there are other ways out of this slightly sticky situation - don't ask the questions, don't recognise the lack, say it's not your job, refer, do a bloody blood test.

But I'm not really giving you that option.

The fact is, it is your job.

Why?

Because you volunteered to be in that room.

When you are in the room, it's always your job.

If you don't like the heat, find a way to turn it down, sorry...it's going to take a bit of work, maybe you'd rather go cycling.

Or step out of the spotlight, take your bow and head for the emergency exit.