Sunday, 26 May 2013

I'm On Fire

Usually when I'm visiting a detainee, I try to have a chat about change. They are frequently addicts, often they use services incorrectly. Currently I am warning them against using A&E, who struggle in my region to give out head injury advice after a head injury. They think this institution is going to engage with these difficult clients in a meaningful way and when they don't, they ruin it for every other primary care institution that may be able to help.

Cutting to the chase a little, when the "patients" ask me what should they do, I suggest to them that they start with their  lowering their expectations of the NHS and attending their GP. Then I reel off caveats. Caveats that their GP may be useless and put them off using medical services ever again. Caveats that their GP may be an excessive prescriber, so I warn them that receiving more drugs is not the aim. And various others caveat I could add, that might help align their expectations and avoid the process breaking down again.

Very few GPs, counselling, psychiatric, psychology services are aimed at supporting and instilling change.
That's why they don't work. They would possibly argue they are not "trained"  in this. It seems to be a usual refrain. 

So when, as yesterday, I saw somebody who had been under this process for 4 years (not that long in the vast scheme of things usually) and asked them to identify what had helped, he struggled. Because things had got gradually worse. Whoever was "helping" him wasn't even keeping up with the present, never mind trying to install some protection against future.

I did my usual proclamation to "start with your GP" and work on from there (despite the caveat that many GPs don't like to engage with drug addicts, I still explain that they are responsible for all their other health issues).
One man a couple of days ago was pretty stunned by this approach - "you mean I can just go to my GP and talk about stuff", he said. "YES", I screamed internally. "Of course", I quietly announced,  slapping my forehead with the heel of my metaphorical hand.

I've often suggested changing GPs when things aren't working. But this week I have reframed this suggestion.
And, as yesterday, I suggest that a GP who is ineffective and uninterested, receives the "sack". 
"Sack your GP!". Yesterday's detainee-in-question raised a smile of astonishment. Before he over thought the suggestion and called me a knob. 
Then he almost begged me to talk more. But there were other things to do. So I verbally forgave him in advance for being a cheeky sod, offered my usual suggestion of... "If I given you any useful pointers here, act on them, if not, throw them out".
And left for the next case.

Irritation is the start of change.
And getting inflamed is a good way to kickstart the healing.
Ask any verruca.

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