Rules of Engagement

Yesterday I was talking to a heroin addict, who had been made into a methadone addict, courtesy of the medical profession. Well done, girls!!
He was not very keen to take more methadone as all his teeth had dropped out, but despite his low dose he topped up with extra purchases to keep his withdrawal symptoms at bay.

But at the time I saw him he was lucid, attentive and articulate. And it's always hard to resist spending a bit of time with people who are keen to listen.
He articulated a point I'd heard several times before by identifying the biggest distributor of drugs in my part of the country.
The name that came up once again was the female consultant for the local drug and alcohol programme, widely considered to be a soft touch for extra drugs, and always looking to increase the doses drug addicts
are prescribed.

This is a popular approach with supposedly therapeutic benefits, but can be articulated easily by people who prescribed before they talk to individuals. It is a level of disengagement dished out by linear thinking clinicians who rarely get to grips with what the patient's needs, wants and strengths are.

It's a failure of one of the first principles medicine. Which is this.
Listen to the patient. He's telling you what's wrong with him.

It's more than that of course he's even telling you what he needs.
Just listen.
Please... for a second put down your pen resting, itching and aching
over your prescription pad, and engage your ears and brain.
Listen.

And then he asked me a question.
He even prefixed it with the phrase. Can I ask you a question? (which is always slightly charming, if a little too deferential).
So I was kind of expecting a tricky one.
But it was the easiest question in the world.

"Do you believe in once a smack addict always a smack addict ?"

Surprisingly simple. Highly articulate. A simple straightforward question.
With that rarity of rarities...a simple straightforward answer.

"No, of course not". The words were out almost as a reflex.

How could anybody in medicine ever continue if they didn't believe in the incredible, (possibly best thought of infinite), potential of the human... well, the human being.

And yet...I can imagine the drugs workers saying or implying this to him.
Who hasn't heard of the same idea of the alcoholic.... once an alcoholic, always an alcoholic.
It's not much to look forward to, is it?
It is spectacularly undignified and ignorant clinical approach, an excuse for not engaging with the next set of motivations, (after hopefully controlling the primary problem).

I can imagine the defence of an articulate professor unable to see my view as anything other than that of a clueless dreamer.
But frankly I prefer clueless dreamer (me?) to just clueless (them!).

And I know the patient and I shared a clue. Because I listened and I looked and I saw and I heard it. And I felt it make a difference. And then I checked it had, checked that I wasn't kidding myself.

That he'd engaged with drug services to such a degree and not even have a clear answer in his head (or been given the wrong answer by rote) to that simplest most primal, most important of all questions, is not a sad indictment of him.
It's a sad indictment of the rest of us.

And when I say I us.

I really mean you.