SMMGP - Substance Misuse Management Good Practice

Substance Misuse Management Good Practice

Supporting good practice in drug and alcohol treatment

Post-its from Practice:
Changing GPs - not always a simple affair (May 2008)

Jack had been a patient of ours for just over 2 years. He had come to register with us when he had moved in with his brother and sister-in-law 6 months after his wife had died. He was struggling with her death, had stopped his HIV medications and gone back on heroin and crack. His health had deteriorated and his brother being concerned about him asked if he could register with us.

We agreed as the only condition for registration is living in our practice area.

Over the following months Jack's health rapidly improved. He engaged well with our local HIV doctor and restarted his HIV medications. This doctor is a gem and treats all people with the same respect however they got their HIV infection. He started bereavement counselling and although he still feels an acute loss of his life partner he is dealing with his feelings better. His physical health is markedly improved and he is settled on 120mg methadone mixture and 30mg diazepam. His urine screens show no other drugs and he doesn't drink.

In the last few months he has been spending more time in his own flat in another part of London and he now felt ready to move back completely. He came to ask me if he could continue to be registered with us. When I explained that that was not possible Jack became very anxious. He had not previously had good experiences with GPs and was not registered for several years before he came to Lonsdale. I quickly reassured him that I would not leave him without a GP who was able to care for him.

Little did I know how difficult that would be and what a learning curve it would be for me. Many times I have been able to use the "network" of friendly GPs, but he lived in an area where I wasn't aware of any such GPs. Hence, I used to search for all the practices in his area.

For a moment, I thought how shall I decide? Unsure I simply started from the top of the list! Wanting to find someone who would be able to care for Jack, I decided after checking with the receptionist that he was in their area, that I would discuss his health issues personally with the doctor.

My first call ended very quickly as the doctor said very rudely "we don't do those here"! I wanted to argue with him but was it worth it? The second was similar, although the receptionist was much more obstructive and rude before I even got to the doctor.

The third in some ways disturbed me even more. He said he was happy and confident to manage Jack's HIV infection but he would not manage his drug problem. I (foolishly?) asked why. He implied people who use drug were bad and it was a criminal offence. I for a change (!) got on my high horse and informed him that it was one of the most useful things I did in general practice. You saw people change, they were always interesting people and the rewards to you and them were great - not to mention it being a sanctioned and ethical responsibility of GPs to meet the health needs of their local community, irrespective of personally held judgements regarding the lifestyles of the people we are employed to serve. He totally disagreed and after a further attempt I gave up and felt very sad that there were those in my profession who were so prejudiced. I know how he made me feel so I was reminded a little of what it must feel like to attend there as a drug user.

But happily my fourth call reminded me of the opposite. As soon as I spoke to the receptionist I knew I was on to a winning wicket! She was cheery and helpful and completely like what I am used to at Lonsdale. She apologised that she couldn't put me through to the doctor right away because she was out on a visit but took my number and said she would get her to call. The doctor did within the next hour, was delightful and agreed to take over the care of Jack as soon as he had registered.

Over 30% of practices now involved with primary care drug treatment and all the GPs I know see this as a vital part of general practice. Due to this, I think I had forgotten how much prejudice there still is in my area of medicine and perhaps Jack's story was a necessary reminder of this I struggle with reconciling such prejudice with the values and purpose of general practice. So the question that remained for me is would I want a patient of mine to see the 3rd doctor for anything? The answer for me is no.

- Dr Chris Ford