SMMGP - Substance Misuse Management Good Practice

Substance Misuse Management Good Practice

Supporting good practice in drug and alcohol treatment

Post-its from Practice:
Stigmatised until the very end (Jan 2011)

A phone call from the London Ambulance Service was put through to me in the middle of a Partners' meeting. My colleagues wondered what had happened when I screamed and burst into floods of tears. They informed me that they were with Angie (who I introduced you to in DDN July 2009 when she was suffering from TB) who was dead, and that I needed to come and certify the body. Jo, the paramedic, was slightly shocked by my reaction and commented she had never had that reaction from a doctor. However, she was incredibly supportive when I explained a little to her of who Angie was as a person.

Before leaving the surgery I needed to tell the rest of the team and the receptionists about Angie's death. The responses were very much like mine. We talked about what a wonderful character she was: warm and caring as well as crazy. There was a real sense of love for her and how knowing her had enriched all our lives.

When I reached the house where she had died (owned by a friend of hers), the situation was very different. There were four uniformed policemen and one man in a suit, who I assumed was the undertaker. I introduced myself and explained that I had come to certify the death. The man in the suit said we should have a meeting in the kitchen before seeing the body. I agreed thinking it was to give me the background but was immediately shocked when one of the young uniformed policemen started by saying "Angie was a known drug abuser and alcoholic" to the suited man. I interrupted, and questioning what relevance his point had and what he was implying. The suited man then introduced himself as Chief Superintendent and explained their aim was to discover what had happened. After another two or three sentences full of assumptions and prejudices, I said that I knew Angie well. She had severe chest disease and had only two weeks previously been in intensive care with a severe chest infection and I was here to certify, not to listen to people who had never met her making assumptions about her and her life.

The Chief Superintendant said they were only trying to find the truth. I commented this seemed a strange way to try and find it. I then left the kitchen and joined Angie, who was at complete peace on the sofa with two of her friends sitting by. I did the necessary checks and it was clear that she had slipped away during the night from her chest problems. She was in the house of a friend who never allowed drinking or drug taking on his premises. I chatted with and comforted Angie's friends, recounting stories about her. We laughed and cried together and then the police joined us. Mr self-important suit man informed me the death had to be reported to the Coroner and because she used drugs he was sure they would want a post-mortem. I agreed we had to inform the Coroner but thought that as I was willing to issue the death certificate that a PM was not needed. He completely judged and condemned her because she drank and took drugs. Fortunately the Coroner agreed with me and I finished the death certificate.

I left the house feeling sad but also angry that the police had made such assumptions on this occasion. (I must say that this has not happened previously and usually they are more sensitive). I knew Angie's pharmacist was also very attached to her so decided to pop in on my return to let her know. Once again, the response was shock and sadness. The pharmacist was really upset, as were all the counter staff. It reminded me again how important that relationship is and how they would see Angie almost daily - much more frequently than I did. Much to the other customers bemusement we all hugged, cried and told stories about her.

I returned to the surgery to discuss these events with one of our counsellors and thought again how important it is to counter the stigma that people who use drugs and/or alcohol can feel on a daily basis. Stigma is damaging to people who use drugs. It is almost worse than the drugs themselves. Breaking the wall of exclusion for people who use them is a bigger problem than breaking the physical addiction. The effects of stigma are a daily reality for many people closely affected by a drug problem. Drug users, their families and friends are frequently marginalised and blamed by large sections of society for a range of social ills.

For that short time, I felt a fraction of what many people feel every day - the "junkie doctor"; she's nearly as bad as them. I loved it when the coroner informed him that I was correct but disliked him almost more when his attitude then became almost sycophantic. For things to improve stigma must be challenged on personal, cultural and structural levels. It is the final frontier.

I will never know how much of this stigma Angie put up with every day but what I do know is that many people, including me, loved her. She will not be forgotten.

- Dr Chris Ford
GP Lonsdale and Clinical Lead for SMMGP