SMMGP - Substance Misuse Management Good Practice

Substance Misuse Management Good Practice

Supporting good practice in drug and alcohol treatment

Post-its from Practice:
What makes a good GP: Education, nature or nurture? (Mar 2011)

As a teaching practice we have lots of junior doctors and trainee GPs working with us. As part of their induction, each one sits in with me and meets a range of patients who have drug and/or alcohol problems. Each of these juniors' reactions tends to be a little different but they mainly fall into two groups: those who want to engage with this area of work and those who want to run a mile. The last two juniors that I have spent time with, really brought this difference home to me.

The first doctor joined us about two months ago. Since then, she has already felt comfortable enough to cover for me while I was away (something that my partners felt a little anxious about); is writing a paper to present at the Royal College of General Practitioners (RCGP) 16th conference in May; and has just completed her RCGP Certificate in Drug Dependency Part 1! The other arrived a few weeks ago, sat in with me last week and was a complete contrast. As a woman shared intimate details of her life being brought up in care, she seemed totally uninterested. As she told us that she felt she had failed her own daughter, now 16 years old, with whom she had just been reunited after 10 years in care, she fiddled with bits of paper. I was appalled at the doctor's insensitivity and tried to shield my patient from her. My patient left thanking me for listening but before she was barely out of the door, the junior doctor said, "I haven't got your patience. I couldn't sit and listen to that rubbish every day and she was drunk you know!" Immediately after I was speechless and it was only later that I was able to challenge her about her behaviour.

Which makes me wonder - what makes two people of similar age; education and culture behave so differently? Is it something innate to them or because of their background? Their reactions are not unique. If we look at the Royal Society of the Arts (RSA) report "Whole Person Recovery: A User Centred Approach to Problem Drug Use", we see that GP involvement is seen by service users as a key element of care. Although many people do receive the care they need, some patients also have negative experiences when they approach their GPs.

Medical education is changing: now drug and alcohol problems now form a section of under-graduate medical training and the general practice curriculum. This doesn't seem to have helped the second junior who sat in with me. SMMGP does and will continue to encourage increased awareness of drug and alcohol issues through the promotion of knowledge and understanding. With the RSA, we are developing a range of user-led innovations, including a training pack for GPs. Prejudice mainly exists through ignorance which we can help to address, but is there something more we can do to address this?

I recognise that I am a wounded healer (like many health professionals) and I feel privileged to work with people who use drugs and/or alcohol. They have taught me much about both my work and about myself. As a group of patients, they constantly change on their journey and I am proud to join them on it for as long they wish. I feel sad that the second doctor may never experience this.

- Dr Chris Ford
GP Lonsdale Medical Centre, and Clinical Lead for SMMGP

Post script: Thank you for your help!
Thank you so much to all those who contributed to Angie funeral, from me, the SMMGP team and Angie's family and friends. You were generous and a good send-off was had.