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Sometimes all a GP can say is: 'That's not my problem'

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Due to the amount of trust that patients invest in us as doctors we are meant to make the care of the patient our first concern, which seems simple enough.

But what if it is not as black and white as that any more?

It seems to me that the act of putting patients’ needs above everything else (including our own needs), makes us less able to carry out the work patients need us to do. The definition of care is being stretched before the capabilities of our workforce, already bowing under the strain of bureaucracy and seemingly endless criticism.

Every now and then GPs have professional dealings with social workers, another public sector profession that is often maligned by the press. Our colleagues are frequently in the difficult situation of having to make assessments about the wellbeing of “service users” (they don’t have patients).

Social workers are primarily, as far as I can make out, concerned with the social situation of patients and in the case of, for example, elderly patients, their ability to clean, clothe and feed themselves. Undoubtedly, the medical issues of that service user, our patient, are an important part of that assessment, but rarely do social workers try to solve or offer advice on medical issues.

Would a social worker say a service user: “Mr Henderson, I think that your ability to dress yourself would improve if your breathlessness wasn’t quite so bad. Have you considered switching to a combination long acting beta agonist and steroid inhaler?” I think not.

So where does that leave GPs?

We have to decide for ourselves what care actually is, what it actually means to care for a patient, what care we can actually offer. And while we should fully take into account the social situation, needs and concerns of our patient, perhaps we need to realise that it is not always our job to try to solve them.

Unfortunately the vast majority of the social issues that patients face with work, relationships and neighbours are not going to be solved by social workers either. The only person that can solve those issues is the patient, with the help of their family and/or community.

So perhaps the greatest service GPs can do for patients is to point that out. If we try to meet every patient need by ourselves, we are doomed to become so disheartened that we won’t be capable of caring, whatever that means to us.

Dr Samir Dawlatly is a former secretary of the RCGP’s adolescent health group and a GP in Birmingham.

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Readers' comments (20)

  • I am a medical professional. Not a social worker, occupational health worker or life coach or counsellor or therapist of Physio. Nor would I try to be, I wouldn't provide any better care than any of these other professionals individually. I can facilitate and evaluate and provide over arching care but I can't solve all the problems patients bring to me. Accepting this is often very hard to do.

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  • It's not simple hey..people frequently come to see their GP because they need 'help' and they don't know where else to turn. The interaction between mental health and social circumstance is central to so many issues. As long as GPs have a role in managing mental health issues...which we do...social issues will loom large in our daily work.

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  • perhaps we should al be provided with a magc wand

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  • Social circumstances have an impact on health whether you like it or not.

    If an IDDM patient can't safely store their insulin as they can't afford to buy a fridge, their diabetes control will be impacted. If an asthmatic lives in a mouldy council flat - their asthma may become worse.

    What's needed is the firing of all those doctors who can only think in simplistic, reductive biomedical terms and the recruitment of medical students who have a holistic outlook on life. A first degree in the humanities (prior to graduate entry med school) would be a start.

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  • Nobody is denying that social circumstances affect health. I am not sure I've ever met a GP who thinks in "simplistic, reductive biomedical terms". The point Dr Dawlatly is making is surely that these things are important, and doctors need back-up from social services, local councils and, ultimately, the government in power, to help with those issues.

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  • Anonymous 12:12 pm - that's an awfully simplistic reductive viewpoint.
    I can only do one thing at a time. The time I spend doing a social worker's job is time NOT spent doing my job. That's not a very holistic way to approach health. We need everyone else to be well staffed and able and willing to do their jobs so that GPs can get on with primary care.

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  • The secret of a functioning system is that everyone plays their role in "covering their sector"- the consideration of the wider determinants of health is a key part of a medical intervention, however where the system regularly fails is its belief that GP's are the "provider of last resort" for nursing skills; therapy.
    assessments ;social issues.
    The sooner the public realise being sent to " get a letter from your Doctor" without a written instruction as to what medical fact would affect the requesters decision is in fact a prolonged and costly "no chance and I'm not discussing it" statement the better.

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  • George Osborne has a degree in the humanities.

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  • "Social circumstances have an impact on health whether you like it or not. "

    Perhaps it would be a good idea to provide some kind of "services" to address "social" problems like this.

    Can anyone think of a good name for such a thing?

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  • Until such time that the medical profession and other health and social services professions are willing to trust patients to self-certify, medical professionals will necessarily be involved in helping patients to access social funds.

    Let's be honest, GPs aren't willing to take the patient's word about what happened in a hospital consultation (you'll wait for the discharge letter). So why would GPs expect other services to trust patients and take them at their word when GPs don't?

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