If I ate a packet of Skittles for every time someone has said to me student health was little more than contraception requests and herpes diagnosis I would not fit through my surgery door. Even in these more accepting and educated times when mental health never seems to be out of the news, there seems to be a distinct lack of understanding and empathy towards young people’s health needs while they study.
Students are a fascinating population, with often unexpected diagnoses (leprosy, anyone?) so it is hugely satisfying to be able to help them along the way.
One in four of our consultations is for mental health, and this is the area I personally find most interesting, but students also need treatment for infectious diseases, sports injuries, and sexual health problems. They are challenging but fun, though you might have to get used to the odd skateboard being parked against your desk sometimes.
Based on 13 years’ experience in a university practice, I have five main tips for GPs in consultation with students.
Some students benefit from complex case meetings and link workers
Students are a vulnerable population, and need support. They take risks that would make most of us blanch and seem to have little insight into the impact some of their decisions may have. ‘Pre-lash’ drinking (drinking a bottle of wine before leaving the house), swimming in Lake Malawi, taking pills and powders whose origins are dubious, if not unknown, and backpacking in Colombia, the list goes on. Some of these may just be part of ‘growing up’, but what really concerns me is how isolated and alone they can feel at university, unsure where to go for help, and trying to manage complex family situations, emotions and often past trauma without clear support.
At Bristol we have a well-established Vulnerable Students team, set up to take referrals from any member of staff or support services who is worried about a struggling student with complex issues. Consider setting up your own complex case meetings with other university support staff.
Manage demand with open or same-day appointment systems
Students often have unrealistic expectations. I have been asked for ‘non urgent’ letters, which the student defined as ‘no rush, I need it for a meeting in 45 minutes’. They work on a 24, 7 calendar, and want to be able to book appointments at 3am on a Sunday morning, so online booking access is crucial. They expect you to cure a cough instantly, so that they ‘won’t disturb the lecturer anymore’. They have little tolerance of waiting for hospital appointments, and repeatedly ask for them to be expedited, because their world tends to be a whirlwind of instant responses (tweets, texts, Snapchat). Unfortunately the Government encourages this expectation, therefore our daily demand for appointments rises exponentially. So it’s best to provide mostly open, same-day bookable slots.
Use social media to promote services and self care
Learn to tweet. Be social media savvy, have a Facebook page and Twitter account for rapid updates about your services, immunisations sessions, closure days and health scares. Write a blog on relevant student health topics. Communicate with them in ways they will access and listen to. Podcasts are great too. Recommend apps that will help them stay healthy, like the latest FODMAPS apps for IBS.
Raise emerging workload problems with the CCG
The double whammy of a population that is weighted on age leads to a low level of resource per patient, plus QOF and DESs which seem to ignore young people’s health almost completely. Dementia, COPD, learning difficulties are not part of student health, but anxiety, eating disorders, OCD, social phobias, self harm and inflammatory bowel disease are, for example. Work with your CCG to recognise this issue and develop local Practice Participation Agreements and pathways to allow service development and improvement to fund this huge unrecognised workload. In Bristol, we are currently working with the CCG on self harm care pathways.
Join a practice network
Link up with other practices who work with students, and share these challenges. The Student Health Association (http://studenthealthassociation.com/) is an educational charity set up to link UK and Ireland practices who look after students, and their list server is a constant source of useful shared knowledge and experience e.g. how the new GP contract will affect us, what to do with relatives of overseas students requesting medication, screening for TB, or new Home Office Guidance on International Students.
The SHA Annual Conference is also a great way to update yourself on relevant topics, as well as network and share ideas for new services, for example working with Diabetes UK to look at the transitional care of Type 1 Diabetic students.
Dr Dominique Thompson is director of service at the University of Bristol Students’ Health Service and a GP in Bristol.