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Media savvy |
Post-its
February 2013 |
drinkanddrugsnews
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www.drinkanddrugsnews.com
One of the privileges of being a GP
is the
opportunity to follow through the ‘cradle to grave’
ethos that the NHS was founded on. Sadly this
does mean that sometimes we are caring for
people whose lives end prematurely.
Gary was registered with the practice before I
joined 22 years ago and I knew him as a young
man with a young family and only occasionally
saw him when one of the children was ill. It was in
his late 20s that his drinking first raised itself as
an issue. He was convicted of a drink driving
offence and as a condition of getting his licence
back he had been told to see us for help. He was a
typical binge drinker, often having several days without alcohol. But when
funds were available, he would drink heavily at weekends.
Little happened for five years but then he reappeared, ostensibly in an effort
to preserve his marriage, which was by now being affected by his daily heavy
drinking. Blood tests revealed mildly abnormal liver function but he declined a
referral to support services, as he was sure he could ‘sort himself out’.
He divorced, a new relationship came and went, he lost his job, and then
another. Eventually he came to see me; the alcohol and a poor diet had taken
its toll. He was underweight, unkempt and slightly jaundiced. This time his liver
function was severely deranged but he had insight into his situation and
agreed to be referred to the specialist alcohol service.
Gary successfully completed a medically assisted withdrawal but despite
encouragement to engage with mutual aid, he found the prospect of a lifetime of
abstinence too difficult to deal with and resumed drinking. Now the pattern
became one of acute hospital admissions, cessation of drinking in hospital and
then resumption soon after discharge. His cirrhosis progressed to decompensated
liver disease and just before Christmas last year he was admitted for the last time.
He died aged 43 from complications of his alcohol-related liver disease.
We have a practice policy of reviewing all deaths and I wondered if at any
time in the past, before he became dependent, we might have been able to
influence him to change his behaviour.
It is difficult for many of us to understand how, in the face of irrefutable
evidence of the harm being caused, some people fail to change their behaviour
– but this shouldn’t prevent us from trying. I was somewhat taken aback by
some of the responses to the recently published Screening and Intervention
Programme for Sensible drinking (SIPS) study, which some have chosen to
interpret as suggesting that a few minutes asking about alcohol use and then
providing a leaflet is all a GP needs to do.
This may well apply across a large section of the population; however in
general practice we work with individuals and it is our duty to deliver the best
possible care to each patient we see. If we do this then we contribute to the
wider public health picture.
Gary’s death at such a young age is a tragedy. For me it reinforces the need
to ask all my patients about their alcohol use more often and in more detail, to
support those at risk and offer help and support. Unfortunately we never really
know when our interventions do prevent adverse outcomes happening, but
seeing the results of the times they don’t, keeps me trying.
Steve Brinksman is a GP in Birmingham and clinical lead of SMMGP.
www.smmgp.org.uk. He is also the RCGP regional lead in substance misuse for
the West Midlands
Post-its from Practice
Partnership for life
We have to keep trying to help patients effect
change, says
Dr Steve Brinksman
MEDIA SAVVY
WHO’S BEEN SAYINGWHAT..?
Iain Duncan Smith’s Work and Pensions department [are] planting stories
about large families on benefits and other supposed wastrels in friendly
tabloids on a daily basis. The government will expect to pluck much more
of this low-hanging fruit in the coming months as its assault on tax credits,
housing benefit and generally those regarded by some as needy and by
others as scroungers intensifies.
This reinvention of IDS, sacked by his party in 2003 on the twin grounds
of being preternaturally incompetent and sensationally dim, is one of the
wonders of the political age… here he is reborn as the deepest of thinkers
on the most intractable of social problems, a gleaming-pated anti-
Beveridge… In his defence, he seems genuinely to believe that stigmatising
people by obliging them to use vouchers at the shops, and forcing millions
without access to a computer to make their claims online, is tough love.
Matthew Norman,
Independent
, 1 January
Just why is this Government so intent on persecuting the hardworkingmiddle
classes while letting those who sponge off the state get off scot-free?
Sunday Express
comment, 27 January
Britain cannot possibly afford its welfare state for much longer... I am sure
a lot of welfare money goes to people who need and deserve it, whose
problems are no fault of their own. But I am just as sure that a lot of it goes
to people who do not deserve it.
Peter Hitchens,
Mail on Sunday
, 13 January
In any fair society it cannot be right that benefit claimants are rewarded
more generously than those struggling to hold down jobs.
Leo McKinstry,
Express
, 7 January
As part of Britain’s absurdly lavish overseas aid budget, we give £3.6
million to the mad mullahs of Iran. Mind you, it’s not all wasted. Some of
it goes towards hanging drug dealers. Apparently, it’s the only language
they understand.
Richard Littlejohn,
Daily Mail
, 3 January
As well as trouble, Britain’s buttoned-up society gets a lot of precious
bonding and cheer from the bottle, which is too often ignored in the public
browbeating.
Economist
editorial, 5 January
The most powerful argument against the puritan zealots who don’t want
us to drink, and would like us to subsist on a diet of boiled sprouts and
lentils, is that their ideal world would be a thoroughly miserable one, and
life in it scarcely worth living.
Stephen Glover,
Daily Mail
, 2 January
It was Tony Blair who warned, almost ten years ago, that binge drinking
was in danger of becoming ‘a new British disease’. He got it wrong. Binge
drinking is now just a way of life.
Bryony Gordon,
Telegraph
, 2 January
The prime minister says the current policy is working. I wish it were. But as
the use of cannabis has declined by a few percentage points over the past
few years, the use of ‘legal highs’ has soared. The position for drugs users
is therefore more dangerous than it was a few years ago.
Molly Meacher,
Guardian
, 15 January