Column

Identity crisis: who am I?

Rosa Hudson, healthmatters’ doctor at large, takes a close look at the ills of the inner city

With the NHS in more turmoil than ever, why can’t I feel passionate about it? Why was my involvement in the recent campaign to save several of the city’s hospitals from being amalgamated — with the usual bed cuts and savings — less than enthusiastic? Perhaps because the NHS needs a radical rethink though not along the lines proposed in the white paper.

In my surgery last week when I told Sheila, who had severe period pains, to take her tablets with food she said: ‘Food... I haven’t had any for two days.’ She is depressed, has had problems with her benefit since the new regulations in April 1988 and has not managed to ‘budget’. I fixed her up with a money advisor at the local Citizens Advice Bureau (perhaps the health workers of the future) who provide a much-needed weekly session at our health centre.

Before the changes in benefit regulations our health centre had a heady six months, spurred on by the Council’s ‘Claim It Now’ campaign, in which every consultation seemed to be about writing medical letters for diets, beds, heating, laundry, mattresses, cookers and anything else we could think of to get patients the maximum amount of money. Now we are left with people’s stress and patients like Sheila who can’t ‘budget’ satisfactorily.

Budgeting is a lovely euphemism for struggling to survive! Even counting the number of journeys Sheila had to make to the DSS and various helping agencies (mostly on foot because of lack of bus fare) took my breath away.

Diagnosis: acute identity crisis. Why am I a GP and not a community health worker?

These problems seem more immediate to me than worrying about what’s going on in the local teaching hospital — where people having their legs amputated for smoking-related diseases puff away furiously in the day ward, while overworked nurses stand helplessly by. The point is, what can I do to stop the effects of unemployment and poverty biting into a person’s anti-smoking strategy if discharged into my care?

Hope for me lies here in the local community. Everywhere there are community organisations like our local Neighbourhood Health Project, the Mental Health Group, the Womens Health Information Centre and others which are rescuing people daily from the indignity of ‘crawling’ (as one diabetic, epileptic patient of mine put it) to the DSS, and from the damage done by racism, unemployment, poverty and lack of self esteem.

Being a GP had its advantages and disadvantages. I have a ‘list’ of patients for whom I, along with the other members of our team, can provide services; including money advice, classes on how to deal with stress, well person check-ups to talk to people about their health, not as individuals in a blaming way but in a positive, action orientated way.

Because of the nature of general practice I am unable to go door to door to work with people on these issues. But I can work with community health groups to tackle in new ways problems which may never even reach me as a GP.

It could be helping the project to organise health fairs at local health centres where people joined in keep-fit exercises, talked with CAB workers, watched videos on cervical cancer, played with animals from the local city farm, sampled non-alcholic cocktails and finally danced the night away to a ceilidh band made up of health visitors. Or the drop-in session run once a week in our centre by members of the local mental health group which attracts people, young and old, who would not consult a doctor about their problems but feel easy about dropping in for a chat with local volunteers.

Community health projects of this kind present a challenge no health worker can ignore. They are introducing a new concept of participation into preventive health care and although they are funded mainly from outside the NHS at present we who work within have exciting lessons to learn.