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Discussion of case study

A brief discussion of how we respond to the first case study where there are no easy answers.
I wonder how we all felt when we read the case study? We probably all recognise that this kind of presentation can be very challenging. I think we can also recognise that there is no one who has a clear evidence based answer for what exactly will help Margaret now. In fact some of her treatments point to the limitations of disease, and guideline targeted, models of healthcare. So what could we do differently? We can refer her to some other service or do more investigation’s, but would that really help her? Should we stop her medication? It is unlikely to be helping her but reducing it without her consent is also unlikely to lead to a positive outcome. What about the diagnosis of pre-diabetes?
Does this help Margaret now? She undoubtedly knows she needs to lose weight, will this label help her do that? We can refer her to a community link worker to try and get involved in positive activities to help her lose weight and maybe improve her mood but I think we all know that while link workers are amazing and help some people there are many who can’t or won’t engage. Should we continue to provide sickness certification? Is this helpful to her right now. What else is going on? What does she think might help with her back pain? What was your response to Margaret? Do you feel aggravated, annoyed, sympathetic?
There is no easy answer and that is quite uncomfortable for us as doctors I think, we are trained to want to find the right answer and solve the problem. Some of us feel that we shouldn’t be expected to operate in this space, that social problems are for social workers and link workers and psychological problems for psychologists. While of course GPs can’t possibly be all things to all people I think most experienced GPs recognise that like it or not part of our role is to help people integrate their illness story in their own lives and provide continuity to help them do that, even if it’s only for a short period of time.
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WISDOM - Tomorrow’s Doctor, Today: Supporting Today’s Expert Generalist GP

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