I was driving to a multi-agency meeting the other day when I saw in my mind’s eye a young woman who I had given smoking cessation advice in clinic on a few occasions. My brief intervention always fell on deaf ears. Then a question ‘dropped in my spirit’. What causes smoking…?
In the ten-minute consultation confined to the four walls of my consulting room, how would I have known that this woman had a son who was more than a handful. Looking after him was a full-time job and when she managed to get him to sleep, she quickly stole away to the back of the kitchen, lit a cigarette and inhaled long and deep followed by slow exhale and relief.
Imagine a world where I had tentacles which grew out of my Practice and related with the Social Prescriber down the road who linked the woman with the Family Support Worker. The door was opened for a referral and the child was assessed and found to meet the criteria for Autism. A package of support was put in place and months later, this woman had a sparkle in her eyes when she came for another appointment. Before, I could tick the ‘smoking advice given’ box, she told me she had self-referred to the Smoking Advice Service.
“Why treat people and send them back to the conditions that made them sick? We need to treat people, but we need to address the issues that make people sick.” (Michael Marmot 2015, 2017)
In the mad rush to reinvent the wheel of health services, one is reminded to build services around people and not fit people into services. More importantly, I must find out the “cause of causes”. What causes obesity? What causes poor compliance with medication, etc. The mother of all questions, “What causes poverty?”
Therein lies hidden the key to unlocking the health and wellbeing of most people.
Abiye Hector-Goma
Partner, Allerton Medical Centre, Leeds, U.K.
