Its lots of things really

In this consultation we see a patient caught in the poverty trap, depressed, anxious, lacking in sleep, confused and worried about her lifestyle. She explain to her doctor the difficulties she is having with her husband, the damp housing and the unruly children.

Previously she has been sent to see the Psychiatrist as she reportedly explains that she is “not going mad”. She has also seen the social services but had no confidence in their experience and powers. The Doctor listens gently to the outpouring of her sorrows, and then challenges her and tries gently to ask her what are her expectations of the system.

He outlines the problems and produces a variety of suggested solutions. He offers the possibility of financial help via his health visitor, who he believes is experienced and mature enough to help in this particular case. The patient initially rejects this solution, and makes the comment that she “feels that she might hit the children if something isn’t done” this is immediately challenged by the doctor, and they reach tacit agreement that this is a very unlikely thing to happen.

The doctor further underlines this by challenging the patient’s desire to have her children removed. The general practitioner drawing on his own experience explains that this is quite a common difficulty in the area and that he would see what he could do: uses the agency of his health visitor. He finally extracts a promise that he will do his best, and draws the consultation to a close.