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His colleague, GP Anne Mullin, also got

involved because she believes patients’ everyday struggles need to be shared more widely. “Tat’s why I got involved in the Deep End because I thought this micro-political level of the everyday stories we hear - people say that is just an anecdote, it isn’t really evidence, but that’s nonsense. Tis is evidence. What these people tell us is evidence of whether the system is working or not. Whether society is functioning or not functioning. “…But we don’t yet have a sophisticated way of doing that because it is part of the patients’ narrative and so it is not really regarded in the same way as, say, a blood pressure measurement in terms of evidence.” Woven together, however, patients’ narratives

create a more complete picture of what life is like for those who bear the brunt of inequality. Completing the trio, Dr Carolyn Gillies reflects on her experiences with one young patient who, she says, typifies the multiple challenges her patients face. “Tis is a young guy, he’s now 22. He was

brought up in poverty with a big family, none of whom have ever worked but despite this - and despite being assaulted when he was 16 and nearly killed, after someone came up and hit him around the head with a metal bar, fracturing his skull, which he got over and got a plumber’s apprenticeship. But he has been to see me a few times recently because he is not coping emotionally. Because he can’t get a job. “He can’t get a job with a firm because it depends on who you know. He can’t get a job

on his own because he can’t afford driving lessons, let alone get his own vehicle. He currently has a girlfriend who he would quite like to get married to and settle down and have kids with but they are living with his mum. He is really quite an old-fashioned boy and he doesn’t want to do that until he has got enough money saved. And he is one of these people who comes through all of this still intact, but not working and living on benefits and now seeing me because he just needs to chat about it

it is at least entirely appropriate for me to feel the way I feel. I’m not going mad. I’m not a bad person. I’m not part of the sick society that we hear about from our esteemed leaders down south. It is just rotten and at least someone has said to me, ‘Yeah, it is rotten and I’m sorry that it is.’”

Collectively, this turns GPs into a valuable

source of information with the knowledge to flag up emerging challenges much earlier than they are currently being identified, Mullin argues. “Look at heroin

“I might see ten people coming in saying they are destitute this week. If we are all seeing that then that is a huge problem”

sometimes.” None of the GPs is under any illusion about the numerous social determinants of poor health; nor that many of the solutions lie beyond their remit and outwith general practice. Sometimes, Paterson says, all he can offer is to “simply sit and witness their suffering,” and let them know that they have been heard. “Not with any intent to do anything about it,” he says, “but just to sit there and give validity to their story so they hopefully go away thinking

in Glasgow. It was established probably in Possil before anywhere else in Glasgow. It was there for about ten years before, politically, it became a huge issue, but by then you’ve had a decade of it mushrooming out of control.”

Te same is true today of the impact the

welfare reforms are having in these communities, she adds: “I might see ten people coming in saying they are destitute this week. If we are all seeing that then that is a huge problem. Tat is not just ten isolated cases. It is an issue that, politically, has to be dealt with.” GPs are a treasured resource in these communities, and yet general practice itself is under-resourced to deliver all that the NHS could be achieving in terms of improving health

19 September 2011 33

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