11 December 2017

The other Christmas carol

General practice Mental Health

Back a million years ago, when I was a new intern at Royal Newcastle Hospital, I was told to try and ensure I wasn’t rostered on in Cas (as it was then) at Christmas.

It was a well-known fact that the festive season was synonymous with the hospital, or more particularly the emergency department, being inundated. And it wasn’t just the children with the Christmas lego in various orifi, the PFOs or Aunt Betty’s dodgy turkey terrine.

It seemed many people with a chronic disease, particularly the elderly and alone had an exacerbation of their symptoms on or around December 25. There was also the expected increase in mental-health presentations, particularly depression and suicide attempts.

Christmas can be tough, especially if you’re lonely and alone. And in Australia, it appears there are a lot of people lonely and alone. Don’t we as GPs know it?

Even in my part-time general practice, I have dozens and dozens of patients, male and female, who present needing a caring friend at least as much as healthcare professional, if not more. They present regularly and often, usually with some relatively minor somatic complaint that will either persist despite numerous therapies or resolve and be replaced by a new problem almost immediately.

Commonly they are elderly, but certainly not always. Separation and divorce, perhaps a focus on career, or chronic illness, has left a lot of younger people living alone and feeling alone. They come needing care, and not necessarily just medical care or even health care. They need someone to care about them.

Over the decades I’ve been in practice, I feel this “caring friend” aspect of my role has increased dramatically.

According to statistics from the Australian Institute of Family Studies, just under one in four (24%) adults currently live alone. Of course, living alone is not synonymous with loneliness, but it certainly increases its likelihood. It speaks to the availability of support and even the World Health Organisation lists “social support networks” as a “determinant of health”.

The fact that loneliness and social isolation has been linked to an increased premature mortality risk as well as cardiovascular disease, Alzheimer’s disease, stroke and insomnia, among others, makes it little wonder that these people appear in our waiting rooms.

However, it doesn’t explain why the numbers appear to be increasing, given that the percentage of lone-person households in Australia has not really changed in the last almost 20 years.

In the words of Andrew Denton, I feel, to a large part, society is to blame.

Courtesy of population mobility, people having children later and having fewer of them, and the rise in divorce rates and blended families, the idea of the extended family with its inherent network of support and interaction seems a thing of the past.

In addition, an affiliation with a religious group, previously such a common source of community, has become less likely. For the first time, “no religion” became the most common answer to the question “what is your religion” in the 2016 Australian census, overtaking Catholic. Similarly, organisations, such as Rotary and most bowling clubs report falling member numbers.

And then there’s the internet. Sure it has delivered a world of knowledge and information at our fingertips, and yes we have never before been so interconnected. But between online shopping, email, online banking and bPay, it is very unlikely people these days will interact frequently enough to develop a rapport with their butcher, post office worker, newsagent or “that helpful chap at the bank”.

All those brief human contacts that make one feel connected with the world are now relegated to a keyboard. A podiatrist I know does home visits and was saying how she often hears that she is the only person the patient has spoken to all day!

As healthcare professionals, care is part of our job description as well as our vocation. Let’s face it, if you don’t care as a GP you really should find another career. And also, as part of our job, we get to know often very personal details about our patients from very early on. A certain level of intimacy is a given.

Even though it’s a very one-way street (they do the sharing and we do the caring) it should not be surprising that some of the loneliest people in our community consider this doctor-patient interaction part of a friendship rather than just a professional relationship. A social connection that, at least in part, fulfils a role that might have in another time been filled by a close friend, adult child, parish priest or next-door neighbour.

Is this a good thing?

Surely yes. If the patient finds the relationship therapeutic, isn’t that a win? If improved quality of life can be an endpoint in clinical trials why should it not factor as a successful consultation outcome?

It’s a privilege really to be able to alleviate, even just temporarily, a person’s psychological pain almost as a by-product of just doing our job.

There is an epidemic of loneliness out there.

If we are true to the principle of wholistic care, then for better or worse this falls under our remit.

We can’t change the world, but at least we can recognise that we can, and often do, make a difference beyond our medical acumen … especially at Christmas.

Something to say?

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2 Comments on "The other Christmas carol"

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Jim Pollitt
Jim Pollitt
11 months 28 days ago

The best and truest medical article I have read all year. Thank you

Justin Coleman
Justin Coleman
11 months 29 days ago

Well said, thanks Linda.
Ameliorating loneliness – a hidden benefit of general practice care.