News POST-IT FROM PRACTICE: ONE SMALL STEP Every opportunity, however slight, can be an important healthcare moment, says Dr Steve Brinksman. Most of the work we do in primary care isn’t treating acute illness, but managing those with long-term conditions. I – like most GPs – spend a lot of time trying to support patients to change behaviours that are, or may be, damaging to their health. This could be smoking cessation, dietary advice and exercise for diabetics, and of course helping those who are having problems with illicit drug or alcohol use. Some colleagues tell me they are reluctant to work with this group as they feel success is unlikely and people will relapse back into problematic use. I have always found this attitude somewhat bewildering as I see at least as much resistance to change in all the other patient groups and I suspect it is another manifestation of the stigma that our cohort of patients face on a daily basis. Almost 30 years as a GP has however taught me a number of things and I can now accept that some people won’t change just because I want them to. The desire, and then the ability, to change comes from within an individual and is contingent on a whole range of factors in someone’s life. Our role is to support and inform and help build self-esteem for our patients. Successful change often isn’t measured in big leaps and bounds but in small incremental improvements in people’s lives and acknowledging this is important. It is also vital to never give up on someone – they may not be ready for change on the numerous occasions you meet over many years but then have the capacity to surprise. I can now accept that some people won’t change just because I want them to. An example was Rob. He had a 15-year history of problematic cocaine use, bouts of heavy binge drinking and daily cannabis use. I hadn’t seen him for over a year and he came in looking the best I had seen him in a long time. He told me he had stopped his cocaine and alcohol use but still has the ‘odd spliff’. I was delighted but also curious and asked him what had changed. He gave me a big smile and showed off his new dentures and said, ‘I went to a dentist and he took my horrible teeth out and gave me these. Now when I go out, I don’t think people are looking at me and judging me all the time.’ I hadn’t realised what a negative effect his teeth were having on his self-esteem, but fortunately his dentist did! And because of that, he also treated Rob’s problematic alcohol and cocaine use. This article was first published in the December edition of Drink and Drugs News.