Scenarios

Chapter 2: The patient in their social context

Sandra is a single unsupported parent, living in a third floor council flat, with three children under five years and with very little disposable income. Sandra visits her GP several times in the course of three months complaining that her children have recurrent chest infections and her middle child has glue ear.

It is noted by her GP that Sandra is a heavy smoker and consequently her children are passive smokers. The GP tells Sandra that unless she stops smoking and attends the smoking cessation clinic run by the practice nurse, she will not give her any more repeat prescriptions for antibiotics for chest infections for her children. When challenged about her smoking and faced with unfilled prescriptions, Sandra becomes defensive and leaves the surgery angry and upset.

• 1. What are the reasons for the GP and practice nurse for supporting Sandra in light of her current health behaviour?

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  Correct answer:
  Blaming Sandra can be very unhelpful for the nurse and patient as it may influence the way nurses respond to or care for patients – and it may mean patients defer seeking care and attention because they are afraid of being judged.

• 2. What are the other influences on health that the GP and practice nurse need to be aware of?

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  Correct answer:
  Sandra is living on a low income that makes it difficult to adopt a healthy lifestyle. Her housing may be damp, contributing to respiratory infections. It will also be important to know if Sandra has family or friends to support her in caring for the children.

• 3. What might be the problem of adopting a behavioural explanation of health inequalities to account for your patient's poor health?

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  Correct answer:
  There is a social patterning of ill health and it may be assumed that this is due to poor lifestyle choices such as Sandra's smoking. Yet Sandra's health behaviour could be a result of her understanding of health, education or expectations. This health behaviour on the part of Sandra may seem irresponsible and reckless, but faced with a life full of difficult decisions and a lack of choices and resources, it may be that smoking is health-enhancing to Sandra's mental health, be it at the expense of the physical health of both her and her children.