Family Practice Vol. 20, No. 1, 95-96
© Oxford University Press 2003
Book Review |
Homelessness: a primary care response.
Nat Wright. (186 pages, £18.) Royal College of General Practitioners, 2002. ISBN 0-850840277-8.
Reader in General Practice, Royal Free and UCL Medical School
There is homelessness and there is true homelessness. Some live through episodes without a place to stay, dependent on others’ solidarity, before finding their footing again in home and work, whilst others are excluded from society because mental ill health, addiction or a lethal accumulation of poor coping strategies erode their use value to near zero. This book is essentially about the latter group, being a guide to action for providing medical care to those not even admitted to the underclass.
Writing such a guide is hard work and following it possibly harder, for the gulf between the homeless patient and the practitioner is enormous, spanning disposable income, expectations, knowledge and control over resources or circumstances. Encounters within these parameters are likely to generate strong feelings on both sides, which this book airs and examines, if only simply, in terms of agenda conflict. This necessary reduction of the issues, to those relevant to face-to-face encounters, allows a useful discussion of evidence about the risk of violence and the value of harm minimization strategies, helpful description of consultation techniques such as ‘yellow card’ compromise and motivational interviewing, and a review of some comfortingly solid clinical medicine. What you will learn from these chapters will work in different situations, and with different patients, supporting the author’s claim that the truly homeless are not so different after all.
The general themes of the book are messages for the long haul. What is the secret of team work? Just doing it, but allowing time and applying honesty, respect and some generosity as you go. How do you avoid burn out? Take your time, build a portfolio of clinical and educational interests, have a hobby, keep innovating. What about joint working? Do not give up on those other agencies, however vexatious they may be, and deploy the methods learned from work with homeless patients to deal with the conflicting agendas of rival organizations.
Such a training manual is an attempt at promoting social inclusion, and we will need it. For as the market’s advocates crank up the turnstile world of work and the facilitators of flexibility wean us off security and stability, the number of those who will fail and fall seems likely to increase.
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