Andrea Williamson
Southern Medical Society Presidential Address 2013
 Biomedical positivism: graphs,
gradients, life expectancy
 Qualitative interpretivism:
perspectives and explanations
 ...
 Social determinants of health
“the conditions in which people are born,
grow, live, work and age…” (WHO)
 People risk m...
 Poverty truth commission video:
Isha from Govanhill
 “the conditions in which people
are born, grow, live, work and age,
including the health system”
(WHO)
“Health equity th...
 45,000 households applied as
homeless, Scotland, 2011-12






42% single men
22% single women
17%single parents (w...
 Refused asylum seekers
 ‘no recourse to public funds’
 Numbers unknown, survey March 2012:
78/112
 Rough sleeping
 S...
 Your experience of working with a
person who is homeless?
All people are individuals and have their
own story
However many people have had the
following experiences:
 Disrupted ...
 Mortality
 X6 risk of death than general
population
 1.4 times more likely to die than the
most deprived housed person...
 Housing First video: Brian
 Adult attachment
 Personality disorder
 Complex trauma
 Impact on
 Thinking
 Feeling
 Behaving

 Impulsiveness…self sabotaging…self harm…emotional
lability….dissociation......
 Listen to what your emotions tell
you when you interact with
patients: frustration, anger,
disgust, fear
 Accept your r...
 Patients respond, feel safe and
function better (so you might
actually get to addressing health
issues)
 Professional p...
 life course approach
– attachment
– adverse life events
– Resilience
 Patient at the centre of care
 Involving wider h...
 “revolving door” patients in
general practice
 Serial missed appointments in the
NHS
 Evaluation of vulnerable women’s...
[Barnett, Mercer, Norbury, Watt, Wyke, Guthrie, 2012]
T, mid 40s. She has chronic depression
with
multiple
previous
suicide
attempts. She suffers from angina and
has had an MI ...
 Role of health care
 at its best where its needed most
 Arrangements and resources
reflecting the epidemiology of mult...
 Within the health system
 Relationship work in consultations
 Relationship work with other
professionals
 Social pres...
Andrea Williamson
Southern Medical Society Presidential Address 2013

andrea.williamson@glasgow.ac.uk
Messy, not smelling of roses and a tilted view required
Messy, not smelling of roses and a tilted view required
Messy, not smelling of roses and a tilted view required
Messy, not smelling of roses and a tilted view required
Messy, not smelling of roses and a tilted view required
Messy, not smelling of roses and a tilted view required
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Messy, not smelling of roses and a tilted view required

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Presidential Address given to the Glasgow Southern Medical Society on 24th October 2013. In her lecture, Dr Andrea Williamson discusses health inequalities and homelessness from the viewpoint of a general practitioner in Glasgow.

Two videos are discussed during the meeting:
The first is Isha and the Poverty Truth Commission:
http://www.youtube.com/watch?v=CKGMok5s2Rs&noredirect=1

The second is Brian and the Housing First pilot in Glasgow:
http://www.youtube.com/watch?v=iKyNhAaCsE0

Published in: Health & Medicine
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  • What is Isha describing? How does that make her feel? Social isolation, alientation, feeling unequal
  • Messy, not smelling of roses and a tilted view required

    1. 1. Andrea Williamson Southern Medical Society Presidential Address 2013
    2. 2.  Biomedical positivism: graphs, gradients, life expectancy  Qualitative interpretivism: perspectives and explanations  The experience of the interpersonal and relationship
    3. 3.  Social determinants of health “the conditions in which people are born, grow, live, work and age…” (WHO)  People risk markers: age, sex, ethnicity, sexual orientation, education  Place risk markers: geography, community, workplace  Meta-risk marker: SOCIO-ECONOMIC POSITION *All are interlocked and socially patterned*
    4. 4.  Poverty truth commission video: Isha from Govanhill
    5. 5.  “the conditions in which people are born, grow, live, work and age, including the health system” (WHO) “Health equity through action on the social determinants of health”
    6. 6.  45,000 households applied as homeless, Scotland, 2011-12      42% single men 22% single women 17%single parents (women) 7% single parent (men) 5% couples with children (Source Shelter Scotland)
    7. 7.  Refused asylum seekers  ‘no recourse to public funds’  Numbers unknown, survey March 2012: 78/112  Rough sleeping  Sofa surfing  Night shelter and voluntary sector support  Right to full NHS care if ever applied for asylum (Scottish Refugee Council 2012, 2013)
    8. 8.  Your experience of working with a person who is homeless?
    9. 9. All people are individuals and have their own story However many people have had the following experiences:  Disrupted family life (poverty, abuse, into care)  Poor educational attainment  Poverty  Experiences of violence  Addictions  Mental health problems  On-going risky relationships (Source National Mental Development Unit 2010) Health
    10. 10.  Mortality  X6 risk of death than general population  1.4 times more likely to die than the most deprived housed person  Drug misuse  Circulatory disease  Respiratory disease  Importance of psychiatric morbidity (Neilson et al 2011,Morrison 2009)
    11. 11.  Housing First video: Brian
    12. 12.  Adult attachment  Personality disorder  Complex trauma
    13. 13.  Impact on  Thinking  Feeling  Behaving  Impulsiveness…self sabotaging…self harm…emotional lability….dissociation...unexplained physical symptoms
    14. 14.  Listen to what your emotions tell you when you interact with patients: frustration, anger, disgust, fear  Accept your response is often a reaction to patients psychological function (not always)  Encourage safety: physical, emotional and social: for you and patients  Be very careful of verbal and non verbal leakage (including psychological environments)
    15. 15.  Patients respond, feel safe and function better (so you might actually get to addressing health issues)  Professional patient relationships are key to an effective health service  You will waste less emotional energy getting angry, frustrated, upset
    16. 16.  life course approach – attachment – adverse life events – Resilience  Patient at the centre of care  Involving wider health and social care team  Snap shot versus the long view  Role of the therapeutic alliance  Trust  Boundaries  Longitudinally over time
    17. 17.  “revolving door” patients in general practice  Serial missed appointments in the NHS  Evaluation of vulnerable women’s addiction clinic in South Glasgow
    18. 18. [Barnett, Mercer, Norbury, Watt, Wyke, Guthrie, 2012]
    19. 19. T, mid 40s. She has chronic depression with multiple previous suicide attempts. She suffers from angina and has had an MI in the past. She lives in a flat with her boyfriend. T has recently been deemed fit for work, but is appealing this decision. Money is extremely tight, and she and her boyfriend are currently surviving on his benefits alone. T has suffered from physical, sexual and emotional abuse all her life and her current relationship is no exception. T wants to visit her daughter (whose young child has recently been removed from her care), but can’t afford the coach fare – her partner (not the daughter’s father) won’t pay, as he will not allow T to leave him, even to see her own family. T is waiting for her daughter to pay for the coach ticket. The daughter in turn is waiting for her own benefits to come through. Another daughter is homeless. [case study extract, Deep End Austerity report 2012]
    20. 20.  Role of health care  at its best where its needed most  Arrangements and resources reflecting the epidemiology of multimorbidity  General practice as the natural hub  Importance of serial encounters  Time  Relationships  With patients  With other professionals in healthcare  Outside health care (social prescribing and advocacy)  Connectedness of care
    21. 21.  Within the health system  Relationship work in consultations  Relationship work with other professionals  Social prescribing and community engagement  Influencing health policy (research, teaching and Deep End work)  Being an engaged citizen and advocate for change
    22. 22. Andrea Williamson Southern Medical Society Presidential Address 2013 andrea.williamson@glasgow.ac.uk

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