The socially excluded have no political voice and have difficulty accessing care. It has been our experience that the heartsink phenomenon can be completely managed and does not need to be shied away from. To manage the phenomenon, we as primary care staff need to move away from a rigid medical model based on diagnosis, treatment, and cure to a soteriological model that goes beyond the clinical to acknowledge, and empathise with the full range of human suffering that presents at our surgeries. We need to be freed from feeling that we have failed if we hold patients suffering yet do not effect a cure. 2 months later Attending TB clinic 3 times a week for DOT Found to be infectious again.
Client stops treatment due to side effects Readmitted to hospital.
Treatment recommenced Discharged after 4 months into Housing Association flat - DOT continues. Social services unhelpful Stays in flat for 6 months . Finally leaves flat to return to a comparatively pressure free existence on the streets. Mass screening with incentives. Hostel or day centre workers involvement in DOT clients are more likely to attend a day centre for DOT if other facilities also available e.g. canteen, showers.