Care Work

Patrick E O’Donnell

doi:10.3399/bjgp14X681517

Working with Vulnerable Groups: A Clinical Handbook for GPs Paramjit Gill, Nat Wright, and Iain Brew RCGP, 2014 PB, 248pp, £24.95 (RCGP members £22.46), 978-0850843507

In these times of austerity, there is a danger that progress made in the tailoring of healthcare services to the needs of vulnerable patients will be reversed. Here in Ireland we often try to model our health services for these types of patients on work carried out in the UK. In this book, the editors have brought together an array of experienced practitioners who contribute both practical and evidence-based advice on managing and advocating for these patients.

The introductory chapter sets out the case for acknowledging that not all patients have the same abilities, opportunities, or means to navigate the healthcare system and that we are uniquely placed to help them do this. There is an explanation of the determinants of health and how they impact on the management of the health and illness of our patients. The chapters that follow cover a wide array of vulnerable groups from prisoners to Travellers to older people. While drug abuse (IV or otherwise) and alcoholism are referred to in various sections, it is surprising that they do not have their own specific chapters. With the use of a number of different authors, the book suffers a little from inconsistencies in the layout of each chapter: some utilise case scenarios, some have sample Applied Knowledge Test questions, and others have reference to the MRCGP curriculum, but it is not uniform across each chapter.

The book acknowledges the difficulties faced at times when dealing with vulnerable patients and urges clinicians to realise their limitations when trying to single-handedly address health determinants. The notion of working closely with other agencies and service providers is discussed, a point often forgotten by those in clinical practice. Towards the end, abstract concepts such as ‘intersectoral action’ are brought to life using the Alma-Ata Declaration as a framework. This section didn’t particularly work well for me and contrasted with the practical advice of other chapters. Overall, I feel this book serves to begin the discussion on the skills needed for, and difficulties in dealing with, vulnerable patients.