Joining the digital dots across primary care and integrated care

My partner and I both received a letter today from our respective GPs. An invitation for a 'FREE LUNG HEALTH CHECK'.

Overleaf is an information sheet in landscape about the health check, plus three more sides of A4, similarly formatted - inviting trifold presentation.

After the 'Re. ......' an opening sentence asks: 'Have you ever been a smoker?'

Suddenly, I was dragged backwards through his-tory (some things don't change); not one history, but several:

INDIVIDUAL

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    INTERPERSONAL    :     SCIENCES               

HUMANISTIC --------------------------------------  MECHANISTIC      

SOCIOLOGY  :   POLITICAL 

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GROUP

My personal and life experience  and not just since my teens . . .

The letter states: **If you have never smoked, you are not eligible for this service**

My mother and father  smoked when I was a child and my siblings.    They got the message early 1980s.    'Society' smoked back then!     Once old enough, I refused to go to the corner shop.   Into the 1990s, patients, smoking (some chain-smoking) on admission, long-stay and other clinical areas. As a community mental health nurse, I learned diplomatic and health promoting skills when in the car, giving a patient a lift to hospital. And, when visiting their home where I was, of course, usually, a guest.

I wondered what has happened to the GP's records? To the primary care clinical record ? The custodians of my health record, that they should need to ask that question?    Or, does confidentiality tie some bureaucratic knots?   Where is 'integrated care' and its driver 'clinical informatics'?  The letter included the NHS Number.    Don't get me wrong, I/we appreciate the obvious effort here, even if the chronology is confusing, or,  speaks of afterthought? The letters are dated 19/06/2025. I must admit I haven't accessed my GP record, checking it for accuracy.   If anything, this is a prompt to do so. And seek a general medical.

Previously: 'smoking' : 'winwick'

HIFA Discussion: Alcohol Use Disorders (37) Do people understand the harms of alcohol? (9) How can they be better informed? (5)

Further to the post on 1st February 2024:

HIFA discussion on Alcohol Use Disorders, 5 Feb - 17 Mar 2024

- I have f/w some reflections (edited here). You may have your own experiences, skills, knowledge to contribute?

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As a teenager you were very aware of peer pressure (as a social expectation) to drink. Is it an acquired taste?

The media played a key role - advertising "Tetley Bitter-men", "Double Diamond - works wonders", Babycham, Advocaat, Martini Rosso .. and many of the popular TV series we consumed (pardon the pun).

Getting in the pub AND served was a right of passage - and a rather 'tame' one for a white, male.

In the family the harms and risks of alcohol were explained. 

Sometimes they were demonstrated at parties, weddings, the aunt, uncle - relative who was notorious for having too much.

Studying literature at school did have a role to play - although less directly.

Although on reflection when there were school assemblies I wonder if 'drink' (Church of England) was mentioned?
Interesting perhaps - the change in daily school routine.

I remember at a birthday party for a fellow class pupil at a social club, the birthday boy was sick all over the table - yes - had been drinking.

Tempered my attitude early on - c.15.

As a nursing asst. and student nurse you realised the other - dark - side. The key being the contradiction that alcohol represents:

• Drink to relax, socialise, be friendly, enjoy yourself;
• Impact of your health, risk of addiction, violence, (brewer's droop was an early lesson - tho not practically);
• IF YOU develop a drink problem then you're on your own and so is your family (there are of course agencies in developed nations - but the funding disparity - as in, gambling, tobacco?).

In a 'local' - public house - pub it was known in 1970s for some regulars (invariably men) to down c.12 (more?) pints in a night - even after drinking hours: they were heavy goods vehicle drivers.

---------
I may have posted before - how in 1987-88 I completed a study of alcohol (intervention) teams, Preston, Salford, Blackburn here in NW England. The consultant psychiatrist made a key point about the (much debated even then) use of economic levers to help reduce alcohol consumption.

Scotland have just updated their intervention:

https://www.theguardian.com/society/2024/feb/08/scotland-raises-minimum-alcohol-prices-by-almost-one-third

As a student nurse - I was already aware of some of the inorganic molecules that have been found in space: the original primordial soup!

The chemical names still remind me of a chemical plant, such as the former ICI plant at Widnes / Runcorn, Cheshire, England, e.g.:

https://thumbs.dreamstime.com/b/heavy-industry-panorama-night-panoramic-view-chemical-plant-refinery-blue-sky-illumination-some-freight-85481422.jpg

This in-turn takes me to the miracle that is the liver - the biological chemical plant - with a potential powerful message in how 'alcohol' is broken down:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6527027/

Sometimes insight into this can work wonders in terms of motivation for change - the facts - not trying to scare (waste of time)...?

Which brings me to the obvious 'contradiction' in caring for people with a primary / secondary problem with alcohol.

Having a liver function test.

If it's OK that *means* I can carry on!!

I have over the years developed what imho I consider to be potentially therapeutic relationships with patients affected by alcohol.

I say potentially as I, with supervision, have had to withdraw input and discharge them. Even if the client can't 'draw the line', you cannot support the patient in their damaging alcohol consumption and related behaviours. The offer of further support was offered, with signposts should there be a change of  mind.

Alcohol, tobacco - vapes, the 'mental pollution' that can be passed as legitimate 'advertising', fake news ... still calls for a generic model, a universal conceptual framework for personal and global health - across literacies and forms of informatics:

'alcohol'
https://hodges-model.blogspot.com/search?q=alcohol

Just to close I saw an item (I will try to find...) on the preponderance of 'smoking' in films 1940s - present day.

Still a problem now.

Of course: advocacy for health requires constant vigilance.

Health Communication: Noise in the Channel(s)*

"Despite overwhelming evidence that illnesses come in clusters with 

mental and physical 

components, we continue to present public health as a series of separate issues - 

"stop smoking", "lose weight", "drink less". 

This is confusing, disempowering and psychologically naive. 

The public has no idea what to prioritise and is prone to either write 

off illness as inevitable, or to feel inadequate and anxious, 

leading to further unhealthy behaviour.

individual

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INTERPERSONAL : SCIENCES

humanistic ----------------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

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group

People see mental illness as mysterious and frightening and ...	... physical illness as explicable and fixable.

Neither view encourages healthy lifestyles."

*still.
 
McCullough, A. (2009) Healthiness is all in the mind, Health Service Journal, 5 February, 119(6142):18.

[Also inc. "Planned investment in mental health promotion in adult mental health services in England in 2007-08 was £4m out of the total mental health spend of 4.5bn - less than 0.1 per cent." ]

Smoke gets in your eyes, hair, socks and underwear....

July 1 2007 England: at last smoke free indoor public spaces!

I don't smoke. Hate cigarettes, but not people who smoke.

I've seen cigarettes used to control patients in the past and seen the effects on people when if the supply of cigarettes was not 'managed' then major problems ensued.

Both patients, staff and nicotine were well and truly locked in an institutionalised embrace. This relationship was strongest in the old mental health institutions on the long-stay (or 'rehab' wards).

I used to arrive home from work and ALL my clothes absolutely reeked of cigs. Into the shower. Nausea as the water ran over my hair.

As I prepare to return to work in the community: on home visits if someone goes to light up, I beg their pardon and acknowledge that I am a guest in their home - but could they please possibly hold-on a while. This isn't just a strategy to shorten visits. The first lesson of first aid is DO NOT become the next casualty. I also take the role of health promotion seriously. When people put the smokes away, I thank them on leaving highlighting the great favour granted to me. In summer and sometimes winter - their addiction helps me to help them - an excuse for us to venture outside to have a walk: ecotherapy! If people value your input, most do not mind. They also remember for next time - so social skills are employed. If needed though in the car I have a jacket just for the 'smoky visits'.

Cigarettes have been the cause of so many problems on wards resulting in aggressive behaviour.

Before I start sounding holier-than-thou - one of the worst instances was an elderly gentleman on a then 'psycho-geriatric' ward who with no smokes was livid. He wielded his zimmer walking frame at staff. We sorted the problem, calmed him down and no one was hurt; but the distress caused to this gentleman and many others over decades....

IF there is a benefit to be associated with cigarettes it's teaching the art of anticipating a person's needs and differentiating between the person and their behaviour.

An organic, naturally occurring pesticide must be bad for you and that's just one of the poisons in a cigarette (a regular chemical factory).

There is an established body of research on the links and effects between mental health, specific diagnostic groups and smoking. As for summer 2007 looking at the grey skies over the UK at present, many people WILL struggle. You have to wonder how referrals to all mental health services (primary and secondary care) will run over the next 12 months (next spring!) and how well we can monitor the effects?

Source: Nicotine molecule image (permission sought): Ron Perry and Sarah Frisken

P.S. To what extent have cigarettes affected human genetic development?