The role of the general practitioner has evolved ever since our profession came in to existence. However, most of us still regard ourselves as family doctors not only looking after the individual but their family and often their care network too.
Stroke patients often bring with them particular challenges in this setting. A person who was last seen in good health returns from the hospital to our care with a completely changed situation. The shift from independent to patient, carer to the cared for, able to unable presents issues for them, their loved ones, and through extension, for their family doctor.
There are components of care that are simpler than others. Ensuring that appropriate secondary prevention is in place is a relatively simple protocol; high dose statins, clopidogrel and blood pressure control is routine in the surgery setting. But the reality is that in the immediate aftermath of the acute event, most stroke survivors just want to know how to cope rather than think about steps to prevent another stroke.
What is the GP's role?
If we are lucky, we have early supported discharge teams in our locality, but some of these recent additions to community support have been the first things lost with CCG cut backs. For most stroke survivors and their families, the return home means feeling lost and alone in a strange new paradigm.
So what role can general practitioners play to address some of these issues? The simple answer, as for so many situations, is support. We support the patient and their carers to navigate complex issues of community therapy support, social care, home adaptation. We are in a unique position to help people adjust and move on with their lives as much as they can.
The issues go further than managing physical disabilities, the hidden effects of stroke are often underestimated.
It is easy to examine stroke survivors who appear minimally affected outwardly and disregard the magnitude of the event. To be plucked from your normal everyday life to that of a neurologically compromised individual, even if the recovery is comprehensive, is not only a physical issue.
The psychological components have to be considered. The ongoing questions of ‘why me?’ and ‘what will happen next?’ are hard to quell. Counselling in the general practice setting will of course be of value but when these demons come to call in the middle of the night who is there to offer support?
Information for patients
Technology can be useful, for example the Stroke Association has launched a website called My Stroke Guide. The site is a reliable resource of information for patients and carers. It features a comprehensive library of user-friendly and practical advice about stroke and recovery, including over 200 videos covering topics from managing fatigue to continence problems.
As well as being free and accessible from any web-enabled device, the advantage for many patients is that they can search for the guidance that is relevant to them, in their own time, as often as they need. Clearly, it cannot replace the advice of a family doctor, and it wasn’t designed to, but it can help survivors and carers start to make sense of a complex condition and that can be very empowering.
Meeting and sharing experiences with other stroke survivors can have a very positive impact, but summoning the strength both mental and physical to go to a stroke group is a big ask. In the early days then, online forums like those on My Stroke Guide which enable patient to patient/carer to carer support are of great value.
I cannot completely empathise with a patient who has undergone the cataclysm of stroke, I have no personal frame of reference, but fellow survivors can. That sense of community, even if it is online, gives people an appreciation that at the very least, they are not alone in their experience.
Vascular disease remains a clinical menace in general practice but we have got use to the post MI patients being re-plumbed and back to normal within weeks. This is not the experience of our stroke survivors, often forced in to different roles, often incapacitated and often feeling isolated. Any support for them and us has to be welcomed and web resources like My Stroke Guide are a useful addition to the tools we have at our disposal
- Dr Fay is GP in Bradford and is a member of the expert advisory panel for the Stroke Association
