So that is what I do:
I am a family physician and I care for families.
In my waiting room the substance user who comes to see me on a regular basis, may be sitting between an old man with hypercholesterolemia and a child with tonsillitis.
That is what general practice is all about: anybody might show up and they all need proper and tailored care.
Apart from dealing with nappy problems, work-related stress and irritable bowel disease, I care for a certain number of people on methadone
maintenance therapy (MMT.) I have done so ever since 1994, the year the method became semi-legal and ceased to be prosecuted in Belgium.
Taking care of substance users in general practice was a bit of a challenge at the beginning, but turned out to
be very rewarding in the end. There is no other category of patients I can think of, who can win so much just by turning to us for care and counsel.
MMT is a cornerstone of the harm reduction approach for some people, but is part of a larger frame,
of the inclusive model of primary care medicine, supposed to be open for all and sundry, with a low threshold, and no fuss.
As a family physician I can address several levels of the problem situation at the same time, which
makes my position unique in the care system.
Apart from providing treatment by prescription of regulated medication, I may give my attention to any other health-related problem that comes to the surface.
We all know that substance users
in the acute phase often present important health issues, which may have remained unattended, some related to the substances used, others to the way of delivery they choose, like for instance injection, basing or smoking.
We often have to get them to
the dentist, take care of respiratory infections, check for hepatitis and so on. We look after their administrative and social status, which can be a bit brain teasing in Brussels, the heart of Belgium.
Quite frequently the user presents psychiatric
conditions which require particular attention. Depression, anxiety disorder, bipolarity, psychosis and several personality disorders, to name but a few clinical syndromes, all come to mind.