Social prescribing in general practice: adding meaning to medicine.

Social prescribing is about expanding the range of options available to GP and patient as they grapple with a problem. Where that problem has its origins in socioeconomic deprivation or long­term psychosocial issues, it is easy for both patient and GP to feel overwhelmed and reluctant to open what could turn out to be a can of worms. Settling for a short­term medical fix may be pragmatic but can easily become a conspiracy of silence which confirms the underlying sense of defeat. Can or should we try to do more during the precious minutes of a GP consultation? Where there are psychosocial issues GPs do suggest social avenues, such as visiting a Citizens Advice Bureau for financial problems, or a dance class for exercise and loneliness, but without a supportive framework this tends to be a token action. The big picture difficulty with leaving underlying psychosocial problems largely hidden in the consulting room is the medicalisation of society’s ills. This ranges from using antidepressants for the misery of a difficult life, to the complex pharmaceutical regimes prescribed to patients with obesity and type 2 diabetes. This sort of medicalisation may help immediate problems (including driving the economy through jobs in the healthcare industries) but it is not enough if our society is to have a sustainable future. Another way of looking at this is in terms of choice. The consumerist type of choice of provider beloved of the government, is what Canadian philosopher Charles Taylor calls ‘weak evaluation’. By this he means a utilitarian ‘weighing­up’ of generally short­term consequences of a choice. These choices represent ‘second­order desires’, such as to feel more cheerful, or to relieve a pain, or to have a good experience of hospitalisation. These do not involve the ‘worth’ of an action, but rather its expediency in terms of immediate outcome. Strong evaluations involve deeper values and address first­order desires. In the present context, whether to grapple with a difficult psychosocial issue requires a strong evaluation because it is about the first­order desires of giving meaning to life, developing your potential as a person, and contributing to society. These are not issues that require ‘weighing­up’ in a consumerist sense; they are prior to that. Societies predicated exclusively on utilitarian, weak, consumerist choices tend to fragment, losing their grip on meaning and their sense of mutual responsibility and interdependence. In his powerful account of his own holocaust experience, psychiatrist, Viktor Frankl concludes that the ‘search for meaning is the primary motivation in ... life’. He describes lack of meaning as an ‘existential vacuum’, often manifesting as boredom, and invaded by numerous neurotic and addictive problems. He quotes Nietzsche: