This comes from a few things that happened last week, kicked off by the trip down memory lane in my last post. Seeing an old flat mate who now is a GP in the Wild West of England it soon became apparent that though we are separated by more than 100 miles of geography and at least three variations in dialect, the jobs we do are essentially interchangable, and all the pressures and changes wrought on us here in Ambridge are mirrored in his neck of the woods.
Then again, on Thursday last, two colleagues and myself met up on the home-from-school run since we each have a half day. Between us we could muster more than seven decades of accumulated GP experience, and again it was interesting to see how similar our experiences were despite being in one inner city, one leafy suburban and one far more rural practice.
Also mid-week our newly elevated senior partner was bemoaning how stressful he feels the job is becoming. As he pointed out, with the trend to ever greater sub-specialization in hospital practice, secondary care medicine has become increasingly "routine" for much of the time with teams of doctors knowing more and more about smaller and samller areas of expertise, but leaving the patient as a whole somewhat in limbo whilst they ponder all the implications of a given condition on their one tiny area of interest-- and as often as not quickly discarding them when it became aparent that there was none...
The final thing that crystallized this post was the realization (epiphany being far too grand a word for the accompanying sentiment) that we were all, severally, a bunch of miserable gits, old before our time. So I have a question to pose, but before I do I want to set the scene.
As jobbing GPs we have always been taught to look at the whole person and not just the initial symptom presented. To use a seemingly banal analogy the consultation of a mother bringing a child with a sore throat will play very differently if the mother is 16 than if she is 36, if an older sibling has died of flu, or suffered with leukaemia, if granny lives two doors down the road or (as is more often the case these days) in Spain, if the child in question lives in a mansion or a refuge and so on and so forth.
Embedded as we are in the community, with a longitudinal view of patients and their families, the surrounding communities, cultures,and prevailing conditions, we feel excellently placed to take such matters into account and deliver the best care to every patient that presents to us. And yet, down the years we have steadily seen that embedded experience diluted, first by combining together to provide out of hours cover from co-operatives, then by loosing it altogether to faceless monoliths supplied by PCTs. There has also been a trend to sub-specialization within General Practice so that patients are increasingly filtered into little mini clinics for asthma, heart disease, warts, family planning..... you get the picture.
I would still argue that our attempts to hang on to the last vestiges of "family practice" can make us more effective in the long term. By "being there" through the minor ailments of childhood, through adolescence, childbirth, chronic disease and even palliative and terminal care we develop relationships with families that allow us to view them in the context of their "back story" and them to see us against the background of our shared triumphs and adversities.
This is the "added value" of traditional "General Practice". The perceived wisdom from on high is that this "value" does not stack up against the consumerist agenda of instant access, speedy treatment, and "quality" measured as tick box questions about smoking and ethnicity for all and registers of obesity with no evidence based intervention to apply once the registers are gathered. If it can't be counted, the present regime wants nothing to do with it. And if you have to wait for it then it must be a poor service that is being delivered. All that's needed, they contend, is IT access and a "Doc-in-a-box" available 24/7.
So the question is this, are we right to assert the values of "traditional family practice" or should we just get over ourselves and embrace the brave new world?