Brief notes before the Battle of Ideas 2011 debate,
Radical surgery for the NHS: what is a GP’s role today?
The answer depends on who is defining the role.
The answer (as always) should not come from GPs, (or those pesky meddlers the Kings Fund, or the Dept of Health) but patients.
And not the pushy, entitled, ‘fix my sore throat before I interview Sir David’ journalists, that cannot understand why GPs don’t keep the same opening hours as Tescos (do they think Tescos could afford 24hour opening if it took 10 years of training to operate a checkout?)
Nor the people who run think-tanks who write long papers about what they would want from a GP if they were a patient, only they’re not actually chronically sick or worried half to death that they might be; these are healthy people, not patients.
No, the answer is that GPs are defined by our patients: moulded, stretched, pummelled, weighed down and held up, worked over, leant on, wept on, bled and spewed over and even pissed on by the youngest ones. Our patients spend years beating us into shape.
Studies have shown that at the start of medical school, GPs are in fact normal people, capable of blending in at any social occasion. After 5 or 6 years we are turned out of the sausage machine that passes for a medical education, unable to speak the same language as our parents; after a few years in hospital we are a different species entirely, harder to understand than the average teenager. Entering General Practice we soften a little, but being unused to conversing with conscious patients who ask difficult questions, we’re like pubescent Dr Spocks trying to cope with the emotional turmoil that our patients, (yes, our-own patients) lay on us. After painful years, we unlearn most of what we have learned and replace it with what our patients have taught us. How to interpret stories and relate them back, how to recognise unspoken signals, appreciate hidden strengths, uncover silent symptoms, and be a part of the narrative of our patients’ lives.
The commonest question my patients ask me is, “Will you be my doctor?”
How can we say no? In spite of decades of incentives to make us all attachment-free, autonomous consumers, to be somebody’s GP is to make a committment, a committment in many respects like that of a marriage. To stand firm in sickness and in health, to be consistent and honest at all times, to take abuse and shoulder blame without judging, to bear witness to suffering and personal tragedy and always maintain confidentiality. To be fair and compassionate, professsional and competent no matter how we ourselves are feeling.
The commonest reason for visiting a GP is ‘fear’.
Fear that the lump is cancer, that the chest pain is another heart attack, the headache a stroke, like the one that tragically disabled Maureen. Fear that I may die before my children grow up, fear that I may lose my sight, my balance or my mind. Fear that I cannot cope, that I am a failure or that I will be judged unfairly and blamed for my suffering. To be a patient is to be unfamiliar with oneself, to inhabit an unfamiliar shell, barely in control and in need of help. The world and our relationships are radically altered when we are patients.
What an extraordinary job we do. Grounded in a therapeutic relationship, everything we do depends on trust. What an extraordinary responsiblity to be charged with caring for people when they are at their most vulnerable and most easily exploited.
Because of this it is absolutely vital that we are not led into temptation. Just as monks and nuns need to be protected from the distractions of the world so that they can dedicate themselves to God, so we need to be protected from mammon and the perverse incentives of the market-place, so that we can dedicate ourselves to our vocation and our patients, and be the doctor that they need, not the doctor the market makes us.