All we are saying is give GPs a chance.
Have General Practitioners replaced bankers as society's most reviled professionals? You would think so after yet another week where GPs have been blamed for everything from hiding from their patients through to intolerable pressure on hospital A&E departments to encouraging the development of superbugs to being incapable of diagnosing cancer. It sometimes seems that everyone from the Department of Health to single issue charities is lining up to take a swing at us. Instead of being the traditional avuncular family physician we have become an amalgam of Dr No and Dr Evil. So why has the criticism become so relentless and strident?
I am an apologist for general practice. There, I have declared my bias. Despite having been a GP for over 30 years I remain in awe of my colleagues and the way that they continue to carry out an incredibly difficult job in an increasingly onerous environment. Almost without question, all my peers entered a career in medicine driven by a vocation to help their fellow man. In this increasingly selfish society of ours such aspirations are no longer either understood or applauded. Nothing delights a doctor more than being able to sort out a patient's problems. It is this basic interaction that underpins all that occurs in medicine. You go to see your GP with a problem and he or she will do their utmost to solve it for innumerable and perhaps unpredictably opaque reasons not the least being a sense of intellectual gratification, a desire to be loved and a wish to bring closure (in the true sense of the word) to a problem in order to move on to another. For us every consultation is an evolving mystery story and we are the detective following and analysing every clue before finally bringing the perpetrator to justice.
Traditionally these interactions were much easier because they were built on long-standing, often lifelong, relationships between patient and doctor. Familiarity between the two led to many advantages. The doctor knew the patient's background; their family, social and past medical history, so that the canvas on which the painting was to take place did not have to be repeatedly rehung. The doctor also knew who tended to overdramatize their symptoms and attend frequently and who tended to be more stoical. In turn the patient became familiar with 'their' doctor's character traits. Did he /she make light of matters? Were they brusque or welcoming? Were they focussed on the problem or did they ask about your dog? In other words they became a comfortable acquaintance, often moving over the boundary to become a valued friend.
Such a relationship between patient and doctor had many advantages and it is the disruption of that relationship that is the common denominator to all the criticisms detailed in the first paragraph. In essence the relationship cemented an understanding between both parties that no matter what, the doctor would always try to do his best for their patient. Thus if your doctor said that you did not need an antibiotic for your tonsillitis then you believed him/her because you felt they were acting in your, not anyone else's, best interests. And if you eventually did have to have a course of penicillin to clear up an infection then you did not accuse your doctor of incompetency but instead appreciated how complex the diagnosis and management of a condition could sometimes be. The last thing on your family doctor's mind would be that you might sue him for some kind of medical negligence and thus his thoughts and actions were unsullied by defensive medicine practiced in fear of litigation. A referral for suspicion of cancer would be made through an understanding of the patient as a whole and whether their presenting symptoms were outside the norm.
Sadly it is that breakdown in the doctor/patient relationship that has led to many of the problems in the current NHS. The decades during which group practice has been encouraged; the problems in recruiting GP principals; the increasing need for locums; the loss of out of hours to faceless commercial providers; the increased demand for GP appointments; the introduction of metrics and drive to meet them; the intrusive and constant surveillance by bureaucrats; all summarised in the loss of independence have resulted in a disaffected patient, and doctor, population increasingly driven to blaming each other for all the faults in the system.
Is there any way we can draw back from the abyss of a totally dysfunction NHS? I think there is. There are huge swathes of the country where the doctor/patient relationship remains personal and intact and we should applaud and advertise these practices. GPs should try to re-engage in the joy of family practice by reintroducing the personal, rather than practice, list and this can be made more attractive by tweaking certain elements of their remuneration contract. The Department of Health needs to understand that medicine is as much an art and social science as it is a mathematical one. Not everything can or should be measured. Rather than putting the family doctor in an increasingly tight straight jacket; they should cut him/her some slack. Take away some of the unproven yet seductively sounding time consuming initiatives such as health screening for the well to allow doctors more time to deal with the ill.
Newspapers also have a vital part to play. They have to recognise the panic induced by their sensationalised stories and the need for a return to responsible reporting. They wash their bloody hands like Lady Macbeth, never acknowledging the morbidity that their stories create.
The ethos underpinning an individual's desire to become a family doctor remains as solid, albeit increasingly care worn, as ever. Any patient questioned will consistently highlight the same points; a desire to see their own doctor, at short notice, for a problem when it occurs. Why are we not listening to and addressing these apparently simple demands? We will and we can if GPs are returned to their previous state of independence and light-touch scrutiny. We need less, not more, regulation. Surveys consistently place doctors at the top of the most trusted professions (89% Ipsi-Mori December 2013) so why is that the only people who don't trust us are politicians?