Why are GPs so busy? Why do more patients seem to need to see someone straight away? Why can I go through a morning session without using my stethoscope, but find myself giving out foodbank addresses and directing patients to third sector counselling services? Could it be that GPs are ahead of the game when it comes to compassion, which has been much-spoken-of in the light of the Francis Report?
Most would argue that more compassion should lead to healthcare improvements; if we could all learn to care just a little bit more, healthcare would be better. Intuitively, this is perhaps true, and since becoming a GP I’ve found that I do need to be a compassionate listener; a challenge that many other doctors from other specialties also face. However, as a GP, I find I face a largely undifferentiated morass of problems presented by patients. Despite working under the terms of a General Medical Services Contract, much of what I do, and my worth perhaps, is not medical per se.
Anecdotally, at least, the burden on GPs to provide what is beyond the scope of medical knowledge seems to be increasing, perhaps fuelled by changes in society that are difficult to quantify. Could it be that already compassionate doctors are encouraging patients to medicalise areas of their life that are less than perfect? After all if doctors don’t care for them, who will?
I don’t believe GPs can remain sane whilst be compassionate listeners and maintaining a high performance on any payment-by-results scheme, whether that be the national QOF, encompassing the locally-policed QP, or the Health-and-Safety-gone-mad CQC. Notwithstanding local schemes conjured up at short notice by CCGs or DESs served up by NHS England.
Although I became a doctor, to make the world a better place and as a way to express care and compassion to other people and my patients generally tell me how much I seem to care , I do wonder what would life be like working as a GP who provided mainly medical services? Not in a corporate, target-driven and time-sensitive way, because I’ve tried that approach as a locum, but simply because I wasn’t needed to provide non-medical, compassion-driven problem-solving. What if I didn’t have to medicalise minor work- or relationship-related stress reactions because my patients had someone or somewhere else to help them deal with that part of their lives?
I think it will take a societal paradigm shift towards the provision of compassion and community for the more vulnerable of our patients in order for GPs to be able to spend the majority of our time caring for sick patients, rather than getting sick trying to be more caring.