Are good GPs holistic?

Andrew Papanikitas is Deputy Editor of the BJGP. He is on X: @gentlemedic

Good GPs are holistic. Is that harder to argue than ‘GPs are holistic’? Is holistic part of being good or just a part of being a GP? I wonder if that depends on what ‘holistic’ actually means! In this issue, Tim Senior road-tests the term and finds that ‘holistic’ is variously used, sometimes as a mantra for including the psychosocial, and sometimes as a cynical marketing brand for food supplements.¹ This month, the idea of GPs in a complex adaptive network interacting in many interconnected ways with wider society is evident. And yet even terms like ‘whole person’, ‘holistic’, and even ‘ecological’ fail to completely grasp the wider narrative of general practice.

GPs in the primary care ecosystem

 Primary care is networked with the rest of health care, something I have been at pains to impress on students and trainees who are spending time in specialities that are not their preferred professional destination. What can we learn about each other that helps us cooperate? Richard Armitage reminds us that recording medications prescribed elsewhere in the patient medication record is not only helpful but critical to patient safety.²

Our interconnectedness does not just apply to medicines but all care. Trisha Greenhalgh reviews a gripping story of two remarkable families, a remarkable heart, and a remarkable organ donor system, ‘faultlessly told’ by Rachel Clarke.³ The relevance to general practice is obvious to anyone who has looked after a donor or recipient family. Illustrating a profound commitment to holistic, networked care, the Ealing Borough primary care team has implemented measures to address domestic abuse, aiming to raise awareness and dismantle stigma among staff and patients. Vasumathy Sivarajasingam shares insights from the Ealing approach.⁴

Paula Wright invites us to consider when and how we provide feedback for each other as a part of the formal and compulsory audit of practice that all UK GPs must undergo. You receive an invitation to rate and comment on a colleague. Do you know them well enough, and what information can you provide? Who and what do you ask when it’s your turn to seek feedback?⁵ The process illustrates an increasing poverty of interpersonal connection. Alex Burrell offers a selection of stimulating papers that illustrate the importance of connections (working with patients across specialities) and their challenges (can AI help with some of the vulnerability in reflection?)⁶.

GPs can at times feel like gorillas in the mist, an endangered species. James Bennett raises awareness that fellowships to support the introduction of new GPs into the wild of practice offer value. They provide new GPs with community and purpose, and instil advanced skills to flourish and create value for the public in their communities.⁷ I am biased – I work with one such fellowship. Bennett also tells us that financial support has largely been withdrawn, begging the question of what a GP is worth in the health ecosystem.

Beware of men with hammers!

Expertise often by its very nature focuses on a particular aspect of the world or a way of seeing it that simplifies the world so that it can be more easily understood. Ben Hoban reflects on the necessity and risks of such reductionism in medicine. The tension between parts and the whole is a necessary part of whole-person medicine.

We need to see the wood and trees if we are to succeed as clinicians.⁸ In his review of The Political Economy of Health Care, a classic work by Julian Tudor Hart, Senior finds dispiriting predictions about technology-driven and market- driven ways of framing healthcare work.⁹ Gopal explains that the goals of business and health care are not aligned. As a profession and as a society we need to consciously align them¹⁰.

‘If the only tool you have is a hammer, it is tempting to treat everything as if it were a nail’, is a phrase variously attributed to Mark Twain or to Abraham Maslow¹¹ — he of the ‘hierachy of needs’. What is less well-known is that the hierarchy of needs was conceived while Maslow spent a world-changing 6 weeks as a guest of the Blackfoot nation in Canada. The community he spent time with were consciously ‘all in it together’.¹² Good GPs may well be holistic, but we should use intellectual hammers judiciously as well.

DOI: https://doi.org/10.3399/bjgp24X739749

 References

1. Senior T. Reclaiming holistic medicine. Br J Gen Pract 2024; DOI: https://doi.org/10.3399/bjgp24X739869.
2. Armitage R. Medicines prescribed elsewhere: don’t forget to record them in the GP record! Br J Gen Pract 2024; DOI: https://doi.org/10.3399/bjgp24X739761.
3. Greenhalgh T. Books: The Story of a Heart. Br J Gen Pract 2024; DOI: https://doi.org/10.3399/bjgp24X739857.
4. Sivarajasingam V. The Ealing domestic abuse initiative: a success story. Br J Gen Pract 2024; DOI: https://doi.org/10.3399/bjgp24X739785.
5. Wright P. Do I know you? (well enough to complete your multisource feedback … ). Br J Gen Pract 2024; DOI: https://doi.org/10.3399/bjgp24X739821.
6. Burrell A. Yonder. Br J Gen Pract 2024; DOI: https://doi.org/10.3399/bjgp24X739797.
7. Bennett J. ‘The Fellowship is breaking, it has already begun’. Br J Gen Pract 2024; DOI: https://doi.org/10.3399/bjgp24X739773.
8. Hoban B. Seeing the timber and the trees. Br J Gen Pract 2024; DOI: https://doi.org/10.3399/bjgp24X739809.
9. Senior T. Books: The Political Economy of Health Care: Where the NHS Came From and Where it Could Lead. Br J Gen Pract 2024; DOI: https://doi.org/10.3399/bjgp24X739845.
10. Gopal D. General practice should tackle healthcare inequalities but not health inequalities. Br J Gen Pract 2024; DOI: https://doi.org/10.3399/bjgp24X739833.
11. Maslow AH. The Psychology of Science: A Reconnaissance. New York, NY: Harper and Row, 1966.
12. Das S. We’re all in this together. In: Uncivilised: Ten Lies That Made the West. London: Coronet, 2024.

Featured Photo by Andrey Tikhonovskiy on Unsplash