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Astronauts, Ivory Towers and Drawbridges – General practice on World Book Day 2023

Emilie Couchman is an academic GP, currently undertaking a PhD with the Mesothelioma UK Research Centre at the University of Sheffield and working as a GP on a part-time basis in Northumberland. Her Twitter handle is @DrEmilieCouch

 

As a mother, I am grateful for the luxury of Amazon Prime delivery. The last-minute panic of finding an outfit for the impending World Book Day will be remediable because of this internet-based witchcraft. In today’s society, we are not a very patient bunch. Does this culture of unwillingness to wait mean that primary care would be completely overrun if the drawbridge limiting access were to be lowered any further? More than likely. But, is it frustrating as hell to be a patient trying to access a GP, let alone your own GP? Yes.

‘GPs are far more than gatekeepers. We are a safety net protecting the NHS from being overwhelmed…’ writes Annabelle Machin.1 Demand is at an all-time high, and resources are limited. We all know someone, or are someone, who struggles to get an appointment with their GP. GPs can hide, to a degree, behind the castle walls and beyond the moat consisting of front-line administrative staff. But I ask myself two questions: does that mean we are in an ‘ivory tower’; and do we have a ‘drawbridge mentality’?

I ask myself two questions: does that mean we are in an ‘ivory tower’; and do we have a ‘drawbridge mentality’?

GPs know how to work hard. My Fitbit certainly doesn’t give me enough credit on my clinical days. We might not be getting our steps in around a hospital, but my goodness, we cover ground. But, full disclosure, we are generally overworked so don’t have the time to do everything we want to, in the way that we would prefer to do it. I dream of using my CPD hours for CPD rather than clinical admin; of eating more than a bag of crisps at my desk for lunch (and then frantically trying to retrieve the crumbs from between the keyboard keys); or of getting my voice heard by participating in the meaningful research going on around me. For example, I am undertaking a PhD exploring continuity in primary care, but I cannot hear GPs’ voices. I cannot easily gain access to the very people whose perspectives I need to hear. I cannot get through to GPs to invite them to participate. I am recruiting through patients, who, ironically, tell me that I cannot involve their GP because they are too busy to participate in things like this. Patients are gatekeeping. I am on the receiving end for a change and feel utterly and completely immobilised.

In a nutshell, time and energy are the two magic potions we do not have in sufficient quantity to be as accessible and malleable as the public requires us to be.

I do not believe that GPs are in an ivory tower due to a lack willingness to relate to or empathise with patients. I have written before that I am guilty of focussing ‘solely on the patient in front of me and the colleagues around me’.2 The choice between engaging with the system (and all its flaws) or saving my energy for my patients, is one I am faced with every day of clinical practice. I realise GPs could outwardly seem resistant to change. I see the root cause as a lack of time to adequately reflect on and enact possible strategies to change, rather than selfishness and arrogance that we have already ‘got it right’. In a nutshell, time and energy are the two magic potions we do not have in sufficient quantity to be as accessible and malleable as the public requires us to be.

Back to Amazon Prime, which helps me to provide my 3-year-old with Buzz Lightyear paraphernalia in a timely fashion. ‘To infinity, and beyond!’ He shouts, as he jumps off the sofa, arms outstretched and dressed in a fleece onesie. ‘The daily work of a GP is not defined by guidelines, or contracts, but by our ability to work beyond those boundaries to manage undifferentiated and complex needs.’1 Astronauts have a fair amount of support to journey into the ‘beyond’. GPs do not. The quietness of the support system is sometimes deafening.

References

  1. Machin, A. GPs are far more than gatekeepers. BJGP Life. Published online 15.2.23 https://bjgplife.com/gps-are-far-more-than-gatekeepers/
  2. Couchman, E. Papering over the cracks. BJGP Life. Published online 24.11.22 https://bjgplife.com/papering-over-the-cracks/

Featured photo taken at The Story Museum, Oxford, by Andrew Papanikitas

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