Caritas in a cold climate

Andrew Papanikitas is Deputy Editor of the BJGP.

General practice is amazing. We care about the whole patient, family and community, the mind and the body. We are versatile and broad in in both professional gaze and skill set, celebrated in Yonder by Ahmed Rashid, who is approaching his 10th anniversary writing the column!¹ Yet, this issue’s life and times articles describe the failure of society and policymakers to value general practice. I use value in two distinct ways: To value is to understand and appreciate both the beauty and appropriate uses of a thing. It also has a sense of quantitate weighing – to value is to attribute worth, usually in the form of money! Our articles also highlight the care that is espoused in the RCGP motto, ‘Cum Caritas Scientia’.²

We value caritas, but do our policymakers?

Simon Morgan relates the experience of newly GP registrars in Australia to the survivalist gameshow ‘Alone’. New GP trainees face a range of similar challenges as their TV survivalist counterparts – isolation, uncertainty, a steep learning curve, and genuine fear.³ Tim Senior takes the survival challenge further. Not only is general practice already complex, fraught with professional peril, under-appreciated, under supported and under funded, but it has to cope with society’s failure to adequately resource and support other hospital and community services.⁴ Extended roles can be a source of  added value for both practitioner and public, putting otherwise suppressed talents to use for the common good. However the GP with extended roles that Senior describes here is also reminiscent of the ‘duct-taper’ described by David Graeber in his anthropology of meaningless work, Bullshit Jobs.⁵ So what has happened to the human and humane aspects of general practice, the ‘Caritas’ of the RCGP motto? Ben Hoban suggests a reason why we feel helpless or overwhelmed by all that we face at work. It is that we are being human in a context in which humanity is routinely undervalued, and sometimes there are no solutions.⁶ Some of the distress is because we are too busy to be allowed to care and exercise the diligence that we aspire to. Some of this in turn is because the time and skills of general practice are not valued.

Nada Khan tells us that the 2019 Conservative Party Manifesto promised an additional 6000 GPs. When it became clear that this goal would not be achieved, ARRS shifted the scope from meeting the manifesto pledge to instead increase the number of appointments offered in general practice by 50 million a year.⁷ The 20,000 alternative roles in practice to deliver those appointments we touted as helping beleaguered GPs, though the worry is now that these are instead ‘replacing’ GPs. Moreover this risks being done in a way which does not lessen but extends the day-to-day work and responsibilities of GPs. And whilst GPs are leaving, this has not been matched by an increase in job vacancies. This approach seems (to me) based on a fallacy that we do the easy stuff and refer the rest to specialists, as belied by the articles this issue.

Medicine has historically exploited this voluntary economy, often in the context of medical education but also in terms of charity work and professional representation. Louise Stone shares her reason for leaving a job and reflects that it has much to do with moral exploitation. ‘My entire career has involved donations of time and labour … over my career, I’ve noticed that pro bono expectations have metastasised.’⁸ This meaningful, often rewarding and slightly stressful work is valued enough to be expected, but not enough to be paid, either in time or in money. In Bullshit Jobs, David Graeber suggests that many people elect to do meaningless but highly-paid work in order to have the time and financial security to volunteer in more meaningful roles.⁵ Whilst general practice still has meaning, some aspects of our roles have started to pong, but the leisure, cash or indeed opportunities to find further meaningful work have not risen to offset this.

Caritas for our common humanity

Pete Young takes issue with the idea that it is OK to always accommodate racism in situations where this might achieve a better clinical outcome. It’s complicated, and we should understand and reflect on that complexity whenever it arises, lest we sleepwalk into accepting racist attitudes as the norm. By contrast, Young recognises the value of diversity and importance that marginalised ethnic groups can attach seeing someone who understands them (See also Yonder this issue).^1,9 Gene Feder, Anwar Khan, David Jewell and Sabena Jameel offer a family medicine response to the war in Israel and Palestine. They call on the Israeli and Palestinian people to recognise their common humanity, and at the very least respect the healthcare spaces as sanctuaries for the sick and those committed to healing rather than to killing. They also recognise the traumas of conflict that can take generations to heal.¹⁰

Caritas and the whole person

Elke Hausmann takes a deep dive into The history of emotions, ‘…one of the most important topics for understanding contemporary life … we can use the insights from this relatively new discipline to understand what we actually mean by emotions…’¹¹

Hannah Milton summarises The myth of Normal by Gabor Maté thus,  ‘Modern life is toxic to our physical and emotional health and here is the evidence as well as lots of engaging personal stories to illustrate the science!.’ Having been convinced about the effect of traumatic life experiences on health, she finds that Maté offers some ways to change that ill health.¹²

We need some sunshine

Shakespeare’s phrase, “Now is the winter of our discontent…’¹³ feels apposite as this issue’s articles describe the challenges of financial austerity, political indifference, sectarian hostility and a 21st century culture that is toxic to mind and body. In the quoted scene, Richard III is quick to add that his team will turn this winter into ‘glorious summer.’ General practice is amazing, as both a community of practice and as an academic discipline. As I read the articles this issue I am confident that if sunshine does not find us… we’ll go and find it!

References

1. Rashid A. Yonder: Surgical site infection, opioid dependence, racial diversity, and meals on wheels. Br J Gen Pract 2024; DOI: https://doi.org/10.3399/bjgp24X736293.
2. Gregory S. William Pickles Lecture 2014: Cum Scientia Caritas — compassion with knowledge. Br J Gen Pract 2015; DOI: https://doi.org/10.3399/bjgp15X683269.
3. Morgan S. Alone: General Practice. Br J Gen Pract 2024; DOI: https://doi.org/10.3399/bjgp24X736245.
4. Senior T. Extended roles and special interests. Br J Gen Pract 2024; DOI: https://doi.org/10.3399/bjgp24X736341.
5. McKenzie-Edwards E. Books: Bullsh*t Jobs. The Rise of Pointless Work and What We Can Do About it. Br J Gen Pract 2022; DOI: https://doi.org/10.3399/bjgp22X718457.
6. Hoban B. Being human. Br J Gen Pract 2024; DOI: https://doi.org/10.3399/bjgp24X736269.
7. Khan N. Amidst a GP workforce crisis, where did all the jobs go? Br J Gen Pract 2024; DOI: https://doi.org/10.3399/bjgp24X736233.
8. Stone L. Normalising exploitation. Br J Gen Pract 2024; DOI: https://doi.org/10.3399/bjgp24X736305.
9. Young PD. Framing the debate: race-based requests in medicine. Br J Gen Pract 2024; DOI: https://doi.org/10.3399/bjgp24X736281.
10. Feder G, Khan A, Jewell D, Jameel S. Responding to the war in Israel and Palestine. Br J Gen Pract 2024; DOI: https://doi.org/10.3399/bjgp24X736257.
11. Hausmann E. Books: The History of Emotions: A Very Short Introduction. Br J Gen Pract 2024; DOI: https://doi.org/10.3399/bjgp24X736329.
12. Milton H. Books: The Myth of Normal: Trauma, Illness and Healing in a Toxic Culture. Br J Gen Pract 2024; DOI: https://doi.org/10.3399/bjgp24X736317.
13. Shakespeare W. Richard III (1.1.1). London: Penguin Classics, 2015.

Photo by Mika Ruusunen on Unsplash