We all need the healing power of good connections

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

Before artificial intelligence the original neural networks were made of people. Recently the Cambridge academic and author, David Runciman, argued that we should look to the behaviours of countries and corporations for insights in managing the machine intelligences of the future.¹ We know that good connections in health care improve patient outcomes including reduced risk of dying.² We also know that connections with colleagues can synergistically affect how well new and existing medical knowledge and innovation is applied in practice.³ Groups can behave in complex, adaptive, and sometimes very dysfunctional ways. As I write this introduction, the Royal College of General Practitioners have publicly deplored the racist riots and attacks on the public, including on healthcare and care workers.⁴ A current explanatory narrative is that the racism and anger has been spread and inflamed by social media forums and key overlapping individuals and organisations,⁵ highlighting the power of connection for good or ill. Primary healthcare’s networked nature is manifest in the Life and Times section this issue.

Fragility and disconnection

The whole of modern general practice in the UK rests on both the electronic healthcare record and networked services for requests and results. Brendan Delaney reflects on the Crowdstrike outage of 19 July 2024. Soon after a malicious cyber attack that affected much of the healthcare infrastructure in South London, there was a global internet failure as software designed to guard against such malicious attacks malfunctioned. Delaney argues for better awareness of how our machine connections are fragile and the dysfunctional ways we interact with them.⁶ The accelerating speed of medical technology and communication has been reflected in workload as human workers try to keep up. Nada Khan finds that research into GP workload suggests an association between wellbeing, burnout, and patient safety.⁷ It is not clinician wellbeing or patient safety that matters on its own, but one requires the other.

Good connections and leadership — notes for the new UK Government

Peter Toon and colleagues call on the new UK Government to re-evaluate the market-driven ethos in which the NHS has been managed. Simple, linear, and mechanistic drives towards efficiency, they argue, fail to take into account the complexity of the UK healthcare ecosystem. Primary healthcare needs rewinding and rewiggling so as not to lose its poorly understood complex adaptive nature.⁸ Paul Thomas teaches us that to understand complex things like ‘comprehensive, equitable care’, we need to combine atomised thinking with thinking about connections and relationship building. To address 21^st century issues, societies also need everyday citizens to understand these things, as well as clinicians and policymakers.⁹ Ben Hoban reflects that it is no longer self-evidently true that the purpose of the system is to safeguard the health of individual patients. Instead, patients are expected to act in a way that safeguards the health of the population at large — even though they are unlikely to benefit themselves.¹⁰ David Misselbrook offers the case study of the polypill, an unlicensed medicine that on the face of it offers better patient and public health benefit than the current approach to preventive cardiovascular medicine in the West, but one unsupported by the pharmaceutical industry.¹¹

Global connections and holistic reading

Good joined-up thinking requires a varied and healthy intellectual diet. Alex Burrell looks at the literature: this months’ Yonder encompasses prescribing drugs that require the prescription of other drugs, the time a teacher should wait for a question in class to be answered, online services for mental health conditions, and community deep vein thrombosis pathways in the Netherlands.¹² Terry Kemple broadens our horizons in his review of Not the End of the World by Hannah Ritchie. The book simultaneously dispels the idea that all hope is lost for reversing climate catastrophe and tells us that as communities, countries, and a species we still need to get our collective act together (or it will be).¹³

To heal (a word that has both an active sense and a passive one) as individuals and as communities we require good connections. Good connections must be the force that binds us well, but must bind us to something good. As I have reflected before, ‘None of us is an island — we survive and flourish through the quality of our relationships.’ As Samuel Shem put it, “The essence of medical care, and life, is connection.”’¹⁴

References

1. Runciman D. The Handover: How We Gave Control of Our Lives to Corporations, States and AIs. London: Profile Books, 2024.
2. Sandvik H, Hetlevik Ø, Blinkenberg J, Hunskaar S. Continuity in general practice as predictor of mortality, acute hospitalisation, and use of out-of-hours care: a registry-based observational study in Norway. Br J Gen Pract 2022; DOI: https://doi.org/10.3399/BJGP.2021.0340.
3. Gabbay J, le May A. Mindlines: making sense of evidence in practice. Br J Gen Pract 2016; DOI: https://doi.org/10.3399/bjgp16X686221.
4. Royal College of General Practitioners. RCGP Chair calls out ‘horrific and completely unacceptable’ attacks on healthcare workers. 2024. https://www.rcgp.org.uk/News/unacceptable-attacks-healthcare-workers (accessed 8 Aug 2024).
5. Mulhall J. Some are calling these far-right riots an outpouring of legitimate anger. They are not. The Guardian 2024; 5 Aug: https://www.theguardian.com/commentisfree/article/2024/aug/05/far-right-riots-legitimate-anger-racist-violence (accessed 8 Aug 2024).
6. Delaney B. Cybersecurity and all that: reflections on the Crowdstrike outage. Br J Gen Pract 2024; DOI: https://doi.org/10.3399/bjgp24X739305.
7. Khan N. GP workload and patient safety. Br J Gen Pract 2024; DOI: https://doi.org/10.3399/bjgp24X739257.
8. Toon PD, Shah R, Stillman K, et al. Regarding general practice: an appeal to the new UK Government. Br J Gen Pract 2024; DOI: https://doi.org/10.3399/bjgp24X739245.
9. Thomas P. Developing compassionate communities through Community-Oriented Integrated Practice. Br J Gen Pract 2024; DOI: https://doi.org/10.3399/bjgp24X739293.
10. Hoban B. Wagging the dog. Br J Gen Pract 2024; DOI: https://doi.org/10.3399/bjgp24X739353.
11. Missebrook D. A secret medicine. Br J Gen Pract 2024; DOI: https://doi.org/10.3399/bjgp24X739281.
12. Burrell A. Yonder: Prescribing cascades, teacher wait time, online services for mental health conditions, and community deep vein thrombosis pathways. Br J Gen Pract 2024; DOI: https://doi.org/10.3399/bjgp24X739341.
13. Kemple T. Books: Not the End of the World: How We Can Be the First Generation to Build a Sustainable Planet. Br J Gen Pract 2024; DOI: https://doi.org/10.3399/bjgp24X739317.
14. Papanikitas A. ‘Only connect’ … relationships and GP life. Br J Gen Pract 2022; DOI: https://doi.org/10.3399/bjgp22X720305.

Featured photo by Tim Marshall on Unsplash.