Andrew Papanikitas is Deputy Editor of the BJGP. He is on Twitter/X: @gentlemedic
In his new book, Thinking About Medicine, which I review this issue, David Misselbrook argues that the tools and skills of philosophy are essential for survival and flourishing as a thoughtful clinician. Tongue in cheek, he suggests that, thus empowered by philosophy, we may not endear ourselves to our managers. This presumes, however, that the managers are too narrowly task- focused to value critical thinking in their staff.1
The articles in this month’s Life and Times illustrate many aspects of critical thinking. This includes how we know things and how we know what things are, as well as how we show others what they mean to us. For example, Richard Armitage demonstrates that taking ‘easy’ work from GPs and replacing it with ‘harder’ work in the same amount of time allocated to the ‘easy’ work, only helps GPs to work harder and is associated with increasing professional burnout.2 Paula Wright asks, when is a GP not a GP? She highlights that while the profession venerates the ‘ideal’ GP, who is a full-time practice partner living in the practice area, GPs who do not fit this paradigm can find themselves ‘othered’, as somehow less of a GP.3
As the dust settles
In the immediate wake of a general election in the UK we also look to national politics, as Mavin Kashyap helps us to see the political determinants of health so that we can recognise appropriate and inappropriate health policies.4 On the international scene, Safiya Virji showcases a primary care- led online resource to help medical students whose teaching institutions have been reduced to ruins by war.5 In this month’s Yonder, Alex Burrell tackles rural generalists, refugee mental health, end-of-career GP reflections, and lung ultrasonography. I was struck by that notion that mental health might be worse among refugees dispersed among dissimilar communities, presumably in an effort to promote integration. Is this a political ideal superseding a public health approach to psychiatry?6
The boundaries of health and illness and their impact on what we offer as health care are explored in this month’s book reviews. Sian Gordon reviews The Maudsley Deprescribing Guidelines: Antidepressants, Benzodiazepines, Gabapentinoids and Z-drugs.7 Ellen Welch explores You Don’t Have to Be Mad to Work Here: A Psychiatrist’s Life, and finds NHS psychiatry struggling in parallel with general practice, albeit with a more surreal sense of humour.8 Armitage reflects on Magic Pill by Johann Hari, reflecting that, while highly effective, a new generation of weight- loss medicines are a poor substitute for public engagement with the social and moral determinants of health.9 Giles Dawnay writes that social media and smart device use might be affecting mental health in the same way that mass produced carbohydrates fuel a pandemic of diabetes.10
This issue we also include an update on avoidant restrictive food intake disorder (ARFID), an eating- disorder diagnosis. Clare Ellison and colleagues outline the potential signs of ARFID, detail an initial primary care assessment, and present educational resources to address patients’ unmet needs and doctors’ educational needs.11
Relationships and meaning are illustrated in two poems, one from the perspective of a GP12 and one from the perspective of a teenage patient.13 Poetry has a particularly effective way of helping us see through another’s eyes and feel and imagine as they do. Use it carefully. The feelings are not necessarily positive ones, even if they promote wider good. In a literary turn, Ben Hoban invites us to reflect on Frankenstein and The Sorcerer’s Apprentice as stories where someone powerful recklessly triggers a chain of events and is unprepared for the consequences. A warning for us all.14
As I write this, the UK is having a general election. By the time you read this, a new government in the UK will hopefully be discovering that thinking about general practice in a meaningful way is a fundamentally good thing to do, whoever is doing the thinking!
References
1. Papanikitas A. Books: Thinking about medicine: an introduction to the philosophy of healthcare. Br J Gen Pract 2024; DOI: https://doi.org/10.3399/bjgp24X739065.
2. Armitage R. Not helpful but harmful. Br J Gen Pract 2024; DOI: https://doi.org/10.3399/bjgp24X739005.
3. Wright P. When is a GP not a GP? The ‘othering’ of new GP roles. Br J Gen Pract 2024; DOI: https://doi.org/10.3399/bjgp24X738933.
4. Kashyap M. Addressing the political determinants of health. Br J Gen Pract 2024; DOI: https://doi.org/10.3399/bjgp24X738921.
5. Virji S. Medical schools in difficulty: supporting medical education amid conflict. Br J Gen Pract 2024; DOI: https://doi.org/10.3399/bjgp24X738945.
6. Burrell A. Yonder: Rural generalists, mental health of refugees, end-of-career GP reflections, and lung ultrasonography. Br J Gen Pract 2024; DOI: https://doi.org/10.3399/bjgp24X739017.
7. Gordon S. Books: The Maudsley Deprescribing Guidelines: Antidepressants, Benzodiazepines, Gabapentinoids and Z-drugs. Br J Gen Pract 2024; DOI: https://doi.org/10.3399/bjgp24X739029.
8. Welch E. Books: You Don’t Have to Be Mad to Work Here: A Psychiatrist’s Life. Br J Gen Pract 2024; DOI: https://doi.org/10.3399/bjgp24X739041.
9. Armitage R. Books: Magic Pill: The Extraordinary Benefits and Disturbing Risks of the New Weight Loss Drugs. Br J Gen Pract 2024; DOI: https://doi.org/10.3399/bjgp24X739053.
10. Dawnay G. Digital ‘Diabetes’. Br J Gen Pract 2024; DOI: https://doi.org/10.3399/bjgp24X738981.
11. Ellison C, Philpot U, Fuller S, et al. What is avoidant restrictive food intake disorder? Br J Gen Pract 2024; DOI: https://doi.org/10.3399/bjgp24X738957.
12. Dawnay G. Poem: Post Heart Attack Review. Br J Gen Pract 2024; DOI: https://doi.org/10.3399/bjgp24X738897.
13. Davis-Leahy C-A, Somers N. The magic ingredient. Br J Gen Pract 2024; DOI: https://doi.org/10.3399/bjgp24X738969.
14. Hoban B. Cautionary tales. Br J Gen Pract 2024; DOI: https://doi.org/10.3399/bjgp24X738993.
Featured photo by Pawel Czerwinski on Unsplash.
