Going the extra mile

Andrew Papanikitas is Deputy Editor of the BJGP.

‘Excuse me, are you a doctor?’ I was an orthopaedic house officer and there was a young woman in the doorway of the doctors’ office. Even in those relatively halcyon days, the instinctive response would have been, ‘Who wants to know?’ She was recruiting for a Times newspaper article.1 I wore a pedometer and kept a diary for a week, and my step count was compared with that of a Conservative politician, a farmer, and a housewife. The house officer (I think) did the most steps but the farmer got the biggest picture, ruggedly staring into the dawn on his tractor. The politician did not compare favourably but was praised all the same. Nearly 20 years later the Royal College of General Practitioners (RCGP) Scotland hosts led a rousing karaoke flash mob at the RCGP conference, ‘And I would walk five hundred miles!’ Some colleagues joined in with the singing lustily (It was pre-COVID), though not all. This issue focuses on the wider healthcare team, all fellow travellers on a mythic quest to bring relief to the sick and promote health. The motif of walking, and the praiseworthiness of going the extra mile, has biblical roots. In the Gospel of Matthew, Jesus says, ‘Whoever forces you to go one mile, go with him two’, possibly in reference to being ‘pressed into service’.2 The extra mile is a problematic concept. If everyone goes the extra mile, do we lose sight of which miles are extra?3 If we are to embark on our quest then the readings in this month’s Life and Times help us to do so …

… as advocates and as leaders

Nada Khan discusses the RCGP manifesto. Billed as ‘seven steps to save general practice and safeguard our NHS’, the manifesto reflects the policies that political parties need to take on board to ‘save’ general practice ahead of the upcoming general election in the UK.4 Joanne Reeve shifts the focus from what they should do to what we can do. She writes:

‘In my 20 years of studying medical generalism, I have seen [advanced generalist medicine] designed out of medical practice, teaching, and healthcare policy … So, in response, I now lead and help deliver work to restore and reclaim the wisdom of general and generalist practice through WiseGP.’ 5

… as a primary healthcare team

We do not travel alone and must recognise those who travel with us, including colleagues and patients. Peter McNelly and David Fowler argue that mental health practitioners (MHPs) can be a valuable addition to the multidisciplinary team, if sensibly recruited and deployed. An MHP should be able take on tasks that would be complex and cumbersome for a GP and require minimal or no supervision. Carrying someone’s lighter load so they can take up a heavier one does not elicit thanks!6 Selena Stellman and Benjamin Ellis tackle an area that is replete with patent unmet need and doctor educational needs. People with chronic pain need personalised care — an approach offering patients choice and control over their mental and physical health, basing care on what matters to them personally, and focusing on individual strengths and needs.7

… mindfully, and well-read

Ahmed Rashid scans the journals for an eclectic treatment of our unknown unknowns, finding insights into care coordination, anal cancer, lay online communication, and positive body image.8

Richard Lehman is inspired to review Habitual Ethics? by Sophie Delacroix, a book that argues that morally bad habits can be hard to shake. Moreover, habits can become bad when failing to adapt to changing circumstances. This book can be read as an endeavour to delineate the conditions under which habits remain plastic enough to be at the service of (rather than hampering) our ethical life.9

Hannah Milton reviews The Unofficial Guide to Therapeutic Parenting for Childhood Aggression and Violence. She invites us to consider the authors’ phrase ‘children who express their distress through aggression’. Understanding the neuroscience behind children’s responses can be key to tackling childhood aggression effectively and compassionately.10

Elke Hausmann is entranced by The Song of the Cell by Siddhartha Mukhurjee. The book ‘is a chronicle of the discovery that all organisms, including humans, are made of these “elementary particles”. It is a story of how cooperative, organized accumulations of these autonomous living units — tissues, organs, and organ systems — enable profound forms of physiology: immunity, reproduction, sentience, cognition, repair, and rejuvenation.’11

Walk with me

Let’s walk together into 2024. Join us in these pages and in our online BJGP Life community. We look forward to seeing your comments and your articles in the new year.


1. Sulaiman T, Rozenberg G. All walks of life take the road to fitness. The Times 2004; 27 Mar: (accessed 8 Dec 2023).
2. Matthew 5:41. In: The NIV Study Bible. London: Hodder and Stoughton, 1987.
3. McKenzie-Edwards E. Professional self-care in primary care practice — an ethical puzzle. In: Papanikitas A, Spicer J, eds. A Handbook of Primary Care Ethics. London: CRC Press, 2017.
4. Khan N. Electioneering and the RCGP Election Manifesto. Br J Gen Pract 2023; DOI:
5. Reeve J. Reclaiming general practice: tackling our workforce crisis with WiseGP. Br J Gen Pract 2023; DOI:
6. McNelly P, Fowler D. Do GPs benefit from having MHPs as part of the practice? Br J Gen Pract 2023; DOI:
7. Stellman S, Ellis B. Making chronic pain less painful — for everyone. Br J Gen Pract 2023; DOI:
8. Rashid A. Yonder: Care coordination, anal cancer prevention, lay online communication, and positive body image. Br J Gen Pract 2023; DOI:
9. Lehman R. Books: Habitual Ethics? Br J Gen Pract 2023; DOI:
10. Milton H. Books: The Unofficial Guide to Therapeutic Parenting for Childhood Aggression and Violence. Br J Gen Pract 2023; DOI:
11. Hausmann E. Books: The Song of the Cell. The Story of Life. Br J Gen Pract 2023; DOI:

Featured photo by Olia 💙💛 Gozha on Unsplash.

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