This is from the heart – a general practice miscellany

Andrew Papanikitas is deputy editor of the BJGP, and a GP in Oxford. He is on X: @gentlemedic

T[\dropcap]his issue focusses on the heart and cardiovascular medicine. Life and Times for its part stresses the metaphysical and metaphorical heart with an eclectic smorgasbord of useful, challenging, and entertaining articles.

The anatomical heart and beyond

In 2015 I took part in running a medical humanities symposium on the heart.* I discovered in the process that the heart has many more physiological functions beyond that of a pump, but also that the heart also can have religious, ethical and political significance, both of itself and as a metaphor.¹ Anatomy and pathophsysiology feature this issue (albeit un-cardiologically): Daniel Baumgardt reflects on a GP career that includes teaching anatomy in a medical school -clinical practice and anatomy are mutually enhancing.² Elke Hausmann reviews, ‘Understanding allergy,’ by Sophie Farooq, and finds a text to read and to share with patients.³ Ahmed Rashid expands our view from the body (colorectal cancer resection) to the body politic (inclusion health, medical missions and the lives of billionaires).⁴

The strategic heart

It is nice to see the heart as political metaphor in our editor’s briefing this month. ‘What is the philosophical heart of a profession that arguably sit at the heart of British healthcare?’ asks Euan Lawson (my summary).⁵ We have some thoughts! Emilie Crouchman reviews, ‘What is a doctor?’ by Phil Whitaker. The very title, she argues, neatly articulates a contemporary query. As the multidisciplinary team (MDT) becomes increasingly complex with additional moving parts, the role of the doctor becomes ever more difficult to describe.⁶ Tim Senior fantasises about what general practice taken seriously and valued might look like, ending endless directives and webinars that are driven by the failure to understand what GPs know or do.⁷ Tim Sanders views the “rewiggling” of the Swindale Beck in the Lake District as a metaphor for a need to nurture and cherish core aspects of generalism, continuity and relationship-based care within the role of the GP. Misguided straightening of rivers results from a lack of ecological understanding.⁸ The same ecological harm might be argued of the NHS seen as a corporate business opportunity. Dave Mummery reviews, ‘The great NHS heist’ a documentary that argues that there has been a concerted and deliberate extraction of financial capital from British Healthcare by ‘Big Business’ under the guise of financial efficiency.⁹ Money and other resources are the lifeblood of our healthcare service. Does that make General Practice the heart?

Stressing the heart… and learning

I once read a nineteenth century book review of Frankenstein, which argued in essence (and wrongly) the novel ‘stressed the heart’ without engaging the brain and imparted no lesson or moral!¹⁰ Clearly there are lessons to be learned from real as well as literary horror stories. Merope Mills’ description of the death of Martha, her 13 year-old daughter, is a harrowing account of the mistakes doctors made that led to Martha’s deterioration and ultimately her death. Nada Khan evaluates the concept of a Martha’s rule, a guarantee of and urgent second opinion in the face of persistent parental concern.¹¹ Grief can be an emotional as well as an intellectual teacher – Isma Naeem reflects on how grief has made her more empathic to patient who are themselves facing loss.¹²

Comedy can also help us cope and reflect on the evolving frustrations of practice. This issue we have a tongue in cheek (apologies for the pun) glossary of administrative language in the NHS by Kevork Hopayian.¹³

What can we learn from a ‘British’ alien with two hearts?

This November is the 60^th anniversary of BBC TV’s Doctor Who, but don’t be fooled by the title of Alex Burrell’s article. He explores how members of the public might use a doctor’s given name in a consultation, and how this might change the nature of the consultation.¹⁴ Ben Hoban (more of a ‘Trekkie’) explores how a legendary test of character in science fiction, the Kobayashi Maru test, could have useful lessons for readers. Star Trek’s captain Kirk famously wins in an unwinnable scenario by cheating and fails the test of character.¹⁴Should we be cheating or learning something more profound? By contrast with the ‘Hospital consultant-like’ Captain Kirk, the BBC’s time travelling hero, ‘The Doctor,’ reminds me of many GP-colleagues I have met over the years. Historically a man, she has just been a woman. The Doctor is usually in the thick of it rather than commanding from the bridge of a star-ship, and has two hearts!

*Deputy Editor’s note. This was a collaboration between The Oxford Healthcare Values Partnership at Oxford University, and the Faculty of History and Philosophy at The Society of Apothecaries of London.

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