Andrew Papanikitas is Deputy Editor of the BJGP.
In 2018 the US National Rifle Association sparked a ferocious response from doctors in the US when, on 7 November, they tweeted (it was before ‘X’), ‘Someone should tell self-important anti-gun doctors to stay in their lane. Half of the articles in Annals of Internal Medicine are pushing for gun control. Most upsetting, however, the medical community seems to have consulted NO ONE but themselves.’ 1,2
There were some clear opposing messages in the response: in the US, being injured or killed as a result of guns is arguably a public health problem, particularly and tragically for children.3 For emergency department doctors and forensic medical examiners there was first-hand experience and expertise relating to the health and social effects of guns. Many graphically illustrated their experiences with gore-soaked ‘selfies’.2 This is, of course, a very extreme example with its own significance. UK GPs occasionally have to agonise over whether someone should have a licensed firearm, or whether it is right that they should offer an opinion.4 I am left, however, wondering whether there is a GP lane, especially on days when some of my clinical work feels more like emergency medicine, and some of it feels more like lifestyle advice. This is before GPs begin to consider whether we should (as consultants in primary care medicine) be participating in public debates about wider social and political issues. Such debates have a bearing on physical, psychological, and social wellbeing, and not merely the direct management of disease and injury.
“I am left, however, wondering whether there is a GP lane, especially on days when some of my clinical work feels more like emergency medicine …”
Blurred boundaries
Who defines our lane? Should we be learning about the adjacent lanes? Should we invest in a street map and participate in the planning of new routes? The articles in this issue helpfully blur the boundaries of our lane. Terry Kemple reviews Ungovernable: The Political Diaries of a Chief Whip5 and reflects on the dysfunctional aspects of UK politics that result in failures of state. Alex Burrell looks at urgent care triage, pre-pregnancy care, heat islands, and e-scooters in his quest for relevant wisdom from Yonder.6
If the goal of medicine is the promotion of health and treatment of disability, illness, and disease (let’s think of this as our lane?), then things are going to get complicated. Our articles this month illustrate that health and illness are problematic ideas. Peter Toon bravely attempts to understand how we decide what is and is not illness: ‘In the 1990s, UK GPs were criticised for “missing depression”, while 20 years later they were being accused of medicalising unhappiness.’ 7 Kerry Greenan reviews A Body Made of Glass: A History of Hypochondria, a detailed history of the evolving term ‘hypochondria’, going from Ancient Greece to current diagnostic criteria given by the DSM-5. It is interspersed with the author’s own health experiences of both life-threatening and medically unexplained illness.8 Ahmeda Ali invites us to walk with her in the grief and bereavement of pregnancy loss, ‘On paper, pregnancy loss is a clinical event. But in reality, it is a quiet unravelling. For parents, it is not just the loss of a pregnancy — it is the loss of a future imagined in soft blankets and birthday candles.’ 9
“I wonder if our lanes give us a convenient view, but one that is reserved for the sightseer rather than the forester.”
The boundaries of health and illness go some way to shape the boundaries of health care. Hugh Bethell explores illness caused by an absence of health as he advocates exercise for older people — is age and inactivity-related ‘sarcopenia’ an illness?10 Clovis Mariano Faggion Junior discusses enteral feeding for patients with dementia, begging the question of whether feeding is deemed a beneficial treatment because of institutional ethos or financial incentives rather than clinical indications.11
The terrain of primary health care
I recently visited the Puzzlewood in the UK’s Forest of Dean (the latter is the setting for John Berger’s A Fortunate Man). The Puzzlewood is a forest that has grown out of an ancient open-cast mine. The combination of mounds and trenches, towering and fallen trees, gives the impression of an impassable British rainforest. And yet it has lanes through it, painstakingly constructed out of logs, planks, and branches, making it a magical tourist trail for families. I wonder if our lanes give us a convenient view, but one that is reserved for the sightseer rather than the forester. The terrain of primary health care defies lanes.
References
1. NRA. Twitter 2018; 7 Nov: https://x.com/NRA/status/1060256567914909702 (accessed 7 May 2025).
2. Rannard G. #ThisIsOurLane: Doctors hit back at pro-gun group NRA. BBC News 2018; 12 Nov: https://www.bbc.co.uk/news/world-us-canada-46186510.amp (accessed 7 May 2025).
3. Gani F, Canner JK. Trends in the incidence of and charges associated with firearm-related injuries among pediatric patients, 2006–2014. JAMA Pediatr 2018; 172(12): 1195–1196.
4. Morris S. GP was not told Plymouth shooter had shotgun certificate, inquest hears. Guardian 2023; 26 Jan: https://www.theguardian.com/uk-news/2023/jan/26/gp-not-told-jake-davison-plymouth-shooter-shotgun-certificate-inquest-hears (accessed 7 May 2025).
5. Kemple T. Books: Ungovernable: The Political Diaries of a Chief Whip. Br J Gen Pract 2025; DOI: https://doi.org/10.3399/bjgp25X742593.
6. Burrell A. Yonder: Urgent care triage, pre-pregnancy care, heat islands, and e-scooters. Br J Gen Pract 2025; DOI: https://doi.org/10.3399/bjgp25X742605.
7. Toon P. What is illness? Br J Gen Pract 2025; DOI: https://doi.org/10.3399/bjgp25X742545.
8. Greenan K. Books: A Body Made of Glass: A History of Hypochondria. Br J Gen Pract 2025; DOI: https://doi.org/10.3399/bjgp25X742581.
9. Ali A. Grief in the consultation room: Alma, my daughter, and the hidden curriculum of loss. Br J Gen Pract 2025; DOI: https://doi.org/10.3399/bjgp25X742617.
10. Bethell H. Don’t kill Granny, send her to the gym! Br J Gen Pract 2025; DOI: https://doi.org/10.3399/bjgp25X742569.
11. Faggion CM Jr. Enteral feeding for patients with dementia: an ethical critique of the clinical and economic considerations. Br J Gen Pract 2025; DOI: https://doi.org/10.3399/bjgp25X742557.
Featured photo: Puzzlewood outside the lane by Andrew Papanikitas, 2025.
