Tim Senior is a GP and Churchill Fellow with an interest in First Nations health and Deep End general practice
The health system depends for its effectiveness on minor illness. We’ve built a system where we limit capacity to only include those with serious illnesses, or those with something dramatic and exciting.
We’ve all seen a “GP missed meningitis,” headline and thought how easily that could be me. Symptoms of many minor illnesses are exactly those of serious illness in its early stages. That fever, that rash, that vomiting is only a minor illness as they are leaving, after the consultation. When they arrive it could be any number of serious conditions.
For the patient, too, these symptoms are not just an isolated collection of independent physical symptoms, they are accompanied by worry and upset. Most people have discussed symptoms with friends and family beforehand and many will ask Google. The reason they are there is not because they think it’s minor illness – they are worried that it isn’t. People want their anxiety reduced, and, hopefully, if it does turn out to be minor illness, then people are happy if they’ve been heard, taken seriously, and have a good explanation.
We’ve built a system where we limit capacity to only include those with serious illnesses, or those with something dramatic and exciting.
Minor illness is a ticket through the door. It’s a legitimate reason to be at a doctor’s without judgement from relatives or colleagues. It’s a way of testing out the doctor you’re seeing with something less serious than the big thing they may actually be worried about.
I’ve come to expect second and third problems in consultations now. The cliché of the patient stopping as they are about to open the door to leave, “Oh, there was this one other thing doctor…” is a cliché because it’s familiar. These are the times where the minor illness has been the entrée to the main course of what’s really troubling the patient. In one sense we can see it as a measure of our own success, as it only happens if we’ve been sympathetic and engaging. People won’t raise the issues they are deeply worried about, whether it’s a deep depression, an abusive partner, an STI, unless they feel they can relate to the doctor they are seeing.
Sometimes it may not happen in that same consultation, sometimes it may be after a few consultations before the big worry comes up. Whenever it happens, though, a minor illness is the entry ticket for the health system to manage something more serious at an earlier point.
T
his is a route that builds a health system that is impersonal, anonymous, and ironically, creates more serious illness.
Fortunately, most people presenting with symptoms of minor illness, do turn out to have minor illness. And while most people may have more than one problem, it’s not always a big, hefty one. There are many people who don’t come to the doctor’s much at all, many who find it difficult to navigate complex health systems, or those who expect a bad experience in health services.
Minor illness is an opportunity to promote vaccination and screening that might not otherwise come up. Not only this, but the seeds are sown in those consultations for minor illness for tougher times ahead. Everyone at some point is at risk of succumbing to a serious physical or mental illness. If that time comes, people want to see someone they can trust. If, having seen a doctor who treated the person with compassion and respect, and didn’t make them feel like they were wasting their time, then that will be remembered. And if it is remembered down the line when that breast lump appears, or those suicidal thoughts keep entering the mind unbidden, the question “Who can I turn to?” comes up. One answer should always be “I remember that nice doctor I saw with my cough.”
While as GPs we have known this for ages* – after all we work in a speciality defined by relationships over time. However, health policy increasingly sees health care as a series of impersonal transactions, with minor illness a collection of trivial symptoms. This is a route that builds a health system that is impersonal, anonymous, and ironically, creates more serious illness.
*Deputy Editor’s note – see also: Hoban B. One Big Thing. Br J Gen Pract. 2024 Mar 27;74(741):172. DOI: 10.3399/bjgp24X736881
Featured photo by Brittany Colette on Unsplash
