Category: Opinion

The Citadel, a 1937 novel by A. J. Cronin, explores the themes of social and health inequalities, drawing from his personal experiences working as a doctor in Britain’s pre-NHS era. The protagonist, newly qualified and virtuous Dr Andrew Manson, begins his medical career in a small Welsh mining town and observes first-hand the close marriage between social inequalities and health inequalities.

Who would have wanted to be a lead clinician in Public Health England at the start of the pandemic? Judith Dawson finds that trying to balance the population losses against individual and economic loss is an impossible job. But in a typical government response to unpalatable results we find ourselves being reorganised at the worst possible moment.

The primary care workforce has been right at the heart of the response to COVID-19, working hard in new and rapidly changing circumstances to ensure patient care continues to be provided to all those who need it in the community.

General practice is well-positioned to identify and intervene in the wider determinants of health. Many of the ingredients are already in place: registered patient lists, extensive data, and the ability to engage both proactively and opportunistically with patients. But primary care’s responsibilities lie with their registered patients, rather than a geographical area.

Judith Dawson reflects on the draft NICE guidelines for the management of chronic primary pain. There is widespread use of ineffective and addictive pain medication of questionable benefit. However, implementing any change will depend on a cohesive approach across primary and secondary care clinicians of all levels and a re-education of public expectations.

Despite ‘seeing’ more patients remotely, we are becoming more isolated, living our lives in lonely clinics and solitary consultations. The art of medicine becomes abstract, doctors and patients united in their separation.

Under the Prevent policy, NHS Trust staff are trained to spot signs of radicalisation and refer cases to the government. Within a systemically racist social system this policy succeeds only in targeting minority groups and those who are most vulnerable. The abolishment of this policy must be sought; GPs must begin to speak out.

Ed Warren is a retired GP. He notes that a feature of getting older is that you have more opinions and are convinced that others want to hear them. He reflects on the ageing process, cognitive biases, coming to terms with his “own journey into dotage and oblivion”.

The opportunities to treat more and more patients in less and less time is the unspoken aim of the improving of technology. But as we move into this future, we must continue to courageously ask both ourselves and our employers; is this really doctoring and who is really benefitting?

The Cumberledge report puts forward the case for radical reform. Dealing with those who have by our actions sustained loss and pain, even as a recognised complication of a necessary procedure, can be exceptionally challenging. It is important to be able to identify and recognise the feelings that we experience in response to this scenario in order to be able to cope with them and avoid transference to the patient.