Ben Hoban is a GP in Exeter.
Progress, we are told, is inevitable, although how meaningful that is really depends on what we understand by progress. If we cannot agree that it is always a good thing, for example, then we are really just saying that life changes, whether we like it or not, and that it tends to move in a particular direction.
It is usual to refer to our current era as the Information Age, and natural to think of its fruits – the internet, social media, and artificial intelligence – as something new. In the strict sense, this is accurate. Viewed more loosely, though, these innovations have ancient origins; they represent the steady march of progress along a straight and dusty road over millennia. Our remote ancestors could manufacture tools with which to hunt, prepare food, and make fire, but they originated a far more advanced technology when they started to speak. We take it for granted that language is simply a means of communication, but it is first a system for breaking down a vast and seamless reality into parts which we and others can recognise. We encode our unique experience as a series of generic vocal and gestural symbols which someone else can decode to recreate the experience in their mind; words are tools of thought.1
Each new advance has enabled us to travel further down the road, but without necessarily knowing what waits for us at its end.
If spoken language was the original information technology, there was clearly a limit to how much content it could support. The development of writing did away with this limit and allowed remote and non-contemporaneous communication. In theory this also offered seemingly infinite data storage and retrieval, although its adoption was held back by practical difficulties. These were eventually overcome by the invention of printing presses using movable type and phonetic alphabets, making it possible to mass-produce written texts at low cost and with little lead-time, and promoting a growth in literacy which in turn fuelled demand for new kinds of writing. Today virtually anyone can produce and consume publicly available content online; indeed, there is so much of it that we depend on search engines to find anything at all and still have to decide for ourselves what to make of it. Our current information revolution therefore simply represents the latest turn of a wheel that has been in motion for a very long time already. Its progress is marked on one hand by the ever-greater accumulation and availability of human knowledge, and on the other, by a corresponding loss of overview. Collectively, we know much more than we used to, but what any individual can hold in their mind has become proportionally smaller, and we often struggle to make sense of it. Our progress has led to a system of knowledge which is universally applicable but therefore also context-free and increasingly specialised.2 Each new advance has enabled us to travel further down the road, but without necessarily knowing what waits for us at its end.
We can apply the same perspective to the way we look after our health: our ancestors first had to deal with predators and prey, then with infections and malnutrition, and now we grapple with the various diseases of modern life. If we fight our way through enough of these stages, will we eventually have become healthy, or is the truth rather that the means we use to overcome one problem simply expose us to others, and that the road has no end? The idea of progress is appealing in that it gives us both a clear direction of travel and a sense of purpose, but it seems inevitable that the pursuit of either knowledge or health can never lead us to a point at which we willingly stop pursuing more: progress becomes an end in itself rather than the means of reaching a worthwhile goal.3 In healthcare it is sometimes difficult to escape the impression that we are more interested in conquering disease than caring for patients; we certainly cannot assume that they are the same.
Progress clearly has its benefits, although the western interest in cultures that have travelled less far from their roots is telling. By default, we value whatever is quick, easy, and makes life longer and more comfortable, but a part of us also longs for something different. Many traditional societies seem to have a greater sense of coherence, arising from a way of life that does not seek to overcome the limits imposed on it, but instead to adapt to them. Their knowledge base is necessarily more limited than ours, but it is also more contextual, defined by the requirements of community, place, and season rather than an endless striving for more; it is in this sense generalist knowledge.4
General practice has long upheld a generalist approach to healthcare which puts a premium on “…the warm, flexible, human-scale world of talk where we can see each other’s distress, respond to it, feel empathy with one another.”5 It is becoming more difficult not just to keep doing this but to demonstrate that it is even worth doing: given the option of seeing an anonymous specialist whenever they wanted, how many patients would still choose to see their GP, assuming they knew who that was?6 General practice, like home in Robert Frost’s poem, is becoming the place where, “When you have to go there, they have to take you in.”7 It is not a cheery picture, but perhaps there are other sorts of homecoming too.
Progress clearly has its benefits, although the western interest in cultures that have travelled less far from their roots is telling.
I have been a doctor at the same practice since 2001, although the photo on my NHS smart-card, taken shortly after I arrived, is barely recognisable: I shed the tie long ago during one particularly hot summer; the glasses are now varifocal; the hair is greyer. I know that I have changed professionally too, no longer the flat-pack doctor boxed up at medical school and assembled on the wards of the hospital around the corner, but a more bespoke bit of furniture, well-suited to its place in the living room, and finished over the years with a patina of spilled coffee and tears. I think that I would find it difficult to work somewhere else now, not just because I am a creature of habit, but because I have learned to fit in where I am. I know how to help someone appeal their Personal Independence Payment decision; I can say no to inappropriate requests without needing to say no; the local dialect of that language of unhappiness familiar to all patients no longer sounds jarring in my ears or on my lips. Even in dealing with the demands of general practice that are universal, I have been calibrated through experience to function optimally when looking after this population rather than another. People where I work are generally appreciative of the service, sometimes even protective of it when GPs are in the firing line yet again, and they use it well. “You don’t shit on your own doorstep, do you?” as one of them put it to me recently.
Change is certainly inevitable, although there are different kinds. The drift of continents, the cycling of the seasons, and the scuffing of a new pair of shoes are all inherent, part of the natural way of things. Progress is different, though, a deliberate and self-reinforcing movement, always in the same direction. Progress has given us antibiotics, MRI scanners, and AI applications capable of designing new wonder-drugs. In the context of general practice, it has also meant the loss of personal knowledge, caring relationships, and the capacity to tolerate ambiguity and hold risk. How can we know which of these things are more important? It may come down to choosing rather than knowing: a weary trudging down an endless road until our strength runs out; or an open door set back from the path where we can rest awhile and decide where we want to go tomorrow.
References
1. The Shape of Things Unseen: A New Science of Imagination, Adam Zeman, Bloomsbury, 2025
2. The Weirdest People in the World: How the West Became Psychologically Peculiar and Particularly Prosperous, Joseph Henrich, Penguin, 2021
3. Small is Beautiful: A Study of Economics as if People Mattered, Eric Schumacher, first published by Blond & Briggs Ltd, 1973
4. The World Until Yesterday: What Can We Learn From Traditional Societies? Jared Diamond, Penguin, 2013
5. Don’t Burn Anyone at the Stake Today (and other lessons from history about living through an information crisis), Naomi Alderman, Penguin, 2026
6. Patrick Burch, Stephen Iles, Aaron Poppleton, Kath Checkland and Sarah Skyrme, What do patients and clinicians think about continuity in general practice in England? a qualitative study, British Journal of General Practice 2026; 76 (764): e223-e233. doi.org/10.3399/BJGP.2025.0323
7. The Death of the Hired Man, included in the collection North of Boston, Robert Frost, first published by David Nutt, 1914
Featured Photo by freestocks on Unsplash
