Johanna Reilly is a first 5 GP, academic fellow at Edinburgh University and Wise GP intern. She is on Twitter: @JohannaSurgeon
Professor Joanne Reeve founded the Wise GP project and Annabelle Machin and Emily Lyness are current Wise GP interns.
The European definition of family medicine states that “GP/ family medicine is an academic and scientific discipline, with its own educational content, research, evidence base and clinical activity, and a clinical specialty orientated to primary care”.
The complexity of general practice consultations is well documented but is not always obvious to outsiders.
We know that as General Practitioners (GPs) we are expert medical generalists, but do we always feel like experts at heart? The complexity of general practice consultations is well documented but is not always obvious to outsiders.1 The media representation of general practice is often negative, focusing on what GPs haven’t done or occasions when GPs have failed to make an important diagnosis.
We know many medical students see this, and this causes problems with GP recruitment and retention. Along with perceptions of heavy workload there is also a feeling that general practice is not intellectually challenging.2 This can be shared at times by hospital colleagues, the general public and even GPs themselves – witness the phrase “just a GP”.
Perhaps we know some of the answers to this ourselves. There is an ideal of the doctor as a hero, using technological know-how and extensive knowledge to find a diagnosis of a rare disease and treatment that will cure the patient and send them on their way to live happily ever after.3 The hero doctor eschews bedside manner in favour of competency but the patients are so happy to be cured they don’t mind.
Of course we know this is a myth, many conditions are chronic, many symptoms patients present with do not have a diagnosable cause.4 Although the lay public might be attracted to the idea of the hero doctor, patients who are actually attending for medical care want compassion and empathy most of all.5 Nonetheless the image of the GP sits uneasily alongside the image of high tech, cure all modern medicine. Following up patients over a long period of time, developing a human relationship and a shared understanding of care and illness. Making small changes, reviewing the effect and if necessary revising the plan. This can help people live better quality lives but it is not the stuff of drama and therefore is perhaps undervalued.
GPs shouldn’t need to be on an “academic track” to contribute to scholarship in general practice.
Perhaps this perception of primary care as unexciting and unchallenging also relates to the sometimes low profile of primary care research. There is a vibrant academic GP community, but is this always obvious to medical students and junior GPs? When spending a year doing an academic fellowship as a newly qualified GP I was surprised to find that not just non-medical friends but also qualified doctors and even a few newly post completion of training GPs had no idea that general practice had an academic element, or even what academic GPs were doing. GP training is short compared to other specialities and by necessity focuses on the day-to-day management of patients. There is a perceived lack of time available for trainees not on an academic track to get involved.
It is our assertion that GPs shouldn’t need to be on an “academic track” to contribute to scholarship in general practice. A casual look at social media for primary care clinicians shows lots of doctors who are thinking deeply about what they do and the reasons behind it. As highlighted at a recent RCGP conference workshop, every patient interaction is an example of clinical scholarship in action.6 We think there is a need for more conversation about the difficult “knowledge work” that GPs undertake and discussion about the paradigms that underly much of our day to day work that includes the people who actually do the work, day in and day out.
Recent research has shown the importance of GP gut feelings in making serious diagnoses, and the importance of continuity of care.7 Research like this can showcase the knowledge work of general practice.8 But we know there are many more human elements of care that can be under-documented and undervalued.
The Wise GP website aims to provide a set of resources that can be used by GPs, GP trainees, medical students and the general public that show the complexity in general practice and some of what GP scholarship involves.
If academic research is to really improve primary care, the research community must be integrated and accessible to grass roots GPs, and GPs must be able to know who to contact if they have an idea or want to know more about a particular topic. We are currently updating and promoting the website and hope it can become a useful resources for understanding, linking and promoting GP scholarship. If you have an idea or a comment – please get in touch!
References
- Salisbury, C; Procter, S; Stewart, K; Bowen, L; Purdy, S; Ridd, M; Valderas, J; Blakeman, T; Reeves, David. The content of general practice consultations: cross-sectional study based on video-recordings. British Journal of General Practice, Vol. 63, No. 616, 2013, p. e751-e759.
- Reid K, Alberti H. Medical students’ perceptions of general practice as a career; a phenomenological study using socialisation theory. Educ Prim Care. 2018 Jul;29(4):208-214. doi: 10.1080/14739879.2018.1460868. Epub 2018 Apr 23
- Strauman EC, Goodier BC. The doctor(s) in house: an analysis of the evolution of the television doctor-hero. J Med Humanit. 2011 Mar;32(1):31-46. doi: 10.1007/s10912-010-9124-2..
- Natalie Steinbrecher, Stephanie Koerber, Dirk Frieser, Wolfgang Hiller,The Prevalence of Medically Unexplained Symptoms in Primary Care, Psychosomatics, Volume 52, Issue 3, 2011, https://doi.org/10.1016/j.psym.2011.01.007.
- Murphy, M., & Salisbury, C. Relational continuity and patients’ perception of GP trust and respect: a qualitative study. British Journal of General Practice, 2020 70(698), E676–E683. https://doi.org/10.3399/bjgp20X712349
- Revitalising general practice: unleashing our inner scholar. Reeve J, Firth A. British Journal of General Practice 2017; 67 (659): 266. DOI: https://doi.org/10.3399/bjgp17X691145
- Friedemann Smith, C., Drew, S., Ziebland, S., & Nicholson, B. D. (2020). Understanding the role of GPs’ gut feelings in diagnosing cancer in primary care: a systematic review and meta-analysis of existing evidence. British Journal of General Practice, 70(698), E612–E621. https://doi.org/10.3399/bjgp20X712301
- Wise GP Website. https://www.wisegp.co.uk/are-you-a-gp-or-gpst
Featured photo by Vincent Ledvina on Unsplash
