Wisdom of a wise GP

Rabia Aftab ia a  GP and Palliative care lead in North Lincolnshire

All doctors, including general practitioners (GPs), are usually perceived as individuals with gifted intellect. This is perhaps due to the strict criteria for entry into medical school followed by long duration of training and various assessments and examinations. Their academic ability is therefore equated with wisdom.

Is being wise the same as being highly academically able?

If that is not the case, then who exactly amongst us, is a ‘wise’ GP?

The concept of a ‘wise’ GP was alien to me until I enrolled onto the Catalyst programme- a unique career development programme designed to improve skills and confidence, particularly of new GPs across Humber, Coast, & Vale.¹ During the programme, Catalyst delegates (myself being one) were introduced to many interesting themes such as whole person medicine, Bananarama principle, de-escalating too much medicine etc. We were also made aware of the existence of ‘WiseGP’ which is a joint initiative between the Society of Academic Primary Care, and the Royal College of General Practitioners (RCGP). This supportive platform is aimed at everyone involved in delivering primary healthcare and patients who use it.²

Among these concepts, that of ‘Goldilocks medicine’ has fascinated me the most: a principle based around getting care ‘just right’ for our patients, not too much, not too little.³ In my opinion, a wise GP’s practice is based around this very principle of Goldilocks medicine: This is where the GP seeks to find possible ways of managing their patient’s problem, is mindful of their clinical safety, makes the best possible use of the limited resources available, utilises well the expertise of their wider team and yet does not let the burden of their job affect their own wellbeing. This may sound like a fairy tale but the more I ponder and contemplate this concept, the more it makes sense. A wise GP is an expert in general practice, who silently observes his/ her surroundings (including patients of course) and has an ability to adapt with the rapidly changing health system and bureaucracies. Let me share my reflection on the ‘just right’ strategies of a wise GP:

Talking just right– A wise GP will allow ample time for his/her patients to share their story and their concern and will repeatedly find that this active, attentive, and uninterrupted listening will not only passively reveal a lot of vital clinical information but also the patient’s expectations. This will generally leave very little active questions for example enquiries into red flag symptoms.

Explaining just right- Following the assessment, a wise GP will give their honest impression of the problem (diagnosis in many cases) including the rationale behind their thought process. They will recognise that although they are consultants in general practice, it is human to have gaps in knowledge, own limitations, and therefore they will not shy away from seeking expert advice if required. They will acknowledge that while some complex/ chronic problems are impossible to fully resolve, others may have no precise answers or explanations. This kind of a GP will appropriately share this personal frustration arising from uncertainty with their patients and this natural empathy will not only earn their patient’s trust but also strengthen the doctor-patient relationship.

Investigating just right– Another trait of a wise GP is insight into relevance of meaningful investigations whilst utilising the minimum available resources. When arranging investigations, a wise GP will only order the most pertinent tests, bearing in mind not only the cost of needless investigations but also the burden and consequences of incidentalomas (incidental discovery of an otherwise benign lesion that causes both patient and clinician worry). No over diagnosis, no under diagnosis.

Risk taking just right– A wise GP will very carefully assess risks and benefits to a patient. He/ she will not only transparently discuss these with their patient but also seek prompt help from other colleagues/ services where necessary. They will wisely arrange a timely follow up and ensure this information is well received by their patient. They will also be distinct in their safety netting advice and ensure that it is unambiguous, easy to understand, and documented clearly.

Working just right– Efficient teamworking is also a quality of a wise GP. They will recognise the unique skills of each member of their multidisciplinary team and understand that their patient care is highly dependent upon this very team work. Whilst appreciating the roles of other staff members, they will allocate tasks appropriately. This will consequently mean a GP who is less exhausted and less overwhelmed and can focus more on the quality of care delivered to their patients.

Mentally just right– A wise GP will be empathetic, sensitive and deeply involved in their patient’s care. Nevertheless, they will also be mindful of their professional boundaries. They will make use of appropriate and safe hand over methods and make a conscious effort to leave work-related issues behind at the end of their work day to enable a good work-life balance. A wise GP will have a hobby or activity that he/ she will make time for to relax and unwind for their mental wellbeing.

Wise GPs certainly have many more admirable characteristics and I hope to continue exploring these through my second year of the Catalyst programme. What I do know, now, is that GPs may be naturally intelligent but wisdom to survive and thrive in our job is a learnt skill. 

Note: I submit this article on 25^th March 2020, Catalyst Celebration Day, marking the end of year one of this amazing, fantastic and inspiring programme. I would like to share my appreciation and gratitude for the pioneers and organisers of the Catalyst team and hope for this programme’s national growth.

References

1. About the CATALYST programme (Hull York Medical School). Available at:https://www.hyms.ac.uk/research/research-centres-and-groups/academy-of-primary-care/catalyst
2. Available at: https://www.wisegp.co.uk/about
3. Reeve, J (2010). Hull York Medical School. Available at: https://www.valeofyorkccg.nhs.uk/seecmsfile/?id=3170

Featured image by James Lee on Unsplash