Healthcare charities and the uselessness of GPs (again)

..and so, again and again, that GPs are in some way ‘undertrained’. We aren’t specialists – we are generalists. It’s a different job, with different skills. But it’s a myth to repeat that just because a GPs doesn’t have specialist training somehow means that the doctor is incompetent or lacking in training. GP training consists of an undergraduate career, a year as a preregistration doctor, and typically two years of further house jobs before another year as a GP trainee. There are exams from the RCGP and then a postgraduate career where one is responsible for a lifelong commitment to continuing education, and annual appraisal when this is discussed. If you are useless, incapable of learning, or unable to spot your deficiencies, your trainer will see your videos, read your notes, meet your patients and find out. As a GP trainee, you may have done jobs in psychiatry, paediatrics, gastroenterology and obstetrics. You may not have done a job in geriatrics or in rhematology. If one spent time in every possible hospital based speciality before reaching a GP training post they would be very old by the time they emerged. The GP trainee year is used to learn about medicine as it presents in general practice, and this is different to hospital medicine.

So when I qualify as a GP, I haven’t just received ‘six days’ training in dermatology – my training in dermatology has been something different, a professional development which continues. What was recommended fifteen years ago is not quite the same today. I’ve a duty to keep up.

It’s incredibly irritating to have single issue pressure groups constantly insisting that ‘they’ are the Cinderella service (something the BMJ has previously found to be a description many specialities believe that they own). I’d like to know what ‘awareness’ charities for psoriasis have about heart failure, what heart failure charities know about brain tumours, what brain tumour charities know about cervical cancer and what those charities in turn know about learning disability. Not much, I’d wager; what we have is a competition for your attention and your wallet. Naturally, it’s very unusual for a health charity to want to play down it’s importance.

The thing is, that GPs are in the unusual position of seeing people who are people first and who are not defined by their disease. Health charities are only interested in ‘their’ disease. They are biased, for right or wrong. Charities may or may not do useful things, and may or may not help patients or do decent research. But they are biased, and I think healthcare charities can be no longer to be assumed as good thing. I think they need as much scrutiny as, for example, the pharmaceutical industry.

6 Responses to “Healthcare charities and the uselessness of GPs (again)”

  1. Alison Finney November 22, 2010 at 2:25 pm #

    I think it’s safe to assume that bias exists in all organisations and therefore a healthy dose of scepticism is the best prescription when dealing with most claims.

    In my experience as a patient with a chronic disease, the best GPs are the ones who recognise they are generalists, know their limitations and act within them. I’m currently with a training practice and like to see the trainee GPs because they’re not afraid to admit when they don’t know something and seek help. The damage is done by those who pretend or assume to know more than they do, which is a sadly quite common occurrence. In the last 10 years I’ve had 7 GPs due to house moves etc. Four of them didn’t have sufficient knowledge of my condition to offer the unfounded and incorrect advice that they did. The other 3 recognised their limits, admitted when they were out of their depth and referred on – that’s the real skill I respect in a GP.

  2. Peter Bray November 23, 2010 at 2:05 pm #

    General practitioners (GPs) are expected to know a lot more than they can possibly manage. 100 years ago the amount of knowledge was so much less than today yet doctors then did not know everything. Today it would be asking the impossible to expect every doctor to recognise, know, understand and provide the essential treatment/direction for every disease. That is why we have specialists.

    However, I have found that older doctors have a tendency to stick with what they have always relied upon and thereby miss the better option. They do, of course, face pressure from reps to use a new remedy or aid. Perhaps there should be a simple source for them to get unbiased opinion instead of either accepting or dismissing the reps ‘new/best whatever’.

  3. Margaret McCartney
    margaretmccartney November 26, 2010 at 2:15 pm #

    well…
    one of the problems is that there are so many barriers to getting expert help when it’s needed. Even the simple idea that a GP might want to phone a consultant for advice is not a recognised need in most of the NHS. It’s something I like to do quite a lot: as a generalist I need that back up. But have a look at some of the ‘referral pathways’ that GPs have to contend with – the object of most of them seems to be to try and avoid a referral. It’s backwards, but it is also seen as ‘good management’.

    As for unbiased sources of info, there are many. Reps don’t provide unbiased information, one of the reasons I don’t see them.

  4. M. Williams November 27, 2010 at 6:37 am #

    Excellent note. The generalist is essential!

  5. I Whitbread November 29, 2010 at 3:18 am #

    An excellent note..it highlights the difference between the expectations of client (patients) and those of some General Practitioners.
    I see GPs as specialists in General Practice who need to be supported by an infrastructure that enables them to perform to that level. By this I mean relative information that is provided in a targetted and effective manner..
    With the increased knowledge base things like Electronic Performance Support Systems (EPSS) have a valuable role to play to improve the efficacy of the GP and the satisfaction of the client.
    Sadly there are perceived and actual gaps as rightly the learning load of a GP to remain “current” can be unrealistically high given the client facing hours, administrative work and only a reasonable salary for the value of their work.
    Without tools such as EPSS the only other practical way to spread the learning and experience load is to work in large practices where the accumulated specialist GP knowledge can be shared and accessed of the member GPs.
    Keep up the good work…it is appreciated…but from one who’s expectations were seriously compromised… please seriously support better ways of extending your collective knowledge for the benefit of those who rely upon you and for your collective selves.

  6. chelle December 12, 2010 at 11:40 am #

    most of the GPs at my surgery lack interest and their training is outdated, their listening skills are very poor and seem to think they know it all. they don’t seem to think patients should have a say in their own health care. I find trainee GPs to be much more professional and kinder, they listen more and actually spend more time with you to assess your condition. their training is more modern and it’s a bonus since healthcare is moving on. their is one really fantastic trainee GP at my surgery she spends quite a bit of time to get to know you and puts you at ease at least she doesn’t rush you out in 2 minutes. I hope this GP is employed eventually in the healthcare field as she will make an excellent doctor. more than i can say for some of the fully qualified GPs i have met before

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