Haslam's view: 'But I always like to see you, doctor...'
Like an increasing number of family doctors, I work part time.
For at least a couple of decades I was a traditional full-time GP, but as I developed special interests of one sort or another, my time in the practice gradually reduced. For me, this has been a good thing. There is plenty of evidence that doctors who do not work full time are less likely to burn out, and developing a series of career interests is almost certainly revitalising.
But, and it's a massive ‘but', this does pose real challenges for the delivery of general practice. As a patient, I prefer to see a doctor whom I know and trust. The more part time more of us are, the harder it is to build up relationships and for the mutual trust to grow.
If this was an exam paper that I were writing, at this stage I would simply insert the single word instruction ‘Discuss'. There's certainly a lot to discuss, but instead I'll tell you a story about a patient I once saw.
She had been my patient for more than 25 years. A pillar of the local community, happily married with two near-adult children. Her first words in the consultation were words that I have heard so often that I should have them hanging on my wall as a framed poster. ‘Getting to see you is harder than getting to see the Pope.' I don't know quite why the comparator for access is always His Holiness, but the point is well made.
I apologised, as I always do. I said that I was sure she realised that I am now very part time, and I reminded her that we have a health centre full of excellent doctors whom she could have chosen to see instead.
‘But I always like to see you, doctor,' she said. And with that she rolled her sleeve up, and told me she had come to have her blood pressure taken.
I suspect that at this point my blood pressure was beginning to rise too. I hope I was polite as I reminded her that not only had she not needed to see me for such a task, but she didn't actually need to see a doctor at all.
She was silent. I told her what her blood pressure was. She rolled her sleeve down. She sat there unmoving. Silent.
‘Go on,' I said gently. ‘What is it?'
She took a deep breath, and started to tell me about her secret double life as a prostitute, and that she was terrified that her husband was on the verge of finding out. She felt that her life was falling apart, that she had no-one in the whole world she could talk to about this, apart from me. And now did I understand why she needed to see me, and not any of the other doctors or nurses or automatic sphygmomanometers that could have dealt with the unimportant fraction of the consultation.
But, she was right. I totally understood why she wanted to share this with someone she knew and felt safe with. As we develop ever more ingenious ways to deliver general practice, will we still have a system that allows patients and doctors to develop a long-term relationship, in which trust is paramount?
Professor David Haslam CBE
GP, Ramsey, Cambridgeshire; President, Royal College of General Practitioners; national clinical adviser to the Healthcare Commission; and Visiting Professor at de Montfort University, Leicester
Will we still have a system that allows patients and doctors to develop a long-term relationship, in which trust is paramount?Haslam's view