Haslam's view: Different locations, same consultations
It was five minutes to seven in the evening. I was standing at the door of a local health centre, talking to one of the GPs, when a young mother scuttled past, hand in hand with her child.
The child was whimpering quietly and holding his ear. The scene could not have been more typical of general practice, and the diagnosis could not have been more straightforward: Read code F52z – acute otitis media.
Except that this occurred many hundreds of miles away from any computer that featured a single Read code. I was standing on the doorstep of a health centre in the south of Kosovo, just a few miles from the Albanian border.
There is something extraordinarily international about everyday general practice, and that is something that I find curiously heartwarming.
A few years ago I was sitting in a surgery in Kuwait, watching a consultation. I couldn't understand a word, but the body language of the mother and daughter could not have been clearer.
The 13-year-old daughter was sitting just behind her mother, and as mum gave a very worried history, complete with sidelong glances at her daughter, the daughter was rolling her eyes skyward and sighing. I could almost have laughed out loud; it was such a familiar sight in general practice.
In Hong Kong I asked a group of GPs what the biggest problem they faced was. They struggled with guidelines, keeping up to date and having too much to do in too little time.
In Namibia a doctor told me about patients who raise their main problem with the words 'while I'm here, doctor…'. The fact that his country had formed a health service completely from scratch when it gained independence was impressive, but it didn't protect the family doctors from all the joys that the rest of us face.
A group of doctors I met in Florida also struggled with guidelines, though they had a different attitude from most British GPs.
One said to me, with complete incredulity: ‘You mean there are doctors in the UK who don't follow guidelines to the letter? British lawyers must think they are in heaven.'
What's the relevance of all this to our day-to-day practice in the UK?
It seems to me that there is an essential core to general practice that seems to be a constant, whatever system you work in, and wherever you are working.
LP Hartley once said: ‘The past is a foreign country – they do things differently there', and put his finger on one of the all-time truths.
When I look back to the start of my career the important nuggets of the consultation haven't changed all that much, even if computers and QOF scores have replaced Lloyd George record envelopes and age-sex registers.
But sometimes foreign travel can be a real eye-opener. An embarrassed GP in Oman once apologised to me about the rather antiquated nature of the X-ray facilities in his community health centre – they were all of 10 years old, and no longer state of the art.
‘Yours must be quite different,' he said shamefacedly.
‘They are,' I replied. ‘We haven't got any at all.'
‘Why not?' he asked.
Good question. Travel certainly broadens the mind.Author
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