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A faulty production line

Haslam's view: The more things change...

One hundred and forty years. That's quite a birthday. Obviously, a huge amount has changed in the world of general practice over all that time.

In 1868 there were no computers (indeed, the first practical typewriter was only invented that year). There were no ballpoint pens, telephones, post-it notes, practice managers, patient participation groups, antibiotics or dictating machines.

There were no dishwashers, zippers or plasters. No one used insulin.

No one had heard of insulin. Colour photography had not been invented. The NHS was another 80 years away. It truly was another world.

Back in 1868, those family doctors who opened the first issue of The Practitioner struggled with diphtheria, cholera, tetanus and rheumatic fever. Infant mortality in many parts of the UK was about one in five. Life for many people was very hard, and the life of the doctor reflected this.

But what is quite extraordinary is the fact that family doctors are still so busy. Almost none of those conditions exist in our practices today, at least not to any significant, time-consuming degree. Doctors back then would have assumed that eradicating all those diseases would have given them the quietest of quiet lives.

Today the population has never been healthier. Indeed, life expectancy has improved by around three months for every year since that first issue of The Practitioner. One day it may be that a 140th birthday will be commonplace. Logically, there should be little for us to do.

But doctors still have more than enough work. Despite all the remarkable changes in healthcare, our patients remain worried sick about their health, their children's health and conditions that they hadn't heard of last year and will have forgotten next year. Our patients are living longer and longer and have every advantage known to mankind, yet our surgeries are still full. I am as busy in my morning surgeries now as I was thirty years ago. We certainly don't seem to be going out of business.

There are two clear reasons. For a start, it is obvious that expectations change all the time. What is normal in one decade is intolerable in another. But perhaps more importantly, the more complex the world becomes, the more people need the human touch. They need someone they can trust. They need continuity and to be cared for. That's what our predecessors offered, even though few of the drugs or treatments they had available had any scientific validity at all.

And that's what we must never lose. The details of general practice may change but the core values must continue.

My father was a Birmingham GP and died when I was young but I clearly remember going into his consulting room fifty years ago and seeing row upon row of issues of The Practitioner on his shelves. In those days, The Practitioner provided then, as now, a vital function. It's great to be part of history, but it's even more important that our specialty is just as vital in another 140 years.

Our patients deserve nothing less.


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

Back in 1868... life for many people was very hard,
and the life of the doctor reflected this

Haslam's view

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