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Stop med school GP 'banter' to boost recruitment, says RCGP

The RCGP and Royal College of Psychiatrists have teamed up to call for an end to stigmatising ‘banter’ in medical schools, which they claim is contributing to the shortfall of GPs and psychiatrists and stifling efforts to put mental and physical health on a par.

College chiefs Professor Maureen Baker and Professor Sir Simon Wessely warned the ‘systematic denigration’ of general practice and psychiatry is putting medical students off these specialties - and said all doctors should take a stand against it.

It comes as latest figures revealed only 100 extra GPs have joined the workforce over the past six months, despite Government aims to boost recruitment and retention of GPs, and the RCGP’s own efforts to raise the profile of general practice amongst students.

In an editorial published today in the British Journal of General Practice, Professor Baker and Sir Simon noted that recent research has shown general practice and psychiatry are the most derided specialties during medical school training, and that medical students are rejecting careers in each ‘because of the stigma attached to them’.

They said a 'hierarchy' that has developed across all medical schools ‘puts physical health over mental health, hospital care over community care, specialism over generalism, and "medical" specialties over "non-medical” ones’.

This also ‘perpetuates the view that hospital-based specialties offer more excitement, clinical challenge, and prestige’ than general practice, which is seen as a ‘back-up’ option, the College leaders argued.

And they warned the stigma around psychiatry – including throwaway comments referring to psychiatrists as ’pest controllers' – is hampering the drive to achieve parity of esteem between physical and mental health.

The editorial concluded: ‘The systematic denigration we are seeing in medical schools is founded on misperceptions that maintain a negative impression of both general practice and psychiatry, and a lack of respect for the importance of these specialties.

‘It is exacerbating a shortage of GPs and psychiatrists in the NHS, and directly contravenes efforts to achieve parity of esteem between physical and mental health, causing a negative impact on patient care.’

The RCPsych is already pushing a #banthebash campaign, to ‘address Badmouthing, Attitudes, and Stigmatising in Healthcare’, and Pulse understands the RCGP is in the process of developing a GP version of the campaign, with the help of members and medical students.

But Professor Baker and Sir Simon insisted their campaigns are not about ‘prohibition of banter’ but about ‘fostering respect between specialties and an understanding that the NHS is predicated on having sufficient numbers of all medical specialties, so that we can keep patients safe and well'.

Professor Baker, who has consistently complained about medical schools’ ‘toxic anti-GP culture’ during her time as chair, said it was ‘depressing’ how little attitudes had changed.

In a separate comment, she said it was ‘very concerning’ that ‘this “banter” is yet another barrier we are up against when trying to recruit enough GPs to ensure a safe and robust service for the future of patient care’.

She added: ‘It has to stop. The College is doing what we can to challenge misplaced and archaic stereotypes, and our Think GP campaign aims to show what a fantastic career choice general practice can be – but it’s clear that more needs to be done from within medical schools, and medicine as a whole.'

Br J Gen Pr 2016; available online 29 September

How medical school ‘banter’ is putting medical students off general practice

Professor Baker has previously raised the College’s concerns about the ‘toxic anti-GP’ culture with medical school leaders, and called on them to each individually tackle what she called ‘blatant bigotry’ against general practice.

But evidence of prejudice against general practice has continued to surface, with one medical school dean telling students they 'must work hard to avoid failing and becoming GPs'.

More recently the head of the RCGP in Wales claimed junior doctors were too scared to tell trainers they intended to go into general practice in case they were barred from experience on secondary care procedures or clinics, with NHS England primary care commissioning chief Dr David Geddes acknowledging the stigma around general practice.

NHS England chief Simon Stevens has also waded into the argument, accusing Oxford and Cambridge Universities of failing to promote general practice to medical students. GMC research from last year found that 'elite' universities are shunning general practice.   

 

Readers' comments (51)

  • Vinci Ho

    (1) First of all , frozen ice deep down to three feet is not down to one day cold ,as Chinese said. And more importantly , ' Every matter has its origin and ramification(s).Every incident has its beginning and its end . One can only find ''the right path'' if one really understands the sequence of order.' Book of Great Learning.
    (2) If a restaurant has good food and services , the reputation will grow despite people so called deliberately spread denigrating , derogatory remarks. Then the opposite of this also applies. The banters as well as 'negative comments' are reactions and 'consequences' . One must always go back to the 'origin' and start challenge the hierarchy with real questions about why we are where we are.
    (3) Sadly , one must recognise that MB was making joint statements with Simon . The arrow would never be pointed towards the government and the SOS. An establishment will always tend to defend another establishment for ' common interests'.
    (4) The comments on this platform are valuable . As we concluded , not long ago , that annonymous or not , they represent and respect freedom of speech as well as freedom from fear. Of course , pro-government protagonists can always blame us for so called negativity destroying the 'good work' of attracting and retaining GPs. But we are only the consequences of the origin. People will naturally stay and come if the 'origin' is properly repaired instead of sticking plasters on the surface . The old fashioned 'take this and it will work' is insulting intelligence. We should understand far better than anyone else for our training in the art of consultation with our patients.
    (5) By the way , what was a Man United fan doing in Liverpool? The big match is not due until two weeks time.

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  • Vinci Ho

    And if you read the interview with Dr Iona Health , foemer RCGP president , she shed some light about the 'origin':
    ''Jeremy Hunt has such bizarre ideas. I don’t think he’s a stupid man but he’s made no attempt to understand the nature of healthcare, and at the same time he’s alienated a whole generation of doctors. He has a fiduciary responsibility to NHS staff to support their morale, to look after them, but I think he behaves in exactly the opposite way. I don’t see how that’s forgivable.''
    This cannot be just 'negative' comment

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  • Vinci Ho

    And as a scholar , she at least showed the integrity and resoluteness to stand up against the government and its SOS rather than dancing with the politicians/bureaucrats :
    ''There is no evidence health checks make any difference to the population’s health. People have found this hard to believe so there have been repeated trials that don’t show anything. And then there is the hypocrisy of it all. One of the low points of my virtual relationship with health secretary Jeremy Hunt was when he wrote to GPs saying it was time they tackled health inequalities, just as the Government was introducing the bedroom tax and slashing benefits, which we know harms the health of the poorest and most vulnerable. So their policies make people sicker and they expect the health service to sort it out. It’s outrageous; you cannot sort out health inequalities against a background of worsening socioeconomic inequalities.''
    Personally , I think we have a duty of candour to oversee that the politicians are not harming people's lives and health . This may not be everybody's cup of tea in choosing a career. If the strategy is to throw as many negatives as possible . So be it........
    Those with no virtues sitting in high positions in the hierarchy spread evils through the most......

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  • Ivan, positivity is a good thing and probably that's kept most of our colleagues going till now.
    However, what great rewards are you talking of ? The only great reward for most is that they are doing what they are passionate about, the rewards are going to some selected few living in perfect harmony with the establishment. Maybe you could explain why the more patients I take the greater is the discrepancy in weighted list size.
    At least, I'm glad you are sleeping well.

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  • Ivan, positivity is a good thing and probably that's kept most of our colleagues going till now.
    However, what great rewards are you talking of ? The only great reward for most is that they are doing what they are passionate about, the rewards are going to some selected few living in perfect harmony with the establishment. Maybe you could explain why the more patients I take the greater is the discrepancy in weighted list size.
    At least, I'm glad you are sleeping well.

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  • Much to the chagrin of Dr Ivan Bennett I will make this post anonymous.

    I'm sure most will recognise that banter, by virtue of it having a smidgeon of truth within it, can serve as a source of mirth when exaggerated. Speaking from the position of someone who has worked as a medical registrar some years ago, and commenting on medicine and not psychiatry, it is clear to me that, as unpalatable as it may be to hear on a forum such as this, the scorn poured upon GPs is somewhat deserved when their superficial and shoddy practise is considered dispassionately and with a degree of objectivity. Moreover, a Royal College which incorporates actors instead of patients with proper clinical signs as part of its Membership exam cannot really be regarded as robust, or indicative of clinical excellence or acumen. GPs are not academically inferior to their specialist counterparts but are undoubtedly lacking in the skills which allow the fullest extraction of relevant information from a clinical scenario whilst displaying a tendency to be self-congratulatory on their prowess in considering vague concepts such as ideas and expectations in 10 minute slots.This may be quite harsh but the phrase pertaining to the one-eyed man being king when in the land of the blind springs to mind.

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  • Much to the chagrin of Dr Ivan Bennett I will make this post anonymous.

    I'm sure most will recognise that banter, by virtue of it having a smidgeon of truth within it, can serve as a source of mirth when exaggerated. Speaking from the position of someone who has worked as a medical registrar some years ago, and commenting on medicine and not psychiatry, it is clear to me that, as unpalatable as it may be to hear on a forum such as this, the scorn poured upon GPs is somewhat deserved when their superficial and shoddy practise is considered dispassionately and with a degree of objectivity. Moreover, a Royal College which incorporates actors instead of patients with proper clinical signs as part of its Membership exam cannot really be regarded as robust, or indicative of clinical excellence or acumen. GPs are not academically inferior to their specialist counterparts but are undoubtedly lacking in the skills which allow the fullest extraction of relevant information from a clinical scenario whilst displaying a tendency to be self-congratulatory on their prowess in considering vague concepts such as ideas and expectations in 10 minute slots.This may be quite harsh but the phrase pertaining to the one-eyed man being king when in the land of the blind springs to mind.

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  • Good god, sir... I was thrashed at my public school every night of the week, except Sunday, and it made me the person that I am.
    This hierarchical banter stuff is good for the morale of the lower orders and keeps them from getting opinions and aspirations above their place in society. Without those methods of control we'll be having comprehensive school trash doing OUR jobs.
    And women with Birmingham accents infesting the wards and operating theatres pretending to be surgeons when they should be home carving the Sunday roast.

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  • Why stop the banter?
    When the med students come to a GP clinic and see it in action they know what work goes on here and they are in AWE. The profession needs to take this as a positive and a source of motivation.

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  • 8.48 - not thrashed on Sundays? Clearly a minor public school then.

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