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At the heart of general practice since 1960

The mods and punks of medicine

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He was a friend of mine. We sat in some of  the same classes, burnt custard in home economics, slumped sleeping in RE and slipped like cartoon characters on the muddy park because neither of us could afford football boots in PE.

He was a clever guy, good at maths. It was the days of music tribalism. At 16 I donned a fishtail Parker, he put on a sleeveless ‘UK Subs’ T-Shirt, tattooed a cross between his eyebrows and dropped out of school. We met occasionally, an oddity, a mod and a punk, chatting and laughing. I lost track of him, last I heard he was working as a labourer. I think about him occasionally on a Friday night as I listen to 80s music and drink lager, it helps me push against my vanity.

I am sick of being constantly patronised

This brings me to consultants. I was one of hundreds of medical students, many of whom are now consultants (indeed, some are my best friends). Firstly, let’s dispel the myth that doctors are made of a higher moral fibre than the rest of humanity, they aren’t. Secondly, doctors have done well academically, but academic ability is not the same as intelligence, wholly and totally confounded by wealth, opportunity, schooling and tutoring.

The bottom line is doctors are clever but not as clever as we think we are. And the guys who did well at university were normally the rich kids who stayed at home and were swots. I liked many of these ‘mummies boys’ and ‘daddy’s girls’ high-flyer students, but I certainly did not and do not venerate them. The guys who scraped through were those generally fending for themselves in horrible flats.

As a student we had virtually no contact with GPs, there was just relentless sneering and condescension expressed towards general practice. To my shame I even indulged in this. Funny how feeling superior is a reflection of immaturity. Then I was a junior doctor in a district general hospital and a large proportion of consultants was pompous, bombastic and absent. Many were fantastic, but the negative far outstripped the positive.

The whole consultant thing was embarrassingly sycophantic, just forced laughter, interminable ward rounds, nails-on-blackboard clinical meetings and the consultants went unchallenged. The only consolation is that the hospital was disrespectful to everyone, nurses, physiotherapists and of course the idiot orthopaedic surgeons.

No one seemed to care much about the patients. Dysfunctional with a capital F, the whole system was broken. And the GP bashing was as loud and relentless as the artillery at the Somme: ’He failed his MRCP so he had to go into GP’ etc, etc, etc. The disrespect was endemic, ingrained and institutionalised. You felt like a second class citizen if you were a GP trainee. So let me be open and direct, I have a  big chip on my shoulder about the expressed and unexpressed attitudes towards GPs. My experiences can’t be different from other GPs.

I would like to think the hospital culture has changed in the last 30 years but I am pretty sure it hasn’t. The hospitals torch all the resources, but offer a poor service. GPs are expected to see patients on the day, but hospital waiting times are expressed in months. We are accessible, call patients back, consultants never do. Modern medicine has no continuity, just lame over-investigation and flow-chart medicine. Hospitals still bleat for more resources over the heads of primary care. The media are the same, always quoting some clipped specialist who offers some unrealistic advice to GPs. The perception is consultants are just better, with an unspoken superiority. I am sick of being constantly patronised; however, beautifully and kindly framed. Consultants expect deference; well, that ain’t going to happen.

So apologises for my chip and two wrongs don’t make a right. Humour remains  one of  today’s few allowable vents for dissent.  So GP columnists will continue to tease consultants, offering rude caricatures to poke some fun their way and generally be disrespectful. Finally, despite all my ‘issues’ of course I do respect consultants, I know they have an impossible task and are very committed to the profession, but respect is a two way street.  GPs and consultants are as tribal as punks and mods. 

Dr Des Spence is a GP in Maryhill, Glasgow, and a tutor at the University of Glasgow

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Readers' comments (1)

  • ZX81

    I don't feel this. This isn't my world at all. I'm irked you're trying to project a fairly marked inferiority complex across general practice as a whole. This isn't how it is. GPs are fast becoming the last and only real Drs in the NHS. I've also got a great deal of respect for A&E consultants. If you're unwell and ain't got a clue you don't waste your time calling the venerable surgical oncologist at Chelsea and Westminster - he won't have a clue. You'll need to see a GP...pure and simple. If I was lost at sea in a boat I'd want a GP in there with me, not a hand surgeon, dermatologist or paediatric respiratory specialist - with the greatest of respect to every one of them. As a GP I kick ass. I respect my specialist collegues but we both know we know plenty the other doesn't.

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