Dr Katie Musgrave writes in response to her controversial blog on the medicalisation of normal life
My blog last week stimulated a significant amount of discussion and debate. I thought it might therefore be worth adding some further reflections and nuance to the argument I was trying to make.
First, I want to acknowledge that our society is clearly suffering from a wide array of problems, which have combined to impact the population’s wellbeing, resilience and ability to lead healthy lives. Environmental factors underpin much of the psychological distress that we see as GPs.
Yet this does not negate the fundamental point I was trying to make in my blog: that many of the issues our patients present with are non-medical issues, so medical professionals may not hold the answers. After all, if you see a doctor, you’ll get medical treatment. If you see a carpenter, you’ll get a new front door. If you see a Pilates instructor, you’ll likely be taught stretches. You get the point.
How often do you see a patient, glance through their document list and find that they have been referred to half a dozen different specialties? Then you look at the patient and are baffled to see what appears to be a physically healthy individual. Our patients come to us for help, and we give them medicine. That’s not surprising considering our training, guidelines and medical role. But all too often, it’s not what our patients need.
Scaled across the health service, this is a gargantuan number of scans, bloods, microbiology samples and referrals – often in cohorts of patients who will hardly benefit a jot from these interventions and may well come to harm. And I believe it’s getting worse as we scale up general practice, as relational continuity acted to rationalise overmedicalisation.
We haven’t got the capacity to reliably see the medically unwell, the elderly, the diabetics and those with comorbidities. For example, my local area has stopped commissioning spirometry – hence there will likely be thousands of patients with undiagnosed respiratory disease coming through.
Impact on GPs
GPs have become so overburdened that they are falling ill, their families are suffering, and many of them feel they cannot continue like this – all while being abused for doing their best in a broken and irrational system. There is moral injury in attending to more trivial presentations while being unable to adequately help those suffering and dying.
Our current overwhelmed system is driving away compassionate and talented GPs, who feel their only option is to emigrate, retrain or leave medicine. Others minimise their clinical sessions to protect themselves. This cannot continue. It will only get worse, until there is no one left.
If my blog held a snippet of truth – and we have medicalised normal life, with surgeries generating unnecessary work – this has very serious consequences for the wider NHS. For example, a GP who is overwhelmed may not have time to speak to the woman with a UTI. She is then left untreated or calls 111 a few days later. Her condition has deteriorated, she attends A&E and needs admission.
There are countless scenarios where an overwhelmed GP service leads to mounting pressure on secondary care, which contributes to inconceivable waiting times for outpatient appointments and places more pressure on general practice. And so on, in an all-too-familiar doom loop. Hospitals are already operating like war zones with patients dying in corridors.
In my (perhaps unpopular) opinion, the NHS, GP leaders and governments have infantilised the public and falsely led them to believe that a doctor’s appointment is needed in times of stress or minor self-limiting illness. TV and radio adverts urge patients to contact their surgery for ever more flimsy and far-fetched reasons.
GPs’ time has been treated with far too little value. I do not blame my patients – the NHS has not communicated properly what our service can deliver and has never incentivised patients to seek help elsewhere. GPs desperately want to be there for patients when they need us, but we cannot be there for every sniffle. The system will collapse.
What’s the answer?
Our country needs to invest far more in better community services, public health and social care. A whole host of services would do a better job of improving patients’ lives than we can – children’s centres, youth clubs, sports facilities, elderly day care. Doctors should stick to medical presentations (including mental illness), while life stress and difficulties should receive the Government’s attention and investment, such as tax relief, better care and more sustainable working practices.
But the state cannot cure all ills. Communities need strengthening and our patients will have to learn to self-care better. It is time to have some honest conversations about what the NHS can provide.
If we want the health service to stand in any form, then GPs cannot – and must not – be the first port of call for all of life’s problems.
Dr Musgrave is a GP in Devon and quality improvement fellow for the South West