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
You don’t need to explain your article – it is the truth and the truth hurts the ignorant.
This fairy tale idea of managers, politicians, UK public, journalists, media and health policy academics that ALL users of the NHS require access and that they are angels who deserve equal access that is world-class and without fault is a perverse, blinded and diseased fallacy. Concentrated lies. The public are not all so angelic, and they are not so all respectful of the superb service that the NHS is. They do misuse it, and they know the game that they are playing. Just call it out. The profession, and Consultants and A+E know it – so did the days of the walk-in centre, and the packed rooms of people playing on their phones and clogging up a useful service which was misused. The public need to fight amongst the public – it is not our place anymore, let them compete amongst themselves and figure out the truth themselves. You step aside and let it crumble. Like emptying the shelves off eggs and toilet roll, they do the same with the NHS. Like I say 10-20% of them, but that is enough. People and even one’s neighbours actually believe that there are no time-wasters out there. That is the name for them. Because, like I said – medicine has entered an era where you can NO longer differentiate the *public from the patient*. They are one grey homogenous soup and you are dealing with them all at once, with equal standards but with an utter dissatisfaction, hopelessness and no end in sight. Bored loneliness and social anxiety and a perpetual fear of death leads to hypothesis and wanting to talk to someone – you: because there’s no one else left, not even their “friend” or the spiritual building. Everyone deserves to have access – now – apparently. That is not true. That is a lie in 2022. Medicalisation is a business commodity and you’re the puppet data gatherer for the business moguls and corporates. The human has changed, face up to it – it is not what it was – it is now at times a weak, aimless and meandering creature – clinging to threads and naive of its own existence, mortality and human being. Being – yes, it means you have a cough, the skin goes red and you get an infection when you neglect and abuse it. Pain is common – it doesn’t make you special, it is called a nervous system, and your heart beats in bed – so what, you’re alive. This is too deep for the naysayers, tree huggers and the people pleasers Dr Musgrave. They conditioned them in GPVTS to do consultation models that permit your own abuse and mistreatment. That programme GP behind closed doors – well, journalists and the public have no clue what goes on behind that door. Let’s open the door – and let everyone hear what is being said and what they come in for. It will be a revelation and game changer. It isn’t nice behind that door, nor is it relevant or interesting for the most part. It isn’t exciting, it isn’t exuding with compassion and interest and it certainly isn’t always medicine, but conjured trivia, imagination and consumerism. All that many of you are now doing is meeting the demands of the ego and the system of medicalisation – the multi-trillion dollar metaverse of coding and activity. Meeting your own ego too – thinking you are doing something worthwhile. You are needed elsewhere, for people who respect you and are in suffering and pain. This is all a mirage. This was all a set-up plan by the elite, the institutes and social networks – to keep you at ground level as THE essentially free, highly-regulated professional, with a limitless buffet, drop in centre, zero payment front door – with exponential monitoring, scapegoating and litigation. Keep them distracting at your revolving door, you – their best and only friend. Displaying your complaints policy, but unable to complain yourself. What a tragedy. The sickest primary care in the world, set up to fail because it never looked at the front end service user and where blame and accountability is due. It hurts to blame individuals, when they have privilege and rights. But in 2022 – when consumerism comes with disrespect, fake knowledge and ignorance – then it has to be called out. This is what private sector thrives on – getting payments for medicalisation and fake medicine. You have integrity, which is why you wrote the article. A private provider never would. Nannying is time wasting – there isn’t enough time, resources or capacity, until people will die, and they wait too long in the clogged up, hypochondriasis system. I always said – the great crisis and tsunami that they never call out the 20-35 year olds – the group they are only empowering – they are running utter riot over the health system, fearless and destroying its fundamentals. You all know it – normal sigmoidoscopies, normal CT brains, normal mammograms, normal blood tests, normal 24 hour tapes and normal trivial nasoendoscopies and gastroscopies. People don’t want to say anything because the GMC and the CQC created an atmosphere around you of delivering everything, now, for them – not you. They are in on it too – making money. Patient first, you second. So be it – keep the referrals high, keep the tests rolling and keep the medicines churning. One sick world – ready for US insurance companies that extract data via EMIS and United Healthcare. Well done to all those that tried. And to all those that are covering up for “them” – stop it, it is looking stupid and childish. Yes, we nanny to avoid complaints – but, find out where your spine is – and locate yourself either near your brain or rectum. You’re a grown up, distinguished doctor – not some clown and dogs body. Believe in something, or step aside. And like I said – believe no one else – it is all a lobster trap. The sad thing is, that it has all now become a watered-down, generic packaging in the UK, but sourced and orchestrated in the USA. Your worth and value will come, but catastrophe will have to arrive first.
I agreed with your article, Dr Musgrave.
This pussy footing around – why is everybody now labelled “vulnerable” now – is so incredibly infantilising. Yes, we are in part to blame for this.
I don’t actually think the answer is yet more “public services”. Public services are a poor substitute for community/family/society. Also needed is a hefty dose of “resilience”. Surely the Royal College can advise on this?
That’s a particularly long rant Patrufini Duffy. Are you OK?
Just ‘step-back’ and allow natural development. Maybe, you care too much?
What’s inevitable is inevitable! No need to stress!
How about GPs ‘prescribing’ fruit and veg, exercise and now free energy – I am not suggesting that these initiatives are not good ideas, but they do not fall within the remit of doctors to sort out.
“But the state cannot cure all ills.”
This is the core of the problem. The State’s love for the citizens crowds out all self sovereignty, community organisation, jobs for the non academic, supportive extended families and, ultimately, Hope for all those dependent on its gifts.
Not working is not ‘allowed’ by the State, but, as health is holly and cannot be challenged, a Med 3 blessing from a doctor give access to housing, heating, PIP payments and income. Thinks directly leads to chronic pain, anxiety and depression.
Decorum – I have increased my sertraline dose to 200mg. Ants in pants.
The medical education and training of physicians is, by way of clinical history taking and examination, primarily designed to detect the presence or absence of disease or medical disorder and then, when needed, to offer corrective treatment.
It is not designed to address societal dysfunction, and nor should it be.
It may be that “Public Health’ agencies have a role to play, but not the primary care doctor, especially when come to misguided suggestions such as handing out vouchers for fruit and veg and to cover the electricity bill or membership to the gym.
Dr. Musgrave commentary is accurate.
Both articles were so very true and thank you. I very much hope there is a new future available. Wise words Dr Musgrave.