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Do we really need a medical degree to do general practice?

Jobbing Doctor gets to the heart of being a general practitioner

The title of this post might seem a strange question to ask, but very pertinent in the light of the times that we live in. One of my colleagues is heavily involved in training physician's assistants. I have had a discussion with him about this in which, I think it is fair to say, there was little middle ground.

There are now many clinical practitioners who are now attempting to do the job of GPs. Nurse practitioners, pharmacists, paramedics number those who are taking over aspects of our jobs. They come to it from a variety of backgrounds, and all think that they can do it well. They can all manage to deal with sore throats, and probably prescribe the pill as well.

But I think we are seriously underselling our abilities if we assume that these are the only roles that we fulfil. Indeed there are days when I am pleased to see a patient with a sore throat to have a break from dealing with the complexities of multiple pathology. It also is a case that I can deal with in under 10 minutes.

Generally many people do not understand general practice. Managers and politicians certainly don't and many consultants do not have a clue as to what is our role.

I have spent some time this morning trying to fathom out the best way forward for two patients who have been mangled by the secondary care that they are receiving. One pretty much wanted to ask me what on earth was going on as nobody had talked to him and given any options: another just wanted to be told that there was nothing more to be done with him.

These need someone with wide-ranging knowledge and some experience to deal with; particularly if you are coming to the end of interventionist treatment.

I recently had a student sitting in with me from a large University Medical School not too many miles away. I think she became increasingly open-eyed with amazement as she listened to the discussion, which was really unlike what she was expecting. This is when the family doctor changes from clinician to advocate and adviser to the system.

‘I have been told that I can have this operation,' the patient told me. ‘Should I have it done?'

This is one of those situations where I really am being totally trusted by my patient, and if I say ‘have the operation' they will; if I say ‘don't' they won't.

In those few seconds of thought I have to assess the patient's clinical condition, make a judgement on the success rate of the operation, the quality of the hospital, the abilities of the surgeon and the possible outcomes.

This kind of judgement takes time, knowledge, understanding of the patient, the pros and cons and a whole raft of other details. That information should be assessed by someone who is appropriately qualified.

It also should be made by someone who is responsible for dealing with the consequences of their decision.

In most cases I will happily agree with the consultant. But not always. I have particular anxieties in relation to certain procedures, and am solidly against any kind of spinal surgery, unless the benefits outweigh the risks considerably, or the outcome of doing nothing is dire.

Since I have had access to MRI scanning, my referral rates for back problems to orthopaedic surgeons have dropped by 90%.

This is the aspect of our work that very few understand outside of general practice.

It cannot be taught on a Mickey Mouse course.

The Jobbing Doctor is a general practitioner in a deprived urban area of England

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