I’m not quite sure how I ended up watching a YouTube clip of Kenneth Williams. It was probably self-preservation, a subconscious way to avoid reading the health articles of online newspapers. In case you don’t keep up with these, I can tell you that GPs are still to blame not only for their own workload, but that of A&E and the hospitals as well. If a tree falls in the forest, and nobody is around to hear it, rest assured that it makes a horrible noise and a named GP should have been providing 24/7 cover.
So imagine my surprise when, idly browsing Kenneth Williams clips for no good reason, this stalwart of the Carry On films turned out to be an unlikely ally. It may have been delivered in the trademark ‘Ooh Matron’ drawl, but he gave a brilliant summing up of the problems of over-specialisation at the expense of generalism.
It’s worth having a look at the original footage, just for the joy of seeing him in full crow, and the dizzying sight of those hypnotic nostrils. If you can’t get onto YouTube, the transcript is pithy and to the point:
‘In the old days, you were better off, because now they’re all specialists. Everyone’s getting better and better at less and less… Eventually someone’s going to be superb… at nothing.’
We have to accept that effective general practice is never going to be as sexy as brain surgery or angioplasty. But it is vital to any effective, economical, and equitable health system. The technology and the honing of specialist knowledge are valuable, of course. But the best (and cheapest) medicine is the kind that lets you sit with your patient and find out what is really hurting or troubling them, before the expensive gadgets and the micro-specialisaion come into play. If they need to at all. Williams knew it years ago, but the value of generalism has been forgotten; we can only hope it is re-learnt, and fast, before things have gone too far to be retrieved.
Dr Nick Ramscar is a GP in Bracknell, Berkshire