One of the things that is continuously emphasized at medical school is the importance of curiosity. In a sense it underpins everything that we do – without scientific curiosity, we would have no medicines and no procedures. On a more human level, our early clinical experience is geared towards honing our natural inquisitiveness about other people. We are taught to look for patterns, to probe exactly what patients mean when they describe their symptoms, and to read up on things that puzzle us. Like the rest of life, medical education is suffering under a deluge of box-ticking and targets, but for the time being the diligence required in taking a detailed history remains a core skill.
The importance of an enquiring attitude increases, the higher you go up the career ladder. In post-graduate training for general practice, the CSA is a cornerstone of assessing readiness to work as an independent doctor.
Despite the hostile dissection it is getting at the moment, I believe the CSA is right in one key way: it uncompromisingly highlights the basic process of asking questions, clarifying the answers, and reacting to subtle clues.
As GPs, a huge part of our work consists of deciding how much emphasis to place on the clues we find in what patients say, what we find when examining them, and (in a proportion of cases) what our tests show. Medicine is still, at heart, an art – albeit one increasingly augmented by science. If we lose this art and simply run a Pavlovian battery of tests whenever a patient presents a particular trigger, we will provide a shoddy service with a crippling pricetag. If we lose the art of gaining patients’ trust and getting them to disclose what they really mean, then we will miss the point, and lose our purpose.
Sadly, the current state of general practice is not conducive to curiosity. The 'Red Queen' model of medicine, in which we are constantly running to stay the same distance behind the clock, kills inquisitiveness.1 On days when the workload is manageable, I enjoy seeing my patients. I provide a better service when I am able to give them time to speak, and give myself time to think. Although I haven’t audited it, I suspect that my budgetary impact on the health service also improves.
As independent practitioners we soak up a huge amount of risk. And in the main, we do this well. But we have to be given working conditions that allow us to do it properly. The strange and poisonous idea that GPs have infinite capacity must go.
We cannot take on any more externally-imposed targets, or any more work that used to be done by hospitals. We have to be allowed to be thoughtful and inquisitive again. Lives depend on it.
Dr Nick Ramscar is a GP in Bracknell, Berkshire
Reference
1 Ridley, Matt. The Red Queen: Sex and the Evolution of Human Nature. Harper Perennial, 2003.
