My perception is heightened by sentimentality today: I’m leaving the general practice through whose doors I walked 30 years ago and moving on to a smaller urban one.
Generally this blog looks at our medical world from the more-than-slightly-skewed viewpoint of a primary care clinician in a secondary care organisation. I work both as a GP, and at a challenged acute trust which is in the process of being taken over by a neighbouring foundation trust.
My trust is struggling with several things – money, emergency care, meeting four-hour targets, hitting deadlines for routine operations. It’s no surprise we’re on the list of 14 trusts to be visited by Sir Bruce and the boys. When the trust has been assimilated by its neighbour, I will be working for a single organisation providing healthcare coast-to-coast from the North Sea to the Irish Sea.
It doesn’t help much when my mother has already been on the phone warning me not to read the day’s Independent and its maudlin feature, Farewell to the NHS, 1948-2013: a dear and trusted friend finally murdered by Tory ideologues.
But I just want to indulge you with a couple of the jewels of general practice, the pearls of primary care – not a heroic cure or diagnostic coup such as spotting Rocky Mountain spotted fever or Kawasaki disease. I’m talking about the everyday gems in your consulting room.
In a recent session I met a sullen teenager and parent. The teenager answers every question with silence, a grunt or, if trapped by an unfair open question, looks at Mum until she describes the quality of the child’s headache herself.
In another consultation I met an elderly man who needed no prompting to reminisce about his childhood growing up on a local farm, hearing the sound of clogs on the lanes and stuffing his own shoes with straw for warmth until being shown to pluck wool from the thorn hedges as a better option.
He’d recently had a loop of tortured and gangrenous bowel excised, the ends joined up again in a single middle-of-the-night emergency operation by one of the breast surgeons. Do you know how many gut surgeons you need to employ to have one always available on call? As the NHS proceeds down the super-specialisation and super-centralisation route, remember you will always need a generalist. How are you going to train them in the future?
These two patients demonstrate oral histories we hear daily and by which we are usually frustrated – both by the poor historian and Mr ‘On and On’ respectively.
But the next time you encounter one of these scenarios or one of their myriad alternatives, put on my rose-tinted specs, lean back and just enjoy it for once.
Dr Peter Weaving is a GP in Brampton, as well as the commissioning locality lead for NHS Cumbria. He has been writing the Diary series for Practical Commissioning magazine since 2007. You can read the archive of his posts here and send him a tweet via @PeterWeaving.