Due to the amount of trust that patients invest in us as doctors we are meant to make the care of the patient our first concern, which seems simple enough.
But what if it is not as black and white as that any more?
It seems to me that the act of putting patients’ needs above everything else (including our own needs), makes us less able to carry out the work patients need us to do. The definition of care is being stretched before the capabilities of our workforce, already bowing under the strain of bureaucracy and seemingly endless criticism.
Every now and then GPs have professional dealings with social workers, another public sector profession that is often maligned by the press. Our colleagues are frequently in the difficult situation of having to make assessments about the wellbeing of “service users” (they don’t have patients).
Social workers are primarily, as far as I can make out, concerned with the social situation of patients and in the case of, for example, elderly patients, their ability to clean, clothe and feed themselves. Undoubtedly, the medical issues of that service user, our patient, are an important part of that assessment, but rarely do social workers try to solve or offer advice on medical issues.
Would a social worker say a service user: “Mr Henderson, I think that your ability to dress yourself would improve if your breathlessness wasn’t quite so bad. Have you considered switching to a combination long acting beta agonist and steroid inhaler?” I think not.
So where does that leave GPs?
We have to decide for ourselves what care actually is, what it actually means to care for a patient, what care we can actually offer. And while we should fully take into account the social situation, needs and concerns of our patient, perhaps we need to realise that it is not always our job to try to solve them.
Unfortunately the vast majority of the social issues that patients face with work, relationships and neighbours are not going to be solved by social workers either. The only person that can solve those issues is the patient, with the help of their family and/or community.
So perhaps the greatest service GPs can do for patients is to point that out. If we try to meet every patient need by ourselves, we are doomed to become so disheartened that we won’t be capable of caring, whatever that means to us.
Dr Samir Dawlatly is a former secretary of the RCGP’s adolescent health group and a GP in Birmingham.
20 December 2021
21 September 2021