Do we need GPs?

摘要

Everyone is prejudiced; we merely have different prejudices. There are widely held prejudices against general practitioners. And, like most prejudices, these are unspoken and denied. But the anonymity of online communities means these views come spilling forth. GPs are the failed doctors: the thick, the lazy, and the useless. Forum members have even suggested that all GPs be sacked, with receptionists simply making appointments with hospital specialists. Generalism means less; everyone wants the expert. So I perennially find myself promoting or defending generalism (depending on your perspective). There is little appreciation of the levels of patient contact in general practice, with 30 to4010-minute appointments a day, and few end in specialist referral. GPs see every condition from every medical specialty, often early, with atypical disease presentation. GPs realise that our pseudoscientific hospital training has little value in the real world, where there is no certainty-only uncertainty. Generalism is about listening not treating, and understanding that symptoms rarely reflect disease, and that investigation creates only spurious incidental findings. General practice is no place for the obsessive, introspective, and fearful because it will melt their brains. Generalism is a difficult specialty, full of art and craft. Trust, reassurance, and misdirection are our greatest therapeutic interventions. And GPs bear witness first hand to the modem erosion of wellbeing and the iatrogenic calamities of medicali-sation, overdiagnosis, and overtreatment.