Before beginning my illustrious career with GP, everything I knew about medicine I'd learnt from House M.D., the US drama in which Hugh Laurie plays an irritable but ingenious diagnostician.
The show taught me that apparently trivial collections of symptoms could rapidly turn out to be life-threatening; that blood gushing from inappropriate orifices could turn out to be nothing more than a tummy bug; and that almost any collection of symptoms you care to name can be diagnosed as either Wilson's Syndrome or sarcoidosis, but actually never is.
House came to mind as I listened to RCGP president Professor David Haslam explaining general practice to an audience of tomorrow's GPs at a conference in London yesterday. Every day, he noted, GPs are faced with patients complaining of apparently trivial symptoms, such as stomach pain or headaches that just won't go away. By distinguishing those in need of a rest from those in need of an MRI, he argues, GPs do the riskiest job in the NHS.
Getting this right takes a lot of training. Professor Haslam notes that he once took a copy of the GP training syllabus to a meeting so as to make this point to other specialists. ‘We only printed one copy,' he says, ‘because we like forests'. Trainee GPs must learn more in a shorter time period than doctors in any other specialty.
Yet when people discover he's a doctor, they invariably ask him the same question: ‘Are you a specialist, or just a GP?' ‘I hate that ‘just',' he says. ‘What is it about our society that says the smaller your area of expertise, the cleverer you must be?'
The answer, one suspects, lies in the numbers. Economics states that value is determined by two things: demand, and scarcity. GPs may face plenty of demands, but there are also rather a lot of them: 40,000 or so, at the last count. That's around 50 times the number of cardiologists there are in the UK, and almost 100 times the number of neurologists. The result is that those who know everything about one part of the body seem somehow more ‘special' than those who know a lot about all of it.
This isn't fair. GPs have to recognise a wider range of conditions, in a wider range of body parts, than other doctors. They must be able to connect apparently disparate symptoms with lifestyle factors, family history and a patient's emotional state. And they have to do all this in consultations that last for 10 minutes, and without the useful clues contained in a referral letter.
In short, they have to do the same job as Greg House, only with less money, fewer staff, and lower prevalence of excitingly novel diseases like leprosy. Yet society still views them as the junior half of the medical profession.
Professor Haslam, though, has a plan. The next time you bump into a fellow doctor over cocktails, he suggests, there's one question you should ask to turn the tables. ‘Are you a generalist?' he suggests. ‘Or just a partialist?'
jonn.elledge@haymarket.com