In message <[log in to unmask]> you wrote:
> As promised a short dissertation on why General Practice is worthwhile,
> response by 7/9/96??
Ah, but I thought the topic being debated was whether or not GP
was any *fun*. GP, and being a doctor generally is almost certainly
"worthwhile" - no argument there - but to enjoy one's work, to
derive satisfactiom, I believe that it has to be more than "worthwhile".
After all, walking around the streets, scooping up dog faeces is almost
certainly worthiwhile, but not very fun.
I suppose "fun" isn't really very appropriate, because what job is fun?
I guess that, as a person of reasonable intelligence, who can appreciate
art and science, who wants to contribute to society, look after his family,
and derive some personal sense of achievement, general practice is not
all I thought it would be - or, more specifically, not what I had been
led to believe it would be by training prior to the reforms then
entering general practice just after the reforms - yeah, yeah, I know,
bad timing, but how was I to know?
> The political and social changes in Britain in the 1990's and the effect of
> three conservative governments has totally changed the practice of medicine,
> in secondary care as well as primary care. We cannot pretend that we are
> alone in our discontent with the system. The economics of medicine are now a
> major player in decision making whether we like it or not. Most of the
> unhapiness in General Practice stems from the results of these changes. We
> feel overworked, under pressure and underpaid.
Agreed.
> The fundamental job we do has not changed, however, and it is this that is
> most important. It is the day to day contact with real people who need our
> help/advice/support that makes it worthwhile.
True, but see above comments re difference between worth and entertainment
value. OK, facetious, I know, but you get my point?
> There are in effect very few
> things we can cure, many things that we do not understand and unfortunately,
> many things that we know could be done better with better resources. The
> simple pleasures of improving the condition of ones fellow human beings and
> their resulting gratitude overrides the frustration and dissapointments
> engendered by the changing circumstances.
Or not.
OK, you can derive some pleasure from knowing that you have improved
the lot of a fellow human, but sometimes, imcreasingly, in my inner-
city practice area at least, gratitude is the last thing on the patients'
minds. If I was paid in gratitude and not pounds, I'd be a very poor man
indeed. It's just as well I'm not after gratitude for the most part.
I agree that there is a balance between "doing good" and struggling
against all the forces stacked up against you (HMG, HA, other
professionals, patients, patients' relatives etc etc etc), but I
would argue that, increasingly, the balance is tipping in favour
of all the crap with which we have to deal.
> We mostly entered into this strange
> profession because of the contact with people and their problems. The
> intelectual stimulation of the endless possibilities of what might happen
> next only adds to the positive side of primary care. The patients and their
> problems are the thing that is most interesting and satisfying about
> medicine, they are still the same even if the working enviroment has changed
> beyond recognition.
True, but it the effect of the changed environment that is causing
all the problems. I'm not denying that the long-term relationships
which can be built over the course of years in general practice is
(in my view) the most satisfying aspect of the whole she-bang (is
that a word? or correctly spelled?).
> One of the major problems that we have faced, and to a great extent overcome,
> is the change itself.
Overcome? I think not. Tolerated at great personal & financial expense
might be a more accurate description for many GPs. Sure, there are
those who have bitten the bullet and worked with the new system as
best they can, but there are many who recognise that the job has
changed far beyond that to which they had become accustomed and simply
want to get out, or reduce their hours to a minimum, or employ a bright
young partner who can deal with all the crap, or do anything so that
they can simply enjoy the doc/pat relationship without all the gubbins
that passes for administration these days.
> Most GP's now have a better idea of the commisioning
> process
So what? It has almost nothing to do with the cherished doc/pat
relationship.
> and many will be greatly empowered by the ability to influence the
> direction of health care provision.
If that's what you went in medicine for, then that's great. When I went
to medical school or when I was considering a career in general practice,
I never wanted to get involved in orchestrating the provision of secondary
health care.
OK, like any area, there will be GPs who are interested which is fine.
But now, every GP (or at least one GP from every practice) is expected
to spend time/energy thinking/talking/discussing/negotiating about such
matters.
> We are turning the corner, I feel, and to
> give up at this point would be to throw away the best system of Primary
> Health Care in the world.
Depends what you're giving it up for.
> The next few years will see further change in the
> mechanisms of health care provision, but not on the scale that we have seen
> before.
God, I hope not. Once per generation is enough.
> The fall in GP recruitment and the loss from the profession of
> experienced GP's through ill health and early retirement will cause many
> problems, but can only serve to strengthen our hand in negotiating better
> terms and conditions of employment with the government.
65,000 ukp average intended net remuneration, here we come!
> It is very easy to list all the things that are wrong with our situation. We
> must look at the changes as a necessary evil ( like most doctors look at
> their computers) and build on the trust and confidence the vast majority if
> our patients have in us as healers, to allow us to continue serving them.
Nicely put.
To my mind, the argument has more to do with point of view than
fact. If you have a personality that allows you to shrug off
the multitude of problems which interfere directly and indirectly
with the doc/pat relationship then you're going to find the job
much more enjoyable than someone who find it more difficult to
do so.
I enjoyed the thread on burn-out and was interested to note that
the thrust of all the advice was to (a) reduce your committment
to the job, (b) take up a non-medical hobby you enjoy, and (c)
allow (b) to take up more of (a)'s time until you feel happier.
No one suggested biding one's time, hoping that the job would
get easier. It won't. 15-20 years from now, doctors will only
work for a few hours a week (in hellish conditions) and spend
the rest of their time collecting butterflies, painting, petting
their dogs, writing specious articles for newspapers, and farting
about on the internet.
Phew! Disjointed and hard to follow but it's all my own work.
Take care GP-UKers everywhere!
--
Iain Hotchkies MBChB ambition: polymath
currently: jack of all trades
www.hotch.demon.co.uk corollary: master of none
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