In message <[log in to unmask]>, Bradley Cheek
<[log in to unmask]> writes
> Most of the people who slag off the RCGP
>don't actually CONTRIBUTE - so it's not surprising perhaps that they see no
>benefits.
>
Well I've done a fair amount of college slagging since 1990 although I
was keen enough before that to be a member of a Faculty Board. The NEED
for the RCGP is as great as it's ever been, and I do think it's
beginning to recover some of its sense of purpose (which it lost amid
power politics and arrogance in the 80s). 

However there is still some way to go, and I'd have to say that the
activities which most turn me on (professionally speaking and
educationally you understand) don't have particularly close links with
the college. These activities are NoReN (the Northern Research Network),
which was started as a result of a college initiative but is now semi-
detached, and various evidence-based practice activities including
informal critical appraisal groups, tutoring at workshops and so on.

The college has little or no input into our local PCG and no formal
input into our local Practice Development Group. "Official" PGEA
activities at postgraduate centres are still lecture-by-consultant-based
and it's plain that fellowship by assessment (which I generally approve
of although don't have time for myself!) has not been taken up by large
numbers of the service GPs it was aimed at.

>PS: Balint is just as valid as it ever was - I wonder if those that think
>otherwise have actually read it?  ;-)
>
Well...he is and he isn't, I think. His work was of fundamental
importance in establishing the consultation as general practice's "own"
specialty and in making subsequent generations of GPs aware of the need
to be skilled at picking up, interpreting and using the emotional
content of consultations - in making us aware of patients as people
rather than just "cases" in fact. He was also important in that he made
the idea of non-directive small group learning acceptable and it became
an important part of GP vocational training. Even now, GPs tend to be
more skilled in small group learning than hospital doctors.

However I think you can overemphasise the centrality of the emotional
aspects of the consultation to the detriment of the biomedical. I need
to be aware how my patients' emotional problems affect their health,
just as I need to be aware of their employment, housing and other
aspects of their lives. However emotional problems are not per se health
problems even if they contribute towards causing them. I am somewhat
sceptical of the scientific validity of Balint's methods, while
recognising the great contribution his work made to establishing general
practice's identity as a specialty, and to the content of vocational
training.

Cheers

Toby
-- 
Toby Lipman 7, Collingwood Terrace, Jesmond, Newcastle upon Tyne. Tel
0191-2811060 (home), 0191-2437000 (surgery)


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