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Medical professionalism matters

Exploring the real life challenges experienced by today’s medical professionals and providing support that doctors want and need

Respect

I love being a GP. It is challenging, varied and hugely satisfying over the last 25 years. It is also a job that has become ever more crucial to the future of the NHS. Our patients are getting older and their combinations of long term conditions more complicated. It is imperative that GPs are present to provide the long term, patient centred care they require. I am very proud of the work we do to provide this care across the country and I agree with Simon Stevens who said:  “There is arguably no more important job in modern Britain than that of the family doctor.”

Unfortunately it appears that medical students and doctors in training often receive a very different message from their senior colleagues. A recent study published in the British Journal of Psychiatry has shown that disparaging comments about general practice and psychiatry are widespread, leading to 27% of students changing their intended career path. 80% of students condemn this practice but 70% believe it to be widespread.

An RCGP survey gives some striking examples.

From students:

  • ‘there is a constant stream of criticism of General Practice within the specialties’
  • ‘many hospital doctors undermine GPs in front of students. For example, in lectures: “of course, had the GP done a simple examination…” or “the GP did not pick it up“.’
  • ‘as is typical of hospital consultants, snide remarks about general practice abound and it is generally assumed that the only reason one would want to be a GP is to earn lots of money and “have an easy life”’
  • ‘on my clinical rotations [I] have regularly been shunned and shouted down for wanting to become [a GP]. … It leaves a very bad taste in my mouth’

And from Heads of Teaching:

  • ‘[general practice as a career] can be undermined in the language that academic leads use in meetings and communications, a classic being the phrase end up a GP’.
  • The patient stories described in PBL cases can paint general practice in a negative light’
  • ‘the prospect of GPs routinely supporting learning of clinical examination skills was considered risible by a number of secondary care colleagues.’

This is directly contrary to GMC “Good Medical Practice” especially paragraphs 35-38 on working collaboratively with colleagues. It is supported by the guidance on Promoting excellence: standards for medical education and training:

R1.17 Organisations must support every learner to be an effective member of the multi-professional team by promoting a culture of learning and collaboration between specialties and professions.

Time for Action

Macdonald et al. suggest we need the equivalent of the Athena Swan Initiative that has been used to counter the discrimination against women in many workplaces (less relevant to GP which is now more than 50% female). I believe this is correct. We need an initiative that clearly states the challenges, rewards and satisfaction of being a GP, valuing the generalist skills and recognising the essential role of general practice in the future sustainability of the NHS. Despite the increasing efforts by medical schools to produce the medical workforce we require, these moves will be futile unless this culture is changed.

We also need an empowered grassroots, led by the flourishing expansion of undergraduate GP societies, calling out this discriminatory behaviour for what it is – until it ceases.

The GMC guidance on “Good Medical Practice” is clear that we have responsibilities to cultivate respect and understanding: working collaboratively with colleagues, respecting their skills and contributions. It is time for the GMC to hold us all to these responsibilities.

It is also time for the profession as a whole to stand together and ensure those branches that have had a lower profile are recognised equally.

Medicine demands teamwork whether you are a surgeon, physician, anaesthetist, radiologist, pathologist, emergency medicine specialist, oncologist, ophthalmologist, psychiatrist or GP.

Dr Miles Mack

GP Partner at Dingwall Medical Group and Chair, RCGP Scotland

@milesmack

miles.mack@rcgp.org.uk

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Discussion

  1. Dr Isaac Sundeep says:

    I am in complete agreement with Dr Mack.

    GPs are the backbone of the NHS and are often under valued. As a Psychiatrist I am regularly impressed by how well they know the patients and their background. Delivery of modern psychiatric care would be impossible without the key role of the GP.

    Disrespecting any colleague is wrong but slagging GPs is very harmful. By doing so we risk undermining the very corner stone in patient care.

  2. John Breen says:

    The only way to ensure mutual respect is to have students serve a lengthy period in a single general practice and to have them converse with the patients prior to the “official” consultation with principal or trainee. It will soon dawn that this work is daunting in terms of knowledge, temperament and stamina. The sharpness of this perception increases with distance from the nearest large hospital, Dingwall being a fine example.
    Antipodean

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