The Doctor’s Surgery
A doctor called Linda Thomas has given up medicine and abandoned her general practice to pursue a career in fashion design. Press reports suggest that this was not owing to any single factor, but because she had found that there was no longer the ‘healing environment’ in general practice.
A report from the University of Exeter Medical School has revealed that Dr Thomas’s mood is likely to spread. The Exeter study has shown that two out of five GPS in Bristol are intending to leave within the next five years. Professor John Campbell, who led the research, suggests the NHS must change the way it encourages surgeries to be run.
A lack of approval for the way general practice is now pursued is not confined to Bristol and Exeter. Criticism of it seems to be universal. One by one, the supports for a civilised community life are removed. A person is now unlikely to have ‘a solicitor’, an old friend who will offer support and information on a wide range of legal matters. Now one is no more than a client of a large firm of solicitors and is referred to one of a number of partners, depending on the problem.
Similarly, few people could now name their vicar. Postmen no longer hold their position in society; the friendly greengrocer, like the fishmonger and even the ironmonger, have now been superseded by a stranger in a giant supermarket.
As important as vicars, solicitors, grocers and other pillars of society were in someone’s life, they have now been replaced by detached strangers. But their loss is less important to us than the end of the GP. A good and alert GP, who has a sound knowledge of medicine and the special interests and abilities of local consultants, can make the difference between life and death.
Among the many reasons why Britain has fallen so alarmingly in the international league tables comparing medical results is the undermining and destruction of the GP’S role.
In a TV programme that looked at different nations’ relative quality of midwifery and obstetric services the best by far were in Japan. A Japanese obstetrician was asked why results were better there than in other developed countries. The obstetrician replied that it was because they had a system and programme that ensured the patients – the pregnant women – were carefully monitored. A timetable of visits was enforced and these visits, together with appropriate tests, were carefully logged.
The obstetrician was then asked to run through their programme. I was amazed as he read out a programme that was identical to the one at the large maternity unit in London that I had worked with 58 years ago.
A few years ago, I asked an obstetrician why we had abandoned the old regime and why the control of the maternity services was now much more midwife-led. He told me that the new system was cheaper and equally patientfriendly; perhaps he should look at the statistics and see if he can’t make a study tour in Japan.
Before he goes, he should read the report that shows foetal mortality and an appreciable percentage of damaged babies are the result of a mismanaged labour.
He should perhaps avoid reading the report of Dr Olufemi Oladapo of the World Health Organisation, who is calling for fewer caesarean sections. There is overwhelming evidence that a caesarean is most likely to have an unfortunate outcome if it is postponed until the pregnant woman is tired, weary, dehydrated and generally exhausted – so that the unborn baby has probably been suffering from an impaired foetal blood flow for too long.
Obstetricians tend to judge the baby before discharge. If they became GPS, and were still looking after the child fifteen years later, they would see the results of the ‘difficult labour’.