Dr Phil Hammond, broadcaster and GP returner in Bristol

Bring the generalists back to medicine

The NHS has always been the hottest of political potatoes, but this year it's untouchable: massive reforms somehow coupled with massive savings, GPs put in charge when most want to be left alone, and a special BMA meeting to vote on strike action that will never happen. Dr Clare Gerada, Chair of the Royal College of General Practitioners, has shown commendable leadership and media skills in openly questioning the finer details of the Health Bill and now her College has entered the fray, announcing … wait for it … a Commission on Generalism.1

I chuckled for a good 10 minutes when I heard that, and then decided not to refer anyone to hospital for a whole day. Generalism is such a rare beast in our overpopulated specialist forest that it doesn't even appear in my Microsoft dictionary. But then neither, reassuringly, does Microsoft. And although most NHS staff and nearly all patients would struggle to define generalism, the decline of the quiet, reflective broad-based, no-panic holistic approach to doctoring is one reason we're in such an unsustainable pickle.

Healthcare is a bit like the arms trade. We scare everyone into thinking that there are serious threats all around us, which only massive investment in expensive equipment and specialist operators can solve. Before the Berlin wall came down, we were led to believe that East Germany was full of warheads, so we'd better stock up on our own. In the end, it had a couple of rusty tanks and a pea shooter. Ditto Iraq. And Libya wouldn't have anything to bomb its own people with, if we hadn't sold it to them.

This conveyer belt of arms dealing fueled by fear is not a million miles from the proliferation of shiny new hospitals we've built at huge expense, which will cost our grandchildren billions of pounds to rent. Treatment costs are elevated to cover this debt, but patients still die lonely, painful, and miserable deaths. If we'd asked a generalist doctor what to do with the money, he'd have spent it on love and friendship, books, music, art, gardening, hill walking, and dogs. All those upstream activities that keep us from falling into the river of ill-health, rather than diving deeper and deeper into it.

There are no general surgeons and physicians anymore, and if we're not careful there won't be many general practitioners. Just lots of specialist commissioners buying specialist services staffed by a never ending tribe of 'ologists' who only do pineal micro-adenomas or the north-north-west face of the gall bladder.

The specialism of nurses may have done wonders for nurse degree courses, but it has blinded us to the plight of elderly patients who don't quite fit into the right algorithm at the right time. Most of medicine is not difficult or technical, but once you're wearing your specialist hat, you only see specialist solutions, and they're invariably very expensive.

What the NHS needs more than ever is to rediscover its humanity. Stop, look, listen, love. Bring back the generalists, I say. There's not much money in it, but it's a lot of fun.

  1. Royal College of General Practitioners website. RCGP establishes new Commission on Generalism. www.rcgp.org.uk/news/press_releases_and_statements/new_commission_in_generalism.aspx (accessed 8 March 2011).

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