How the doctor-patient relationship is changing | Letters

Your report (Seeing the same GP ‘improves patients’ health and reduces doctors’ workload’, February 23) is welcome, but rather late: experienced practitioners in previous decades always knew that continuity of care was an essential cornerstone for building the art and ethos of their community and professional work. Like the Victorian era doctor William Osler advised: “It is much more important to know what kind of patient has a disease than what kind of disease a patient has.”

This should be especially true for general practitioners: not just the technical aspects of diagnosis and treatment, but even more so the human skills of containment, comfort, guidance and informed support – the art of caring, which is a large part of therapeutic care from a doctor. influence.

The last thirty years of successive NHS reforms have attempted to replace all this relationship-based pastoral healthcare with technically defined, company-managed procedures of procedures, modeled on competitive manufacturing industries. This depersonalization of healthcare has been deeply destructive for providers and patients – and for the managers who cannot control the chaotic consequences. The consequences are becoming increasingly visible to everyone. All this had been clearly warned and researched by the past decades of general practitioners. It is remarkable – even emblematic – that it is a business school study that is now most noticed.
Dr. David Zigmond
Doctors for the NHS

When I retired in 2020, I had been a GP in the same practice for 31 years. I had many patients that I cared for throughout the period, along with their families. They knew me and I knew them, and that made their care for all of us better and easier. It also made the work fun, which was an important part of keeping us going as GPs. After all, we treat patients, not diseases, and understanding the lives and stresses of individuals and their families makes diagnosis and treatment easier.

When I talk to my former partners now, they lament the demand pressures that have eroded that continuity – these demands arise from the fact that the system is so overloaded that it is an uphill battle to maintain continuity. I enjoyed my three decades there, I’m not sure I would again.
Dr. Emile de Sousa
Cobham, Surrey

There is a significant risk of putting on rose-tinted glasses if you equate good continuity with just traditional GPs. The reality is more complex and nuanced. We risk presenting a false dichotomy of a traditional, named GP in a clinic providing continuity of care every day, versus a modern, part-time, digitally enabled, team-based GP practice with a primary care network as the core delivery unit.

After working as a general practitioner for 10 years, I now have about 1,500 people, and the associated 1,500 life stories, registered with me. Only by getting to know them can I help them in the right way. For some, regular text messages flow, and for others, there are occasional face-to-face appointments. No two are identical in need or in our response.

Digital is often misunderstood as an inevitable threat to the human element of healthcare. Online consultations or texts may seem transactional and impersonal, but with continuity they become embedded in long-term professional relationships.

General practice is in a precarious position. Doctors respond to this by working faster, longer and harder. This is understandable, but untenable. Instead, we need to reconnect with our sense of purpose. What do we value and how can we maximize it? For many, the answer lies in continuity, or more clearly: in knowing and being known.
Dr. Richard Pratt
Truro, Cornwall

As for your editorial about seeing the same doctor (Feb. 26), this is absolutely true: human connection is good for us and keeps us healthy. Did the University of Cambridge investigate that this was based on alternative models of human connection? In group consultations, which usually last 90 minutes, approximately twelve people with a long-term condition are brought together to gain insights from each other about how they can deal with their condition. A doctor is on hand to advise and provide accurate medical information, while patients share experiences to help them self-manage their condition and address other non-medical issues they face as a result of their illness.

Group consultations are just one example of peer support, for which there is now good evidence of positive health outcomes.
Merron Simpson
Managing Director of The Health Creation Alliance, Birmingham