Monday, November 07, 2011

Crossing the Line (Part 1)

Being a doctor, and particularly being a GP, is a complex process. It is not enough to simply spend five or six years at medical school, followed by four years or more in hospitals and general practice as a junior doctor. Neither is it enough to have a list of qualifications, or to have worked in your own practice for decades. Nor is it sufficient to hold a licence to practise, read all the recent research, apply all the latest guidelines, pass an annual peer-conducted appraisal, or be revalidated by the General Medical Council (GMC) every five years.

According to the Royal College of General Practitioners’ guidance ‘medicine…is based on a set of shared beliefs and values, and is an intrinsic part of the wider culture’ (Being a General Practitioner, 2010). For centuries, doctors have been exhorted to consider the ‘physical, psychological and social’ aspects of their patients’ health needs. This is called taking a holistic approach and, according to the RCGP guidance, requires caring for the person in the context of their ‘personal values, family beliefs, family system, and culture in the larger community’. This, of course, is the ‘art’ of medicine, rather than the science. The RCGP guidance acknowledges that ‘the holistic approach…admits that people have inner experiences that are subjective, mystical (and, for some, religious), which may affect their health and health beliefs’.

The GMC ethical guidance is equally of interest. In the booklet Good Medical Practice, the GMC states that patients' ‘personal beliefs may be fundamental to their sense of well-being and could help them to cope with pain or other negative aspects of illness’. It also recognises that ‘all doctors have personal beliefs which affect their day-to-day practice’, and advises a doctor that ‘if carrying out a particular procedure or giving advice about it conflicts with your religious or moral beliefs…you must explain this to the patient and tell them they have the right to see another doctor’. The GMC guidance also states that a doctor ‘must not express…personal beliefs, including political, religious or moral beliefs, in ways that exploit (a patient’s) vulnerability or that are likely to cause them distress’. What the GMC does not state is that a doctor is barred from expressing personal beliefs in any way or at any time during consultations, or indeed at any other time.

The holistic approach is not new. Throughout my career I have often expressed the view that modern GPs are ‘part physician, part priest and part social worker’. The second aspect of that statement is in recognition of the diminishing impact of the parish priest within local communities. (I accept and respect the fact that communities with a faith system based on something other than Christianity may still have a stronger daily role for their religious leaders). However, in communities where the population would once have been regular church attenders, many of the problems now brought to a GP are issues where a person may once have sought advice from the parish priest. That acknowledgement brought me very close to becoming a non-stipendiary priest some twenty years ago; a move which would have seen me officially wear the combined mantles of ‘white coat and dog-collar’. Such a move is not new; before Hippocrates, priests were also the physicians of the day, and prior to the advent of scientific medicine, laws regarding health and the practice of healing rituals were largely laid down within religious texts (the Bible’s Book of Leviticus being a prime example).

Next week I will explain how all of the above is topical, why I think the medical profession is confused and acting illogically, and why I believe such muddled and contradictory thinking is not good for doctors or patients.

(First published in the Scunthorpe Telegraph, Thursday, 20th October 2011)

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