What does the future hold for the relationship between a patient and their GP in the UK?

[摘要] ‘Everything we see has its roots in the unseen world.’(Hafez)The GP landscape has changed considerably in the last 18 months. COVID-19 has forced a rapid mass reorganisation of the way we practice in a way that could scarcely have been believed as Big Ben and Jools Holland played us in on New Year’s Eve 2020. Somehow the sacred physical space of doctor and patient was completely overhauled to the medium of telephone and video. The healing hands were put away and the noise-limiting headsets put on. And we, the clinicians, adapted and became used to it.Yet now, after a seemingly concerted and targeted effort by the government and media, patients are coming back again face-to-face. And so we must re-adapt, re-remember how to consult and examine in one go, and re-motivate ourselves to find the energy to welcome those occasional patients into our clinical space who we strongly feel do not need to be there.What does this most recent turn of events say about the public, what does it say to us, and what does it say about the future in which we are heading?There are so many forces at play that surround and create any given consultation in the GP consulting room. The expectations and vulnerability of the patient, the workload on the doctor at the time the interaction takes place, the political forces that guide the time and money that can be invested into that meeting, the cultural view of what being healthy means and who is responsible, and ultimately, the relationship between the two human beings (or more) who hold that space together. This is a multifaceted intersection of both the biophysical and the abstract, the truth and the story, the strong and vulnerable, humanity and efficiency, and the ‘do no harm’ to the ‘do something’.It is the entangled interplay, therefore, of all these vital elements that charts our course for the future and creates the roots of future relationship. To attempt to explore and answer this question we need to look at all these tributaries before tracing our path to the mouth of the surging river and the powerful ocean they will flow out into.THE PATIENT ‘All good things arrive unto them that wait — and don’t die in the meantime.’(Mark Twain)What the patient wants and what the NHS wants are curiously not always aligned. Perhaps never more evident is the manifestation of this in primary care. We’ve all had or overheard that conversation with a colleague about the consultation where we cannot work out whether anything useful was done. Yet the patient still departed seemingly satisfied. From our point of view we couldn’t scratch our conditioned itch of needing to actively do something, yet perhaps, hidden deep in the dark matter of the encounter, far more was done than we realise?The title of this essay is an interesting one, it asks about the relationship between the patient and ‘their GP’. In the use of the word ‘their’ there is implied ownership. It has often struck me how often I have heard patients talking about ‘my GP’ or ‘my consultant’ in reference to their health. This could be for one of many things; that the patient perceives the doctor to be at their service (that is, their taxes pay our wages), a reference to a sense of continuity that they are well known by the same doctor, or even from a more infantilised approach as we might refer to our own parents with such possessive pronouns.With ownership comes expectation. With expectation comes the possibility of future resentment if the wanted outcome does not match the reality. The loss of the recent face-to-face appointment seems to have triggered a deep sense of loss of control, hence the desire for it to return. A patient comes to their GP in the hope of being understood and maybe even influence the direction of treatment, but how hard is it to give a full account of oneself if we cannot even share a room with the one who is listening?Alongside a coherent explanation for their troubles, I believe the patient comes to be both witnessed and dignified by their encounter with their doctor. In a post-religious world where once the priests used to guide their charges through the interpreted word of God, now the same people look to the guardians of science and evidence to make sense of who they are and how to find meaning in their crises. Most, if not all, patients simply want to be given time and recognition from their doctor. Any future system that wants to enhance this relationship must incorporate this or suffer the interminable grumbles and outrages at what is perceived to being denied.

[学科分类] 卫生学