General practice in a crisis: a critical play on words

[摘要] When I was a medical student last millennium, the European Medical Students’ Association at Guy’s, King’s and St Thomas’ School of Medicine ran a conference titled, ‘Medicine in a crisis’. The casual reader might have interpreted the title as relating to many of today’s headlines, and a few of this month’s articles, taking in a loss of professional morale and an ostensible collapse in society’s esteem for doctors. Of course it was about medicine responding to a crisis, focusing in particular on medical care in catastrophes and conflicts.We are a world in crisis, in all sorts of ways. The word crisis derives from the Ancient Greek word, krisis, meaning decision or judgement. In modern English there are three broad meanings: a time of great disagreement, confusion, or suffering; an extremely difficult or dangerous point in a situation; or a moment during a serious illness when there is the possibility of suddenly getting better or worse.1DISAGREEMENT, CONFUSION, AND SUFFERING (THERE AND HERE) Our crises have all sorts of causes encompassing (and not limited to) disaster, disease, war, and climate catastrophe, as well as more local crises of politics, philosophy, and economics.Two articles in this issue focus on primary care in relation to catastrophes and conflicts. Richard Armitage writes from Türkiye as part of the UK’s medical humanitarian response.2 Aaron Poppleton and colleagues reflect on a year providing primary care to Ukrainian refugees in the UK.3 Both highlight the need for ordinary care in extraordinary settings as well as the special physical and psychological healthcare needs that conflict and catastrophe generate. Rupal Shah and colleagues argue that ‘More validation should be given to the therapeutic benefits of listening closely, forming a connection, and bearing witness to somebody’s suffering’.4 They focus on the importance of relational care in general practice as a core element of finding and making visible a sense of meaning for GPs. Tim Senior highlights the existential problem of invisible work in general practice across the world.5 Much of a GP’s work is invisible in the sense that it cannot be easily counted for the purposes of reimbursement. This means that much of a GP’s work is neither valued economically or politically. I suppose this is a global issue with primary care.

[学科分类] 卫生学