Sheffield doctor examines general practice: from individual care to population health

As a junior doctor there wasn’t a bit of the job I didn’t enjoy.

Wednesday, 12th June 2019, 08:43 am
Updated Wednesday, 10th July 2019, 14:43 pm
Dr Andy Hilton

The career opportunities were broad and the exposure to disease, pathology, illness and injury seemed endless. I revelled in the intensity and excitement of the Accident and Emergency department, making rapid decisions and trying to make a difference in life threatening situations.

On the wards I was stimulated by the opportunity to connect the theory and knowledge I’d learned at medical school to real life situations, translating the symptoms and signs in front of me into diagnoses and a management plan.

I developed a strong foundation of experience which has stood me in good stead throughout the rest of my career.

Over the same time I watched on as my own father went through a series of hospital admissions and battled with his own chronic illness. I witnessed the impact of his illness on my mother and sisters and on his work, ultimately forcing early retirement through ill health.

I will never forget the day I stood helpless by his bedside watching him deteriorate, in terrible pain and powerless to do anything despite my medical knowledge and my experience. I realised at that point that patients weren’t just a list of pathological diagnoses, of laboratory results or radiological images. I realised that behind every illness was a person, an individual with their own perspective, with a family, friends, job and a unique set of circumstances within which their health problems are given context.

One constant throughout my father’s illness was his GP. He took great comfort in knowing somebody was holding the ring on his care, making sense of the medical issues, and translating them to him in a way that made sense and that took account of his own personal circumstances.

Looking back it was these early experiences that shaped my approach to patient care and that eventually led me down a career path in General Practice. I’ve always maintained that being a GP is a difficult job to do well. The field of medicine is a broad and ever changing one and keeping up to date across the full range of specialities, even at a generalist level is not easy.

Whilst it’s a bit of a cliché for all medical school applicants, having compassion, empathy and an interest in people’s lives is really important and is probably central to the role of a GP as we attempt to support people through some of the most difficult periods of their lives.

Expert Medical Generalism

Although at times GP’s can be viewed as a jack of all trades, in reality we are expert ‘generalists.’ We take a range of undifferentiated presentations and make sense of them. Sifting through groups of nebulous symptoms presented by the patient almost like a detective, weighing up the potential risks, the possible diagnoses and determining a management plan. Wherever possible we do this in partnership with the patient, after all, they’re the ‘expert’ in their own particular set of circumstances. This often entails working out levels expectation, uncovering hidden agendas and placing the presenting symptoms not only within the context of a person’s own perception of health and wellbeing but also taking into account social and emotional factors.

Continuity of care, that ongoing doctor-patient relationship lies at the heart of traditional General Practice and there is good evidence that not only does it vastly improve patient trust, reassurance and their experience in general, it also reduces hospital admissions and demands on specialist services. As we work at greater scale, protecting continuity becomes an issue.

Uncertainty

One of the greatest challenges for GP’s is managing uncertainty and holding risk, something that can be difficult for more junior colleagues to become comfortable with and that is never easy. We’re all aware of the consequences when we get it wrong and so ‘safety netting’ and continuity of care are crucial. Through our knowledge of patients, their families and their circumstances we can build a picture of what’s important to them, of how we can best support them to be well, to live with the conditions they have, to manage the risks and help them to navigate what is a hugely complex and often daunting health and care system.