The grand old man of GP literature, Michael O'Donnell, has just published a compilation of the articles that my generation used to read before we read anything else, and sometimes instead of reading anything else. Originally in World Medicine, they are of course hilarious, but they are also moving and their insights are as penetrating and relevant as ever. But more than that, the book Dr Donovan's Bequest1 is an important record of the extraordinary background from which British general practice so recently emerged, blinking, into the sunlight of our brave, new age.
Modern readers may think the stories are wildly exaggerated, but they are not. For example GPs in those days really were treated as a sub-species by hospital specialists. The word generalist had yet to be coined, and the idea that trying to practice in an inclusive rather than an exclusive way, to specialise in a group of people over a period of time rather than in a group of diseases, and to develop expertise in fuzzy things like communication and empathy, were aspirations as high and as difficult to achieve as any in medicine, was still to emerge.
But emerge it did, and this was the immensely exciting ‘golden age of general practice’, which was catalysed to such a crucial extent by the newly founded College of General Practitioners, soon to gain its royal charter and its princely president. General practice, and especially general practice in that greatest of all British achievements, the NHS, was in a unique position to influence the way that society chose to use the unprecedented technological developments, which exploded onto the scene at the end of the last century. With its foundation in science and technology, and, at the same time, its uniquely privileged and intimate access to life at its most individual, human level, these, the last professional generalists in the modern world, had something vital to say about how to keep all this technology humane.
I have an interest to declare in Michael O'Donnell: he recommended my first book in one of his columns, he helped me write my second (for example by eliminating all but one of a 111 exclamation marks), and he wrote the foreword. Now, I can tell you something: you don't write a book, or for that matter an article like this, to make money; you do it in order to promote ideas. And the idea, which was the conclusion of my second book, seemed so bold and presumptuous that I have hesitated to return to it. But I returned to it for an audience of GPs last week, and after their reaction I'd like to try it here.
My suggestion is that from the unique viewpoint I have outlined above, GPs are the first to see a great new truth about the reality of human experience. Anyone who uses Google and pauses for a moment to contemplate the power and accuracy of the tool that they have been using, knows that IT has given us a view of life, as utterly new as that given to Galileo when he used his telescope to look at Jupiter and discovered the stupendous truth that it had moons. Similarly, GPs are in a unique position to watch government and managers attempting to use the unprecedented power of modern computers to indulge their seedy proclivity for central control and construct a comprehensive model of life at the individual level in rigid, digital terms. Thus, GPs are seeing better than anyone else that this does not, and cannot, ever, work — the sum will never add up. They are beset by mad ideas from the centre. If we have sensed that such things can only be modelled in analogue terms, in other words in the human mind, now we have seen the experiment and we know it is true. To carry out that function, which is the essence of medical professionalism, human minds need freedom from all forms of rigid constraint.
If they have confidence in their viewpoint and true role, and if the College supports them in this, GPs can end the anomaly of being treated as a sub-species by such as Ernest Twigg, Waiting List Adjustment Manager, who appears on page one of Michael O'Donnell's book.
- © British Journal of General Practice, 2006.