Being impossible

James Willis

doi:10.3399/bjgp11X588574

While GPs may not work miracles as often as some of their patients imagine, they do the impossible everyday. Rather than being ashamed of this, it is time everybody realised it is something to be proud of.

I am reading Bill Bryson's At Home: A Short History of Private Life. Bearing in mind that Bryson's 1990 book The Mother Tongue: English and How it Got That Way more or less covered the English language, that he then wrote books which more or less covered, in turn, Britain, North America, and Australia, and after those, A Short History of Nearly Everything, which more or less covered science, the way that his new book more or less covers social history ought, you must surely agree, to be impossible. But — hey presto — it manifestly isn't. Unless you think he's a committee, which I don't.

What we actually have here is a man with a gift for communication, who has the courage, the intelligence, and the intellectual humility to explore a subject, get his head around it, and then set about explaining it. It is almost as though, by putting the subject into words, he is explaining it to himself. So, can you see that he is rather like a GP?

Can you see that he is doing something which nobody who has spent a lifetime focusing their minds on a particular field — however admirable and necessary such people undoubtedly are, and however obviously Bryson respects their expertise and depends upon their work — could possibly do? The fact is that his work is of an entirely different kind; a kind which is complementary, just as challenging, and at least as important.

Part of the difficulty of grasping the scale of the achievement of the generalist mind is this very problem of focus. Nature has equipped us with a mental microscope of literally infinite power: you only have to think fora moment to realise that there is no limit to the minuteness of the subject upon which you can concentrate your entire attention. But only slightly less obvious is the fact that nature has forgotten to provide us with any means of calibrating the magnification of this instrument, so that we have no intuitive sense whatsoever of the vastness of the ‘everything else’ which may be being excluded in any particular view. And this hides from us another of nature's uncalibrated endowments — the staggering scale of the hidden capacity of our minds.

So, unless we stand up for ourselves and our approach, generalists are at the mercy of every passing pundit. The glorious irresponsibility of journalists, single-interest pressure groups and administrators, is to be able to ignore the ‘everything else’ — every item of which may be just as important as the topical issue for which they are so sure GPs should have special training, accreditation, audit, CD ROMs to study in their spare time, certificates for the wall (in A3), extra pay, you name it.

This is why I have always revolted against over-prescriptive training for general practice. The hallmark of the generalist is a willingness to tackle anything, a willingness to be interested in anything. Like Bill Bryson in fact. Some doctors training for general practice have been encouraged to exclude some areas, even areas within medicine itself, from their attention because they deem them irrelevant to their future career This is profoundly misguided. It reflects this failure to appreciate the fundamental inclusiveness of the field they have chosen to enter. Outstanding GPs often have wide interests and wide experience beyond medicine, never mind within it. That is exactly as it should be, even though the currently fashionable mind-set has come to doubt that it is even possible.

GPs are the heirs of a wonderful tradition, a wonderful role, which is uniquely valuable to, and valued by, patients. It is time they stopped selling themselves short to a world that measures their worth by an alien yardstick.