In the September issue of the Journal, Tim Ballard wrote: ‘The penny dropped with me at the RCGP Annual Conference in Harrogate last year, that the best way of future proofing the healthcare system in the UK is to invest in the education and skills of GPs and their teams, in short, helping them to deliver high quality generalist personalised care. At the heart of this is the skill to deliver bespoke patient care and manage risk without resorting to over-medicalisation and consequent high resource use.’1
In the same issue, in an article on dyspepsia in primary care, two gastroenterologists wrote: ‘The initial management of uncomplicated dyspepsia in the community should consist of either non-invasive testing for Helicobacter pylori, so-called ‘test and treat’, with proton pump inhibitor (PPI)-based triple therapy for those testing positive (PPI and two antibiotics) and 4 weeks of PPI for those testing negative, or empirical PPI for all patients.’2
The gastroenterologists seem to be teaching us how to cope without an endoscope. Surely, as Ballard’s editorial indicated, our scope needs to be wider than this: we have to learn not just about H. pylori but also about other causes of abdominal pain, about the low predictive values of tests, about the way symptoms change over time, either improving spontaneously or becoming more clearly defined, and about the power of serial history and examination.
- © British Journal of General Practice 2013
