Compassion, continuity and caring: a new GP’s perspective

The following quote and text is an excerpt from a chapter of a Royal College of General Practitioners’ publication: Compassion, Continuity and Caring in the NHS; out now. This is a celebration of over 65 years of the RCGP and its motto ‘Cum Scientia Caritas’, edited by Rodger Charlton, the honorary editor of RCGP publications. ‘When In 1922, on the very morning after I had graduated I plunged straight into general practice armed with a thermometer and a stethoscope, and precariously buoyed up with faith, hope and charity — faith in whatever knowledge I had succeeded in acquiring from my excellent teachers, hope that I should remember the dose of strychnine and which forceps blade to insert first, plus my inborn but, so far, undeveloped caritas.’

This was GL McCulloch speaking in 1969 to the East Anglia RCGP faculty about the RCGP’s motto, Cum Scientia Caritas.¹ The college and its motto (‘Science with Compassion’) will be celebrating its 65th anniversary next year. How times have changed since McCulloch was practising.

For me, in 2013, on the morning after I had registered as a fully-qualified GP (7 years after graduating from medical school), I plunged straight into general practice armed not with a thermometer but a smartcard. Although I too was buoyed up with faith and hope, my faith was in Google and BNF Online, and my hope was that as the only male GP at the practice I wouldn’t be called on to do too many smear tests.

But what about my caritas? I had certainly learned the techniques: I was asking about ideas, concerns, and expectations long before I could take blood or write a prescription, and I had later learned the value of connecting with patients so convincingly described by Roger Neighbour.² To any observer, or Clinical Skills Assessment examiner, I was a caring, compassionate doctor. But inwardly, did I experience a ‘feeling with’ my patients that would allow me to see them as something more than a piñata to be hit in such a way that their symptoms fall out in a form that I could apply my accumulated knowledge to?

Now that we have a better understanding of disease and more effective treatments, our patients are less obviously suffering (at least physically) than they were in the 1920s where there: ‘... was almost no science at all … We had opium and morphia and caritas.’ ¹

As we have become more scientific have we become less compassionate? McCulloch argued that his junior colleagues, in unnecessarily investigating patients rather than acknowledging and addressing their suffering, were depriving them of their martyrdom badge. The bottles of brightly-coloured and hideously-flavoured medicine that McCulloch dispensed were the martyrdom badge that they required to gain ‘that sympathy of which they have been starved’.¹ He went on: ‘... whatever these things contain, our giving them to the patient, short of poisoning him, is good therapy. Indeed, nowadays they are an absolute necessity.’¹

Should we find room for the martyrdom badge in a world dominated by evidence-based medicine? If prescribing drugs that we know are little more than placebos helps to provide a compassionate rather than scientific response to patients’ circumstances, might this not be such a bad thing?

• © British Journal of General Practice 2016