This book should be available on prescription. Simon Stevens, the Chief Executive of the NHS, wrote in the General Practice Forward View that ‘There is arguably no more important job in modern Britain than that of the family doctor.’1 In The Appointment: What Your Doctor Really Thinks During Your Ten-Minute Consultation Graham Easton, an experienced GP, writer, broadcaster, and teacher, and also a member of the BJGP Editorial Board, fleshes out this argument so effectively that everyone who reads it will want to be a GP.
The book describes a 3-hour ‘composite’ morning surgery, consisting of 18 10-minute appointments, each based on a real patient, preceded by a short summary of the medical record, and interspersed with a ticking clock icon, which simulates remarkably well the passing of time and the pressures on the doctor. There is only one DNA, and the surgery runs slightly over time. A short follow-up is provided for each consultation in a concluding chapter.
The clinical problems presented during this memorable morning cover most of medicine — chest and abdominal pain; rectal bleeding; cardiovascular risk; depression; red flags; skin problems; thyroid disorders; respiratory infections; challenging patients; prostate cancer and drug addiction. Easton lucidly describes his thought processes about each patient, their reasons for the encounter and his pathways to diagnosis. He also reflects, inter alia, on pay-for-performance, chaperones, simulated clinical teaching, statins, continuity of care, and the role of the humanities in medicine. Every chapter is a pleasure to read: Easton makes it all look so easy as he moves effortlessly between experience, empathy and evidence — echoes of Mindlines2 here — and he wears his erudition lightly throughout. It isn’t easy at all, of course, and this facility with people and illness is the product of many years of hard work, application and wide reading. And in case you think he has had a comfortable ride, read on to the final chapter about oxycodone.
Simon Stevens obviously ‘gets it’, but many important individuals and organisations do not. In promoting the role of general practice, it isn’t always easy to describe the value of the expert generalist, and sometimes we miss the mark. In this book Graham Easton is bang on target. This isn’t a book simply for the ‘interested lay reader’: it is a book for anyone with an interest in medicine, from a sixth-former contemplating a career in medicine, a medical student wondering about general practice, a GP registrar struggling with the challenges of the consultation, a specialist trainee wondering what general practice is all about, and everyone in the NHS with a responsibility for primary care.
It is a book for all patients and, of course, we are all patients.
- © British Journal of General Practice 2016