This time last year I suggested that we needed a mundane revolution — a better awareness of primary health care’s effect in and on the world that would go hand-in-hand with a change for the better.1
This year I would like to suggest that we need to recognise the ‘embodied’ or ‘peopled’ nature of primary health care in the UK and abroad — patients, practitioners, and policymakers are complex ‘storied’ beings. I have argued that ‘they’ are also ‘us’ — and to forget this is to accept the commodification and even demonisation of humanity.2 This is especially important as things have not really improved in the UK or the world over the last year, with a war on the borders of Europe, and manifold crises of poverty in the UK. Many of the existential threats to humanity have been inadequately addressed if at all. We need to understand and value ourselves and each other to have a chance at flourishing as a profession or indeed as a species.
EMPATHY FOR THE WHOLE PERSON
What is it about us as individuals that allows us to thrive in primary health care? Emilie Couchman reflects that we have many demanding, rewarding, and sometimes competing roles. It is unreasonable to expect that someone can completely fragment themselves and cease (for example) to be a parent while being a GP, or to expect that each and every role has a ring-fenced store of ‘Va-va-voom’!3 Nada Khan renders visible some of the overlooked aspects of part-time clinical practice — the time spent away from the consultation is often both worthwhile and tiring!4
Perhaps ‘fragments’ of role and identity can help us to see more of the whole person, and to respond humanely. Jeremy Howick and colleagues embrace the diversity of individuals who consult and who work in health care as the route to better empathy. We need to try harder with people who we recognise to be different from us — this goes both for colleagues and patients. Howick et al remind us that this can be both a moral and an empirical awareness. Empathy, they argue, can not only lead to better health outcomes but it is also arguably a morally desirable virtue in and of itself.5 They also point to the socioeconomic homogeneity of the medical profession as a barrier to empathy, and, as if to prove this point, Hannah Milton highlights the positive effect of female pioneers in the medical profession in her review of Women in White Coats: How the First Women Doctors Changed the World of Medicine.6
PEOPLE AND SYSTEMS
We live in an age of automation and machine learning, and this itself prompts us to reflect on the differences between knowledge, intelligence, and wisdom, and between high ideals and situated realities. In this issue Richard Armitage warns us that we must close the gap between intelligence and wisdom. People and machines that are intelligently capable but unwise have the potential to wreak great harm.7 Similarly the application of wisdom must include the human element in healthcare systems. In her review of a book that shares ‘hopeful’ narratives about digital health care, Trish Greenhalgh writes:
‘No technology is ever introduced seamlessly in a complex socio-technical system. Rather, people need to learn to use and trust it; pathways and technologies need to be mutually adapted; if front-line staff are being asked to do additional work (for example, complete templates) to make the jobs of back-office staff (for example, data aggregation and audit) easier, resources need to follow that work.’8
Ideas are useless in a silo. Ahmed Rashid curates a smorgasbord of practice-relevant nuggets of knowledge to share and digest.9 Saul Miller reflects on the death of his father, an illustration that shared decision-making is transactional and dependent on both parties to a decision.10
More than this, however, he reminds us that the festive season can be a time of bereavement, challenged by the impersonal nature of hospitals and idealistic practice. Even at a moment of bereavement, there is something for us all to reflect on and learn from.
So as we start 2023, I’d like to invite our readers to engage with the wisdom shared in this issue’s Life & Times and visit us at www.bjgplife.com. The past year has seen a number of excellent regular contributors on the BJGP Life site. Notable regulars in 2022 have included Nada Khan, Richard Armitage, Ben Hoban, Austin O’Carroll, and Hannah Milton, some of whom are featured in this issue. Many others have contributed useful, enlightening, and inspiring work from book reviews to high-impact polemics on poverty and mental health. We look forward to a 2023 that is as rich in collegial discussion and debate.
- © British Journal of General Practice 2023
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