The NHS is struggling. Reports are pouring out suggesting that the health service needs more generalists and better trained general practitioners, as the patient coming through the door rarely has one pathology any more.
Think of the olden days which had general medicine clinics and general physicians. They ‘specialised’ in having the bigger picture, could join the dots and come up with the clever diagnosis.
And then specialism happened.
We all became specialists, with a niche and little else. Cardiologists left general medicine. No longer were they dual accredited – they looked only at the heart. They dealt with heart failure, but if it was the result of a pulmonary embolism, it was now the respiratory physician’s issue. If by chance the patient had a minor bleed secondary to the warfarin, off they went to the gastroenterologist. If, heaven forbid, their blood sugars were high, call the diabetologists. And if they had anything resembling silver hair, it would be a travesty if the elderly physicians weren’t looking after them.
So what happened to us as physicians?
I take my hat off to medical assessment unit colleagues who still practice and understand general medicine. But they are being reduced to triage doctors due to the incessant pressure of discharging patients or moving them to another speciality.
Most us physicians are trained in a speciality and general medicine. I have no problem with anyone being a super expert, but that should not negate the reason why we obtained our degrees in medicine.
In super hospitals or big regional training centres, there absolutely needs to be super specialists. Don’t get me wrong, I don’t want a cardio-thoracic surgeon dabbling in gall bladder surgery, nor do I want the ace pituitary endocrinologist looking at deep vein thrombosis. I would rather they saw, diagnosed and treated all the tertiary, complicated referrals they have as a centre of excellence.
But in other hospitals, physicians should be specialists in their outpatient clinics and on the wards too, refusing to utter the words “I don’t do anything else”. It’s dishonest to their training and to the public who (as taxpayers) paid for it. And, believe you me, seeking advice from one source rather than making four referrals for one patient will help GPs when dealing with a patient with multiple pathologies.
So, who looks after that old lady with multiple pathologies who doesn’t fit into a pre-defined speciality category? The answer isn’t “let’s play a game of poker to see who blinks first and accepts the patient.” The answer is that all of us as physicians do. The ability to do so is what makes us ‘special’. Maybe it’s time for us to stop taking ourselves so seriously and just do what we are supposed to. Now that wouldn’t be a bad start.
Dr Partha Kar is a consultant in diabetes/endocrinology and clinical director of diabetes at Portsmouth Hospitals NHS Trust.