Is there a ‘best kind of doctor’ in the house?

During a recent meal with some non-medical friends, the question was posed: “which is really the best kind of doctor?” My wife, always looking for ways to tease me, laughed when I volunteered that GPs were most likely to fit the bill. She said with a wry grin: “Sure don’t you know that all GPs do is hold people’s hands”.

Admittedly, in some ways this is a pointless debate as the best doctor is probably whoever the patient needs at a given point in time. However, I don’t like to be bested in an argument and especially not by such an affront. In the midst of doom and gloom about the future of medicine and doctors in Ireland and the return of emigration stories and my own negative equity to boot, it’s easy to become pessimistic in contemplating my chosen career. So I thank my wife for giving me the fire to be enthusiastic and reflect on what I do everyday.

In April’s issue of Forum Tadhg Crowley searched for the comprehensive definition of the role of the GP – wheeling from WONCA’s aspirational European definition through to being a consulter, a conductor, a telephonist, a delegator, without ever settling on a satisfactory conclusion. 

The late Cecil Helman in his inspirational book Suburban Shaman wove a much more complex and mystical role for the GP. His career as an anthropologist prior to becoming a GP allowed him to write the book’s tagline: “Medicine is not just about science. It’s also all about stories, and about the mingling of narratives among doctors, and between them and their patients.”

His view was that modern medicine is succumbing to the seduction of the specialist. Educators, regulators and public opinion encourage the need to measure, to categorise, to investigate, to glorify in the minutiae of the latest enzyme, molecule, immune modulator or dazzling medical device.

But what are the tools of my trade? As a GP I don’t dwell on the intricacies of GPIIb/IIIa receptors and anti-TNF agents. My toolkit is filled with much more mundane things. I have my stethoscope, my eyes, my otoscope, my thermometer, my touch, my voice, my reflex hammer, my tongue depressors, my heart. Specialists may sniff at such a mixed bag of clutter: No Zooplex B levels? No T 47/Z23 weighted images? My prescription pad writes scripts for amoxicillin, atorvastatin, amlodipine, donepezil, escitalopram, googledizp, jumpletipx… the trade names change, the doses differ, the guidelines update, the scanning machines become brighter, the reference ranges tighter but the people in front of me stay the same.

The woman that has been beaten by her husband, the mother who has lost a child, the pregnant woman who doesn’t want a baby, the man who has just been told he has cancer, the woman who is showing the early signs of dementia, the parents who are driven mad by an errant child. The cup of tea and warm welcome on a house call, the smile of a soon-to-be mother at an unexpected but welcome pregnancy, the laughs at a moment of humour between a well-known patient and you. The Mass cards, the salutes as you pass on the road, the chocolate biscuits at Christmas.

Yes I do work for my patients to optimise their HbA1c, to assess their ‘Heartscore’, to screen for depression, to minimise antibiotic usage, and to achieve quality in prescribing. Yes I do work to collect my external and internal CPD points for the Medical Council. But despite, perhaps in spite of all this, sometimes you know, I think my wife might be right – I do just hold a patient’s hand. And do you know what? I think that makes me the ‘best doctor’ for them in that moment. 

Note: Zooplex B levels, googledizp, jumpletipx and T 47/Z23 weighted images don’t exist… at least not yet!