Book Review

Abstract

Depending on the reader's perspective, this treasury of a book is aimed at multiple audiences or is intended as the type of reference that can be taken off the shelf and consulted at many points in an individual general practitioner's (GP's) career. Advice on what kinds of intercalated BSc medical students might consider is followed by consideration of different paths within the speciality, whether based on the type of employment (partner versus salaried versus locum) or the content of the job (e.g. what does being a GP with specialist interest involve?). In the chapter on international primary care, Pettigrew and Heath even offer international work as option for partnership sabbaticals and retirement projects. Hutt and Park have assembled a knowledgeable ‘Who's who’ of authors (including two RCGP presidents) to cover key elements of a developing general practice career, including chapters on academia, teaching and international primary care. In the foreword, Roger Neighbour claims that the book will help new doctors and students decide whether general practice is the right career and that it will provide those with teaching and mentoring roles ‘with a persuasive ally.’ Does the book deliver, and is there balance between the wisdom of the GP glitterati and street cred? Does this book capture enough of the essence of a career in general practice? Arguably, it does – and in a way that does not waste too many words! Roger Neighbour's forward begins an implicit thread that runs through this book, namely that of professional identity. He describes the controversial 1958 statement of Lord Moran, President of the Royal College of Physicians, who suggested that GPs should not be paid the same as hospital doctors because they had fallen off ‘the ladder’ of a hospital career. Neighbour goes to describe the subsequent movement by GPs: to prove that clinical generalism and clinical competence were not mutually exclusive, to clarify the defining characteristics of good general practice and to pioneer the UK's system of GP vocational training. Neighbour defines general practice as the open-ended and unconditional medical care of the uniquely individual patient and in the chapter on professional development Dicker echoes Neighbour's definition of good practice when he describes how GP trainees have to unlearn hospital-based history taking habits in favour of an ‘ethical conversation’. He defines this as what happens in a meeting between patient and doctor. It is devoid of judgementalism and attempts to place the patient's problem in the wider context of their life, using a systematic approach, and sharing an understanding of both the patient's and the doctor's perspective. Neighbour generously concedes, ‘… many good specialists try to remember that the patient is a complex and multidimensional individual. It's just that a true generalist can never forget it and wouldn't want to.’ Does this mean that GPs who concentrate on the biomedical aspects of practice are not ‘true’ generalists? The triumphalism of good general practice is sometimes challenged in the book by personal reflections on practice. Steve Iliffe, for example, states, ‘The claim by general practice to be biopsychosocial medicine is exaggerated. Most GPs know little about either the “psycho-” or the “socio-” parts of the job as this is squeezed out of the curriculum …’ and describes his own academic career as ‘… a belated attempt to catch up’. The manner in which such reflections can illustrate situations that are not ideal serves as a reality check for aspiring GPs – and just because senior colleagues might not value or be aware of ethical conversations and psychosocial aspects of practice does not mean that these aspects are not important or should be abandoned. In the chapter on academic general practice, Raymond argues that qualitative research can lead to a better understanding of health beliefs that affect patient health outcomes in diseases such as diabetes (a point of note even for the cynical among us). Raymond also rightly asserts, however, that primary care academia has more recently evolved to meet demands of chronic disease and acute disease management, which have moved from the hospital into community settings. Accordingly, there is major emphasis on quantitative approaches to research which can incorporate pharmaceutical research as well as public health, clinical trials and bio-bank research. This book is for aspiring GPs and for anyone who would like to attempt to understand what current practice involves for GPs. Foundation-year doctors, GP trainees and qualified GPs may find the constant references to opportunities for medical students annoying at times, unless they are one of those precocious medical students who refer back to their old well-thumbed copy in years to come!