Building an efficient and healthy practice.

Abstract

All happy families are alike but an unhappy family is unhappy after its own fashion.1 General practitioners' professional status is, or at least has been, lower than that of hospital consultants. The jibe of “perfunctory care by perfunctory men” still cuts, more than 80 years after it was made,2 although the context is at least partly sympathetic - what can be expected of inappropriately trained, underpaid, overworked doctors without effective treatments?3 Lord Moran's surprise that general practitioners (doctors who had fallen off the career ladder) could be thought equal to consultants, expressed in 1960, can still make sensitive general practitioners wonder whether consultants regard them as equals. This history of being overshadowed by the hospital service may explain the egalitarian philosophy ingrained in general practice. Marshall Marinker, until 12 years ago a general practitioner and now director of medical education at Merck Sharp and Dohme and visiting professor at Guy's and St Thomas's United Medical and Dental School, agrees that “there is an unwritten law that general practitioners must never be hierarchical, an unwillingness to accept that some general practitioners might be better than others, a fear of unfair competition. The BMA used to frown on the display of degrees and diplomas on general practitioners' brass plates.” The need to be equal hinders cross fertilisation between practices and stultifies development. New ideas imply criticism of the status quo and elicit a defensive reaction. Dr Marinker's solution is to “Abolish the rank and file mentality. Give everyone the chance for growth.” Perhaps this is what successful practices, like Tolstoy's happy families, have in common. This article is about the development of pride and identity for ourselves, our practices, and our profession. The need to be equal hinders cross fertilisation between practices and stultifies development. New ideas imply criticism …