COVID-19 and the death of the family doctor.

Abstract

You know the old trope: ‘General practice would be great if it wasn’t for the patients.’ The last three months have been among the strangest of my career. The car park and waiting room eerily empty, all day on the phone. ‘This will change the way we practice for ever’, my colleague breezily opined. ‘We’ve always known we don’t really need to see people for most of what we do.’ Really? Among its many victims, will COVID-19 kill off another weakened creature: the ‘family doctor’? The term ‘general practitioner’ was first recorded in 1809 when surgeon-apothecaries were plying private trade from their own shops. The Apothecaries Act of 1815 initiated the first common licensing arrangements, and thereby the professionalisation of this branch of medicine.1 GPs struggled initially — ever complaining about the expense of education, the difficulties of establishing a practice, poverty, competition from ‘irregulars’ — but the profession had become firmly established by around 1850. Generalists in the likeness of Tertius Lydgate came to dominate the practice of medicine.2 Their rise led to a decline in demand for physicians other than as more genteel attendants of the aristocracy. Indeed, the provincial GP enjoyed a virtual monopoly of the local health economy.3 The notion of the family doctor emerged over the second half of the 19th century. The Royal Colleges of Physicians and Surgeons were reactionary and continued to resist the establishment of a college for GPs. Novelists reflected attitudes of the time. The fictional stereotype of the early family doctor was often poor, shabby, and old-fashioned, but always accessible. He enjoyed the confidence of his patients. A contemporary users’ guide intoned: ‘Let not your doctor be too useful … and avoid the man whose dress and demeanour indicate puppyism … Be not averse to him if …