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LucyGransnet (GNHQ) Thu 29-Jan-15 11:14:03

Where have all the family doctors gone?

Jane Haynes describes the increasing distance between the once familiar family doctor and the patients they serve.

Jane Haynes

Where have all the family doctors gone?

Posted on: Thu 29-Jan-15 11:14:03


Lead photo

Jane Haynes is a psychotherapist whose previous book was shortlisted for the PEN Ackerley Literary Memoir Prize and was endorsed by Hilary Mantel.

While my children were growing up the welcome arrival of our family doctor to diagnose an acute ear infection late at night was not uncommon. I remember our small son clambering the nursery curtains, pleading for his ‘friend’ our doctor to arrive, driven by the relentless pain. I can also remember our doctor - a dapper man by day - sitting past midnight on our son’s bunk bed and delicately checking his throat and ears.

Dr. Smith, who spent his days in pinstripes, wafted Eau Sauvage and stole wet-lipped kisses from some of his lady patients, but only at his door where he ‘courteously’ stood to bid them goodbye. That particular night however, he had arrived in jeans and an open necked - if crisp and wife-ironed - striped shirt. How young he looked! I had always thought of him as old, but what then took me by surprise as he knelt down by the bunk, was a gold chain and the flash of a most unlikely over-sized and sparkling medallion. At this clash of aesthetic, some of his gravitas fell away and I realised that he was another ordinary man who concealed - behind his day-consulting façade - all sorts of quirks, vanities and clues to another life beyond the limited one to which I had access.

Long retired and dead now, I still have an image of him sitting pinstriped and elegant behind his mahogany desk, fountain pen poised, as he entered in long hand those medical tidings, both benign and malignant in a leather bound manuscript.

Now it is becoming rare for doctors ever to enter their patients’ homes, or even to remember their names before they glance towards their computers. Some futurist physicists like Michio Kaku are predicting that before the end of the century microsurgery will be conducted remotely over the Internet. But regardless of predictions there needs to be something sacred about health: it is the opposite to disease and thus a visit to the doctor will subliminally remind us of our mortality and our prospective death.

Twenty years ago it would have been uncommon for any GP not to know the names of all the families on his panel and likewise we would be able to name our GP.

These days, how rarely are our GPs now available to be summoned in those lonely hours of the early morning, which are most disposed to seeing the dying depart. Whilst we may have to accept that along with the population explosion there are many ideals of leisured medical consultation that belong to the past, there is something awful happening when patients cannot expect to be remembered or attended to, except by a stranger in their hours of greatest need and terror.

During the Swine flu debacle of 2009, I was told by a family member who is a specialist in infectious disease control, that it was not uncommon to witness anxious parents arriving at a medical centre in Lambeth only to be instructed to remain in their car until a doctor in full protective environmental suiting and mask, emerged to thrust a do it yourself swab kit through the car window. What will happen to the doctor and patient relationship when a major environmental infectious disaster strikes at the heart of society? Between one day and the next, and usually without warning a trickster virus can descend, or a stroke paralyse. Too easily we are able to eradicate the facts of the 1918 flu epidemic, which infected 500 million people across the world and killed between 50 and 100,000 million of them.

When something goes wrong with our body, or our children’s bodies, we are immediately vulnerable and liable, if not forced, to abandon our autonomy and place ourselves in what may be an uncomfortable, or even a hostile stranger’s hand. Depending on how ill or vulnerable we feel, we may, or may not fear that we are falling apart. Illness creates disorder: Things fall apart/The centre cannot hold/Mere anarchy is loosed upon the world. We need only to substitute ‘upon the body’, for Yeat's lines to serve as a description for what can happen when we are suddenly taken acutely ill. Many connections are severed and taken away as illness isolates us from the familiar routines of our lives and renders us most vulnerable.

Twenty years ago it would have been uncommon for any GP not to know the names of all the families on his panel and likewise we would be able to name our GP. Today, when I ask my patients, (I am a psychotherapist) if I can write to their GP, it is not for fear of confidentiality that they reply, "No point. He/she would probably have no idea who you're writing about".

Jayne Hayes co-authored Doctors Dissected with Martin Scurr, available 29 January from Amazon.

By Jane Haynes

Twitter: @gransnet

granjura Thu 29-Jan-15 11:19:41

Retired- and sadly very happy to be out of the current mess. What you describe is exactly how it was for DH and his generation of doctors. When we visit the UK, it is common for ex patients to run up to him and cry.

Anya Thu 29-Jan-15 11:20:11

I remember our old GP arriving in his battered split-screen Morris Minor to confirm that we had measles or chicken pox or something spotty anyway. He had a live chicken in a bag that a patient had given him. He asked my mother if she wanted it (he knew we kept chickens) so she gave him some cabbage, potato and beetroot she'd given him in return.

Anya Thu 29-Jan-15 11:21:19

(Oops too many 'gave/givens there)

Agus Thu 29-Jan-15 11:35:31

I remember our old family GP fondly. He once asked me when I was aged 5/6 if I had any pain passing water to which I replied, no, I pass the loch every day and I'm fine! He burst out laughing and said to my Mother that it hadn't occurred to him, what a silly question to ask a child. grin

Our current GP knows our names, both DDs and both GDs and has been our GP for many years. A lovely old school gentleman who, if we meet outside, enjoy a blether together.

loopylou Thu 29-Jan-15 11:38:27

How this reminds me of the wonderful doctor I had from birth until I was 35. He kept the children and I on his books long after we moved 17 miles away, an utter gentleman, courteous and very caring, and worked what seemed to me as 24 hours a day.
He died recently at the age of 96 and the church was packed with many of his old patients.
Wonderful wonderful man.

Galen Thu 29-Jan-15 12:03:20

Retired ( at least this one is) and disgusted with way general practice has gone.

Mishap Thu 29-Jan-15 13:33:38

My OH is always being accosted by ex patients who say things like "I shall never forget when you saved my granddaughter's life" - when we are out of earshot and I ask who it was he often says "I haven't a clue!"

We are registered with his old practice and in many ways nothing has changed. The GPs are plagued by edicts from above and paperwork and targets and all that jazz - but underneath their hearts are in the same place and it does come across in their approach to patients. Because it is a small rural practice they still know who is who's auntie, and who has just lost their job etc. and have that personal touch. I can always speak to my GP the same day (as long as he is there), either on the phone or by email, and if I need a quick appointment there is always one that day or the next.

I admire the way they have incorporated the necessary changes to tick the boxes, but have not lost sight of what it is all about.

When patients arrive the receptionists greet them by name and ask after their family.

grannyactivist Thu 29-Jan-15 13:49:38

My GP is a woman who I'd guess is in her late forties. She has been my GP for 17 years and, in my view, is a wonderful, caring and considerate doctor who has gone the extra mile for me many, many times. However I've met several people who would describe her as the opposite, so I guess it's a very subjective matter. She has occasionally telephoned me at home just to check how I am after I've been really ill and always takes my telephone calls. The out of hours service has been contracted out, but if I've been seen by one of the OOH doctors she usually calls me or asks me to make an appointment to see her - again just to keep an eye on me.
I know times have changed and GP's don't make house calls as they used to, but they work so hard (mine do at least) that they deserve to have planned time off with their families - just like anyone else.

feetlebaum Thu 29-Jan-15 14:41:55

I remember the days when if there was a car parked in the street people would say 'Somebody must be ill at number so-and-so...' because only the doctor had a car! Ours had his own little dispensary in a corner of his consulting room, and would make up bottles of jollop - usually 'a tonic'... I don't know if they were any use, but most of us survived most things!

Today one is registered with a practice and there is always a doctor one can see, but I prefer to stick to one doctor - mine has now twice swanned off on maternity leave, but her locums have been fine, and we have a relaxed sort of relationship. And to be honest they have far more weapons to fight our many diseases with than the old-time GP - and they have never once offered me a 'tonic'!

durhamjen Thu 29-Jan-15 19:59:13

They are too busy trying to see where they can get the most money from private healthcare companies.

granjura Thu 29-Jan-15 20:08:07

Doing Botox and such like!

GrannyTwice Thu 29-Jan-15 20:36:14

Feetlebaum - 'swanned off on maternity leave' ? You'll be saying next she "got herself pregnant'.shock

durhamjen Thu 29-Jan-15 21:00:15

If new legislation gets passed, GPs will have to display their CQC ratings on their doors.
Will this be useful or not?
I can see if you live in a city or large town you might be able to go somewhere else, but not in a small village with only one GP surgery.

Falconbird Fri 30-Jan-15 07:20:46

I do so agree. I have posted elsewhere that I was fortunate enough to have the same doctor for 25 years and he was great. He did house calls, knew his patients and was a real tower of strength.

I've had to move to a different area and I'm now part of a big practice which is impersonal and briskly efficient. I don't like the new approach but I suppose we have to move with the times.

I was a volunteer at an Elderly Peoples' Home before I had to move and met my doctor many times when he was visiting the residents. It was nice, to just say hello and on one occasion he asked me to let him out of the Home because he couldn't manage the security system. {smile] It all felt very human and relaxed.

I'm not sure what CQC stands for but I imagine it's something like an Offsted Rating. I think all this tick box evaluation is not a good thing. People make their own decisions (hopefully) about who is a good GP and what makes a good school for their child.

durhamjen Fri 30-Jan-15 13:18:45

For you, falconbird.

durhamjen Fri 30-Jan-15 13:19:34

Sorry, you do not just want the logo.

sweetmelissa9 Fri 30-Jan-15 15:35:43

I am recently retired after 20+ years working in the health and social care sector and have watched services deteriorate over the years, so very sad. It seems to me that GPs are trained only to prescribe, and to refer when certain criteria are met. They are encouraged to reduce the drug budget, but don't seem to have the time or inclination to consider alternatives, at least in the practice that I attend. I end up finding my own solutions on the internet most of the time. Also I agree with the comments about CQC - a box ticking exercise in my experience.

Iam64 Fri 30-Jan-15 19:11:50

I feel fortunate in being in a group practice, where we can always be seen o the day with emergency stuff or wait to see our chosen GP with the chronic things that go with getting older.

My current GP of choice did 2 years as a registrar with my rhuematology consultant, so I feel lucky. She is also a joy, in her 30s and full of enthusiasm, always smiling and supportive but last time I saw her she talked about working 12 hour days regularly and feeling unhappy with the way the NHS is changing. I'll use the word changing to avoid this thread deteriorating into a political discussion. Maybe that's inevitable grin

J52 Fri 30-Jan-15 19:20:18

When we lived in London and the children were small, we had a lovely old fashioned GP who had consulting rooms in his own home. He was highly amusing ( although I don't think he realised it!)

One notable occasion he kept the anthrax vaccination he'd got for a relative living with us ( long story, don't ask) in his fridge, next to the eggs!

Now, because I hardly ever go to the Health Centre, I don't know who my doctor is and they certainly never inform me when they make changes to the appointment system. Friends tell me it is regularly changed.

Still, I expect they get some sort of payment for having me on their books! x

hildajenniJ Fri 30-Jan-15 19:39:40

When I was eleven I managed to get yellow jaundice at a Christmas party. Our lovely GP came to see me on Christmas Day! I was in quarantine in my bedroom. Nobody was allowed to enter as I was contagious, but Dr. Harry came in and sat on my bed!!

Galen Fri 30-Jan-15 20:32:47

Grannytwice I stopped work two weeks before my due date and back full time six weeks after. That was all the maternity leave I was allowed A! In my second pregnancy I had to drop to two thirds of my income! Reckon it cost me £2000 to have my daughter

thatbags Fri 30-Jan-15 21:12:15

There are still family doctors. Our GP is one of them. He knows who letters are about. I think that blog is a bit OTT. Either that or I've been damn lucky in various parts of the UK to stumble upon good GP practices with good doctors who obviously cared about their patients. I expect my experience is not very unusual.

Mishap Fri 30-Jan-15 21:23:13

When we arrived here many years ago there was a GP in the town who did his rounds in a horse and trap. When his horse died he had it stuffed and put it in the waiting room. They don't make them like that any more.