Dr Maureen Baker: GPs are not able to treat everything

You can't have escaped the John Lewis Christmas advert depicting an old man living on the moon, alone. Without getting into why the old man is living on the moon in the first place, it does highlight the issue of loneliness and, as GPs, we are being asked more and more frequently about our role in treating lonely patients.

Loneliness can be a sign of an underlying mental health condition and as experts in treating the whole person, it is something we need to consider when making a diagnosis. But loneliness in itself is not a medical issue so there is very little that GPs can do.

That's the problem. There is an expectation that a trip to the GP will result in treatment, usually in the form of a prescription, but we know that this isn't always the best thing for our patients. There isn't a prescription we can write to cure loneliness and many other states of mind, which are unfortunate but can be simply ‘normal’.

All we can say to a lonely patient – when we don’t suspect a mental health issue - is to encourage them to meet more people; to join a group; to learn a skill; to make a friend. All, I am sure more easily said than done, but regretfully the only 'cure' - and much healthier than taking an unnecessary pill.

Over-reliance on medication

This mentality of wanting something tangible from your GP is, in my opinion, the joint result of a culture of expectation coupled with growing frustration at the difficulty in getting an appointment (and therefore wanting something other than advice to make the visit seem worthwhile).   

We saw the evidence a couple of weeks ago when the British Journal of General Practice published research that found patients rated their GP as less satisfactory if they did not prescribe them an antibiotic.

This is a snapshot of our society’s over-reliance on medication and our patients’ belief that they can be treated, whatever is the matter.

The truth is that over-diagnosis or medicalising normal behaviour can do more harm than good. But getting this across to our patients can involve both difficult conversations and ethical quandaries when we make decisions about what is best, to treat or not.

Sometimes interventions don’t improve our patients’ health and can even lead to complications or further illness, reducing their quality of life. The harms of over-diagnosis are often side effects of treatment, but which side effects are more important than others? Who should decide – patients, GPs or pharmacists? And what if we all disagree?

Medical advances are an ethical minefield

Stepping back from general practice for a moment and looking at the wider NHS. I recently attended a thought-provoking conference that really brought home what an ethical minefield medicine can be.

On the topic of ‘too much medicine’ one case study that stood out was the use of intensive care units. In the past, these wards treated the very ill before they either died, or became well enough to be treated by services in the community. Now, they are becoming places where very sick people remain very sick as doctors and nurses do everything they can to keep them alive for as long as possible.

It reminds me of former college president Iona Heath’s speech at our annual conference in Glasgow when she asked what was better, living longer and being ill or shorter and well?

Advances in medical technology – excellent as they are - mean that death, however inevitable, can be a long drawn out process that doesn’t necessarily translate to quality of life.

Is this in the best interests of patients? Is this the best use of NHS resources?

I definitely don’t have the answers – but these are important ethical and moral issues that  are essential to consider as we look forward to the future of our health service, and how it can work in the best interests of our patients.

Back to general practice, perhaps it is testament to the high regard in which we are held within our communities that people expect us to have the power and the know-how to cure everything. Unfortunately we don't – and we can’t be put in a position where we are pressurised into medicalising sad, but normal, behaviour. But that is a hard message to get across to people who are desperate for someone to help.

Community services are vital

Another Christmas advert – from the Co-op where a young lad buys groceries for an old man who can’t leave his house due to the icy conditions – tells us much more about what really could help lonely people; simple compassion and kindness towards each other, old or young.

It brings home the importance of services in the community, such as day centres for the elderly that can really help to alleviate loneliness and related conditions, but they too are under considerable financial pressure.

It’s essential that these services are protected, and that there is greater integration between health and community support, so that GPs and our teams can signpost our patients to the services that will be most beneficial to their long term health and wellbeing – without writing out a prescription.

  • Dr Baker is chair of the RCGP and a GP in Lincoln

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