Liam Farrell: The real secret of general practice

As scientific knowledge expands and medicine fractures into ever-smaller divisions, the role of the generalist becomes even more critical.

We are the Corinthians, the Renaissance men (and women) of medicine, people who can look at the big picture, put all the pieces together, take responsibility and make the right call.

But our importance lies far beyond being merely the conductor of an orchestra of subspecialties. 'It is easier to understand mankind in general than any individual man,' said La Rochefoucauld, many centuries ago, and this remains at the heart of the multicoloured tapestry that is general practice.

We may not be experts in any particular disease, but when it comes to knowing Joe and what makes him tick and what import to give his symptoms, we are the true authorities.

This knowledge can't be be seen or touched, there's no form to be filled in for it, private medicine won't provide it, it can't be counted by any bureaucrat or parcelled into a convenient package for QOF points, but it is very, very real; a lot of important things are like that.

Joe always had multiple complaints. He didn't need a list; they were always there on the tip of his tongue and would pour out in a glorious fashion. If a kitchen sink had come flying by, I wouldn't have been a bit surprised.

Joe considered it the obligation of the universe to provide shelter, sustenance and amusement as required by him. His self-importance was more solid and extensive than the Great Wall of China, quite enough to be visible from space; Commander Hadfield could have taken a snap while he was flying by on the space station.

I let the familiar soothing litany of complaints wash over me like a warm tidal wave. When I was young, I would have appreciated Joe's loquacity as much as a case of flaming gonorrhoea, but time has revealed to me the real secret of general practice; not your patients liking you, but you liking them.

And I understood Joe's problem; being the centre of the universe must be a big and stressful job.

Dr Farrell is a GP from County Armagh. Follow him on Twitter @drlfarrell

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