Manor Field Blog #2 – I am a GP not.

No, I am not a GP, that is, General Practitioner.

I don’t have the breadth of knowledge and understanding, the ability to shift from old to young and back again, to balance fertility with care needs and the running of a small business; I plod from patient to patient, lost in the experience of understanding an individual, all the way, as far as I can go, as far as I can see.

Over the years I have been a critic of specialists – those who know lots about little, preferring the path of the generalist; it wasn’t until I saw GPs in action (as a grown-up, cf a medical student) that I understood what it is to see medicine in general.

All of this is ironic, as part of my professional qualifications are ‘specialist in general internal medicine’ – this is in effect everything that stops short of an operation. We physicians and, especially geriatricians like me, are seen as the last bastion of general medicine; preferring a wide-angle view of care than the -ologists who inhabit the shady nooks of the big hospitals.

Yet, by comparison, general medicine, as compared to general practice is narrow.

In my new role, I am seeing older people.

Ah, you ask – what is an older person? Is this not a poor term to use as a focus for my activities, is not a toddler older than a new-born? And, yes, it is all relative.

For my purposes, when asked, I usually suggest ‘older’ refers to anyone older than me, in other words, it is a moveable feast, adapting to my lifespan.

In the olden days, over 65 was considered old.

Now, when I meet someone who is 75, I consider them young.

Age is quite meaningless, yet it is still an arbiter.

Without going-round in too many circles, I will say that my profession, my, perhaps, expertise, is supporting those who have diseases associated with the ageing process; these are actually quite easy to define;

Falls

Dementia

Osteoporosis

Continence

Immobility

These are the Geriatric Giants as described by my fellow Glaswegian Bernard Isaacs.

You can add-in conditions like pain and frailty, end of life care, delirium, polypharmacy (too many medicines) and more modern or trendy concepts such as de-prescribing and de-diagnosing (stopping unnecessary drugs and removing lifelong diagnoses respectively) (I de-diagnosed a patient with hypertension today – their actual diagnosis is postural hypotension; a drop in their blood pressure when they stand, hypertension was something they had in their 50’s which was successfully treated with medicine that is now doing more harm than good, in their 80’s)

Am I different to a GP?

Well, not really, not necessarily.

I guess I have spent longer thinking about the ins and outs of ageing, I have sat the exams and somewhere, in my garage is a log-book demonstrating my competency in certain specialist fields of medicine.

Am I the guy you want to see if you are old?

Not necessarily.

I am fortunate.

Let me repeat.

Very, very lucky.

I have been through times of trouble, where, lost in the madness of hospital life I have been a fish out of water; coming to the community has been my salvation. Indeed, I don’t believe I am working, it is like a great game of care and, I fear one day I will wake-up.

My luck runs into allowing me more time than a GP to spend with patients, more time and space to focus on what is wrong, on what matters, to link with family and carers, to not have to rush, to do what is right and what is needed.

I don’t know whether what I am doing will be a model for future care.

Certainly, bringing doctors, nurses and others out of hospital, away from the system that is fuelled by pathways, protocols and bed-pressures is the direction of travel; so, says NHS England, what impact this will have on the hospitals I don’t know.

What I know for certain is that my focus – maintaining the wellbeing of my patients, supporting their independence and autonomy, reducing their risk of delirium or falls is a broader and more satisfying part of the health and social care jigsaw than I have previously undertaken – that of the picker-up of pieces.

My aspiration is to keep Humpty on the wall, to stop him falling and shattering. This is overall better for Humpty and probably better for everyone.