Sometimes I feel a bit of a fraud working on the WiseGP project- it implies I’m particularly wise, or maybe have a skillset beyond other GPs. It’s not the case- there are skills all GPs possess that WiseGP aims to support and highlight. So, what do I think it takes to be a ‘wise’ GP?
Knowledge
Knowledge is important, but the internet has made this available to all. Memorising facts helps to speed-up our clinical reasoning, while building patient confidence in our clinical acumen. However, knowing all the required facts is impossible, since medical knowledge is constantly evolving.
The GP curriculum is several hundred pages long. I’ve recently assisted with updates to this, which have expanded it even further. The breadth of knowledge needed can be intimidating, particularly when newspaper headlines vilify certain GPs for missing a rare diagnosis, leaving the public asking, would a wiser GP have recognised it?
Experience
The phrase, “with age comes wisdom”, holds some truth. Through our work, family and social lives, we gain experiences of value to our professional work. Experience can particularly help with pattern recognition, but when a condition is rare, being open about what we don’t know can reflect true wisdom. Socrates once said, “The only true wisdom is in knowing you know nothing”. To be wise, we need an open mind to consider new concepts or to ask for advice when needed.
Whole-person approach
Often there may not be a disease diagnosis to make- this is where a pivotal aspect of a GPs wisdom comes into play. GPs apply their knowledge to an individual’s context, to help decide whether to medicalise an illness. When appropriate, we avoid harm through medicalisation of distress. Informed by our knowledge and experiences, our gut feelings help us to negotiate complex decisions, reflecting an integral part of our wisdom.
Complex problem-solving skills help us to work with patients to develop potential explanations for their symptoms and plans to manage them, which we review and revise over time. These are key expert generalist skills emphasised by WiseGP. Skills that make us wise, that the newspaper headlines fail to feature.
Critical reflection and caring
Having the time and headspace to reflect on our work is integral to developing these skills, but it isn’t built into our contracts. I used my limited study leave this year to learn how to give joint injections, which has meant I’ve had to use my evenings and weekends to complete other professional development work. My commute provides some time and headspace to contemplate decisions I’ve made, but there are still occasions after 13 years as a doctor that I sit at home wondering if I’ve done the right thing. This is part of why I think a caring nature is key to being a wise doctor- it drives us to critically reflect on our decisions and experiences. It drives us to recognise our weaknesses and improve. How we learn from experiences is integral to our wisdom.
Teaching and learning
Teaching is intrinsically linked with learning and wisdom- the word ‘doctor’ is Latin for ‘teacher’. I still recall lectures at medical school that were poorly attended, while others attracted a packed hall. The best lectures were delivered by doctors who understood the challenges we faced and had the wisdom of practical experience to share. They went beyond what we could learn from reading presentation slides and talking to patients, by sharing powerful anecdotes that I still pass onto students today.
We can learn continue to learn beyond our experiences as individuals, through teaching others and sharing our experiences with colleagues.
Leading improvements
Supportive general practice teams can build their wisdom by developing and evaluating new approaches to delivering care for complex patients. Across my Primary Care Network, I've observed how practices could enhance their systems of care through mutual learning. As an aspiring WiseGP, I'd like to have the opportunity to discuss and help implement changes, but this would demand additional time beyond what is supported in my roles as a salaried and extended access GP.
Supporting the profession
This is why I’m glad to be involved in the Wise Provocations work. We aim to challenge common misconceptions about general practice and help the public, policy makers and politicians understand the depth of wisdom involved in a WiseGP's everyday work. We hope this understanding will drive the changes needed to enable GPs to deliver whole person centred care and lead, rather than react to imposed changes, to improve frontline care.
I hope that WiseGPs will be given the voice they deserve to help shape our future health service. In the meantime, I’ll continue my drive to be a better WiseGP!
Dr Annabelle Machin
Comments