By GP and New Statesman medical editor, Phil Whitaker.   https://canongate.co.uk/books/4323-what-is-a-doctor-a-gp-039-s-prescription-for-the-future/ 

“This book is written for patients, of which I - all of us-are one.” writes Phil Whitaker. As a retired GP and, recently, very much a patient, I found the book fascinating and challenging. Phil uses stories, including from his own life and family, and case studies from his 30-year career in the NHS, to examine what has happened to the role of doctor during his career, tracing both positive and negative developments over this time, and some of the negative unintended consequences of the positive. The book is a page turner and makes a vital contribution to the discussion about the future of doctors and the NHS. While this book is about more than general practice, this is the lens through which Phil examines the NHS. 

Phil describes entering general practice  in the 90s  when “aloof paternalism was being supplanted by a new style of practice that sought to forge rapport between each individual patient and their physician” and the gradual take-over, by guidelines, targets, and what he calls “EDM” (Evidence Dictated Medicine, derived from David Sackett’s Evidence Based Medicine).  He discusses the gradual medicalisation of people into patients and the epidemic of both multimorbidity and over-diagnosis. As a GP and Primary Care Trust board member I have been part of this trend, which, although leading to better preventive care in many ways, has now gone too far. Doctors have become disconnected, almost alienated, from their patients, even before Covid came along.  

Phil stresses the centrality of the GP/patient relationship in navigating the complexities of medicine today. I liked his feeling of confidence that we can regain some of what has been lost or mislaid about primary care in recent decades. He says: “Continuity with a good general practitioner is vital if we want to experience holistic care. A system, a protocol, a guideline – they are by definition impersonal. The GP, steeped in the medical world, intimately acquainted with the ways the NHS works and sometimes lets us down, and equally conversant with the myriad interplay between biology and emotions, psychology and life circumstances in the experience of illness- the GP is our expert ally”. 

The book concludes with ideas and suggestion for the future. To fulfil Phil’s vision more resources are needed, of course, but also a reset of values.  Iona Heath (former president of the Royal College of General Practice) writes in praise of What is a doctor?: “If just one member of the government could be persuaded to read this book, there might be hope for a reinvigorated NHS”. Wes Streeting recently spent a day at Phil Whitaker’s surgery. He seemed to get the message.  You can see their encounter on the New Statesman  podcast (https://www.youtube.com/watch?v=G2f_BqbtXBg)

Katy Gardner, August 2023