As part of our commitment within the CMH to keep lines of communication open with the potential users of our research, Martyn Evans and I meet with a group of GPs from the Royal College of General Practitioners (RCGP) last week on an unseasonably warm late September day in London. The aims of this meeting were to inform GPs about developments in medical humanities and in CMH in particular, explain some of our research developments, and explore synergies with what are live and urgent issues for general practice. We were fortunate to have engaged a group who represented significant potential for influence in the College, including the current president, Iona Heath, and John Gillies, Chair of RCGP Scotland.
Several key matters of concern for general practice emerged from the day, as areas with which medical humanities might engage in partnership with general medical practice:
· resisting the reductionist pull in medicine that draw practice away from caritas towards scientia (the RCGP motto is cum scientia caritas = science with compassion);
· defending against the threat to generalism that comes from reductionist ways of measuring quality such as the Quality Outcomes Framework (QOF), and from the notion that professionalism in general practice is reducible to a series of measurable competencies (Competency Based Education)
· promoting aspects of practice that are not measurable: instances include the clinical importance of time taken to observe, and the therapeutic value of paying close and mindful attention to the patient; one particular focus of this is the need to understand the implications of co-morbidity (as one participant put it, ‘helping to plug the NICE gap’);
· developing a plain speech – a ‘vernacular’ – for the medical humanities that is available to all practitioners and not simply to medical doctors (and humanities specialists!)
· facilitating humanities’ engagement with the new ‘biology of biography,’ in the process helping us to understand the complexity of decision-making
· understanding and proclaiming the embodied practitioner as combining tacit knowledge, physical skills and virtuous habits; and underpinning professionalism through rehabilitating the notion of trust.
These themes all map well onto one of the central concerns of medical humanities: that of resisting the reductionism pull of biomedicine. The group felt that it would be useful to expand the dialogue in relation to these issues in the form of a research day to be organised by CMH under the auspices of the College.
For further reading, see Richard Baker’s editorial in the British Medical Journal, King’s Fund report on improving the quality of care in general practice, and Iona Heath’s response, Who’s complacent now? The King’s Fund on general practice.