“Emergency and specialist medicine are crucial, but it is the ongoing relationship between GPs and patients
that really makes the difference.” These are the words of Atul Gawande, US surgeon and journalist. Since World War 2, we are inclined to have a heroic view of medicine. As a result of the discovery of penicillin, of vaccines and of several antibiotics, which have cured diseases deemed incurable, medicine became the solution to problems that only “heaven” was supposed to be capable of solving. From that moment onwards, we started organising our healthcare systems like a fire brigade, with doctors becoming our saviours. But if diseases are like fires, some of them can only be extinguished after months or years, while others can only be contained. Treatments can have side effects and complications that require attention, which is why prevention, regular check-ups and incremental treatment are of paramount importance. Several studies show that countries with a low mortality rate are those with a high percentage of general practitioners. The skills doctors possess to use essential information to understand and change the future is improving in several ways. At least four types of data are crucial to our future health and well-being: those about the state of our internal systems (the results of MRIs, laboratory tests and DNA sequencing); those about our living conditions (home, community, economy and environment); those about the care we receive (what our doctors have done for us and which drugs or interventions they have prescribed for us); and those about our behaviour (sleep, exercise, diet, sexual activity, compliance with prescribed care). The potential of such information is immense and almost overwhelming. But the actual importance of this information lies in the special attention given by the doctor to the patient. Gawande claims that “the trick” was found in 2017 with a study conducted in a Boston neighbourhood, precisely the Jamaica Plain. The community was served by three full-time doctors, three specialist nurses, three social workers, a nurse, a pharmacist and a nutritionist.
All in all, they were able to see around 14,000 patients per year in fifteen medical practices operating at full capacity every day. One might wonder how going to one of them for any problem is better than visiting a specialist. The answer is self-evident: it is a matter of relationship. This was evident from the fact that doctors, nurses and staff working in reception called almost every patient who came in by name. Often, they had known them for years and might have continued to see them for as many. Having a doctor who treats us and visits us regularly, a person who knows us, has a great influence on our willingness to contact him or her in the event of serious symptoms and very much more. Hence, the commitment of doctors to follow patients in the long-term leads them to adopt an approach to problem solving that differs considerably from that of doctors who see them occasionally.