Seeing people in their own clothesBMJ 2011; 342 doi: https://doi.org/10.1136/sbmj.d3338 (Published 15 June 2011) Cite this as: BMJ 2011;342:d3338
Iona Heath is president of the Royal College of General Practitioners
Iona Heath worked as a GP in London since 1975 and retired last year. She has held several roles in the Royal College of General Practitioners (RCGP) including chair of the Ethics Committee, the International Committee, and the Health Inequalities Standing Group. She was vice chair of the college and in 2009 was elected college president. She chaired the BMJ Ethics Committee 2004 to 2009 and writes a regular column for the BMJ.
Why did you decide to be a GP?
When I told my family doctor I was going to read medicine, he told me, “In general practice the people stay and the diseases come and go. In hospital the diseases stay and the people come and go”—working in hospitals confirmed this. I realised I like to see people in their own clothes and homes rather than the way they can become depersonalised in hospital, however hard you try.
So why did you become president of the RCGP?
That was an accident really. My illustrious career has been almost entirely based on luck, and being in the right place at the right time. I first got involved with the college kind of by mistake.
There was a big controversy when the college, which was responsible for inspecting training programmes’ quality, threatened to suspend training in the north east Thames region. That meant that trainees would suffer and we, as trainers, were really agitated about it.
I realised if I stood for election to the RCGP Council, they distributed a 50 word statement to their whole membership. So I wrote about what was happening in north east Thames. I only intended to have my statement distributed and didn’t realise it was so easy to get elected.
Since then I have had lots of opportunities in the RCGP, and applied for president as I think its something I can do well—building GP morale and highlighting for them their immense worth.
It’s also a good bridging project into retirement. I have stopped seeing patients and have three years left as president. By then I will have forgotten what its like to be a GP, so can take to my knitting and grandchildren.
Many people feel doctors have lost political influence in recent years. What do you think about this?
It’s interesting that the lay people who get involved with general practice are very critical of doctors for not defending their powerbase more effectively. We have been so susceptible to accusations of paternalism, being on a pedestal and living in an ivory tower. Through this we have been excruciatingly sensitive and very keen to climb off our pedestal. By doing this, we have betrayed our responsibility to argue about the integrity of medicine ourselves.
We are living in an unfortunate historical moment, where computers allow things to be measured that couldn’t be measured before. So we are now obsessed with measurement, 99% of which probably plays no constructive role in the functioning of society, or medical care.
We now have politicians saying they won’t tolerate any doctors that are below average, which is simply to misunderstand the meaning of the average.
The issue is that the quality of medical care is being reduced to “tick boxes” and “outcome frameworks,” and medical education to a series of competencies. Subsequently, the huge knowledge base of medicine is being invalidated and subtly diminished. The core of medicine—how doctors glean their knowledge then make judgments about individual people—is becoming lost because we can’t “measure” it.
So the time has come for doctors to stand up again?
Exactly, and with any luck, with MTAS [Medical Training Application Service] we will have a new radicalism within new doctors. People may say that the new generation are completely uninterested in politics. However, the action seen regarding environmental issues and tuition fees shows that’s completely untrue, just that there are differences in opinion concerning what the real political issues are.
There is a challenge for young doctors to fight again for this ground. A medical educationalist I know said to me “It’s time that doctors had the confidence in their own skills and knowledge base to teach it themselves. They always have taught it themselves . . . and they need to continue to teach it themselves.”
The sign of a coherent discipline is one that does its own research and teaching. However, although you can always make your knowledge richer by taking in expertise from outside your discipline, you shouldn’t abdicate your own responsibility.
What advice would you give to medical students?
General practice is an incredibly exciting place to be, but really we all need each other. A wonderfully synergistic relationship can exist between specialist and generalist medicine. We just need to really value each other.
Secondly, a problem for medical students is this business of having to decide what you want to be at a FY2 [Foundation Year 2] level. Then you get put in that sausage machine. Almost everyone in my generation changed their mind at some point and changed from one specialty to another. Actually, by moving around and finding where you wanted to settle you could then bring different skills into an arena.
Finally, believe in yourself and that doctors are a power for good. Most people go into medicine because they want to make the world a better place, and this is still possible.
Cite this as: Student BMJ 2011;19:d3338
Competing interests: None declared.
Provenance and peer review: Not commissioned; not externally peer reviewed.