Discussion Forum topic – James Mackenzie Lecture
The following comments refer to this article:
Haslam DA. Who cares?The James Mackenzie Lecture 2006. Br J Gen
Pract. 2007; 57(545): 987–993.
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Date: 25 Feb 2008 14:56:38
Topic: The James Mackenzie Lecture 2006
Comments by: Dougal Jeffries
I too was delighted by the tone and content of David Haslam's James
McKenzie lecture, but like the previous commentator I am baffled as
to why the personal convictions of such College stalwarts as
Professor Haslam seem not to be reflected in any official College
policies. It seems as though every thoughtful GP is railing against
the imposed rigidity of QOF and its unintended harmful side-effects
(medicalisation, excessive prescribing, creation of anxiety,
detraction from non-targeted clinical areas, reduction in personal
and individualised care etc.), while the College proclaims what a
wonderful job we are all doing.
I attended the Annual Conference in Edinburgh last year, and far
from perceiving it as the triumph that the College establishment
proclaimed it to be, I thought it was a depressing spectacle of
self-congratulation and complacency in the face of the most
aggressive assault on our professional independence and integrity
for the past 30 years. I would love to think that David's wisdom
and his suspicions that something is seriously amiss might be
reflected in some serious self-questioning among the senior ranks
of the College.
Date: 19 Dec 2007 17:22:11
Topic: The James Mackenzie Lecture 2006
Comments by: Dr Nicholas Shah MBChB MRCGP MSO MSc,
Whetstone Medical Centre, Birkenhead
Thank you very much for article ‘Who Cares?’. I found it
thought-provoking and I can strongly identify with your thoughts. I
have been an inner city GP for 15 years and have pursued the
medical model with postgraduate exams, diplomas, and degrees etc.
but wonder what it all means in these evidence-based, target-driven
days. Your suggestion that making people feel better might be
important reason that we exist as GP’s has caught my
imagination!
Date: 14 Dec 2007 14:37
Topic: The James Mackenzie Lecture 2006
Comments by: John McGough
I have just read David Haslam's lecture. It is rare to feel such
tremendous empathy with a writer as I did on reading it. He so well
encapsulates many of the faults of our current medical model,
especially as it is applied to general practice.
I frequently feel confusion as to my patients' problems,
so, as he suggests, I just listen and reassure. They appear to go
away happy, and they return, so something beneficial must have
passed between us. I also feel a strong sense of guilt and
uncertainty when I treat problems such as hypertension and
hypercholesterolaemia, knowing that only a small proportion of
those treated will benefit from the treatment. I often tell people
the figures for the benefit to help them decide on whether to start
treatment, which frequently elicits ‘What do you think,
Doctor?’.
I do not see any easy answer to this in a population whose fears
are fed by a media that appears to base its stories on the sales
they will generate, and not on any perception of public good.
Perhaps there is no answer but to continue to listen and to
reassure.
Date: 13 Dec 2007 19:48
Topic: The James Mackenzie Lecture 2006
Comments by: Ian Stevens
Just a note to say how much I enjoyed and valued your paper. I
am an NHS physiotherapist and work with GPs and in a pain clinic. I
have the time to listen, and find that biomedicine and measurement
are often blind to narratives and suffering. I recommend the
following paper to other clinicians interested in the area of
meaning and placebo: www.annals.org/cgi/content/full/136/6/471
All the best and I loved the Neil Young quote!
Date: 12 Dec 2007 15:04:16
Topic: The James Mackenzie Lecture 2006
Comments by: Kenny
I have just finished reading your excellent James Mackenzie lecture
in December's BJGP. Thought-provoking, relevant, and to the point.
Thanks in particular for introducing me to the McNamara Fallacy, a
useful and expanded alternative to the rather overused ‘drunken
search’.
Date: 4 Dec 2007 09:17
Topic: The James Mackenzie Lecture 2006
Comments by: Michael Jameson
An original, valid portrait of ‘The Complete Doctor’ which is
relevant to today and to medicine worldwide. Medicine led other
self-registering and self-regulating professions in portraying ‘The
Doctor’ of both sexes, and then did the same in portraying ‘The
Good Doctor’. This lecture leads the rest of our profession in
portraying ‘My Doctor’ as recognised by the patient without
deference but with an understanding of the link between rights and
responsibilities of consulting one. Well done. Now for family
solicitors and parish priests to adopt these tested principles by
improving the quality of care they provide for the people who trust
them.
Date: 3 Dec 2007 4:49
Topic: The James Mackenzie Lecture 2006
Comments by: Jonathan Heatley, GP, Horsham, West
Sussex
I loved your Mackenzie lecture in this weeks' BJGP. I entirely
agree that boosting patients' confidence and self-esteem is one of
the things we should do well if we are to be effective GPs.
However, there is the subsequent problem of making patients
dependent on us and this has been a constant conflict in my
experience. Every now and again one has to remind patients that
although we are free and sympathetic, they need to stop using us as
a sounding board. If we have been too kind they take this very
badly and this is the typical trap that catches doctors who are
keen to be liked. It seems to be a more reliable practice to be a
mixture of strict and kind and this really is a difficult balancing
act that is hard to teach and must be learnt through experience. I
have sometimes gone out of my way to be helpful/kind to someone I
feel I have been too strict with, and its astounding the positive
effect it has. They should not by rights be so thankful but by some
quirk of human nature they are. On the other hand when a colleague
who is kinder and more indulgent has to get stricter there
occasionally follows a complaint.
Date: 2 Dec 2007 15:56
Topic: The James Mackenzie Lecture 2006
Comment by: John Sharvill
Thank you David Haslam for writing this. It should be compulsory
reading for all NHS reformers, QOF points designers, GP registrars,
and probably evidence-based gurus and lawyers. I particularly liked
the illness/disease comparison and the digital/analogue
contrast.
My muddle is though how can we have got into the current state
with you at the rudder of the College? The little yellow boxes that
pop up invading every consultation almost demand that patients now
need to book a double slot. Firstly, to get the new contract bits
sorted so that the practice can survive financially, then to see
the doctor to discuss their problems. Please could you write a
follow up with the solution?
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