Britain has a two-tier system of medical care. A person who is ill goes first to a primary care physician or general practitioner. The general practitioner treats most problems himself, and refers patients with unusual or serious illnesses to specialists for secondary care.
The two-tier system has several advantages. Primary care is a cheap and accessible way of treating minor illnesses. The patient can consult the same doctor for almost all illnesses. Specialists do not waste their time on simple problems. In case of serious illnesses, the general practitioner helps the patient find the most appropriate specialist. General practitioner is the ‘gateway’ to specialist health care, but it is also becoming a specialty in its own right. In Britain 99% of population is registered with a general practitioner. Two-thirds of the population visits a general practitioner every year and 98% do so at least once every five years. The general practitioner can therefore offer preventive medicine and health education to almost everyone in the country. In the past the general practitioner dealt only with ‘presenting complaints’, that is, symptoms and anxieties which patients brought along to the doctor. This is called reactive medicine, where the doctor does nothing until the patient has noticed that something is wrong. Modern general practice involves pro-active medicine, where the doctor makes contact with healthy people and offers medical care to people who have not asked for it.
An example of pro-active medicine is cervical cancer screening. Cervical cancer is a type of cancer of the womb. It begins as pre-cancer, which grows very slowly and develops into destructive cancer after five to fifteen years. Women with the pre-cancer are quite healthy and have no symptoms. A test called the cervical smear can detect this pre-cancer. The pre-cancerous cells can then be treated (by laser therapy) to prevent cancer developing. The cervical smear test and laser therapy are both very simple procedures. But its administration is not that simple. It is not easy to trace all women in the country and invite them for screening every three years. In Britain, the task is much easier because almost all women are registered with a general practitioner. A simple computer programme can identify what patients need their three-yearly cervical smear. The computer writes letters to these women inviting them to come for the test. The general practitioner takes the smear tests and writes to each woman a few weeks later to tell her the result. In this way, if the result is abnormal, the woman receives the news from a doctor she knows and trusts. She can then go back to him to discuss her fears. Health education is another important aspect of modern general practice. The general practitioner is usually a well-known and respected member of the local community. People are more likely to accept the advice of their own general practitioner than that of a stranger or an ‘expert’ on television.
Advice from a general practitioner to stop smoking is the most cost-effective health policy in the developed world. Many general practitioners now organize ‘lifestyle’ clinics, where patients can come for advice about smoking, diet, alcohol, exercise or stress reduction.
Perhaps the most important skill in general practice is communication. Even when a patient has seen a specialist, it is the general practitioner who explains the diagnosis to the patient and supervises the treatment of the illness. If the patient does not understand the problem, or if he finds the treatment painful or tedious, he may not follow the doctor’s advice. It is important to involve the patient in his own care. The days of ‘doctor’s orders’ are gone. Some old-fashioned general practitioners do not like this new system, where the patient often knows as much about his illness as the doctor, but many general practitioners find it both challenging and rewarding.
In Britain, general practitioners are also known as family doctors. They provide primary care for patients ‘from the cradle to the grave’. If one member of a family has a serious illness, the general practitioner can give support and advice to the rest of the family. If necessary, the general practitioner visits the patient at home. This unique relationship is often envied by other countries. In the United States, for example, every new illness requires a new specialist doctor who has probably never met the patient or the family before. This leads to a very reactive type of health care. The doctor treats such illness but does not accept overall responsibility for the patient’s health. Most doctors do not see themselves as pro-active health care providers for a whole community. Recently, doctors in the US have admitted this problem, and ‘fair medicine’ is now the fastest-growing medical specialty in that country.
Some specialists still think of general practice as a low-status and uninteresting branch of medicine. They think that the general practitioner does little more than give out aspirin and weigh babies. But good general practice demands a wide range of skills. The general practitioner should know a little about every branch of medicine, and know when to ask a specialist for advice. To many people in the community, the general practitioner is ‘my doctor’ – healer, adviser, helper and friend. He must also be a manager, an accountant and an administrator. Of all doctors, the general practitioner enjoys the greatest variety of medical problems, the ‘most satisfying doctor-patient relationships’, and the greatest potential for improving the health of an entire community.
Exercise 1.Explain the following words and word combinations:
Primary care physician/general practitioner; secondary care; preventive medicine; health education; reactive medicine; pro-active medicine; pre-cancer; cervical smear test; lifestyle clinics.
Exercise 2.Discuss the following issues:
1. The two-tier system of British medical service. Is the system different in your country?
2. Dwell upon the advantages of pro-active medicine.
3. The importance of health education. Do you think health education is important?
4. Skills of a general practitioner.
5. General practitioner as a family doctor.
6. The status of a general practitioner in British community.