‘Continuing relationships build solidarity’: Iona Heath

‘Why we have to work to defend primary care, I have no idea.’
 
It is a sentiment shared by many GPs, and one voiced by Dr Iona Heath during the final keynote address of the 2023 WONCA World Conference, which focused on ‘remembering what we know’.
 
Now-retired, Dr Heath was a GP in London for 35 years, President of the Royal College of GPs from 2009–12, cared for three generations of families, and was made Commander of the Order of the British Empire in 2000 for services to the care of elderly people.

Speaking to the Darling Harbour Theatre, Dr Heath said that across the world, the stories are always the same: any shortage of GPs does populations ‘no good at all’.
 
‘General practice is struggling to keep pace with need, let alone demand, all over the world, and can only be revived … if we remember what we know,’ she said.
 
‘The uncertainty and doubt that clinicians experience every day are also what makes new knowledge and understanding possible.
 
‘We have to doubt existing explanations if we are ever to discover better ones.’
 
Dr Heath said one of the most important things she learnt during her decades of clinical practice is the value of continuous care in improving both morbidity and mortality – an aspect of general practice she believes is crucial to it being so effective and exciting.
 
‘We are not talking about the skeletal vignettes that populate so many policy documents. We are talking about the detail of actual lives and each one of these stories is different, because each context is different,’ she said.
 
‘Doctors and patients share and exchange stories over many years, stories that vary from those reporting the minutiae of daily life, to those which grapple with the need to keep going in the face of overwhelming personal disaster.
 
‘Serial encounters build a continuing relationship between two unique individuals, neither of which is interchangeable, and the continuing relationships build solidarity.’
 
With strong primary care systems in place, Dr Heath said health outcomes can be improved at a lower cost, but that the worldwide expenditure on pharmaceuticals is unsustainable.
 
‘The “whirly-gig” of greed, fear, wishful thinking, and vested interest continues to turn inexorably to drive the medicalising of society,’ she said.
 
‘The overmedication of populations, the corruption of research, and regulation of pharmaceuticals and medical devices … we need to remain alert to our role in protecting patients from the excesses of the medical industrial complex.
 
‘Our global medical culture has driven excessive diagnostic testing, over-medicalisation, and over-treatment across many conditions that may harm patients, exhaust healthcare resources and harm the planet.’
 
The unprecedented, worldwide impacts of COVID are well-known and well-documented, but Dr Heath said one that is not often mentioned is the loss of physical touch.
 
She said in a world of medical machines and instruments, sometimes hands are the most important tool of all.

‘The sad truth is that the use of remote consultations during the pandemic has tended to erode the skills in our hands, so that fewer and fewer of us are confident that we know what to do with them,’ Dr Heath said.  
 
‘This has been particularly important for young doctors who were not yet fully confident when the pandemic started and have missed out on valuable experience.
 
‘When this happens, the temptation becomes to move straight to investigation by machines and simply omit the crucial manual skill of examination, and this is dangerous for both doctors and patients.’
 
Summing up, Dr Heath said GPs need to reclaim their listening and storytelling abilities, speaking of the importance of ‘biography alongside biology’.
 
She urged doctors to move forward in their careers and their lives with ‘care, kindness, curiosity, and caution’.
 
‘Doctors, and perhaps particularly GPs, are not biomedical scientists. They have a different responsibility, which is to attempt to relieve human distress and suffering and to this end, to apply general scientific discoveries derived from the study of populations to a series of unique individuals,’ Dr Heath said.
 
‘The vast majority of scientific research in medicine, and even in general practice, has prioritised biology over biomes.
 
‘We need to reclaim the maligned subjectivity of the anecdote and rename it a story and see it as a basic unit of research and general practice.’
 
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