News

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More respect needed for ‘Craft of Generalism’: GP

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Despite this year’s Federal Budget bringing some relief to a chronically underfunded general practice and primary healthcare system, it is no secret that many GPs are still struggling.
 
Business sustainability and work-life balance remain chief concerns among the profession, while excessive red tape, workforce maldistribution, the lingering fallout from the COVID-19 pandemic and an ageing population are adding pressure on an already demanding job.
 
The causes of these issues are complex and varied, but for University of Queensland Senior Lecturer and GP Dr Johanna Lynch, they can be partly explained by a healthcare system that has continually failed to understand the value and expertise of generalists.
 
The lead author of a newly published article in the Australian Journal of General Practice told newsGP that their growing list of responsibilities now includes innovative care, political advocacy, financial and personal generosity, and countless examples of unpaid work – but without much additional support.
 
‘It’s really very gratifying, but it’s often done in a hurry and underpaid,’ she told newsGP.  
 
‘There’s something that’s such a privilege in our practice, I have patients that I’ve seen for 25 years, but it also is demoralising when you continue to give and nobody’s noticing that you’re giving.’
 
Dr Lynch and her co-authors delve further into the issues in their article, explaining how Australia’s healthcare system is contributing to the problems, rather than helping to resolve them.
 
‘Generalist care is undermined by systemic and bureaucratic devaluing of GP time and expertise, primary care policy that fragments care and encourages short transactional encounters, and an excessive focus on disease or procedures,’ they wrote.
 
It is also why they are championing the ‘Craft of Generalism’, the acknowledgement of which is put forward as both a solution to poor healthcare policy and a way of improving morale among the general practice community.
 
‘Clinical decision making in the face of uncertainty, undifferentiated symptoms, conflicted goals or chronic disease and grief is … cognitively, emotionally and morally difficult,’ they wrote. 
 
‘In order to protect GPs from doubting the value of their work, it is important to understand generalism as so much more than biomedical service provision: it requires philosophical attitudes, overarching priorities and practical skills that are often unnamed and unnoticed.
 
‘Understanding the sophisticated craft and practical skills of generalist care could help both GPs and health policy makers value, respect and navigate the challenges of this complex and important work, especially at this time of change for Australian general practice.’
 
The college’s Health of the Nation report last year described general practice as being ‘in crisis’, with less than half of GPs surveyed intending to be practising in 10 years, and 73% saying they feel burnt out.
 
However, Dr Lynch believes promoting the ‘generalist philosophy’ can assist the ‘ongoing effort to help GPs value, hone and protect the often-misunderstood complexity of their work’.
 
She says this comes down to ‘whole-person care’, the idea of looking at a patient as a whole person, rather than treating them as fragments.
 
This includes:

• a thorough approach to information gathering
• a pragmatic focus on outcomes for the patient
• and prioritising community connection.

But while this approach is intrinsic to sound general practice, it is difficult to achieve a healthcare landscape that is leaving GPs feeling unsatisfied with the level of care, and time, they can give to patients.
 
‘There are pressures on the health system in terms of time and money. That means short appointments are more highly valued than longer appointments,’ Dr Lynch said.
 
‘We are chronically, chronically under-acknowledged by the way Medicare has funded work over time, because I’ve been doing long consultations for the last 15 years knowing that I would lose money in order to provide this kind of care.
 
‘And at the moment, we have a flat career pathway. You get paid the same by Medicare when you just graduate to when you’ve been doing it for 40 years, so that doesn’t actually acknowledge that we’re not just technicians, we are experienced workers.’
 
To help remedy the system-wide ailments, Dr Lynch said GPs need to be involved in decision-making conversations on both state and federal levels, ensuring public policy is informed by best practice and firsthand knowledge. 
 
‘Not just because we represent primary care or we represent the GP voice, but because we’re good thinkers,’ she said.
 
‘We’re so good at looking at the wide and then bringing it back to the narrow, and we’re good at crossing cultural barriers and translating medical things for the community in front of us.’
 
However, in order to enact change, she also believes GPs need to also start recognising the value and dignity in their own work.
 
‘[We shouldn’t be] pushed around by people who say they have evidence for things when the GP can see something different in front of them,’ Dr Lynch said.
 
‘[They say] “that’s just anecdotal evidence”, or “it’s just intuition”, or “it’s just your gut feeling”.
 
‘But that helps bridge the gap. Thinking, “no, actually, that’s why I asked that question today. I don’t fully know how I knew to ask that, but I just know from experience”.’
 
Overall, she says GPs need more recognition for the work they do on the frontline every day, but also the confidence to look after their own health – not just for the healthcare system, but for Australia as a nation.
 
‘The idea that we’re adventurers or discoverers has helped me,’ she said.
 
‘Because we’re right on the front line … we start to discover things that nobody else has noticed before.
 
‘Dream, change and participate in change.’
 
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