What do these words conjure up for you?
For me, ‘caregiver’ has a personal, relational ring to it, whilst ‘caretaker’ sounds more procedural, task and object based.
This past week I saw an advert via Instagram indicating that Braemar Health Centre is looking for a replacement doctor. The current GP has been there for 30 years and his colleague is retiring, hence the search for a new GP and eventually also a successor to the remaining GP. Response to the traditional advert had been lacking and so the community made a lovely video highlighting the beauty of this rural remote Highland town and its wonderful amenities, and their appreciation of the services of their local GPs in an effort to try to attract the right candidate for the job. I noted that they seem to work to the ‘old fashioned’ caregiving model of general practice that I grew up with as a young doctor. That triggered some wonderful memories for me.
GPs were known as ‘family doctors’ and as such, were and are still in the unique position of being able to provide generalist continuing and comprehensive care to families across all generations in a holistic way.
This prompted me to reminisce on my 24 years as a GP in Aberdeen. When I started at the Practice, there were seven male partners and I was one of two female trainees during my first year there. I continued to do regular sessions at the same practice for the remainder of my career.
We ran a personal list system, meaning that each doctor had direct responsibility for a number of patients in a section of our catchment area. As a medical team, of course there was overlap to cover holidays and suchlike. At that time the total list size was around 10,800 patients. The personal list system had the advantage of offering continuity of care which was patient-centred and allowed for extensive knowledge and understanding of patients, family dynamics and a healthy, helpful doctor-patient relationship. As a natural consequence of this, the medical care included a clearer understanding of the socioeconomic and psychological factors often also at play in ill health.
We had an amazing and stable team of practice-based nurses, reception and admin staff, district nurses, health visitors and a social worker along with visiting specialist nurses. The workplace camaraderie was great. We felt like family, supporting each other in the ups and downs of our personal ‘lifey’ lives and also in the work we did, pulling together, for the best for our patients.
I felt privileged to have a window into the lives of patients and their families and even to share in their life journey to a degree. Home visits were a daily occurrence and again this allowed for a deeper insight and a felt-sense of the struggles of life which often contributed to various health conditions.
There were many patients who held a special place in my heart over the years. Establishing trust and connection with patients is integral in delivering good patient care.
Contrary to what might be thought, general practice work is not boring. It’s not all coughs and colds – nor ‘golf’ courses! Over my many years of practice, I saw several unusual, rare and complex issues which were managed in the GP setting. There were experiences which were joyous and others which were heart wrenching – and everything in between.
The satisfaction which comes from helping people is immense and I treasure the opportunity I had to do so in that setting with such a great team. Sure, the stress is also significant but that’s where teamwork helps to share the burden.
There appears to have been a shift in the way that many general practices deliver their services nowadays. The pandemic seemed to trigger this, along with the increasingly automated world in which we now live, coupled with a more transient GP and patient population.
From personal experience, the first point of medical contact nowadays is often by means of form-filling tick boxes online in order to ‘fit’ the patient into a diagnosis – and the treatment which may follow is largely protocol driven. It can feel quite impersonal. Qualifying (or auditioning through gatekeepers) to get past that computerised ‘first base’ can be difficult and feel glitchy and even distressing and obstructive, especially when already feeling unwell.
Complex or multi-factorial medical issues may entail some detective work and don’t often fit neatly into one algorithmic category. To me, a consistent clinician-patient relationship is important in bridging this. Without it, opportunities for clinicians to dig deeper and see the bigger picture can be missed. The surrounding psychosocial factors and historical knowledge of the family dynamics may remain unexplored. Thankfully doctors and nurses are still caring and compassionate when they are able to speak to or see patients, but that old fashioned thread of continuity and wealth of information woven from years of personal family contact is often absent, especially in the urban setting. Many issues are now directly outsourced to optometrists, physiotherapists, pharmacists etc which is helpful regarding immediate specialised care but when underlying factors are at play these can be missed or inappropriate to address in those settings.
The world of general practice has changed significantly and possibly necessarily in light of today’s fast paced, pressured way of living. There is a danger however that the ‘secret ingredients’ of whole patient caregiving may be lost or fall by the wayside amidst the modernisation and streamlining of the GP caretaking system. Perhaps even making the workload more expansive and expensive in the long run. The old saying, “a stitch in time, saves nine” comes to mind…
A few thoughts on keeping those secret ingredients alive?
When with a patient, ask ourselves as caregivers, questions like :
‘What would it be like to be this person?’, ‘ How is this condition affecting their life?’, ‘ What does this person need?’, ‘ How best can I discern this need?’
If we are able to really feel into these questions, deeper clues and solutions to the presenting problems may emerge. It’s likely we won’t always have all the answers ourselves, but affording people the time and dignity to be seen, heard and understood can in itself work wonders.
My personal experience is that medical caregivers hearts have not changed. Kindness and compassion continue to be at the forefront of their raison d’être.
Let’s hope the structure of the caretaking, gatekeeping system doesn’t tie itself too tightly in whatever-coloured tape – and that general practice can continue to breathe it’s very purpose in life – that of holistic caregiving.
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Everythingistickityboo 
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