GPs are accused of being masters of none, when that title better describes the consultants that infest health policymaking.
A recent suggestion that GPs do not have enough training and expertise to provide support to motivate weight change behaviours prompted these two GPs to get together to talk about what makes an expert.
We are experts in primary care, but the general public forgets this because we are not considered “specialists” in the classic sense. We are not just paper pushers, script pedlars, jacks of all trades and masters of none. What we know among ourselves is that our training makes us uniquely placed to assess, triage, manage and coordinate undifferentiated health problems, small and large. We are experts in our field. And we shouldn’t have to continue to prove ourselves when our time and energies are best spent doing what we want to do, which is care for our patients.
The complex interplay of information gathering, processing of biopsychosocial factors, memory recall, scientific understanding, logistics coordination, resource availability, capacity of the patient and clinician, and risk assessment that is demanded from each and every clinical question that patients pose to us should indicate to you the level of training needed to become “just a GP”.
The fact that we don’t collapse in a heap at the end of each consulting session is a sign of our expertise.
We should not have to justify our training or expertise, simply because we make it look easy.
One of us has spent the last few years working in rural and remote Australia. Out in those parts, the GP is often the only doctor for hundreds of kilometres. It is counterintuitive to question the expertise of the GP when entire communities are relying on them.
The crisis in rural and remote health is at its peak, and the people who suffer are the patients. We believe the ongoing denigration of general practice to the general public is contributing to the lack of medical students and junior doctors wanting to pursue general practice as a career. This is a tragedy for regional and rural patients who already suffer enough not having access to metropolitan-level healthcare, in particular First Nations people and their communities.
We collectively groan when we read about new health policies that do not come close to addressing the turmoil within the field, but do give the people what they want to hear, what they want to believe.
So who creates these policies?
From positions we’ve held behind the curtain, we’ve had glimpses of what it takes to make a difference. It’s not the experts who are then subject to such changes. Rather, elite consulting firms advising on said changes are deferred to as the experts in the room. This is a real shame, and echoes the problems with the outsourcing of traditional public sector roles.
The recent consulting firm scandal demonstrates the extent to which the denigration of the expert can potentially have grave consequences affecting the legitimacy, honesty, and trust of public policy. For healthcare – when people’s lives are at stake – this is unacceptable.
Next time you find yourself subject to expert advice, ask yourself these questions and what makes the most sense to you:
Is this expert one who has spent many years training on their expert subject?
Is this expert one who has significant professional experience in their field of expertise?
Is this expert one who is capable of teaching others to become experts?
If you answer yes to all of these questions, then you can safely presume this person is a bona fide expert.
But an expert needs the correct conditions to thrive. If experts do not have the facilities to demonstrate their expertise, they fail to exist as experts simply because they are no longer visible.
So who has replaced these experts? The empty (brightly coloured, often quoted, very expensive) vessels that make the loudest noise? Is an expert one who consults on how experts should do their job, with no professional experience in said expert field, and suffers no consequences of their expert advice?
Because if this is the case, the whole definition of what makes an expert needs, ahem, expert revision.
Dr Samantha Saling is a GP and founder of Rose Healthcare in Sydney; Dr Sonia Henry is a GP and author currently working in the Kimberley region of WA.
