A year or so ago I wrote a blog on the film ‘Stan and Ollie’ and what it had to say about how we practice medicine. It was entitled ‘I’ll miss this when we’re gone’. Two months into the coronavirus pandemic, as the sadness lingers on, much of it still rings true.
- Not all good advice is good advice for all.
A global response to a global pandemic is always going to struggle to deliver care tailored to an individual’s specific needs and preferences, and a generic approach to Covid-19 has been, therefore, unavoidable. Nevertheless, whilst top down protocols have necessarily been put in place to deal with what is after all a new and deadly disease, and whilst we shouldn’t beat ourselves up on account of it, it needs to be acknowledged that what is best medical advice for populations is not always the best advice for individuals. Because individuals are more than just their physiological make up.
Furthermore, and inevitably when responding so rapidly to something so unknown, not all advice has turned out to be good. So many opinions have been expressed as to what should or should not be done in response to Covid-19 that it has sometimes been difficult to discern what should be taken on board immediately and what should be viewed with caution. This was especially true in those early days when advice was changing so rapidly. What is more, whilst it’s been hard enough to familiarise oneself to a novel disease whilst simultaneously adopting to new ways of working, its been harder still to apply all that to individuals according to their particular needs, especially when, as well as being concerned for those we are to care for, we have been concerned for our own and our family’s welfare.
We have all wanted to be purveyors of the best advice to our patients but some of what has been shouted loudest has been best ignored, or at least not attended to until a little more information has become available. Time, though, has not always been on our side, and decisions have had to be made at pace. And so, as a result, though there have been times when changes have of necessity been made wonderfully quickly, there have also been times when changes have best been avoided.
None of this should allow us to think that we no longer need to try to treat patients as the individuals they are, to do so is the one thing that general practice is genuinely ideally positioned to do. But, given all of the above, it is no surprise that in these exceptional circumstances this has had to be compromised a little. Even so, we have, I think, along with the overwhelmingly excellent support of our patients, managed to maintain personal care as well as has been humanly possible.
- The main thing has been to keep the main thing the main thing.
But what the main thing is, has also been open to debate. Covid-19 is without doubt a thing, a huge thing, perhaps even, temporarily at least, the main thing. But it isn’t the only thing. And if it is the main thing, then it must not be allowed to remain the main thing for longer than it ought.
Furthermore, whilst we have all been concerned about minimising loss of life, we need to accept that, however strongly we hold our point of view, how that main thing is best achieved in the long run is still not entirely clear – and may not become so for some time yet.
What is certain though is that whilst there have been some who have been unduly cavalier in their attitude towards the pandemic, there are others who have massively overestimated their personal risk of coming to significant harm. Many, in their understandable desire to stay alive, have stopped living any sort of life at all and have found themselves isolated from everything that makes their lives meaningful. And that’s not good. I don’t suppose I’m the only one who has found themselves trying to help patients put coronavirus into some kind of perspective.
Life must, and will, go on, with or without coronavirus, and, as we all know, there is more to life than merely staying alive. And therein lies the thing that I believe will always truly be the genuinely main thing.
- Contradicting emotions have been experienced simultaneously.
Who hasn’t managed, having felt overwhelmingly anxious one minute, to convince themselves the next that everything just might be OK after all? Who hasn’t felt distressed by all that has been going on, yet been cheered by working in teams made up of individuals who remain a joy to work with? And who hasn’t mourned the daily death toll, and our colleagues who have been lost to Covid-19, yet rejoiced at news of those who have survived?
I hope we have all known some happiness in all the sadness. Perhaps you’ve known what it is to smile, even as you’ve cried.
And finally,
- We have all needed to hope.
Amazing though it is, working within the NHS causes one to see its limitations and the need for something greater in which to place one’s hope, something that really can carry us through this crises. Perhaps that’s why so many of us, though appreciative of the appreciation, are uneasy each Thursday evening as the country applauds us and other key workers. We know we’re not enough. Our hope is not simply that we’ll be up to the task, we know we may not be, but that all of this will come to an end and some semblance of normality will eventually be restored.
And when it does, as it surely one day will, my hope is that General Practice, though perhaps taking hold of some of the new ways of working developed over the last few weeks, won’t lose what has always been at its heart and makes family medicine the special thing it is. And that thing is, and will always remain, the doctor-patient relationship – the cornerstone on which the whole of general practice depends – built on trust, nurtured through adversity and established over time, significant amounts of time, spent together, in the same room.
Because, if I’m honest, despite how amazingly well general practice has contributed to the cause, I’m beginning to miss that, now that that’s beginning to go….
For the original blog ‘I’ll miss this when we’re gone’ click here
Some musings 
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