What does professionalism mean for today’s GPs?

Like any doctor, I am humbled to be considered a member of the “world’s most trusted profession”. However, this headline does not reflect the professional challenges that GPs are currently facing. Providing the high-quality care expected from society and upholding public trust have become increasingly challenging. In our recent InnovAiT article, we examined some of the main professional dilemmas affecting GPs today. This blog shares my personal views on some of these issues and expands further on the case scenarios in the article.

For someone still in the training stages on this career, it has been demoralising to witness a surge in negativity towards GPs. Despite being traditionally recognised as one of the more compassionate breeds of doctors, our professionalism has been a recent focus of public scrutiny, with some media reports portraying us as “lazy” and “hiding behind zoom screens”. It is unsurprising that we are seeing a plummet in GP recruitment and retention, especially with concerns rising about unsurmountable workloads and increasing public abuse. It is more critical than ever that both GPs and patients understand these current dilemmas, so that expectations are realistic and sustainable.

The shifting nature of societal priorities has been evermore apparent during the COVID-19 pandemic, where the role of GPs has evolved dramatically. For the first time, I have questioned my own professionalism and its limits. Being pregnant when the pandemic first hit, I was conflicted by my duty-of-care and concern for the pregnancy. Making decisions based on remote consultations has been incredibly hard. I have missed the human interaction which initially drew me to the profession. I am now seeing many patients face-to-face again, although there is a tangible tension which wasn’t there before. Patients have various problems which have accumulated during the pandemic and are understandably frustrated with the delays they are continuing to experience. I feel like I am starting on the backfoot— rebuilding trust, rather than it being implicit to the consultation.

GPs qualifying today will be familiar with the approach of “shared decision-making” which is ingrained into our training. Yet, I am finding more and more that my decisions have wider influences beyond the doctor-patient relationship. Case scenario 1 refers to a common situation, where a patient is requesting an inappropriate scan. Patients with long-term conditions are rightly seen as the “expert” in the relationship. However, it is discouraging when patients are influenced by online information which is unreliable or inconsistent. Despite attempts to achieve a shared understanding, the disparity between patient expectations and organisational demands is often too great to align. GPs may also experience shifts in their own professional attitudes during different stages of their career. Some GPs may utilise their expertise to diverge from professional protocols. Whereas others may exercise caution from fear of adverse incidents, complaints or litigation.

Case scenario 2 involves another familiar situation where a patient is seeking advice about his COVID-19 vaccination. GPs hold a key role in supporting patients to make decisions about their future health. It has been difficult to fulfil this role ia can now be prescribed puberty blockers and cross-sex hormones.