General Health Articles

After having a nomadic childhood - what made you want to become a GP?  

I had a lucky childhood. ‘Nomadic’ maybe represents more travel than there was but does capture the amazing diversity that I grew up with. My parents were committed to their calling as NGO doctors, thus I spent my childhood in Malaysia, Nepal and the Himalayas. It was formative, challenging, and enlightening, and has given me a lifelong appreciation of cultural diversity and the independent spirit that has guided much of my life.   

One memory that stands out was accompanying my mother on a three-day walk into remote Nepal where healthcare was virtually invisible. I saw her work there, from simple general medicine and vaccination to emergency obstetric surgery, in the most basic circumstances. She saved two lives that day, but I only came to realise later the many she had helped.   

It was inspiring and it instilled in me the need to help, to create a life of purpose through giving. I resolved to learn a trade that could be helpful anywhere at any time.  

What is your favourite part of being a GP?  

I count myself very lucky to be doing a job that is challenging but meaningful, connects me to other people, and fills me with a sense of purpose. I am incredibly fortunate to love my job most of the time, although like most jobs there are good and bad days. I can be feeling stressed and overwhelmed one day, yet a single conversation with a patient or a bit of chat with the staff can buoy my spirits.  

Are there any specific areas of healthcare that excite you? Why?  

Undoubtedly one of the most enjoyable things I do is teach. I have been mentoring Sunderland medical students in the first two years of their training for several years. Their new course introduces them to patients from the outset, and connecting their learning to the reality of the work they will be doing is exciting. It is fun engaging with the enthusiastic youth of our profession, and guiding them in their knowledge and communication skills. I believe this early contact with patients will make them great doctors and it encourages me to maintain my focus and appreciate the privilege of being a GP.   

Deprivation and health are intrinsically linked. Why was it important for you to highlight this in your book?  

Deprivation drives every aspect of health from birth to death. Childhood circumstances are dictated by it; whether that is poor nutrition or the sinister impacts of parental drug and alcohol abuse fuelled by lack of opportunity and the need to escape their harsh reality. That is not to say that poverty limits the love or care that the children in our area are given, but the impact of parents struggling to make ends meet, working multiple low-paid jobs or disenchanted and looking for work does make the impact of poverty inescapable. With few resources or opportunities, lower aspirations, and less emphasis on education and development the cycle of poverty in a small semi-rural, semi-urban population of low-level employment is hard to surmount.  

I think it is hard for people of privilege to understand this. It is difficult to truly appreciate the impact of lifelong poverty, and how it often drives an unhealthy lifestyle whether that it is in poor diet, inadequate exercise or substance misuse. It is cheaper to buy frozen processed food than fresh vegetables, difficult to counsel someone who does 12-hour shifts on their feet to do more exercise, and hard to expect them to give up the things that make their life feel a little easier or more enjoyable. These can be the crutches used by any section of the population. Still, there is no doubt that their prevalence in sites of deprivation fuels the epidemics of physical and mental ill health that plague our patient population. It is an uphill challenge to reverse these trends for us as GPs and of course even more so for our patients.   

Why are patient stories so important for people living with chronic health conditions? 

One of the invisible and most divisive aspects of chronic ill health, beyond its physical limitations and emotional impact, is the loneliness of that experience. The isolation that comes from enduring a life which is dictated by hardship. The hardship of simply moving about when you are overwhelmed by breathlessness or pain, the loss of independence and dignity in the face of daily challenge.  

Having the understanding that you are not alone in your hardship, and that there are others living lives, similarly challenged who have found things that help can be enlightening and invigorating. Exploring those pathways to self-care and self-determination, independent of medication can enable you in your struggle and can be of inestimable benefit.  

What do you hope for the future of general practice?  

My overriding hope is that it survives. That sounds dramatic but it is questionable how long we can go on as we are. The entire foundation of the NHS is built on General Practice. Without it the NHS will crumble. We are the access point for care, dealing with simple problems that need to be addressed without escalation, but also assessing, referring, and then managing the long-term health needs of our population. We are based within our communities, steeped in the understanding of how they function, what their greatest needs are and the paths to improvement of local systems and care.  

The NHS may be a monolithic structure, fractured in places but it is still an enviable healthcare system providing free at the point of access, excellent care to an increasingly challenging and growing population. We must find a way to build a scaffolding to save it and even re-elevate it to its place as the best healthcare system in the world.