Knowledge work and the future doctor

Martin Marshall, head of RCGP, recently outlines the pressures facing general practice.

While consultation rates can be variable, we cannot escape the fact that volume and complexity of GP workload is growing but our GP workforce is not big enough to manage an ageing and growing population. This was the case before the pandemic and the events of the past year have further exacerbated the crisis in general practice that has resulted from a decade of underinvestment in our family doctor service.

It might be fair to ask in such a crisis do we have time for primary care scholarship? We would argue that if primary care is to survive and thrive into the 21st century placing value on primary care scholarship is more essential than ever. Systems and funding issues are beyond the scope of this module but even if these were all addressed it is still the case that general practice would be a challenging job with a high degree of uncertainty.

We know that to thrive under difficult conditions we need resilience – defined as an individual’s capacity to adapt to and manage stress and adversity. A study of resilience in GP registrars produced this model above¹.

This illustrates the balancing act we are all in as doctors, we need empathy to form relationships with our patients but we must also retain a degree of detachment. We need flexible approaches but sometimes we need to stick with something. We must make time for our friends, families and hobbies but be committed to our profession.

The skills that were associated with resilience were metacognition (thinking about what you are thinking), self-reflection and an optimistic attitude. This ability to step outside a problem and reframe difficulties is exactly what is promoted by scholarship and knowledge work. Understanding the limits of our understanding means we know we cannot aim for perfection, only “good enough” for today.

A qualitative study of resilience of GPs working in deprived areas also had interesting findings. In this case doctors viewed resilience as something not primarily developed by the individual but through teams². We have seen the importance of teams and informal talk in generating and sharing knowledge, in this case not just clinical knowledge but knowledge about how to survive and thrive in difficult environments.

In this week, we have introduced knowledge work and primary care scholarship, not as something new but as something you are already doing. We hope that by highlighting the importance of knowledge work in general practice it will give you confidence to prioritise and focus on this aspect of your work and create conversations about generating knowledge in practice with your teams and colleagues. It is our hope this will help you survive and thrive as the future doctor today.

References

1. Walters, L., Laurence, C. O., Dollard, J., Elliott, T., & Eley, D. S. (2015). Exploring resilience in rural GP registrars–implications for training. BMC medical education, 15(1), 1-8.
2. Eley, E., Jackson, B., Burton, C., & Walton, E. (2018). Professional resilience in GPs working in areas of socioeconomic deprivation: a qualitative study in primary care. British Journal of General Practice, 68(677), e819-e825.