Editorial

A recent trip to Norfolk was memorable, less for the small dent in the back of my car, and more for a salute to absent and distant friends. I was reminded a few days later by Matthew Syed on Sideways, broadcast by the BBC, of why we make friends and the lifelong influence they have over us; of course, according to the anthropologist Robin Dunbar we are limited in the number of friends and acquaintances we can maintain by our brain size. On average we are likely to have just five people in our tight, inner circle of loved ones, 15 good friends, 50 friends, 150 meaningful contacts and around 500 mere acquaintances. On average, I am told, we can recognise about 1500 people. What does this mean for us as GPs and in the age of emails and social media?

It took me several minutes to recognise the tall, distinguished former colleague delivering a heartfelt eulogy. We talked afterwards and quickly filled in some gaps. Many colleagues share an appreciation of the value of continuity of care, an appreciation of general practice built on this and consultations that have enough time to focus on the patient and what the doctor has learned about their patient, often over many years. My tall former colleague, Dr Andrew Yager, has recorded, after several decades of rural general practice, some of his own memorable experiences in a book, Tales of a Suffolk GP. He is a strong advocate of continuity of care and the stories tell us why.

We need brains big enough, it would seem, to accommodate recognition of so many faces, so many stories. Perhaps the average GP list size conforms to the research by Robin Dunbar. It certainly fits that we can accommodate some familiarity with our patients in line with the scale of the average circles of acquaintance. I suggest the scale and style of traditional general practice is in keeping with a balanced life, for us as social animals. A move away from personal lists, continuity of care and healthy socialisation, combined with wider impersonal, remote contacts and other digital developments may not be just anthropologically unsound, but psychologically damaging to us and our patients! Do we need an anthropologist to guide us in shaping the form and scale of general practice?

GPs often find that their hospital training for general practice leaves them short on knowledge and skills in particular specialist areas, such as dermatology and ophthalmology. We need often to better understand what allied health professionals are doing for our patients. This issue recognises these shortfalls with articles on eye examination from Suleman Kanani and Monica Mechrgui, from Clare Byrne with some help on the diagnosis and management of contact dermatitis and from Jenny Walton on the important work of our colleagues offering speech and language therapy.

A timely article from Clare Thomson et al. details how we might improve the diagnosis of heart failure and better follow current guidelines. It is often assumed that heart failure is now less common. This article highlights some important truths and identifies worthy targets for our attention and the great benefit of patients.

Maxwell Cooper adds some novel insights into our consulting with help from Charles Dickens and Little Nell. Dickens may have been poking fun at Victorian doctors, but we might learn something of substance from his astute observations of style. Style with the greater substance of modern medicine is a powerful, artful alliance if well applied and understood. Max offers interesting insights and a new perspective on old observations. The capacity of modern medical science to save lives by preventing disease is integral to Gurpreet Bhamra’s informative article updating on vaccination for the human papilloma virus. After science has delivered the opportunity, some art is required to effectively, empathically, enact both the necessary screening and the essential vaccination.

Whatever pressure you are put under by work and the stresses of a sometimes, difficult job, make sure you look after your friends. Whichever circle they are in! As social animals we need the nurture and empathy of our circles of family, friends and acquaintances. Perhaps of our patients too, the ones we know and see quite often over quite a few years. Or are the circles breaking?

Christmas is a time for reacquainting with friends and sharing time with family. I hope you get the time to do both and enjoy a very Happy Christmas! Make the time, but take your time, especially when reversing.

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