Honesty with hope – some reflections on maximising our messages

December, 2014

Professor Amanda Howe, our President–Elect, said in her speech at the WONCA Council that she would “help with policy messages. In WONCA, we know what we want to say. I’d work on how we say it – getting accurate clear briefing documents out, so you can adapt them for use in your place”. Here is her latest Policy Bite.

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Over the last year, many of you have shared concerns about the progress of family medicine (FM) in your own countries, and worldwide. Evidence of amazing gains by WONCA member organisations are often offset by disappointments – not enough family medicine residents in training; lack of commitment from governments; problems of financial reimbursement; perceptions that we are less respected than other specialists; and constant political change and challenge.

In my own country we have seen an emerging weakness in the FM workforce, in spite of the ‘maturity’ of general practice within the U.K. health system, which seems surprising. We have representation in all medical schools, strong research and educational capacity, a mandatory specialist postgraduate training, a fascinating and flexible career, and a consistently high satisfaction rating by patients.

Yet young doctors are not choosing to become FM residents – training places are under-filled; many newly qualified are leaving the U.K. workforce after training; and many doctors of my age are retiring at 60, rather than struggle on in the increasingly adverse environment created by lack of investment in primary care, and by increasing workload. The U.K. population is ageing, living longer with more diseases: unemployment impacts on health , especially in the most deprived communities; and the public sector cuts made by the current administration bite ever deeper into the support systems for anyone with health or social problems. So where to go but the local doctor?

Now the big question to you, my dear colleagues and readers, is ‘should I be talking about all the problems in family medicine?’ Life is surely difficult enough without your President – Elect wading in and admitting that all is not rosy even in the U.K. – how can we give hope and direction to countries with less investment in family medicine, if it isn’t working here? I have been living through this dilemma in my member organisation, the RCGP – we have been running a fantastic campaign led by our Chair Maureen Baker called ‘Put Patients First’ , where we have spelt out the facts about how bad things are in the primary care sector, and why our political leaders really need to take this seriously. Interestingly, while getting huge public support and media attention, we have been accused of causing the problem – people saying that negative talk is leading to anxiety, and doctors feeling they can’t safely commit to FM as a career for the future because ‘even GPs are saying that things are so difficult!’

So how can we speak the truth while avoid adding to the adverse environment and demotivation? This reminds me of the dilemma with patients with a serious diagnosis – how to tell them the risks and to ensure we act before it is too late, while wanting to empower and support, and give them the choices that may carry them through an uncertain and difficult time. The answer is problem with solution – a clear message that we can make things better, the job is still worth doing, the evidence supports us, and governments need to understand this (see RCGP news). The personal touch also helps – in a place of uncertainty, an honest but hopeful opinion can make the difference between negative and positive outcomes. Many of you have told me that nothing good is ever easy – that helps me to have hope that things may change if we are persuasive both in our diagnosis and the factors that can alter the prognosis.

And things can change - in the dark nights of our northern winter, I still know that on the other side of the world it is already day.
Amanda Howe