Returning the soul to medicine

In my view modern general practice is divided on its future direction.   

The first direction is an increasing demand for rapid patient access in the treatment of specific symptoms and diseases. This has been met, to some extent, by national rapid access targets. The recent Quality and Outcomes Framework of the GP contract has also encouraged this direction of travel, offering faster access and good quality treatment within a biomedical model based upon stringent definitions of evidence-based medicine. The focus is on rapid treatment of symptoms and diseases and identification and treatment of risk factors. However this approach is often not patient-centred and takes little account of the patient’s background, culture, and health beliefs.

The second is an interpretation of general practice, which aims deeper and wider than the symptom or disease. It treats the patient as a whole person and offers a broader range of therapies and interventions that are more sensitive to a patient’s wishes, beliefs and needs. This is a more personal and flexible method, which is less rigidly confined to the presenting symptom (which may sometimes be simply a metaphor for distress) or the disease (which may be the result of a given lifestyle). It is an approach that can provide more sustainable effects on a patient’s health and wellbeing. This is the integrated vision of general practice: a vision that is perceptive enough to acknowledge that health and wellbeing (i.e. the harmonisation of body, mind and soul) transcends provenance by randomised control trial methodologies only.

This second and more holistic approach has been neglected in recent years by a system that appears to value only the easily measurable. In my experience the growth of what could be called ‘Doc in the Box’ medicine has fuelled an equal and opposite demand by patients for a form of general practice that respects its roots in family medicine and emphasises personal care and continuity. These things seem to be particularly important for patients over 60, those with long term illnesses and those who develop a very serious illness.  

I believe that an increasing number of patients and GPs are seeking to embrace a way of working which has the potential to offer a wider perspective on the patient (beyond their presenting symptom) and an expanded range of therapeutic approaches beyond the purely conventional. Three quarters of the British public would like to see complementary therapies available on the NHS (according to a 2006 poll conducted by ICM for The Prince's Foundation for Integrated Health) and over 50% of GP practices are now providing access to complementary medicine.

This document is about this second kind of general practice - the integrated approach. 

I believe that an urgent redefinition of general practice is now required. One that better meets the needs of patients and practitioners but which also provides a more sustainable approach to the health and wellbeing of the local population generally.  One that offers a wider choice of safe and effective therapies, while ensuring that patients do not turn their back on proven conventional treatment. 

My aim is to define and describe how this integrated vision of general practice might look. It is 'work in progress' and to be used as a basis for discussion and debate. I, and The Prince’s Foundation for Integrated Health, hope that it will raise the profile of integrated practice and be of some use to GPs and patients struggling towards a wider vision of what is possible when the soul is returned to medicine.

Read the full paper here, then leave your own thoughts in the comment box below.