They also learn who only sit and wait

6th September 1996 at 01:00
On the eve of the annual conference of the British Association for the Advancement of Science, Paul Wymer suggests an educative role for the general practitioner.

A GP visited me the other day to tell me about his ailments. I listened attentively as he described symptoms that would cause harder cases than me to blanch. The demise of humane medicine and the rise of "coercive healthism" were making my visitor distinctly uncomfortable.

He bemoaned the annual Pounds 2,000 given to doctors to collect meaningless data on their patients which is to be used in misguided attempts at health promotion. He abhorred the gross waste of money in the National Health Service on many psychoactive drug prescriptions and above all he railed against the narrowness of contemporary medical education which places great emphasis on science and technology while failing to take personal experience and the individual seriously enough.

Unfortunately he is not an isolated case. In fact the condition is becoming much more common so that in urban areas at least, there is a marked shortage of recruits into general practice. But my patient was not surrendering.

Indeed, as I was to learn over the next couple of hours, he is a man with a mission, determined to reverse this decline in the status of doctoring and nursing and, more importantly, to generate a new role for the GP, who would be less of a prescribing, surgery-based doctor and more of a local perceiver of social change, an observer of patterns of illness and health very broadly defined and, consequently, a teacher and stimulator of imaginative solutions.

This was heady and uplifting stuff, but there was more to come. The encouragement of new patterns of relationship, the articulation of what in the past has been constrained or taboo, the allowing of the rough edges of experience to show - these are all necessary in building a new kind of community practice. They are also of course the essentials of artistic work.

Here we were getting to the heart of the matter. What is needed he said, is a blurring of the boundaries between what we now think of as physical health, cultural vitality, spiritual balance, quality of life and communal well-being. C P Snow himself said that it is dangerous to have two cultures which can't or don't communicate. In a time when science is determining much of our destiny, that is, whether we live or die, it is dangerous in the most practical terms. Scientists can give bad advice, and decision-makers can't know whether it is good or bad.

The more I heard, the clearer the analogies became between "coercive healthism" and the main thrust of the public understanding of science movement; that which centres around the proselytising scientist or their institution, rather than the fringe activities which attempt some kind of interactive approach, in which the ordinary person actually participates. Entering the spirit of the occasion, I spoke my thoughts, allowing my visitor to gain a well-earned second wind. My point was well taken and immediately contextualised. In some areas it seems, the GP is often the only easily accessible, educated person in the community and therefore a potentially potent force in promoting genuine scientific understanding. Helping people to help themselves by making them more scientifically aware on their own terms, makes good sense; it not only exploits the demonstrable interest of the public in medical science, but would inevitably lead to a far greater emphasis on self-help and preventive health care.

It follows that, for appreciation of science in general, the prior requirement is to explore what adults recognise as their needs for scientific knowledge in relation to concerns which they have identified for themselves. This is a far more rational foundation on which to base any institutional intervention.

All this is very well in theory, I thought, but in general practice? With doctors pushing teachers hard for pole position in the "death from a thousand bureaucrats" stakes, where are they going to find the time to emulate their illustrious peers? The answer, my visitor explained, lies in judicious use of the waiting room. Time spent here is generally wasted time - dead time during which one is apt to become more anxious than when entering. Why not put this time to good use, or at least provide the opportunity for doing so, by re-thinking the waiting room as a creative space? He had no shortage of ideas for changing a "waiting" room into a "happening" room. It is an opportunity, as many artists apparently have shown, to create paintings, prints, mobiles and crafts which are colourful, witty and yet which carry meaningful health messages to complement a multi-media library of health and scientific information. The emphasis should be on interaction; the passive space becoming an interactive space where the patient and local culture are truly valued.

The "whole-person" approach to health care is hardly new, but the way in which it is being pursued in Withymoor village surgery, Dudley, by Dr Malcolm Rigler, seems revolutionary. The vision for the work has come out of allowing other peoples stories a greater claim on perception than either medical training or prevailing medical practice would recommend. The whole approach is encapsulated in a recent project where art teachers and students from nearby Thorns School, have helped in making a CD-ROM to educate patients about asthma. The teenage students were guided through interviewing specialists and patients and they then prepared cartoons and graphics for interpretation. "Asthma Attack" is the product and it is soon to be marketed for use in other GP surgeries and hospital outpatient clinics.

As we drew to the end of our conversation, I thought of all the waiting rooms I had visited and I thought of my own work in promoting the public understanding of science. The only advice I could offer the doctor was to keep taking the medicine.

Dr Paul Wymer is head of communication and education at the Wellcome Centre for Medical Science.

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