The death of the personal doctor

Creating an impersonal NHS? Personalization, choice and the erosion of intimacy

“…This new ability for patients to pick and choose which doctor they see may prevent the development of long‐term clinical relationships between patient and doctor, especially if patients are encouraged to value the convenience that choice affords over the long‐standing relationships that come with getting to know another person over a number of years. Those, like Gray, who identify the continuity of care as essential to the possibility of ‘personal care’ fear that greater choice may lead to what Adam and Guthrie describe as ‘convenient care from expert strangers’ in which the important qualities of intimacy are lost and standards diminish . (P. 129) Moreover, it may be that the introduction of personal budgets and direct payments accelerates this process, particularly if patients are encouraged to choose cheaper, more efficient or more commercially attractive providers over their existing providers of care.…”

Whither British general practice after the 2004 GMS contract?

“…This concerns the GP as understanding her patients' illness in their home, family and community context and making interventions from an understanding of how biological, psychological and social factors interact to impact on patients' conditions. The importance of continuity, sometimes across generations (Adam and Guthrie, 2001), and the relationship with patients and their families as part of the intervention (Balint, 1957) is part of the story.…”