Yesterday's post was a little rushed, and I didn't have the time to mention the de-skilling of GPs. In my youth, GPs were capable of dealing with nearly all of the medical problems of their practice themselves; most patients will have routine and minor medical issues, and the number that used to require referral to hospital or to a consultant was, from memory, low. The stethoscope and the sphygmomanometer were the tools of choice, and clues in the patient's eyes, tongue, fingernails, skin, demeanour and so on aided diagnosis. White flecks on the nails? Vitamin C deficiency. A little yellow ring around the cornea? A smoker. Blue nail-beds? A pulmonary disorder. If confirmation was needed, the GP would take a blood, sputum, urine or stool sample and send if off.
Now of course a GP won't even bother to look at your hands or eyes, let alone ask to take a peek at your tongue. Unless you've brought one of the half-dozen common and minor complaints he or she feels capable of dealing with without further investigation, these days it's a battery of blood tests to start with. Everything from Cholesterol to Zinc. Then they use a little book like a primer, with easy to follow flow charts, to tell them what the numbers mean. Half of these flow charts end up with the instruction 'Refer to Consultant'.
Again, when I was younger, consultants were men (and yes almost always men) at the peak of their profession; members of the Royal Colleges in expensive suits and with a Bentley in the hospital car park. They were not to be bothered with trifles. Now, they're as ubiquitous as ward-cleaners, younger, and a lot less well qualified. In short, in the same way that 'A' levels have regressed to the level of the old 'O' levels, a first degree to the level of 'A' levels and a Master's to the level of the old Bachelor degree, so newly qualified GPs have regressed to the skills level of a nurse, and consultants to the skill level of the sort of GP that one found in my youth. To be frank, unless you've got a British-qualified GP over 50 you're probably better off using Wikipedia.