86th EGPRN Meeting, Lille-France, 10-13 May 2018
World is changing and general practice has to be adapting to accompany profound mutations.
The traditional European self-employed GP practicing in a solo clinic is not the model of practice that young GP expect to join. On the other hand, the running of public primary care clinics appears to be too expensive to national health authorities and patients complain about a lack of attention of the health professionals who work there: there is a trend to privatize these settlements. Young GPs mainly intend to work in group practices, if possible in large towns, as a team with midwifes, nurses, physiotherapists and other primary care health professionals. As they have been studying for a long time and start to earn money much later than those who did shorter studies, they consider deserving comfortable incomes, but they are not keen on managing primary care clinics or to have (very) long working days. For these reasons, though medical schools and vocational training schemes never trained as many GP registrars as nowadays, many countries in Europe are facing difficulties to replace the GPs from the baby-boom generation. How can research in primary care propose new practice models offering satisfactory quality in care, consideration of the patient, and a fulfilling vocational frame to primary care health professionals?
The population in Europe has considerably changed in the past decades. A mass-migration due to local wars, overpopulation and poverty in some developing countries, the attraction of wealth and shortening distances (physically by plane and intellectually by mass tourism and the internet), has led to a cultural miscegenation as Europe has never experienced since the fall of the Roman Empire. This cultural enrichment is also a source of incomprehension in part of the population who feels like stranger in its own country. It is also a culture shock for the GP, with patients sharing other health beliefs, other lifestyles, other medicines and who have difficulties in understanding the organization of our health services. How can research in primary care approach these social changings to adapt primary health care services to new expectations and beliefs?
The western civilization itself has known great upheavals: homosexual weddings, children living with parents of the same gender, surrogacy and insemination with donor sperm, transsexuality and transgender have reversed the codes of the family, needing adaptation of family doctors. How can primary health professionals adapt their medical records to these changes? How can research in primary care recommend new preventive approaches when sexual determinations are blurred?
Goole, Apple, Facebook and Amazon (GAFA) (and Microsoft) are promoting a new revolution, at least as important as the industrial revolution, and our habits are increasingly changed by the growing importance of online services. Today online shopping, ticketing, music and literature, hotel booking, etc. But also direct one-to-one services: Uber, B-Air-B, etc. Online consultation of medical literature, online conferences, online medical education, online advices from colleagues, online medical appointments for patients. Tomorrow probably online encounters between doctors and patients, or online control of the function of diverse medical devices. This possibly leads to the collection of an immense amount of data for research and healthcare service quality enhancement. This could also lead to a scary big brother brave new world. How can research in primary care make use of big data and simultaneously prevent the risks regarding intimacy and individual freedoms?
The development of computing technologies and nanotechnologies will also impact medicine and pharmacy: DNA directed drugs or nanosurgical interventions, stem-cells transplantations, electronic brain implants to enhance memory or correct dementia or addiction, or computer guided prothesis responding to brain control. Here again, extraordinary innovations through research could turn into the worse brain contention system. How can research in primary health care anticipate these medical progresses and find a place for the counselling and follow-up of the affected patients?
What changes does all this mean for general practice/family medicine and primary health care?
At the same time, there will be a growing gap between those who will adapt to this ongoing revolution and those who will get stuck. Adaptation means behaviour changes as entire lifestyle changes in patients and profound changes of beliefs in health professionals are needed. Development of alternative screening processes for cancer prevention, implementation and efficacy of new immunization programmes, promotion of physical training in obese patients, will remain necessary goals to keep patients healthy, whatever the technology and the cultural gap.
Prof. Christophe Berkhout
Lille University School of Medicine
Department of General Practice/ Family medicine