Smears and Tears

Today an unexpected insight arrived. A dysfunctional Twitter discussion about qualitative research, ‘failed scientists’ and ‘fluff’ suddenly gave way to an interesting view of the world of general practice.

Oddly, the comment was directed at a hyper-rural doctor. They’re that rare breed of advanced trauma life support qualified GPs who could easily combine a keyboard-warrior Quality-And-Outcomes-Framework admin session with single-handedly running a cottage hospital, a HEMS air rescue service, and an obstetric emergency.

So, slightly defensively, I tried to work out what percentage of my urban village practice day could truly be labelled as tears or smears. And, in fairness, it covers a fair bit. Psychiatry and gynaecology do make up a pretty large chunk of the work, and they commonly overlap.

A “GP only” smear appointment is a rare event, and a prime example of overlap. It usually signifies (in no particular order) cancer phobia, herpes, FGM, childhood abuse, distressing incontinence, or recent bereavement. Very occasionally it just means a retroverted uterus, or a booking error at reception, but I can barely recall the last ‘simple’ one.

The strangeness of the ‘smears and tears’ comment wasn’t its description, though. It was the tone, and the apparent lack of understanding that (taxing though smears and tears can be) the role of a generalist encompasses all that, plus a whole lot more.

And I’m sure I’m preaching to the converted when pointing out the relative solidity of the general practice research base. I sometimes feel embarrassed for our good fortune, when seeing other specialties’ reluctant compliance with fluctuating guidelines. It’s hard to rely on evidence based on p-hacked trials, for overpriced me-too drugs, but abandoning data is a step too far.

Yet for some reason, the old GP-hospital divide remains. I’m still trying to figure how someone came to believe that mental distress and vaginal examinations are excluded from ‘real’ medicine, as practiced by proper ‘scientific’ specialty doctors. Surely based on anecdotal evidence?

And we all know that the plural of anecdote is only data when the subjects are selected by stratified random sampling. Plus have their semi-structured interview transcripts objectively and independently analysed by a team of trained qualitative researchers. And then put through all sorts of complicated software to rule out any funny business. Or something.

Difficult thing to capture, fluff.


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