Abstract
I recently attended the 6th Annual Forum of the Vasco da Gama Movement (VdGM) - this is the European Young Doctors' Movement of the World Organisation of Family Doctors (WONCA), made up of GP trainees and First5®s from across Europe. The Forum is run by VdGM for its members, and is held in order that we can share ideas and learning with our international colleagues and work together for improvements in primary care and family medicine. Having previously benefited from the experience of attending a conference exchange in Croatia organised by the VdGM earlier this year, I decided to attend the Forum to find out what it was all about.
This year’s Forum took place in the city of Turin in the Northwest of Italy - a picturesque city surrounded by the Alps and a perfect setting for discussions and an exchange of ideas to take place.
The theme of the Forum was `Raising Our Sails Towards a New World: Empowering Family Medicine'. Many of the workshops and plenary talks focussed on practising medicine in an ever-changing world and how we, as primary care clinicians, will need to adapt to the new opportunities and challenges this brings. The variety of workshops, oral presentations and plenary lectures on offer, delivered by doctors from all over Europe and beyond, was of such high quality that it was difficult to choose which session to attend.
A common theme running through many of the workshops was the overwhelming breadth of information (albeit of varying quality) now available to patients and the impact of this on our consultations. We are increasingly faced with patients armed with research about their various symptoms or conditions and the investigations and treatments they want. Although there are many positives in having informed and engaged patients, in a workshop about over-medicalisation, we explored some of the negative implications that this can have and how to combat them. A vicious cycle of over-investigation and over-treatment, often with limited benefit and sometimes even harm, can be driven by limited knowledge and intolerance of uncertainty by both the patient and doctor. For doctors, there may also be a fear of missing something and even of litigation. Discussion around this and the idea of quaternary prevention (the concept of preventing harm to patients resulting from over-medicalisation) added to our awareness of the implications of over-investigation, and highlighted that sharing good-quality information and decision-making with our patients is the key to ‘choosing wisely’. I learned that this problem is perhaps even more common in other countries, where, for example, patients can pay for their own blood tests without seeing a GP first, or where pharmaceutical-driven health campaigns encourage people to undergo screening tests which may be based on limited evidence.
Another example of this problem, which is becoming more common in the UK, is the rise of direct to consumer genetic testing. This was the focus of another workshop where we discussed the limited accuracy of such tests and the effect that this might have on our practices. When considering the outcomes of these tests in consultation with patients the clinical significance may be difficult to derive from the results, but consultations can open a door to discussion about lifestyle changes and risk management for patients. Overall, these workshops reflected a change in the emphasis of our role as GPs where we help patients to understand and interpret the vast array of information available to them, enabling them to make better informed decisions about their health.
Far from shying away from this shift in emphasis, we need to embrace patient involvement in their care. One of the most inspiring plenary lectures came from Vincent Dumez, Codirector of the Centre of Excellence on Partnership with Patients and the Public at the Université de Montréal. As someone who has lived for many years with both haemophilia A and HIV, he is an advocate for the treatment of patients as partners in decisions which affect their care and as experts in their own condition. He illustrated this with the example that every year, patients with chronic disease spend on average 5–10 hours in contact with a doctor, but 6000 hours managing their condition alone. He spoke passionately about the importance of listening to and working together with patients to achieve the best outcomes – reminding us that if we do not involve the patient in the decision-making process, they are less likely to follow any plan we may set out. In fact, the very idea of ‘empowering family medicine’ surely has to incorporate empowering our patients to take control of their own health.
Another topic relevant to the idea of primary care in a changing world was environmental health, and one workshop was dedicated to sharing ideas for making our practices ‘greener’. Of note, the Forum itself attempted to address the issue, with policies such as not providing printed copies of the programme, instead sharing it via email and Whatsapp. Such small changes can have a big cumulative impact. Perhaps the fact that the start of the conference coincided with the local school students’ climate change protest had an impact. Their activism and passionate demonstration clearly inspired many attendees, and by the end of the Forum the newly-formed VdGM Special Interest Group for Environmental Health had found some new members.
There were other common and not quite so novel challenges for all of us to face. One presentation from the Special Interest Group for Family Violence focussed on the sad reality that a large proportion of women still suffer domestic violence regardless of country, ethnicity or socio-economic status. We all have to be alert to this wherever we work and be able to offer and signpost appropriate support. Working with difficult colleagues was also a widespread issue that many of us have had to deal with at some point in our careers, and a workshop on considering this in the context of cultural background and personality factors provided food for thought on ways to tackle the problem and achieve resolution.
As well as our shared issues, we also considered significant differences between practices. Our Dutch colleagues ran a seminar on euthanasia in their country- I was surprised to learn that this is mostly carried out by GPs and not specialist clinics. Although not currently legal in the UK, euthanasia is now legalised in four European countries. British patients are travelling to such countries for this purpose, and ongoing discussions suggest it may one day have a role to play in our practice. It was useful for us to consider the arguments for and against euthanasia. Whatever your own opinion on the subject, understanding the practicalities and appreciating different opinions is the key to understanding and supporting patients in their needs and choices.
It was not all in-depth discussion and difficult dilemmas. The social programme allowed us to network with other attendees, to get to know each other and to form lasting connections with peers. We also got to know the city of Turin and to sample its famous cuisine. Of course, one of the biggest changes that we as UK practitioners are facing is our impending exit from the European Union and the uncertainties it brings. I was frequently asked about this by our European colleagues, but I was often unable to offer any answers. As RCGP members, we are all automatically members of WONCA, so whatever the outcomes of Brexit, we can be reassured that we can maintain this level of collaboration with Europe through the VdGM. The experience was truly invaluable and I returned home feeling inspired, energised, and proud to be working in primary care. The next Forum takes place in Edinburgh in February 2021, and I would encourage trainees and First5® GPs to attend. I will certainly be attending!
