Monday, 4 August 2014

Are Traditional Doctors (GPs) Becoming “Ill-heath” Advisers?

If you want advice about your health who do you turn to? Do you talk to your doctor, chiropractor, nutritionist or personal trainer? A decade or so ago your answer may well have been “my doctor”, without hesitation. Today your response may be “it depends”.

For as long as I can remember there have been a range of health and fitness professionals offering the general public their services, however, it only seems to be in more recent years that they have become more prominent and their services more affordable or accessible. The internet provides a platform on which all manner of health and fitness professionals can promote their services and offer advice, opinion or solution and there has been a rise in health or fitness oriented clubs and societies.

If I want to find out whether fats or sugars are worse for me, I’ll go and find an online article or documentary. If I’m interested in adjusting my diet or activity levels to achieve fat loss or reduce my risk of developing type 2 diabetes, I can find any number of blog posts and websites offering advice, or I can talk to a nutritionist or PT. I don’t need to go to my GP and given the difficulty that can be faced when trying to arrange an appointment it’s likely that I will only approach him/her for treatment of ill health rather than for advice or preventative measures.

I recently underwent a basic health check at work. One of the tests carried out by the physiologist was a cholesterol level check. My reading was slightly high at 5.52mmol/L (norm is 5mmol/L) and I was told that although, given my lifestyle, it was unlikely to be anything to worry about, it would be worth getting a more detailed test carried out by my GP to determine the ratio of HDL (good cholesterol) to LDL (bad cholesterol). When I spoke to my GP he was rather reluctant to administer such a test, on the grounds that it wouldn’t change any of the treatment that I currently receive. It’s worth mentioning at this juncture that I had many appointments and tests with my GP at the start of the year to investigate severe tiredness which eventually led to the identification of iron and vitamin D deficiencies and the decision to restart B12 supplementation after having been denied injections that I’d been given for a decade.

I wanted the more detailed cholesterol test to find out whether it was my HDL or LDL that was high. In the event, of high HDL, I would have carried on life as normal. If LDL had been high, I would not have sought to be prescribed statins or any other medication to regulate it but to instead address my lifestyle to manage the situation; increasing exercise and adjusting my diet would likely have been sufficient. Even though I was seeking to improve my own health without medical intervention, my GP was reluctant to approve the test. It seems that spending money on enabling people to take preventative steps is not a priority, whereas treatment of conditions that could perhaps have been prevented is the main business. My GP will offer me advice and treatment for ill-health but I am encouraged to turn to other health and fitness professionals for good-health advice.

In April 2013, Primary Care Trusts ceased to control local spending on dentists, hospital operations and tests, and medicines and GP-led Clinical Commissioning Groups took over this control. The CCGs control around 60% of the NHS budget and have a say in how it is spent locally. GPs have more say in how their budgets are spent than before so is it possible that their treatments now are more finance-driven rather than patient-driven?

Of course other health and fitness professionals also have financial drivers. Frequently self-employed they have a living to make but their ability to achieve this is often more strongly linked to their reputation. Helping people to achieve their goals and live a healthier lifestyle is at the heart of what they do and perhaps makes them more “patient-centred”.

It could be argued that the GP, or at least another facet of the NHS or a medical professional, should still be the first port of call for any advice relating to health and fitness. But it is worth remembering that thousands of other health and fitness professionals, such as PTs, nutritionists, physical therapists, athletics coaches or fitness instructors will have undergone significant training, assessment and examination in order to develop the knowledge and tools to enable them to offer good advice.

I'm not looking to answer the question I pose in the blog title but just to get us all thinking. What do you think, and is it a problem one way or the other?


  1. I lost faith in GPs a long time ago. As their title states they are just "general". They don't know much that is specific. After a couple of attempts on my life (by GPs) through lack of knowledge and not listening to me, I have basically given up on them. I use Google and my own knowledge and experience as a fitness professional (and my mums advice - she worked for many years as a Nurse / Lecturer). ...Their choices always come down to finances and not what is in the nest interest of you as a patient. I will say though that there are some GPs out there who understand the benefits of prevention rather than cure, and who also realise the benefits of exercise as "medicine". It'll be a long time before we see the changes that we need...but at the end of the day I'm still grateful for the NHS!

  2. I agree with this article based on my personal experiences trying to get treatment for a running injury. I had to sit through the "you probably should stop running and not all humans are designed to run" speech before I was referred for a MRI and off to a physio for treatment.

    I understand the costs associated with such time and treatment but it is disconcerting when the best option is to stop moving!