Just a GP: Diaries From a Career in General Practice

Book Title: Just a GP: Diaries from a Career in General Practice

Author: Denis Pereira Gray

Publication Information: Taylor & Francis Ltd., 2024, 462 pp., $42.49, paperback

When Queen Elizabeth II knighted Dr Denis Pereira Gray in 1999 for outstanding service to general practice, he had his photo taken beside the polished brass nameplate on the practice where he started in 1962, after his father before him in 1930, and his grandfather before him in 1895.

This autobiography of a celebrated English general practitioner (GP) is also a biography of British general practice. It traces the development of GP as a distinct medical specialty with research, literature, postgraduate training, and leadership in health care. Professor Pereira Gray shares a special perspective on these events; he was in the room, at the table, and often in the chair for many of these important milestones. His practice career and professional achievements ran concurrently with the development of general practice in Britain and family medicine in North America.

The book is not a diary, but it is an organized text that leads readers through developmental stages in his practice, professional career, and the history of GP. Each stage, organization, activity, and accomplishment is detailed in its own section. Many read like short stories, with characters, drama, comedy, and the grand narrative arc of generalist whole-person care. The authentic, diary-like feel creeps in through candid asides and private regrets. Despite his exceptional resume, what comes through in Dr Pereira Gray’s writing is humility, caring, curiosity, and thirst for criticism to help advance patient care, general practice, and population health.

When he began training in the 1950s, GPs were the doctors who “fell off the ladder" of specialty training. After 7 years of hospital-based medical education and learning to take the body apart into organs and systems, he describes how he struggled for another 7 years in general practice to learn how to put the patient pieces back together (p 28).

The book is aimed primarily at British readers. Many programs, organizations, and health system structures will be unfamiliar to North American readers. Some details read like inside baseball, or, more properly, cricket. He mentions continental Europe occasionally, but North America rarely. Still, the issues faced, problems solved, and resources deployed will be familiar to family doctors worldwide. A glossary is provided to help bridge transatlantic communication.

Like the epidemiologist he is, the author keeps an account of everything: publications, citations, degrees, students, awards, and people. The text delivers names, dates, places, and meticulous references. Links between topics weave the tapestry together tightly. Helpful appendixes summarize key information.

The book is more readable than its weight suggests. The author is a professional writer, broad reader, generalist scholar, and humanistic clinician. Literary and scientific quotes grace the text adding nuance and interest. Sentences are refreshingly short and clear. Dr Pereira Gray's warmth and wisdom permeate the entire text.

This is a hard book to skim. Any temptation to gloss over a chapter on some exotic academic organization risks missing engaging stories and insightful observations. Dr Pereira Gray is an expert in nonverbal communication, in both the exam and board room. He shares anecdotes about his interactions with royals, government ministers, leaders of other specialties, and the patients he has cared for over 50 years.

Clinicians appreciate his practical suggestions, philosophical musing, and astute observations on becoming a compleat family doctor, running a practice, taking care of patients, and integrating all with family and fulfillment. Leaders will want to learn from his enormous experience with practice groups, research institutes, universities, professional organizations, health service bureaucrats, and politicians. Historians will find in this book the best review of the development of GP into an independent scientific discipline, a Royal College of proud practitioners, and an effective voice in national policy.

Dr Pereira Gray's career and this book demonstrate that physicians trained in comprehensive, whole-person care are more than "just a GP." All readers will find an exemplary resource on the chronology and evidence for the key themes of general practice and family medicine: relationships, communication, continuity, generalist expertise, whole-person care, cost-effective community-based medicine; and the integration of acute, chronic, and preventive medical care with psychological and social needs.

Readers will also appeciate the author’s reflections on practice, with stories of patient interactions that gave meaning to his life as a GP. He pauses amidst his busy career to remember, "In the quiet moments of a consultation, I find the heart of medicine; it is here where trust is built and healing begins.”