What's in a name?- it's a Quantum Thing

People often talk about primary care, secondary care, General Practice, community care. But really what does it all mean?

Sometimes General Practice, which is strictly speaking General Medical Practice is used interchangably with primary care and equally community care is also blurred in the boundaries. 

The reality is that Primary Care is probably better thought of as a space rather than an organisation. A space in which multiple services operate providing care appropriate to deliver within "Primary Care".

Lets face it-there are Hospital Nurses who spend their days delivering primary care, being the first port of call for a child with diabetes, or a stoma patient, or specific illness. These nurses are by default part of the primary care approach, albeit operating from a secondary care base.

Equally most General Practitioners spend considerable amounts of time delaing with complex patients who have been through the halls of secondary care institutions and now need to return to some kind of normality.

I suppose my point here is that sometimes naming the process or issue, tends to fix the observed packet of care in place. It's probably best thought of as a quantum event, until you name it it is potentially everywhere, but once named it becomes fixed in time and space as a primary or secondary event.

The trouble with quantum observation is that it also changes the observer. Until the box was opened on schroedingers cat the observer wasn't happy or sad- not knowing if the cat was alive or dead.

Once opened, defined as dead, the observer is also "fixed" in sadness, so we also change who seek to define what should be in primary care, what is and isn't possible in each domain of care.

Perhaps we should seek less to define what should be done where and concentrate on the infinite possibilities that a quantum view of healthcare might provide.

Trust me I'm a Doctor!

A key part of being a leader is to be trusted by those we lead. many of us think that trust is something which has to be earned, takes time and either happens or not. 

Oddly enough I used to think that until I came across an article in Harvard Business Review which outlines the factors on which trust can be built. Of the ten or so listed there are three which are entirely dependant on the individual who needs to develop trust in someone else. The remaining factors are all able to be influenced by the person who wants to be trusted. 

These factors include obvious features such as consistency of action, perceived risk, having similar goals and ambitions, as well as some less obvious factors. If someone asks you to trust them you need to know they actually care about you, not in a romantic way but in a benevolent way, considering your interests as pat of their value set. 

Our emerging clinical leaders in primary care will need followers who trust them to lead. These leaders need to be able to communicate, be predictable, be capable, care for their colleagues, be transparent in their goals and strategy and build on the common agenda of all clinicians. 

There is obviously a significant trust gap within primary care, small practices, GP providers and self aggrandising leaders will all contribute to the trust gap. However that gap is nothing in comparison to the gap in trust between secondary and primary care.