With huge thanks to Dr Zakariya Goga, GP Partner and Trainer in Sale for sharing his reflections, and allowing us to publish.
“This is the media, an irresponsible media. It will make the criminal look like he is the victim and make the victim look like he is the criminal. If you are not careful, the media will have you hating the people who are being oppressed and loving the people who are doing the oppressing.” Malcom X
“I am not what I think I am, and I am not what you think I am. I am what I think you think I am.” Charles Cooney
The current torrential and relentless vilification of General Practice - the very bedrock of the NHS; that should General Practice fail the entire NHS will fail - is taking a serious toll on the profession.
I would never have dreamt of living in a period where I would witness health care professionals leaving their profession in droves after dedicating their entire life to it, others committing suicide as they can see no other way out and collectively becoming so accustomed to abuse for simply doing their job AND it is deemed as being perfectly acceptable.
A few weeks ago marked the 20th anniversary of the tragic events of 9/11. Words still cannot express the horrific events of that day. I am not diminishing 9/11 and the trauma it caused nor am I putting a spin on it to attract sympathy in what I write next. You will understand as the words follow.
Overnight I went from a regular Muslim to either a “good” or “bad” Muslim. People who knew me very well in a flash saw me as someone else or something else. “You are either with us or against us,” said Bush Junior. This became a subconscious narrative & collective guilt became an acceptable notion. It was binary. I, like many other Muslims, subsequently spent over a decade of my life exhausting my energy to prove to everyone I met that I was a good Muslim.
Furthermore, I was becoming a polarised human being towards “others” around me. To illustrate how bad it became, visualise this. My son was 5 years old at the time and was obsessed with Match Attack like any other child with a passion for football. I was in the local Spar queuing with my son who could not wait to open the pack to see which footballer is in his good fortune. I heard a voice shout, “Come on!”. I looked up and saw a Caucasian tattoo laden skin head man gritting his teeth and looking at me like a wolf. “Come on!”, he shouted again. My heart sank. Not so long ago I attracted another altercation by virtue of my beard as I came out of the mosque after sunset prayer. It is handy to have a non-uniformed officer pray at the same mosque, otherwise that episode could have got ugly. I was not prepared to put up with any beef in front of my child, neither was I going to be a terrible example for my son and respond like a child.
He said again, with gritted teeth and piercing eyes, “Go on! Let the boy go and pay for his football stickers before me. Never hold a child’s passion for anything back, he looks so excited, let him pay before me.” I paused, reflected, and put my doctor-hat back on. He was leaning on a stick, nearly limping from one leg to another, he looked very pale and unwell. He was likely to be in pain and that is why his facial expressions did not appear welcoming. We had a short yet wonderful discussion about respect and manners towards seniors and he convinced me to let my son go ahead before him.
What happened here is exactly was certain media outlets either intend or their narratives become an unintended consequence. That is to create division of fellow human beings despite the fact we have far more in common than differences. Reflecting on this season of my life it dawned on me after a decade of mental exhaustion, I was behaving no different to what my faith demands. The first few lessons every Muslim child is taught in madrassas across the globe are the Prophetic traditions of mercy and peace. The first being: “The Merciful One (God) will have mercy on those who show mercy to others, have mercy on what is on this Earth and the One in the heavens will have mercy upon you”. The second, which was the first sermon Muhammad delivered when he arrived in his new city of abode, al-Medina, after being forced out of Mecca: “Spread peace, feed the hungry, keep up with kinship bonds, stand in prayer in the depths of the night when others are asleep - you will enter paradise with peace”. This was and is my blueprint.
And so, I switched off from the media. I still do not own a television nor a smart phone. I fleetingly check the news and choose carefully which media outlets, commentators, and trend setters I lend my eyes and ears to. Within no time my conscious calibrated. It was no longer a battle anymore. I need not figure out what someone else is thinking about me based on their facial expressions or body language. I began to start seeing people with the eyes of innocence and quickly realised that the overwhelmingly vast majority of humans are intelligent beings with a soul that also has intelligence and insight.
Why am I mentioning this to you my dear brothers and sisters of the fraternity of General Practice?
Do not validate yourself by external coordinates. Validate yourself from within.
Just as I figured out, painfully, I was already striving to be true to my faith and no one can judge me, you must tell yourself that you are currently in your element as a GP, and no one can judge you.
For every one person who believes the current narrative that GPs are utilising a virtual platform to provide virtually no meaningful service you will find 100s if not 1000s in my estimation who do not buy this narrative. Their real-life experience with you annihilates the tripe.
Take a step back and view the past 18 months with a sense of birds-eye view. Being able to continually deliver primary care - pretty slickly in my humble opinion - in the current climate of PPE that is similar to what we wear with our 3-year-old whilst we paint pictures; is nothing short of incredible. Fact: The vast majority of patients prefer the new norm of working, have much easier access to their GP & allied medical staff in general practice, less waiting times in terms of being seen and responded compared to any other recorded period of health care. We have never provided so many appointments with such limited resources in the history of general practice than currently. GP practices in England delivered over 31.1m appointments in total in June 2021 according to the figures from NHS Digital - including 4.2m as part of the COVID-19 vaccination programme. That is a 30% increase to the previous year. Oh, did I mention the monumental smash of delivering covid vaccines or annual flu in our spare time?
So switch off from this noise and save your brain from unnecessary turmoil. Leave the “fight” to the RCGP, LMCs and activists. Realign with core values, self-motivated purposes, and goals. Focus on this over everything else, give meaning to this over anything else and continue to deliver excellent health care. General practice is like no other system in the entire globe.
Like you, I have patients who openly inform me that if it was not for me they would not be alive, how much they value me, how grateful they are to the staff at the surgery for constantly being there for them in the hour of need, for listening to them without judgement, for believing their symptoms, for dropping them off to A&E as the ambulance services were struggling, for paying for their taxi ride home as they had no money, for dropping them off home after a late clinic as they had not means of transport, for giving them money to buy food because they have not a single penny to their name, for making breakfast for them as their carers were running late, for grappling with them (yes literally) whilst they reach for the knife to end their life in their kitchen, for buying the emergency services time and holding it together for the patient on the other end of the phone whilst he has a knife to his chest as he cannot take lock down anymore (yes this was for real), for being part of the search party when they apparently go missing, for being the lifelong committed health care professional from birth, for calibrating the anxious first time mother without passing judgement over and over again, for guiding an overwhelmed teenager through the storms of life, for supporting the victim of domestic violence in stealth mode so she and her innocent children can escape violence, for instilling belief into them when everyone else doubts them, for not rebuking that 90 year old who falsified symptoms to secure a home visit late on Christmas Eve just so she could escape loneliness over the Christmas period as her children are not bothering with her this year, for being their rock for them and the entire family as that terminal period of their life enters & for all those smiles, selfies and laughter when their health is restored.
This is who and what I believe over anyone and anything else. This is what validates me - let it validate you.
Obsessive fixation of the insistence of face-to-face appointments for every single patient is a demonstration of complete obliviousness of what we do in General Practice. However, you and I do not need to prove ourselves to anyone. We already are remaining true to our dedication to our patients. Your legacy, wherever you work, in whatever type of practice population is woven in the fabric of your community and will be palpable for generations to come. They may not verbally express this, but the small changes you are making to your patient’s lives every single day, will not be left unnoticed. Proof is the loyalty of your patients to you and your practice. At times this may be perceived as being demanding, however I see it as being an honour that we are their SOS.
On the other hand, certain commentators’ legacy will be remembered by the eyes and ears of history as division, discord, and disharmony. I know which legacy I prefer.
Besides, there is something much deeper going on: “That is the standard technique of privatisation, defund, make sure things don’t work, people get angry, you hand it over to private capital.” Noam Chomsky.
Now that is something worth reporting about.
Dr Zakariya Goga
