Monday, October 14, 2013

Is Downton Abbey making a case for primary care? (or is it just me)

Downton Abbey

It's no secret on this blog that I will be a family physician, as I have said in previous blog entries here. It's not secret that I believe in primary care, as I have said here.

But now I'm bringing in my non-medical life to this blog: I wholeheartedly love Downton Abbey. I have shamelessly watched every episode at least once. Downton Abbey is about a British aristocratic family of a husband, wife, and their three daughters, and their servants set in the 1910s-1920s. They have a huge mansion in the British country side. 

I tell you this because this is relevant to my medical life! Downton Abbey shows that family doctors are important. Dr. Clarkson is the GP in the village where they live. There aren't other specialists in the village because, well, it's a village. 

I won't give away any plot points from season 3 but I will say that Dr. Clarkson's relationship with the family members was important to the care he provided. In one episode, a specialist was called in by the family to assess Sybil, another daughter. But this specialist hadn't known Sybil before whereas Dr. Clarkson had known the three daughters since they were girls. Because of this Dr. Clarkson picked up on a mental status change in Sybil, another daughter, when the specialist missed it. This missed sign led to a serious deterioration in Sybil's health. 

In the most recent episode of Downton Abbey last night, Dr. Clarkson mentioned that he was proposing to the hospital board to opening an out clinic. Don't worry, this is a minor plot point so I haven't given much away. 

Dr. Clarkson: I'm just on my way to convince the board of the merits of an out clinic so people can come early for treatment. 

I think "out clinic" meant an outpatient clinic for less-acute problems. Later Robert, the patriarch of the family, dismissed at the idea of the out clinic saying that it would make people go to the doctor more often than is necessary. Basically Robert's character is old-fashioned so it doesn't surprise me that he disagrees. 

Robert: Aren't we encouraging a nation of hypochondriacs if people rush to the doctor at every twinge? 
Isobel: On the contrary I think it encourages people to look after themselves, and not become a burden. 

There, I'm quite pleased to find common ground between primary care medicine and Downton Abbey! 

Dr. Clarkson

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