The Space of Consulting: A Photographic History of General Practice

Originally a creative enquiry submission:

This work demonstrates the contribution that archival research and an understanding of the past can bring to the field of academic primary care. Historical photographs of clinical encounters and spaces of primary care have reframed how we as researchers think about the built environment of primary care. Taking a historical approach to bring together contextual and archival photographs taken in primary care shows that this environment has changed in a relatively short space of time.  Photographs depict these changes visually and this has informed our understanding of how the changing spaces of clinical practice impact and influence the encounters that happen within them.  The interdisciplinary integration of historical research into that of primary care allows for a deeper exploration of context and understanding. In this creative enquiry, we will use archival images from the Royal College of General Practitioners Heritage Collections and more contextual images to illustrate these changes, starting with the patient’s home, moving to a surgery inside the GP’s house, to purpose-built clinical facilities and onward to consider the impact of remote consultations where the patient and practitioner do not share the same space. A brief investigation of these images will explore changes to the healthcare environment and consider how they may relate to the changing power dynamics within the medical encounter and the increasing sense of depersonalisation felt by both patients and clinicians.    Historically, medical encounters have taken place in personal spaces, intertwining the lives of doctors, their families, and their communities. The subsequent development of purpose-built facilities replaced the home with wipe-down chairs, plastic curtains and, particularly since the Covid-19 pandemic, infection control guidelines restricting the furnishing of clinical spaces with personal artefacts. The photographs consider whether these changes have contributed to some of the evolving attitudes towards general practice by shifting the encounter from the ‘personal’ to the ‘impersonal’ space. Not acknowledging the history of these spaces is at odds with many patients’ experiences; by bringing historical experiences into context, we may be better placed to create spaces that strengthen relationships between patients and clinicians and not just clinical efficiency This work complements ongoing current research into relationships in primary care, particularly in the evolving new world of remote consulting and provides a novel view.  By utilising photographs, this work will provoke reflection as to how space and environment influence the clinical encounter and relationship between patients and clinicians. Whilst this piece uses archival images, future work could include engagement with the public to sharing photographs and memories of space and relationships within primary care.