There is an ancient curse, 'may you live in interesting times'. For the latter half of the 20th century it seems that general practice has been its victim. In most countries general practice has gone through multiple re-organisations, profound lows and some major highs. Eventually, governments that have to pay for the delivery of medical care, come round to support for general practice. This is not out of altruism, but a recognition that general practice provides care, which is extremely cost-effective.

The therapeutics revolution following World War II has seen many infectious diseases virtually disappear and conditions which required surgery, such as peptic ulcer disease, as well as others such as hypertension, become almost exclusively treated in general practice.

In prescribing, the uptake of computerised prescription writing is bound to become universal. With it, will come much better decision support systems. These will cope with the uncertainties of general practice in a way that hard line evidence-based medicine currently does not.

General practitioners will work in teams, with other health professionals doing tasks that medical practitioners do not need to do. This already happens in many other countries such as Canada and Holland, and is a liberation rather than a threat. In rural practice, the only viable way to deal with the shortage of rural practitioners is to restructure the way in which medical care is delivered.

In Australia, one of the most highly sought after postgraduate trainings is now general practice. This century is beginning as the last century did, with the bulk of medical care being delivered in general practice.

John Marley

Professor, Department of General Practice, University of Adelaide, Royal Adelaide Hospital, Adelaide