Monday, 26 March 2007


This morning a middle-aged woman came to see me. She has relapsing-remitting multiple sclerosis and her condition is slowly deteriorating. She has not been able to work for a little while, and she came for a sick note. Until recently we might have issued the sick note after talking to her on the telephone, as physical examination was not required. But our practice policy is now that the patient must be seen in all cases where a sick note is issued. Her husband came with her, and took the opportunity to tell me about the problems they were both having. There was no specific advice or help I could offer that they were not already receiving. He just wanted to tell me. So I listened.

In his book “A Fortunate Man”, John Berger says of the GP John Sassall:
He does more than treat them when they are ill, he is the objective witness of their lives. They seldom refer to him as a witness. They only think of him when some practical circumstance brings them together. He is in no way a final arbiter. That is why I chose the rather humble word clerk: the clerk of their records.
Some may now assume that he has taken over the role of the parish priest or vicar. Yet this is not so. He is not the representative of an all-knowing, all-powerful being. He is their own representative. His records will never be offered to any higher judge. He keeps the records so that, from time to time, they can consult them themselves. The most frequent opening to a conversation with him, if it is not a professional consultation, are the words “Do you remember when...”

I think something like that was going on this morning. The patient's husband wanted recognition of the difficulties he was going through, not just from a fellow human being but from the “clerk of the records”: one of the doctors in the practice he and his wife have been attending for many years. No particular skill was required of me, except to recognise that listening was important at that moment. Anyone could have done it, provided of course that they had worked in this particular practice for a decade or so. I was pleased to realise that this is one way in which I am still performing some of the functions that Sassall did, despite no longer working out-of-hours and being endlessly distracted by biochemical minutiae and data collection.

And the Government think that general practice can be done by an ever changing roster of anonymous doctors, armed with computerised records.


The Angry Medic said...

I'm also considering General Practice as a career (despite the many voices persuading me not to) but it's precisely this aspect of it that appeals to me (and many other GP-wannabes). The closeness to the family unit and the patient is something you don't get in many other branches of medicine. The government seems intent on killing all this and wiping out any traces of the old family doctor. Such is socialised medicine to them.

Great start to the blog, Dr Brown! I look forward to reading your future posts. Don't have many other GP blogs on my blogroll, unfortunately. They always seem to have the most fascinating tales to tell.

Dr Andrew Brown said...

I'm pleased that you are interested in General Practice, and particularly pleased that the personal aspects of it appeal to you and your peers. Look out for stuff by Trisha Greenhalgh and Iona Heath (papers, not blogs!), who write far better than I can hope to do.

And many thanks for your kind comments. I am new to blogging, and your remarks are very encouraging. I will see if I can find a few more interesting tales to tell.