Sunday, 27 May 2007


On this Pentecost Sunday I have been thinking about vocation. Writing this blog has been good for me because looking back I can see that at least some of what I do has been beneficial and appreciated by patients. I have also been heartened by the comments that have been made and particularly those by medical students, keen young men and women who are looking forward to a career in medicine. Contact with students is usually good for GPs because beginners can see the wonder of what for us has become routine.

But I don't get that warm rosy glow while I am working. I don't know how it is for others but I find general practice stressful and hard. On Monday mornings I am far from being full of confidence while looking forward to doing more good deeds. Instead I feel slightly anxious the whole time, the work is often stressful, it requires careful thought, frequent rapid adjustment from one clinical scenario to another, flexibility of approach with different people, intuition, understanding, being able to cope with uncertainty, and good communication. Deep emotions may be unearthed (in both patient and doctor). I am repeatedly torn between doing what is best for the patient and constraints of resources, including money. There is the constant threat of missing something serious, to be balanced against the imperative not to refer unnecessarily. Matters are complicated by the demands of guidelines and the need for data collection. All this has to be done under pressure of time and interruptions. You are lucky if you can finish all your consultations, visits, telephone calls, paperwork and still get home at a reasonable hour. And then you have to keep up to date with the spiralling increase of knowledge. General practice, like old age, is no place for sissies.

And what reward do we get? The money is pretty good but, though you might think it is justified by the long years of training and the difficulty and responsibility of the job, the Government are currently looking at ways of reducing it. From time to time we get thanks from our patients, in the form of comments cards letters or small gifts. It is easy to overlook and forget these in the hurly burly of the job. The camaraderie and support of colleagues and staff in the practice is worth a lot. Some GPs may earn the respect of their colleagues locally, but many of us are quite isolated in our small groups or working single handed. A few will rise to giddy heights in the BMA or RCGP, but fame (and gongs) will elude most of us. Our faces may be recognised locally, but this is more often a disadvantage than not. From time to time we have to endure criticism from the Government or the press or other ill-informed people. We are expected to be perfect and infallible. The threat of complaints and litigation hovers over us like a sword of Damocles, and the GMC is always on hand to remind us that they will remove the great privilege of being a doctor should we deviate from the path of righteousness.

For me the game is just about worth the candle. I certainly don't feel the Holy Spirit breathing down the back of my neck and inspiring me. It is something that I have to do (with a wife children and mortgage to support) and though I don't have a strong sense of vocation I feel that since God or chance has put me here then I ought to get on with things. My ambition is not wealth or fame, but to do more good than harm. As George Eliot wrote in Middlemarch:
For the growing good of the world is partly dependent on unhistoric acts; and that things are not so ill with you and me as they might have been, is half owing to the number who lived faithfully a hidden life, and rest in unvisited tombs.
I am however looking at early retirement. I am in no hurry to reach my tomb and you can expect only so much from one man, be he ever so fortunate.


A. said...

I suspect your feelings are ones shared by many. I doubt whether anyone in any field can keep the "rosy glow" indefinitely. Or if they do, they are most fortunate people. When I look back I have a tendency to think that if only I could have stayed in such and such a place (trailing spouse status having prevailed), I would have had the perfect job. If I'm honest I know that it's only because there wasn't time for the freshness and enthusiam to wear off, and I'm probably looking back with rose-tinted glasses anyway.

Don't look too soon for the early retirement - it can be quite a shock to the system unless you can achieve it gradually.

Dr Andrew Brown said...

Thanks, A.I know what you mean. It's a bit like a relationship, isn't it. You have to work hard to convert the initial rosy glow into a strong relationship that can stand the course of time. On that basis I ought long ago to have developed an adult appreciation of the pros and cons of the job, and made a firm commitment to it. Or got divorced!

These postings are really me thinking out loud about the problem. I am rebuilding my faith and hope in the job after an extremely ropey patch. By no means all GPs will be experiencing these problems. Unfortunately, some will have them to a much greater degree. I am simply being honest about how it is for me.

Anonymous said...

It's difficult to tell when a job (or profession) evolves into a vocation - when it becomes what you are as well as what you do.
I didn't appreciate that my profession was really my vocation until after I retired. I second A.'s cautionary note.

The Shrink said...

I found life in GP land to be precisely as you described, which didn't suit me so I jumped ship. The medicine and patients is largely the same (same headaches, same tired all the time, same struggling to cope with stuff) but the reduced pressures and fantastic rich team work in hospital practice are (for me) much better.

Would I retire if I won the lottery? No, in my heart of hearts I really know I wouldn't. At the moment I really do like doing what I do.

But then, through mass on Sunday, I did find myself praying for both patients and also staff, so it's not all rosy!

Dr Andrew Brown said...

Janeway: I love your definition of vocation ("what you are, not what you do"). I shall "think on", as they say in Yorkshire. You and A. are prompting me to wonder whether when I retire I shall be singing "Halleluia" or "don't it always seem to go that you don't know what you've got 'til it's gone".

Shrink: I don't know that hospital life would have suited me, but you paint an attractive portrait all the same. :-)

tielserrath said...

I think this is a personality thing, and you have to either make your peace with it or get out. I too find GP stressful and hard. I am continuously aware that any mistake, no matter how minor, could crucify me. I know that the longer I stay in this job, the more likely it is to happen. A friend of mine had a recognised complication while performing a lifesaving procedure - the patient survived, and successfully sued him. That day I lost all faith both in human nature and in the legal profession, and have never regained it.

And yet...I can do a surgery, concentrating absolutely on each person who comes to see me, in that slightly magical space where you're using all your professional knowledge, all your empathy, all your experience of human behaviour and body language, and people seem to leave feeling that something has been achieved.

But it's that constant lurking fear of the day the letter arrives...I can't be the only doctor who has to fight not to throw up every time I see an envelope with GMC on it lying on the mat. And so far (15 years) I've never had a complaint against me...but it doesn't help.

Dr Andrew Brown said...

Tielserrath: Thank you for your insights. You sound very much like I was just a short while ago. The things you say still ring true, but I do not feel them as strongly. I have ceased worrying about whether there is a letter from the GMC in the post.
As you say, you have to make your peace with our peculiar situation. One thing I have tried to do is avoid "catastrophic" thinking. I am not a selfless hero who may at any moment be irrevocably converted into an incompetent bungler by a single mistake. I'm just a fortunate man. :-)