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.