Wednesday, 9 April 2008

A following wind

My partner Elizabeth often tries to cheer me up. She came into my consulting room after I finished seeing my last patient this morning. “I was listening to you outside the door” she said, “you are a kind doctor”. On a good day with a following wind, maybe.

I don't really know what sort of doctor I am. I think I am trying to find out, and to decide what sort of doctor I want to be. It may seem a bit late to be doing that after more than twenty years in the job, but better late than never. And writing this blog is clearly part of the process. It is a bit nerve-wracking to be working out my salvation in public view, but you have been very kind to me so far. Although I have not stopped working during those twenty years I have been through a very low patch, and though I have now emerged on the other side I find myself insecure and uncertain, and not enjoying the job very much. For family reasons I have decided to continue for another two years (at least).

I am certainly an Indian and not a Chief. I am temperamentally unsuited to Leading Men (and Women) and I shall make no Great Discoveries. Brown's Disease remains mercifully unrecognised. I think I should like to be Quietly Appreciated. I want to be reasonably helpful, to do my best, and to be a “good enough” doctor. I want to take a kindly intelligent interest in my patients that will be appreciated by the more perceptive ones. I want to be an approachable figure of authority to those who don't like authority figures. I want to be supportive without encouraging dependence. I want to be unfazed by anger and gently immune to manipulation. I want to remain calm. I want to assess situations well, and understand and explain things clearly. I want people to suspect that I am a Christian without making it explicit. And I can do all of these things. Sometimes. On a good day with a following wind.

But I struggle to do it consistently. As I prepared to see my first patient this evening I looked at the note made by the nurse, whom he had just seen. He was a new patient and wanted to talk about his chronic disease and about his headaches. I hate headaches! GPs generally make a mess of diagnosing them, and despite doing a lot of reading on the subject I still find them difficult to sort out. Just briefly I had an overwhelming feeling that I couldn't carry on. I was unable to cope with the problems that this patient would bring to the consultation, and the problems of the rest of the patients booked in this evening, and the problems of all the patients who are going to consult me over the coming weeks and months and years. An endless stream of problems and misery brought for me to solve until I retire or drop dead, punctuated by brief periods of respite.

Fortunately the feeling didn't last long. I went to collect my patient and he was a friendly chap and we talked about his problems and things slotted more or less into place and it was business as usual.

Later I saw a teenage girl who has an unsettled background, recently lived in a hostel and is on Probation. I had previously seen her about a month ago and she came back with a recurrence of her symptoms. I couldn't work out exactly what was going on her mind (she's a teenage girl, for goodness sake!) but we seemed able to drop our preconceptions and talk openly about a few things. The really important thing was that she could see that this middle-class middle-aged bloke was being helpful and non-judgemental, and that I could see that she was basically a good kid.

All this is not complex. It is the simplest thing in the world. But it can also be the hardest. I remember the advice of my mentor when I was a junior hospital doctor, and as he was a devout Baptist I will recast it in the form of a prayer. “Lord, help me do the simple things well.”


Anonymous said...

From what I've read of your blog, you seem like a wonderful, caring and very competent doctor. Have faith in yourself! All the best, Emma.

Elaine said...

Emma has it. I think your greatest difficulty in the way of feeling good about yourself consistently is that you work to such high standards.

You have empathy with your patients and that can be wearing, but it is a large part of what makes you such a good GP.

Take care.

The Little Medic said...

It isn't for you to decide if you're a good doctor. All you can do is try your best (which it seems that you do, most of the time, if not always) The patients will then make their own mind up.

You can't exactly ask them explicitly what type of doctor you are but if they keep coming back to see you, then you must be doing something right!

Anonymous said...

Wow - what amazing writing. You are doing a considerable service to your profession in helping patients understand what it must be like to be a GP. When I have to see a doctor (in fear and trepidation of the authority figure, and increasingly frequently as I get older, and aways in fear that I may be wasting his time) I try to remind myself that however he may come across, inside he may be feeling the feelings you describe; and whatever he says it is probably with my best interests at heart, even if I find it hard to understand the logic.

I am surprised that your blog doesn't get more comments. It must be a bit frustrating taking the time and trouble to carefully describe your experience, have your posts read by dozens - hundreds - thousands of people - and get merely a handful of comments. Come on readers - can't we reward Dr Brown with a little more feedback and interaction?

Unknown said...

The desire to be quietly appreciated is, in my view, one of the most honourable aims. I'm sure it's one you've achieved and continue to achieve time and time again. That was a wonderfully moving post. Thank you.


Sara said...

An endless stream of problems and misery brought for me to solve until I retire or drop dead, punctuated by brief periods of respite.

Remember, they are not for you to solve. More for you to witness.

Anonymous said...

Ooooh! I enjoyed this post and the comments.

Very insightful stuff!

Doc Brown - you sound like a very normal, well-balanced, non-judgemental type of person to me.

I like sensitive types - in fact I recommend them having married one almost 30 years ago and I'm still learning from him :D

Jobbing Doctor said...


This is a lovely description of what our working life can be; the highs and the lows, the pressure and the pleasure. I wish I'd written it, and I'm linking it to my blog.

Anonymous said...

you are definitely quietly appreciated by your readers.
i know another gp very much like this - otherwise there would be a house move or a recruitment drive from your area to this.

Anonymous said...

Thanks chooky Brown.

Anonymous said...

I can't better some of the comments above, so I'll just say hang on in there (and try and enjoy) - you're doing great.

XE said...

I'll echo everyone else.

Dr Andrew Brown said...

Thank you everyone for your kind and supportive comments.

Just a few points.
1. Naturally I tend to write about the good aspects of my behaviour. Less admirable thoughts and actions are toned down or omitted. My patients may not think that I am as wonderful as I portray myself here.
2. I am writing this primarily for myself (and my children, if they care to read it one day). I have a poor memory, and I hope that when I am retired I shall be able to look back at these writings and remind myself of what life was like as a GP.
3. I do this in public because I think it may be of interest to others. Your kind comments are also very welcome and I would be dishonest if I didn't admit that they are part of the motivation for writing the blog. But I hope that I am not "fishing for compliments" excessively. What I write is how I see things, from my slightly depressive point of view.
4. As well as being supportive, your comments often raise fascinating ideas that I had not thought of - so I thank you all for them once again.

ELIT - not all GPs are like me, but I think a significant proportion are.

MSILF - an interesting idea. Certainly it is a mistake to think that we must provide a complete solution to every single problem the patient mentions. As a trainee I was told that it was the GPs job to "make an initial response" at least. Maybe I have taken that too much to heart?