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.”