The Pearly Gates

I was pleased by the interest shown in my last posting about being a doctor. Since writing it I have thought some more about the subject in the light of the comments I received. You may have noticed that my position changed while writing the post, since I started off by denying that being a doctor is part who I am and ended by hinting that perhaps it is. As I said, I was loath to dismiss my perceptive friend's opinion.

My change of heart was partly due to an improvement in my general condition. Although I have not been significantly depressed for some time I was still finding general practice hard work until very recently. Surgeries continued to be long and draining, leaving me little time or energy to reflect, plan for the future and be pro-active (as they say). As a result my job was a burden and wearisome to me. Small wonder that I wanted to cut the Gordian knot and leave it all behind. However my recent short break working on an entirely different project, challenging but rewarding and (in the end) highly successful, has made a difference. I now recognise that low self-esteem has been a major problem, and that I was letting consultations drag on because I felt I had nothing to give patients except my time. I am now taking a more active role in the consultation, keeping up the momentum while still listening to the patient, and as a result do not run as late. At the end of a surgery I feel less tired and have more time for what I have to do next. Generally I feel more in control and can contemplate staying in the job for some time to come. Last night I told my wife that I had been reading an article on gout. She asked why, saying “you'll be retiring soon, anyway”. For the first time in ages, early retirement sounded like a slightly odd idea rather than a blessed relief. I'm not saying that this improvement will last, but I will keep working at it because the benefits are so great.

On reflection, I think that being a doctor does become a significant part of many doctors' identity, including my own. There are rites of passage involved in becoming a doctor such as cutting up a dead body. There is a long period of demanding training. The status of doctor is sanctioned by society, giving rights and privileges. But the main quality of being a doctor is committing yourself to the care of your patients, devoting your time, energy and skills to their wellbeing, and sometimes putting their needs before your own. This is a significant commitment which, like matrimony, is not to be enterprised nor taken in hand unadvisedly lightly or wantonly. In a sense you are married to your patients (even the annoying ones) and cannot easily give them up. Of course doctors may change their jobs and gain a new set of patients, but the sense of commitment to serve the ill remains.

For me the turning point was when I was a medical SHO and first started to take responsibility for decisions about patients. I had a great deal of power over what happened to them, and they trusted me to use all my skills for their benefit. It was a humbling but subtly intoxicating relationship, and still is. When you have been in that position for a few years it does indeed become part of you.

Not all doctors would feel the same way about this, but I think that the more empathic ones would agree. General practice does not have a monopoly on empathic doctors but many GPs are good at empathy, otherwise why would they go into that branch of medicine? Whether in general practice or in hospital, I think that it is the empathic doctors who are most appreciated by patients. You may need the skills of a clever doctor at times but above all you want a kind doctor. The best doctors are both. Empathic skills can be taught, but they come easier to some than others and it is in that sense that doctors are “born, not made”.

So, starting with good intentions and some natural empathy, the neophyte doctor passes through the rites of medical training and then finds herself in a lifelong commitment to serve her patients, which she carries out at some personal cost for many years. This is a true vocation, which must surely change the person who follows it to some degree.

I find the GMC's attitude to be less than generous. In their publications they describe being a doctor as a privilege which is in their gift, rather than something earned through years of training, work, devotion and sacrifice. And they will no longer allow retired doctors who have served their patients for nearly forty years to remain on the medical register without paying their fees, which are rising steeply. I suppose that is what happens when control passes from doctors to bureaucrats and politicians. It is part of the spirit of the age, which knows the price of everything and the value of nothing. If the doctors of the future are less inclined to go the extra mile for their patients then those patients will have got the medical service they deserve.

I can see that I am opening myself to further charges of self-satisfaction. So be it.

Finally, I note that no-one asked to hear my Pearly Gates joke. Probably because you have all heard it many times before. But I press on regardless. It is a busy day at the Pearly Gates and people are jostling in the queue. Important politicians and businessmen try to argue that they should be let through first, but St Peter sends them all to the back of the queue. Just then a nonchalant figure in a white coat with a stethoscope draped around his neck ambles past the queue and is let in by St Peter without a word. Someone is brave enough to ask “how come you let that doctor jump the queue but made all those important people go to the back?” “Oh he's not a doctor” says St Peter, “it's God. He just likes playing doctor”.