Lifesavers

In last week's BMJ Professor Trish Greenhalgh was talking about the lives she has saved, ranging from a few heroic events as a junior hospital doctor to the more mundane disease detection and treatment during a career in general practice. Depending on how you define “saving a life”, my personal tally amounts to fewer than a dozen in my entire career - or several thousand. She was not boasting, but making the point that the frequently repetitive and unglamorous work of a GP is just as valuable as the dramatic deeds that go on in hospitals.

Professors are often self confident and ebullient folk, promoting their valuable insights to all who will listen. Doctors are not all like that, and you will not be surprised to hear that I do not recall ever saving anybody's life. I remember a few people dying in hospital despite my best efforts to save them. Although of course some people did get better, despite me being involved in their care. I might have echoed the words of Amboise Paré: I dressed the wound but God healed him.

I believe in the truth of the Jewish saying he who saves a life, saves the whole world and am profoundly moved by stories of brave and selfless people, such as those who saved Jewish children from the Nazis. Anything I might have done myself pales into insignificance.

But recently I did something which made me feel pleased with myself. A chap in his early sixties came along and complained of indigestion for just two weeks. I might have been tempted to give him a bit of antacid treatment and see how things went, but he was not someone who is always at the surgery with an “organ recital” of symptoms. So I packed him off for an endoscopy under the two-week wait scheme. And this detected an early stomach cancer, and he underwent pre-op chemotherapy and then had a partial gastrectomy, and the histology shows that there were no cancer cells in any of the lymph nodes sampled. He is cured!

Now I wasn't involved in any of the clever and difficult stuff at the hospital. I didn't do the endoscopy, devise and administer the chemotherapy regimen, anaesthetise him, operate on him, or nurse him during recovery. All I did was listen, think briefly and make a referral. And yet one could argue that my decision was the sine qua non which enabled all the other activity to be carried out in time.

Alternatively one could argue that the guidelines state clearly that new indigestion over the age of 55 should always be referred for endoscopy. What I did was no more than would be expected, and indeed had I failed to do so then I would have negligently have delayed the diagnosis until it was too late.

But I still feel good about it. Don't destroy my illusions, please.