Chapter 10 Moments of Change

The context of our study was the day-to-day world of general practice. Patients coming and going, bringing the widest imaginable variety of symptoms and troubles, pains and anxieties, difficulties in relationships and illnesses. It is a world of powerful feelings, some arising from expectations before even the first meeting, and others that develop between the doctor and patient over time. There is a mass of physical symptoms, some of which the doctor must relieve, others he must learn to leave alone, and yet others he must respond to, yet not cure, as though courageously failing on repeated occasions, without losing heart and rejecting the patient. There are illnesses that need the doctor’s attention, and others which protect their owners from something worse, that need the doctor’s understanding. It is a world where the doctor is frequently in the dark, getting glimpses of his or her patients from time to time, being careful not to find out too much, being content to find the right distance for the patient and the doctor; sometimes needing to take the initiative, at others needing to be more restrained, waiting patiently for the developing pattern of the doctor-patient relationship to emerge.

There is a steady flow of patients in and out, but the doctor is a relatively fixed figure. He or she is available in a more or less constant fashion, and frequently works in the same community for most of a professional lifetime. But of course the doctor’s own world is changing too. They have their own reactions to particular patients and particular problems. They have their own attitudes to illness, suffering, ageing and death, and their own strengths and limitations in human relationships just as their patients have. GPs who sit behind their desks hoping to make all their patients better will soon be exhausted and disillusioned. Doctors in general practice have to learn to live with their patients in a much more unchanging world than often both would wish. The frustration o