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This book examines general medical practice and its psychological implications from the vantage point of the trained psychotherapist and analyst. It is the result of a long-term research project conducted in conjunction with a training course in psychotherapy for general practitioners at the Tavistock Clinic in England. The program, developed jointly by Enid and Michael Balint, consists of weekly seminars in which a group of eight to ten general practitioners discuss cases with one or two psychiatrists. There are no formal lectures but the seminars continue for an average of two to three years. Reports on their cases by the participants are unprepared and the reports as well as the ensuing discussions are recorded verbatim. In the book itself twenty-eight cases are reported by fifteen participating physicians and six of the doctors are represented by more than one case. This makes it possible to become acquainted with certain individual characteristics of these physicians. At the same time, it illustrates the author's observations on the importance of the distinct atmosphere created, quite unwittingly of course, by every physician in his office. Further, the case presentations serve to illustrate the problems encountered and the various therapeutic measures most frequently adopted in general practice.
In the first section, Diagnosis, Dr. Balint scrutinizes the relationship of physician and patient and seeks to establish some of the reasons for the strains and stresses which arise despite good will on both sides. It becomes readily apparent how physician and patient misunderstand each other at times and how they talk at cross purposes. In this connection medical training and medical tradition come under severe criticism by the author. The physician is not taught to 'listen' properly. Moreover, a hierarchy of diseases, with organic illness at the top and functional disorders at the bottom, is slowly established and quietly sanctioned by our teaching methods