My colleagues in A&E may have dramatic stories of life and death, but they’ll never know their patients as well as I know mine
Being a GP feels a little like being someone’s friend – without the awkward small talk or feigned interest in their love life. I’m granted 10–minute glimpses into someone’s everyday life – and their everyday problems, their hopes and their fears. Sometimes we’ve barely exchanged names before the air is heavy with emotion. I’m constantly reminded what a privilege that is.
When I worked in a hospital, I’d try to forge a connection with the person behind the hospital gown or the surname on a whiteboard. But they’d soon be churned back into the ether with just a discharge summary to remember me by. I’d spare a moment to wonder what became of them – only to look up and find a new patient had filled their bed.
I remember a GP, Dr Iona Heath, saying: “In general practice people stay, and the diseases come and go. In hospital the diseases stay, and the people come and go.” I can now see the truth in this.
I’m reminded of an evening I spent with hospital colleagues; the conversation resembled a story-swapping therapy group. The A&E registrar told of the tangled mass of metal and limbs extricated from a car crash; the paediatrician told of the twins she’d helped deliver and handed to the inconsolable newly widowed husband; our surgical colleague painted an all too vivid picture of the gangrenous appendix he’d plucked out and held aloft to imaginary rapturous applause, his trophy for flying solo in theatre for the first time.
Being a GP trainee isn’t glamorous. There isn’t much drama. The adrenaline-fuelled scrambles to crash calls are a distant memory. But I’ve recently finished my first six month job in primary care, and something’s changed. I’ve stopped saying: “I’m just a GP trainee”. It was a phrase that spilled out in the hospital as I tried to shake the feeling that I was an imposter.
Take just one snapshot of a typical surgery. A young boy sat trembling before me. With glassy, tormented eyes he painted his vision of hanging himself on the local heath. We stared at it together. After a lonely struggle to pry himself from the grips of drugs, I watched his journey from the cusp of losing everything to getting help. It was a start.
He was followed by the chief executive, who’d left her husband of 30 years after discovering his affair. She’d been too mortified to confess to anyone else her fear that, along with the heartache, he’d left her with a sexually transmitted infection. She cried with relief a week later when I told her he hadn’t.
She was swiftly replaced by an elderly lady asking for a prescription. As we waited for the printer to wake up, I asked about her husband with prostate cancer. The tears flowed. She was never alone, but was crippled by loneliness. We talked about some simple changes, and she checked in with me regularly. The light had come back on in her eyes when she hugged me at our most recent appointment.
And at the end, a home visit for a 90-year-old retired professor with Alzheimer’s. He looked up at me blankly as the paramedics closed the ambulance doors. They were taking him to the same hospital where, for decades, he’d once been on the board of directors.
I remember as a student being told that the word patient comes from the Latin “patiens”, meaning “to suffer”. In general practice, I’ve become aware of a subtle shift in my role from treating disease, to alleviating suffering. And, consequently, from ensuring health, to enabling wellbeing.
Over the last six months, I’ve witnessed the dents in this wellbeing that can lead a patient astray from their identity. And I’ve felt like a stop on their journey to restore it, or their quest to find a new one altogether. I find myself shifting shape to meet theirs: prescriber, diagnostician, counsellor, advocate, interpreter, confidant, detective, sounding board, navigator and friend.
I’ve been struck by the power of one tool in my medical repertoire that’s more effective than any intervention I’ve ever come across: just listening.
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