I sometimes get invited to run seminars on primary health care for other professions, particularly social workers and psychologists. People in these professions can have odd ideas of what primary health care is and does, and even odder stereotypes about GPs. One of the ways I tackle these stereotypes is to ask seminar members to get into pairs and tell each other about encounters with GPs. I ask them to exchange one story about a recent professional encounter, followed by one story about a personal encounter when they have visited a GP’s surgeries as a patient, carer or parent.
A striking contrast often emerges between the two sets of stories. Tales of professional encounters usually centre on the frustrations of trying to contact GPs during busy clinics, or the mutual incomprehension that can occur when trying to discuss a shared case or elicit some information from a GP. The personal stories, on the other hand, generally have quite a different tone. They speak of longstanding, trusting and even tender relationships with family doctors. They testify to people’s capacity to tolerate all the huge and conspicuous inadequacies of general practice in exchange for the things they value: a listening ear, a warm touch, some blunt advice, and the ability to display friendliness without an inappropriate claim to friendship. Inviting people to reflect on the contrast between their personal and professional encounters can then lead people to hold a subtler and less critical view of primary care.
Another exercise I use is even more fruitful. It is to ask people to share memories of the GPs they saw when they were children. Almost invariably, people recall their childhood family doctors with respect and fondness. However, this can be a very powerful exercise, so it is unfair to set this exercise without being prepared to reflect on one’s own recollections. And so I find myself casting my mind back to the three GPs of my own childhood and adolescence: Dr Newman, Dr Tanner, and Dr Dean.
Dr Newman was a refugee from Nazi Germany. We used to go into his consulting room from the waiting room when a red light came on, but afterwards we went out straight through the back door into his yard, so you never knew how much time he spent alone between patients. Sometimes he asked you how many people there still were in the waiting room. If you told him the number was large, he would groan. My mother came from Vienna – in the same era and for the same reason – so they spoke together in German. Dr Newman dispensed lots of practical advice, and once told my mother to go out and buy a fridge, which she did. He was famous in our family for always claiming to suffer from whatever ailment you came with. ‘Das hab ich auch!’ he would say: ‘I’ve got that too!’ The favourite family story about him told of the day my mother went to him with a foot complaint. He took off his shoes and socks, and then put his feet up on the desk to prove his claim. After that, we changed our doctor. As an adult, I can guess at the reasons why his relentless claims for sympathy for his own suffering became intolerable for my mother.
We moved to Dr Tanner. For some reason I am entirely unable to explain, I am quite certain she was a Roman Catholic. She was very well spoken, and there was an aura about her that she was ‘a cut above’ the area of London where we lived and she practised. (How can a child of two continental Jewish refugees have been so aware of English accents, religious denominations and class? Yet it seems I was.) She was frail-looking, tense and pale, and I connect that in my mind with her departure after only three or four years, although that connection may only be a fantasy. She was kind, and I felt safe with her.
She was replaced by Dr Dean, whose most striking feature to a nine-year-old boy was the prodigious quantity of hair growing from his ears. He was Indian, and my adult self deduces that he was a Sikh, although he did not wear a turban. One of the most magical things he used to do was to reach into the drawers of his desk for samples that visiting pharmaceutical reps had just left for him. He would then hand them over to my mother to try out on my eczema. As a result, I tried out hydrocortisone cream for the first time. Hence I was able to throw away the thick tar ointments that had befouled my bedclothes for years, and the bandages I had had to wear under my trousers at school. I loved the presence, smell and feel of Dr Dean: burly, squidgy and comforting all at the same time. The last time I saw him was in late adolescence for a medical before I went off to teach in Kenya for my gap year. I was convinced he was going to discover the extensive cancer I had been concealing for years. He didn’t, and so my trip went ahead. On my return from Africa, I went to a university doctor who told me my fears were ungrounded. I had been suffering all through my teens from swollen glands in my armpits and groin as the consequence of my eczema.
I have no idea if these three numinous figures influenced my eventual decision (halfway through university) to become a doctor and later to be a GP. But I recognise in these memories – and the memories evoked in my seminars – a truth that as doctors we often ignore or forget. The experience that most patients have of doctors is a sensual, affective and aesthetic one. Moral and cognitive judgements may sometimes displace their consciousness of this, but they cannot obliterate it. In all our professional encounters, the acuity that our patients had as children still persists.