In the introduction to his recently-released compilation of assorted pieces of general practice journalism,1 Roger Neighbour muses on various motivations for writing. An allusion that resonates with me is of writing as an activity to divert our attention from the intrinsic dissatisfaction and ultimate incomprehensibility of the human predicament. In this sense, medicine can serve a similar purpose to writing: ‘Having doctors is one way of making ourselves feel better.’, writes Neighbour, ‘Being a doctor is another.’ I agree that all these activities (writing, being a patient and being a doctor) can go some way towards alleviating life's stresses, injustices and perplexities.
Not long ago I spent 2 months as a GP registrar at a practice in Dunedin, New Zealand. My trainer during that time was a hugely inspirational doctor called Tony Fitchett. Tony's first son, Marcus, also qualified in medicine but was tragically killed at the age of 26 years, together with his girlfriend, in an accident in British Columbia in 1996. When news of this reached home, Tony says that ‘all life's framework fell apart.’ Writing — in Tony's case, poetry — subsequently became a powerful tool for the reconstruction of his world. He wrote a series of intensely personal poems, describing his sense of loss, the grieving process, and the gradual ensuing efforts to unravel some sense of comprehensibility in life.2
During my time in Dunedin, I was privileged to live with Tony and his wife Bron at their home, and to receive the gift of friendship with two very special people who have experienced the utter devastation of what matters most to them. I have benefited too from Tony's lifetime experience as a GP, and I have heard from his patients how important his friendship has been to them. Tony's patients all know about the tragedy that has affected him, and as he cares for them, they continue to support him through their kind words and gestures. I keep my copy of Tony's poems as a treasured reminder of my time in New Zealand, and of a person who I admire greatly, as a role-model and a friend.
If the best form of writing represents an author's uniquely personal quest for understanding and clarification of thought, then any effect that it has on its readers is purely incidental. On a personal note, one such side-effect of Roger Neighbour's writing was my choice to pursue a career in general practice. It was the discovery of his books, The Inner Apprentice and The Inner Consultation, near the start of my clinical years at medical school, that ignited the passion for a holistic and generalist approach to living life that has motivated me ever since.
Articulating my motivation was important recently, during an interview for the full-time GP registrar post, which will comprise the final year of my experimental vocational training scheme. During the interview, I was also asked about what expectations I had of my trainer's role. So far, I think one of the most valuable contributions from my trainer has been to provide a sense of mentorship that allows me, in confidence, to express any of my concerns, worries or problems without fear of being judged or negatively criticised (even if my conceptualisation of those troubles is often only half-formed, and provisional!). The opportunity that this affords to speak frankly and to feel understood is an immense source of comfort. Another highly valued aspect of my trainer's role is in setting an example to aspire to, by consistently striving for the highest achievable standards of care.
I am coming to realise, however, that the most vital factor in my education is my own attitude to it all, not that of anyone else. In order to get the most out of medicine (and also of life in general), the best attitude seems to be one of ‘interestedness’ and curiosity for everything. But it's easier said than done! The process of becoming really interested in something is, in my experience, frequently inspired by the genuine enthusiasm of someone else about something that fits suitably within our own overall system of values. It's sometimes hard to become interested in something just because it is said to be interesting, even when it is recognised to be important. A bit of magic is required to light the flame that makes ordinary aspects of the world become extraordinary, and this is what role-models, and all the best GP trainers, are there to provide.
- © British Journal of General Practice, 2005.