Books: The Inner Physician: Why and How to Practise ‘Big Picture Medicine’

Being a doctor has never been an easy role. We are members of a profession. Within that, we are part of a specialty. Our specialty of general practice has had a rather mixed relationship with the wider profession of medicine. Our profession as a whole has had a rather mixed relationship with our host society, and to the organisations that society has set up that both provide for, and constrain, our work.

As individual doctors we are all trying to maintain our sense of coherence. Our specialty is trying to maintain its own sense of coherence, as is our profession, and indeed as is our society and its body politic. It’s not easy these days for us as doctors to think through our role, our tribes, and our society and reach a coherent view of our work and what it should consist of and what shouldn’t be there.

There’s no shortage of people telling us what our work should be, and offering us guidance about how we should do it. Doctors carry a huge burden of deontological imperatives, all of which apparently must be obeyed, but not all of which can possibly be obeyed at once. Our thoughts and actions as doctors are increasingly contested actions. Previous generations of doctors largely thought of their actions as supported actions. Currently we are feeling these contests sharply as individuals. As a profession we are experiencing an uncomfortable cognitive dissonance.

The Inner Physician speaks into this distress. It shows where the wisdom of the inner physician can be found, and it shows a way towards a richer, deeper, and more satisfying practice of medicine. Neighbour is always the great author of thinking things through from multiple positions — how does this look to a doctor? To your responder? To your observer? To a patient? To the family? These days he might usefully add the viewpoints of other specialists, the CCG, and a regulator to these considerations. He is actually celebrating the increasingly rare art of understanding all sides, and the proportions, of an argument.

He uses the metaphor of camera lenses and the lines of wide-angle, normal, and close-up views. He encourages us to work out when we need to zoom in on a problem and when we need to zoom out to a wider perspective. In medicine there’s a constant art to balancing these various viewpoints around a problem and knowing which to pay most attention to at any particular instant. We can all get stuck in one particular viewpoint and in this book he shows us that we can easily move between viewpoints and keep them in balance. Neighbour is very much an options-oriented writer — he wants us to have lots of choices available. There is a place for more focused and procedural work, but this should come into play once the context around it has been appreciated.

To achieve such understanding requires us to have integrated our own life experience with our professional knowledge. Neighbour is keen that we learn how to use our experience of life as part of our service to patients. Medicine is never just the technicalities of diagnosis and treatment. We cannot, and must not, be reduced to what Raymond Tallis memorably feared as ‘sessional functionaries robotically following guidelines’. It’s always an interaction between at least two individuals and at its best it’s a human and humane relationship, and the relationship is a key part of the treatment.

Neighbour wants us to be able to bring our whole experience of life to help our patients. He is arguing for a wholehearted engagement with patients. He shows how to achieve this by using our integrated experience and understanding alongside our wider, more objective professional knowledge. He argues we need to do this to practise medicine properly, and because we can’t check out of ourselves and into doctor mode. We always bring ourselves, as well as our profession, to every consultation.

Neighbour argues that we need to understand both ourselves and our patients at a deeper level. Too many of us are swept up, and may be lost, in the day-by-day activities of life and medicine. We may be doing the system’s business, not the patient’s. This book brings us back to doing the patient’s business.

This book is beautifully written. It will take you to new places for thought and action. It speaks to doctors and for the wholehearted practice of medicine, and for commitment to this. It will encourage doctors to find new resources within themselves that will help towards this.

At a time of stress within the profession this book is an optimistic step out into what we can truly become.

• © British Journal of General Practice 2017