I missed out on flares, twice. First time I was too young, second too old. Even so, at various points in between I remember feeling the world was my oyster, waiting and ready for me to shuck and suck. As arrogantly confident as I might have felt at those times, though, my family tell me I was never hip. I might have felt cool, but it seems my feeling was never visible to others.
Of course, those days are long gone. My children wouldn’t tolerate attempts to look trendy now: it’s not how parents should behave, apparently. Anyway, I am more comfortable simply playing to type these days. Tweed jackets are comfortable after all. And, like me, they’ve stood the test of time.
Nassim Taleb calls it the Lindy effect.1 His reasons do not really matter here but the heuristic does: the chances of something surviving into the future are generally greater in proportion to how much of the past it has already survived. Notwithstanding the wry jokes of teenagers, my tweed jackets have a better prospect for the future than Primary Care Networks (about which those teenagers have no knowledge, never mind jokes).
There is an inherent fragility in the world. In some senses we know this through articles and films about such matters as deforestation, depletion of the ozone layer, global warming, and the loss of countless species. But ordinarily we are less likely to be conscious of it as we go about the routine of our lives. I mean to say that I tend not to think about the many things that might go wrong as I drive to work or negotiate my day. Of course not: that would be emotionally destructive. Nonetheless, my capacity for surprise has reduced over the years.
Luck plays a part in all our lives, more than we care to admit. There might be a few medics who make it this far without mishaps along the way, but I doubt it. Life is hard. It is my privilege as a GP to listen into my patients’ lives and find out in quite how many ways it can trip us up. And the more I experience, directly and vicariously, the less I will be surprised by what the next person tells me. Or by what happens to me.
And this is not just about the personal events that shape our lives: family crises, accidents and mishaps, chance meetings, arguments and fallings out, triumphs as well as disasters. No, it is also about the wider context within which we live and how that changes: politics and policy shifts, reforms and reorganisations, rebranding and re-banding. Surviving all of these makes me more resilient, less liable to be caught out by what follows next.
So, still to be at work is a triumph of sorts. I and my jackets have stood the test of time. By the Lindy effect that means I should be good for another 30 years, having already got that amount under my belt. My jackets should last longer still. Why though would I want to keep wearing them for even half that time?
So here is the problem for general practice: that those with the longest organisational memory, with the deepest capacity to face what is new and not be surprised, with the greatest potential for resilience, are those with the least need to remain.
The Lindy effect would suggest general practice does have a good chance of surviving, having already done so for around 200 years.2 But it might help if someone finds a way of persuading those with a choice to stay.
- © British Journal of General Practice 2019
