I’ll always remember consoling a couple who had recently lost their child to leukaemia. Less than 10 minutes later a lifelong smoker was telling me they were expecting their centenary birthday card from the Queen.
An individual working as a GP runs the risk of becoming an automaton. Evidence-based medicine and professional standardisation contribute to uniformity and, by definition, a reduction in diversity. It is both risky and strenuous to act outside of established clinical behaviours, and instead we acquiesce. The automaton GP is unable to deviate from the prescribed sequence of actions but can sleep easy at night without contemplating the true terror of clinical life. Nevertheless, it may only take one tragic clinical outcome to change a clinician and undermine their entire mode of practice. This brief moment of reflection is dangerous: we decide whether working in a familiar yet obscure world is more preferable than becoming a stranger in our own profession.
Of all professionals, it is perhaps the GP who most witnesses the full spectrum of human life. We are well poised to witness intergenerational medicine with all its banality and eccentricities. Despite our prestigious position, attempting to fathom the untimely death of a child using statistics or genetics is to debase the universe to a level where a human might understand it. In reality, there is no reconciliation but our appetite to find invisible patterns cannot be satiated.
Greek mythology tells us of Sisyphus, who is forever pushing a boulder up a hill only for it to roll back down again. This was his eternal punishment for evading death. Within health care this myth has become analogous with the endless task of helping patients. Existing interpretations reveal two major themes. First, the patient (the boulder), is considered a burden and, second, that healthcare professionals (Sisyphus) can reduce the burden through teamwork. I hope to propose an alternative interpretation, one that is based upon the absurdist philosophy of Albert Camus (1913–1960). The absurd refers to the constant conflict humans encounter when searching for meaning and order in a meaningless and chaotic universe. In this version, the task of healthcare provision is no longer tiresome or futile.
Feeling sentimental about the golden era of medicine when life was straightforward is a dangerous thing, especially when we know that it never existed. Yet many of us believe it. The use of the word nostalgia in absurdism describes our yearning for a unified clarity. GPs are rational individuals trying to make logical sense of the things presented to them. But the world is complex and we make artificial connections between events that are beyond human comprehension. Children inexplicably develop leukaemia. The universe of the prion is very different from that of the cow. Our nostalgia juxtaposed with the unreasonable silence of our universe is the substrate for absurdism.
It is interesting that Sisyphus himself tried to escape death, the very thing health care is designed to do. Perhaps there is a natural attraction for the GP to view themselves as a Sisyphean character. When we gaze upon our computer monitor to see the appointment slots laden with names we recognise, it is human to question whether the task is pointless. Hope with its simplicity becomes our thoughtless crutch. On the contrary, the absurd practitioner acknowledges the struggle and like a chronic illness recognises that there is no cure but constant friction. Life without hope or meaning becomes better. Accepting and revolting against our own obscurity gives life value.
Primary care coerces us to act with a concern for the future as if we can direct it, despite the facts highlighting the contradiction in our liberty. Freedom only arrives when we are released from being responsible for the future. Once the absurd is realised the illusion is shattered and instead we develop passion for life as it really is. We conclude that maximising life’s rich experiences regardless of how deplorable they may be is the only option. Both doctor and patient can live the adventure that is their life.
Managing uncertainty is perhaps the defining characteristic of general practice. At a time when doctors and patients seek simple solutions to increasingly complex problems, an absurdist approach to health care has never been more relevant. Camus said that ‘if the world were clear, art would not exist’, and I would suggest that if health was straightforward there would be no primary care. Each patient experience contributes a stroke to our masterpiece.
As GPs we need not imagine whether Sisyphus was happy; we need only ask ourselves.
- © British Journal of General Practice 2020
