Do you know your marigolds from your muscari? Or your lupins from your lilies? Neither did I. But, like most of us, our unparalleled year of lockdowns nudged me into spending more time in the garden. Scratching around in the soil in a vain attempt to reinvigorate my wilting flowers, I realised quickly that I was utterly clueless. So, I got myself a book. I chanced upon Monty Don’s Down to Earth: Gardening Wisdom.1 He is as gifted a writer as he is gardener. I devoured chapter after chapter. Soaking up Monty’s pragmatic advice, I realised that a lot of his wisdom could be shared with general practice. Here is some of his sage advice.
‘IF IT WORKS, IT WORKS’
It is easy to get lost in the rules of gardening, but there are many ways of doing the same thing. No one garden is identical. If you have success with what you are doing, then keep doing it. Equally, we can become accustomed to disease-specific guidelines with the aim of standardising the care for all patients with a given condition. After all, regularisation in health care is a way to improve patient care, while keeping it affordable. However, ‘cookbook medicine’ may not be the correct recipe for all patients. Indeed:
‘It is more important to know what sort of person has a disease than to know what sort of disease a person has.’
(Hippocrates, a Greek physician widely known as the ‘father of medicine’. He lived from about 460 bce to 375 bce)
‘SOIL IS THE IMPORTANT THING’
Soil provides anchorage for roots and holds water and nutrients. It is our life support system. If you sow in rich compost, the plant will take care of itself. If plants are the people, then relationships are the soil. Cultivating a healthy team is enriching; the ecosystem of a successful practice is effective teamwork. Teamwork is what separates the good from the great. Striving towards an atmosphere where talent blossoms, people are seen, and voices are heard will create a happy environment. An energised, dynamic practice will weather even the worst of storms.
‘IF YOU DON’T HAVE FAILURE, YOU DON’T KNOW WHY THINGS ARE SUCCEEDING’
It has taken me at least 2 years to reach a point where my vegetable patch is producing edible food. Patience and perseverance have paid in kind with delicious produce this season. Gardening is not perfect, but the determination to learn from mistakes can lead to beautiful things. Although I have my sturdy gardening manuals to refer to, most of my gardening is learnt as I go along. General practice, like gardening, is an experiential process of constant learning. ‘Failure’ is not a word many like to invite into their vocabulary. But it is inevitable. By embracing failure and our own fallibility, we can become the doctors we yearn to be.
‘FIND WHAT YOU LOVE AND DO THAT’
Make your garden a sanctuary that is personal to you. Take inspiration from others but focus on a space that is like nowhere else. In our routine world, we all need a place to express ourselves. So too, the world of general practice is alive with opportunities to diversify and wander off the beaten track. We are, after all, the architects of our own future. For instance, the pursuit of a portfolio career can have a meaningful impact on both you and your practice. Following a passion gives purpose and protects against burnout; a change in setting can bring refreshing colour and break up the intensity of workload.
‘WHEN IN DOUBT, DO NOTHING’
Doing nothing can be very effective. In the garden, by and large, problems solve themselves. The same can often be said for general practice. When in doubt, being an observer and allowing the passage of time is often safest. Quiet observation is not the same as ‘nothing’. It is not mediocrity, but frequently a chance for reflection, curiosity, and to reframe a question. There are however lots of barriers to achieving a ‘less is more’ approach to medicine. Fear of taking this approach too far and ending up with ‘too little’ medicine is probably the most common apprehension. Yet, I am reminded of many a clinical scenario where not acting has been entirely reasonable. In a time of declining resources, maybe we should all take a leaf out of Monty’s book.
BEYOND THE PARALLELS
Looking beyond the parallels, there is something immensely grounding about working with the earth and weathering the seasons. Gardening is immersive. It slows you down and can be a humbling experience.
As wind and weeds alike conspire against perfection, you are reminded daily that ‘good enough is good enough’. It is better to aim for the overall health of the garden, rather than micromanaging little things. Battling nature is futile; you have to work with it. It is easy to get lost in the guidelines, but, like in general practice, there are always different ways of doing the same thing.
The more I garden, the less I know, but the more I seek to know.
- © British Journal of General Practice 2021
