At the time this is written, I am reflecting on a lecture that I have given to students on the subject of wisdom in medicine (the course- authors like virtue theory). My predecessor at BJGP Life is arguably a much better authority — David Misselbrook has in the past summarised practical wisdom for GPs in this Journal with tips for practice and appraisal reflection.1 Wisdom is not the same thing as knowledge or even intelligence.2 I would like to think, however, that some wisdom can be communicated through reading. GPs need to practice wisely in order to survive and thrive. This edition sees wisdom as a subtext for Life and Times
Wisdom is often enhanced through reflection on a concrete experience, asking the questions, ‘So what?’ and, ‘What now?’3
Distinguishing conditions that would benefit from diagnosis and earlier intervention from those that are temporary, self-limiting, and prone to harmful medicalisation, remains challenging. Margaret McCartney and colleagues argue that a framework to consider some diagnoses as ‘delicate’ will aid in the identification and analysis of influences surrounding them.4 The wisdom here lies in recognising that care must be thoughtful, and aiming at benefit to the patient rather than a ‘one size fits all’ transaction.
Peter Young and Rebecca te Water Naudé suggest that GPs may have a duty to discuss the pros and cons for patients who contemplate crowdfunding for cancer treatment, and outline some of the issues. Crowdfunding is problematic in many ways. It may be harmful and may not always promote fairness.5
Agalya Ramanathan and colleagues reflect on trying to learn general practice in a manner that will allow them to pass a licensing examination — the MRCGP Recorded Consultation Assessment. They suggest that the assessment does not reflect the actualities of their work. Unsurprisingly they find that preparation materials also align with the examination rather than their experiences. They argue that there are consequences for the wellbeing of trainees as well as examination performance.6 In the Yonder column, Ahmed Rashid draws wisdom from all around us, showcasing work on why patients stop their psychiatric medications, post-migration stressors, hesitancy in asking suicide prevention questions, and role modelling on the choice of medical career. He concludes by sharing advice for financial survival during our cost of living crisis in the UK.7 Wisdom here is not just about evidence- based knowledge but the factors that enable and disable our uses of that knowledge.
A RICH SEAM OF WISDOM
The arts and humanities often serve as foci for wise reflection. David Mummery uses music as a metaphor to relent on the role of the GP in the orchestra of health care.8 What does the music itself signify I wonder? Ben Hoban dreams a satire of mafiosi and HRT shortage.9 This issue’s reviews span literature, social history, and politics. Austin O’Carroll is persuaded by Reading To Stay Alive. Tolstoy, Hopkins and The Dilemma of Existence, that literature can engender a sense of deep empathy and compassion: ‘The traditional clinical teaching carves up patients’ experiences into discrete symptoms and signs ... disaggregating the patient’s story from the depth of emotional suffering inherent in their story. As dispassionate clinicians, we tend to remain in the shallows. [The book] also offers us physicians the means by which literature can help us explore our patients’ pain and offer them hope and an existential purpose’. 10
Hannah Milton reviews The Immortal Life of Henrietta Lacks, finding a rich seam of ethical questions and racial prejudice with which to challenge doctors and medical researchers.11 We also need to distinguish the signs and symptoms of what is wrong in society. One of the most influential books I read in lockdown was Isabel Hardman’s Why We Get The Wrong Politicians. Having read this book, the alien strangeness of our politics, our politicians, and our policies begins to make more sense. This is frustrating but also liberating and empowering.12 Better understanding implies better ability to be a moral agent rather than a passive recipient of others’ choices.
Some of the authors in this issue are wise and some are also brave. Reading can be a safe way to learn and acquire some wisdom. However, what we read must also be discussed, shared, challenged, and modified or reinterpreted in the light of experience and better arguments or it ceases to be wisdom.
- © British Journal of General Practice 2022
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