Balint work and the flourishing practitioner

INTRODUCTION

Visiting a community clinic in China some years ago, we saw a room with seats placed beneath hooks in the ceiling. Seeking an explanation, the doctor reluctantly admitted that most people expected intravenous antibiotics for sore throats. She knew it was unnecessary, but if the clinic didn’t do it people would just go to the hospital.¹ The doctors in this clinic were not flourishing. The doctor’s unease illustrates the discomfort of practising primary care medicine in an unsympathetic context with the wrong tools, and without a culturally shared understanding that differentiates it from technical biomedicine.

Doctors in that clinic did not have the benefit of the long history, training, and esteem that generalist doctors have in the UK. But, in spite of these advantages, our UK discipline of general practice remains marginalised within the wider discipline of medicine. Whether in medical education, where GPs can still be seen as the doctors falling off the specialist ladder, or in everyday conversation, when the comment ‘So you’re just a GP?’ holds a sting with consequences for how we practise. For many GPs there is a lack of flourishing that goes beyond the current crisis of workforce, time, and money currently tearing at the substance of the NHS.

When Michael Balint started his groups for GPs in the 1950s, also a time when practices were poorly resourced and edging towards crisis, his idea of bringing a specialist service into the consulting room soon gave way to providing a meeting place for GPs and psychoanalysts to study the everyday work of general practice. By paying attention to unfolding, often difficult, encounters in the surgery Balint opened a window onto an additional approach to medicine that needed study.

Other commentators² have noted the challenge that Balint brought to the hegemony of biomedicine in …