Emma Ladds is an academic GP partner in West Oxfordshire, currently doing a part-time DPhil about the GP–Patient relationship in modern general practice. She is on Twitter: @LaddsEmma
‘Were you Dad’s doctor?’
A hand touched my shoulder and I turned, choking slightly on a mouthful of sausage roll.
I nodded mutely and the man in front of me smiled. ‘I’m so glad we got to speak to you,’ he said. ‘Thank you. We just wanted to say thank you. Thank you for coming and for everything you did for Dad.’
I don’t know why I went to the funeral. It was the first one I’d been to for a patient.
We don’t talk much about grief as doctors … Not our grief … Perhaps we need to be more honest in acknowledging ours.
Perhaps it was Roy’s character, his larger-than-life attitude and the way he could turn the saddest thing into a terrible joke. Perhaps it was in recognition of the laughs we enjoyed about his hospital letters clogging my inbox or our shared black jokes about his illness as it progressed. Perhaps it was his promise to bring me a stick of rock from his seaside holiday — the last one he would take, 2 weeks before he died. Perhaps it was to say sorry. Sorry I couldn’t relieve his pain. Sorry I couldn’t ease his suffering. Sorry I couldn’t give him more time with his family.
Perhaps it was simply to say goodbye.
We don’t talk much about grief as doctors. Not our grief. We talk about death and dying. We talk about patients entering a ‘terminal decline’, ‘palliating death’, ‘a good death’. We talk about ‘anticipatory medicines’ and ‘fast-track funding’. We try and support the families through their bereavement. We think about their grief.
Perhaps we need to be more honest in acknowledging ours.
We are offered glimpses into the most intimate parts of someone’s life as well as sharing their mundane moments.
Although they come and go and wax and wane, some GPs still manage to form long-term relationships with their patients. We are offered glimpses into the most intimate parts of someone’s life as well as sharing their mundane moments. We are offered a spectrum of emotions — joy, guilt, shame, remorse, fear, angst, love — often in the same consultation. Those of us in this privileged position know how lucky we are. There is something awe-inspiring about overhearing a mother whisper to her child, ‘that’s our doctor’, carrying, as it does, overtones of responsibility, duty, candour, and care.
However the realist in me knows this portrait is becoming an idealistic trope. Relational continuity is plummeting. The augmentation of the GP workforce with additional roles and decline in personal lists has made it increasingly difficult for GPs and patients to form such intersubjective relationships. ‘What we have is rare,’ a patient told me this week. ‘I feel very lucky. I don’t have anywhere else to contain …’ she gestured, indicating the weight of her emotions, ‘this’. A momentary pause. ‘Oh and I need some more Gaviscon please.’ We collapsed in laughter.
It’s a funny thing being a GP. You are tasked with becoming a master of integration. Lives are seen in snapshots. Snapshots in time, in place, and perspective. Sometimes the images slot neatly together and the whole story emerges coherently. Or sometimes as one picture falls into place another drops away, Rubik’s-cube style, and the narrative becomes more obscure. Our job is to piece the deconstructed mass together to find clarity – for us and the patient. For policymakers, charged with quantifying outcomes, it is a challenging target, best ignored. However, for those of us in the consultation room, that laughter has an important, eloquent, and unquantifiable meaning.
Such moments are endlessly humbling. The power — and pain — of simply bearing witness, often helpless — is underrated. Except by those of us doing it.
How does one act as ‘gatekeeper’, ‘safeguarder’, ‘integrator’, ‘electronic data manager’, in the absence of relationships …
Much emphasis has been placed in recent years on access. How easy do you find it to contact this GP practice by phone? Using their website? Using the NHS App? So begins the annual GP Patient Satisfaction Survey. Were you offered a choice of time or day? A choice of location? Do you get to speak to your preferred healthcare professional when you would like to? All underscore the transactional elements of healthcare, viewing it as a commodity.
There is no denying that appropriate, timely access is important. Seeing your doctor when you need to is important. However, our increasingly fragmented, transactional, quantifiable approach to health is failing across the whole healthcare system. Our reactionary approach addresses illness, rather than promoting health. It drives inefficiency. It also gives no role to relationships, despite the many relational aspects of our role. How does one act as ‘gatekeeper’, ‘safeguarder’, ‘integrator’, ‘electronic data manager’, in the absence of relationships — even ignoring our prime roles as diagnosticians and healers. By such accounts we are being set up to fail.
So why did I go to the funeral? Well it was a privilege to know Roy. He was a lovely man. It was a privilege to be asked. But above all because it is still such a privilege to be a family doctor, with all the opportunities for connection and meaning this implies and perhaps because as humans, engaged in the act of relationships, we too need to grieve and say goodbye. Our healthcare system needs to give us the space to acknowledge this.
*Written consent from Roy’s widow was obtained to share this narrative, and pseudonyms used to protect anonymity.
