Suhaib Anappadiyan, GP Trainee, Woodview Medical Centre, Northampton, UK.
Saleem Khitab, GP Trainee, Woodview Medical Centre, Northampton, UK.
PN Boteju, GP Trainer and GP Partner, GP Trainee, Woodview Medical Centre, Northampton, UK.
ES Ong, GP Trainer and GP Partner, GP Trainee, Woodview Medical Centre, Northampton, UK.
Prakash Katwal, Salaried GP, GP Trainee, Woodview Medical Centre, Northampton, UK
It was a Friday morning.
Nothing unusual about it.
The surgery was already busy. Phones ringing at reception. Blood results waiting. Prescription requests building up. Hospital letters needing action. And a waiting room full of people, each with their own worries, their own stories, their own lives.
Just another morning in general practice.
Then we had our protected tutorial.
Our Educational Supervisor wrote one word on the whiteboard.
Transcendence.
That was it.
No PowerPoint. No NICE guideline. No learning objectives. No prescribing update.
We spend years learning medicine. Anatomy, physiology, pharmacology, guidelines, risk scores, clinical reasoning. […] But sitting in that tutorial, another question came into my mind. What actually makes being a doctor meaningful?
Just one word.
And somehow, the room became quiet.
I had heard the word before. Of course I had. But I don’t think I had ever put that word and general practice together.
It stayed with me.
We spend years learning medicine. Anatomy, physiology, pharmacology, guidelines, risk scores, clinical reasoning. We learn how to recognise disease and how not to miss something serious.
Now we are entering another era. Artificial intelligence can recognise patterns, interpret information, and increasingly help us with clinical decisions.
But sitting in that tutorial, another question came into my mind.
What actually makes being a doctor meaningful?
Beyond the pyramid
Most of us have seen Maslow’s hierarchy of needs at some point. At the top of the familiar pyramid sits self-actualisation — becoming what we are capable of becoming.
But Maslow’s thinking did not stop there.
Later in his life, he wrote about something beyond self-actualisation: self-transcendence — moving beyond ourselves towards meaning, service, and something greater than the individual self.¹
When I heard this, I started thinking about general practice differently.
Because every day, people walk through our doors carrying far more than symptoms.
Someone comes with headaches.
But behind the headache may be a marriage falling apart.
Someone comes with poor sleep.
Behind the insomnia may be loneliness.
Someone comes again with chest pain, even after reassuring investigations.
Perhaps underneath it all is fear.
We are trained to find the diagnosis. And rightly so.
But sometimes the diagnosis is only part of what the person sitting in front of us needs.
Later in his life, [Maslow] wrote about something beyond self-actualisation: self-transcendence — moving beyond ourselves towards meaning, service, and something greater than the individual self
Martin Buber wrote about two ways of relating to another person: I–It and I–Thou.²
Medicine needs the I–It. We have to analyse. We need numbers, examinations, investigations, diagnoses, and treatments.
But there is another human being sitting on the other side of the desk.
And sometimes they need the I–Thou.
They need to be seen.
Not as ‘the diabetic in room three’.
Not as ‘the frequent attender’.
Not as ‘the anxious patient again’.
Just as a person.
I think general practice gives us a rare opportunity to do this.
We meet people again and again.
We see the young mother who once brought in her newborn and, years later, comes worried about that child’s mental health. We know the man whose wife died last year. We remember the patient who received the cancer diagnosis. Sometimes we know three generations of the same family.
Continuity is clinically important, and research suggests that greater continuity of doctor–patient care is associated with better outcomes.⁴
But there is another part of continuity that is harder to measure.
Sometimes the therapeutic act is simply remembering
‘How have you been since your husband died?’
‘How is your daughter doing?’
‘Last time you were here, you were worried about your job. What happened?’
These are small sentences.
They don’t appear in guidelines.
But sometimes you can see the patient’s face change when you say them.
You remembered.
Viktor Frankl wrote extensively about our search for meaning and about looking beyond ourselves.³ Perhaps there is something here for us as doctors too.
We talk a lot about burnout in medicine. Workload matters enormously. The endless tasks, administrative pressures, and emotional weight of the job are real.
But I sometimes wonder whether there is another kind of tiredness.
The tiredness that comes when medicine slowly becomes only a list of jobs to finish.
Next patient.
Next blood result.
Next prescription.
Next letter.
Next problem.
We can become very efficient and still quietly lose contact with the reason we wanted to become doctors in the first place.
Perhaps self-transcendence does not require anything extraordinary.
Perhaps it happens in very ordinary consulting rooms.
Putting the keyboard aside for a moment.
Not interrupting.
Being curious instead of judging.
Allowing a few seconds of silence.
Remembering something that mattered to the patient 6 months ago.
People allow us into moments of their lives that they may share with very few others — illness, birth, ageing, fear, grief, recovery, and sometimes death.
Seeing the fear underneath the symptom.
Sometimes we cannot cure.
Sometimes we cannot fix the situation.
Sometimes there is no clever diagnosis or perfect treatment.
But we can still be present.
And perhaps that is one of the hidden privileges of general practice.
People allow us into moments of their lives that they may share with very few others — illness, birth, ageing, fear, grief, recovery, and sometimes death.
We are invited to witness all of it.
That Friday tutorial lasted only 29 minutes.
Then the whiteboard was wiped.
The phones were still ringing.
The blood results were still waiting.
The next patient was still outside.
Nothing about the surgery had changed.
But perhaps something about the way I saw it had.
Maybe transcendence was never somewhere above us?
Maybe it was here all along?
Behind an ordinary consulting-room door.
Sitting in the chair opposite us.
Waiting to be seen.
And perhaps, beneath many of our patients’ words, there is a quieter question:
‘Doctor … will you truly see me?’
References
1. Koltko-Rivera ME. Rediscovering the later version of Maslow’s hierarchy of needs: self-transcendence and opportunities for theory, research, and unification. Rev Gen Psychol 2006; 10(4): 302–317.
2. Buber M. I and thou. Trans. W Kaufmann. New York: Touchstone, 1996.
3. Frankl VE. Man’s search for meaning. Boston: Beacon Press, 2006.
4. Pereira Gray DJ, Sidaway-Lee K, White E, et al. Continuity of care with doctors — a matter of life and death? A systematic review of continuity of care and mortality. BMJ Open 2018; 8: e021161.
Featured photo by – Kenny on Unsplash.
