Andrew Papanikitas is Deputy Editor of the BJGP. He is on X: @gentlemedic.
Let me tell you about the ‘Invisible Man’ sketch. Enacted live on stage by comedians Rowan Atkinson and Angus Deayton in 1992, the sketch is a memorable mime performance.1 Deayton’s disembodied voice provides a first-person commentary from the invisible man as he torments Atkinson’s hapless train passenger. Atkinson accordingly moves as though being pushed and pulled, tickled, and even kicked by his invisible assailant. As a teenager, I found it funny. Would it be funny without the explanatory voice though? Is it as funny in hindsight? When discussing empathy and the seemingly unreasonable patient at a communication skills workshop, I was recently reminded of the sketch. I wondered whether we can see a person’s reasons and influences, and their impacts on thinking and behaviour. A noticing mentality often requires that we take our foot off the proverbial accelerator and see the world, rather than just the immediate mandated task. As 20th-century poet William Henry Davies accuses us, who work in 21st century health care, ‘What is this life if, full of care, we have no time to stand and stare.’ 2
Noticing
So we need not only time to notice but also permission to look up from the computer keyboard. Janani Lambotharan gives a medical student’s perspective on the art of noticing as an essential skill in medicine, modelled by the GP she observed.3 It is a skill that requires that we are not overwhelmed by our mounting pile of tasks. A wealth of research supports the need to safeguard empathy and foster communication skills in medical training,4 a phenomenon Lambotharan reflects on in herself. Rebecca Quinn uses a poem about narrative to challenge us: are we paying attention to narrative and meaning? Ideas, concerns, and expectations cut no ICE; they are a starting point.5 Noticing enriches what we do and how we are.
Seeing and understanding
Marianne McCallum et al argue that the communities we live in and our life encounters influence our decisions and actions. Failing to consider the diverse experiences of those facing socioeconomic disadvantage or marginalisation leads to services that align with central policy rather than unmet needs. They also argue that we must recognise the work done by an array of practitioners in the deep end of primary health care. A failure to recognise need and the services striving to meet the need will result in deeply flawed clinical commissioning decisions that abandon both.6
We must also recognise and understand uncertainty. Richard Lehman reviews The Art of Uncertainty: How to Navigate Chance, Ignorance, Risk and Luck by David Spiegelhalter. He reflects, ‘Can we be taught how to cope with so much miserable uncertainty throughout our professional lives?’ 7 To fail to grasp uncertainty is to lose grasp on reality. This serves both patient and practitioner poorly. We go from uncertainty of facts to ethical complexity as Ben Hoban unpicks some of the irresolute tensions between sincere ethical and epistemic perspectives over medical assistance in dying.8 This is helpful at a time when the UK Government is considering a change in the law, and many clinicians are considering the implications for ethical and conscientious practice.9
Alex Burrell brings a selection of published wisdom to extend our understanding. This month we consider the impact of workload, ethics of lateness, GP registrar professional identity, as well as sleep apnoea and dementia.10 We also have direct shared experience from a different kind of yonder. In October and November 2024, Brian Lambert spent 6 weeks volunteering as a ‘medic’ at the Mavrovouni refugee camp on Lesvos, working for the Dutch charity the Boat Refugee Foundation.11
Showing and telling
Reviewing What Do I Say Next? Everyday Mental Health Conversations in Primary Care: A Practical Guide by Sophie Jadwiga Ball and Liz Moulton, Hannah Milton reflects on how many of her consultations involve mental health, and how it is useful to periodically refresh (even) clinical communication skills.12
Luke Sayers argues that we must re-engage with the public at the clinical interface and not let algorithms and tasks hijack the consultation. We must also engage with the public more broadly so that they can understand the triumphs and tribulations of practice. We must win the crowd back.13 Notice again, the primacy of the narrative and meaningfulness beyond the sum value of a series of tasks.
The articles this issue invite us to take the time to stand and stare, to see what is going on around us, to learn from it, and to be better.
References
1. Scraps from the Loft. Rowan Atkinson Live (1992) – transcript. 2018. https://scrapsfromtheloft.com/comedy/rowan-atkinson-live-1992-transcript (accessed 7 Feb 2025).
2. Davies WH. Common Joys and Other Poems. London: Faber and Faber, 1941.
3. Lambotharan J. The age of noticing: a lesson from general practice. Br J Gen Pract 2025; DOI: https://doi.org/10.3399/bjgp25X740889.
4. Keshtkar L, Ward A, Winter R, et al. Does empathy decline in the clinical phase of medical education? A study of students at Leicester medical school. PEC Innov 2024; 5: 100316.
5. Quinn R. Poem: Narrative Medicine. Br J Gen Pract 2025; DOI: https://doi.org/10.3399/bjgp25X740949.
6. Dickson N, McBride L, Mason C, et al. Meaningful community engagement: a Deep End perspective. Br J Gen Pract 2025; DOI: https://doi.org/10.3399/bjgp25X740913.
7. Lehman R. Books: The Art of Uncertainty: How to Navigate Chance, Ignorance, Risk and Luck. Br J Gen Pract 2025; DOI: https://doi.org/10.3399/bjgp25X740937.
8. Hoban B. Irresistible and immovable values. Br J Gen Pract 2025; DOI: https://doi.org/10.3399/bjgp25X740877.
9. Lawson E, Papanikitas A. GPs and assisted dying. Br J Gen Pract 2024; DOI: https://doi.org/10.3399/bjgp25X740409.
10. Burrell A. Yonder: Impact of workload, sleep apnoea and dementia, ethics of lateness, and registrar professional identity. Br J Gen Pract 2025; DOI: https://doi.org/10.3399/bjgp25X740961.
11. Lambert B. Working in a refugee camp on Lesvos. Br J Gen Pract 2025; DOI: https://doi.org/10.3399/bjgp25X740901.
12. Milton H. Books: What Do I Say Next? Everyday Mental Health Conversations in Primary Care: A Practical Guide. Br J Gen Pract 2025; DOI: https://doi.org/10.3399/bjgp25X740925.
13. Sayers L. Win the crowd. Br J Gen Pract 2025; DOI: https://doi.org/10.3399/bjgp25X740973.
Featured photo by Simon Wilkes on Unsplash.
