Andrew Papanikitas is Deputy Editor of the BJGP.
The autumn haunts me in so many ways. There is the ‘back to school’ smell of stationery shops, the vibrant colours of falling leaves by sunshine and lamplight, and the bracing gusts of light rain for which Britain is famous. It is also a season for ghost stories as the nights draw in. I use the word ‘haunted’ in a nostalgic way. I find this season to be rich with memories and the potential of a new academic year after the hiatus of summer. The ordinary meanings of ‘haunted’ as an adjective are darker, however. They apply to a person who shows external signs of worry or anxiety, or to a place where one or more ghosts congregate. Whether the articles in this month make you feel nostalgic, spur you into action, or help you to hear a hitherto hidden voice calling for help, I invite you to be gently haunted.
Back to school
There is a growing mismatch between the structured, protected world of training and the reality of modern general practice, where decisions must be swift, pressures are high, and ambiguity is the norm, suggests Anuj Sean Chathley.1 How do we support GPs in training so that they can acquire wisdom in a manner that safely prepares them for practice? In clinical scenarios that are unfamiliar or require in-person review, GP residents are often forced to leave their patients mid-consultation to seek help. The act of ‘door knocking’ — interrupting a colleague who is themselves consulting — can feel burdensome. Hana Esack reflects on this educational issue that is most acute for new GP residents encountering the internal geography of a practice for the first time.2 It is also one that affects qualified GPs too, especially those working in a new or unfamiliar practice. New workforce models also mandate better communication within practices.
“Life and Times is more than food for thought, it is a monthly Harvest Festival!”
Should training be tougher or professional life more humane? We certainly need to be realistic about what the system will demand of us. Caroline McCarthy reviews The Episode: A True Story of Loss, Madness and Healing by Mary Ann Kenny.3 She argues that as a profession, our inability — or perhaps reluctance — to step back and reflect on practices that may need to change has no doubt contributed to a gradual abandonment of ethical ideals. But we are capable of change and reform both individually and collectively. As if in answer, Ben Hoban takes a deep dive into the culture of British general practice and concludes that, ‘the GP model has become outdated, but only through having had one hand tied behind its back by false notions of progress; the answer is not to abandon it, but to set it free.’ 4
Listening to and learning with neurodiversity
Rebecca Quinn reviews Searching for Normal: A New Approach to Understanding Mental Health, Distress and Neurodiversity by Sami Timimi.5 Timini writes that we need to consider the structure of society (where ‘normal’ people behave in a standard way) in conjunction with the industrialisation of mental health. Consequently, treatment options may be unhelpfully restricted to talking therapies and medication, when other interventions are more appropriate but less easily packaged for sale. Heidi Phillips and colleagues make the case that well-resourced diagnosis and support for neurodiversity can prevent considerable harm and unlock considerable flourishing in our society. Well-resourced and suitably-trained GPs have a key role as holistic clinicians.6
More things in heaven and earth
‘There are more things in heaven and earth, Horatio, than are dreamt of in your philosophy’ Hamlet tells his scholarly friend in Shakespeare’s famous play.7 We look yonder beyond the headline articles and journals with Alex Burrell. This issue we discuss access and quality of life, vaccine hesitancy, short-acting beta agonists and acute cardiovascular events, and air quality.8 Chris Ellis discusses how he uses poetry in medical education. There is now an extensive literature and choice of poems to use in helping students and GP residents to connect with human nature and illness experiences. Ellis offers an example from his own anthology.9 There’s still some time for improving reading as the days begin to draw in. Tony Avery reviews Kaiser Frederick’s Throat by Mike Pringle, ‘a gripping tale of how professional and political rivalry led to the mismanagement of Queen Victoria’s son-in-law with devastating consequences.’ 10
Life and Times is more than food for thought, it is a monthly Harvest Festival! An indelible autumn memory of school is of hearing for the first time, a Psalm (65, vv.9 and 11) set to music for a four-voice choir by Maurice Green in 1743, ‘Thou visitest the earth, And blessest it, And blessest it; And crownest the year, The year with thy goodness.’ 11,12 It’s a haunting melody and an apt celebration of the new academic year.
References
1. Chathley AS. From 100-hour weeks to work–life balance: how did we get here? Br J Gen Pract 2025; DOI: https://doi.org/10.3399/bjgp25X743313.
2. Esack H. Knocking for help: a hidden strain of GP training. Br J Gen Pract 2025; DOI: https://doi.org/10.3399/bjgp25X743409.
3. McCarthy C. Books: The Episode: A True Story of Loss, Madness and Healing. Br J Gen Pract 2025; DOI: https://doi.org/10.3399/bjgp25X743361.
4. Hoban B. Kieran Sweeney Prize winner 2025. Br J Gen Pract 2025; DOI: https://doi.org/10.3399/bjgp25X743325.
5. Quinn R. Books: Searching for Normal: A New Approach to Understanding Mental Health, Distress and Neurodiversity. Br J Gen Pract 2025; DOI: https://doi.org/10.3399/bjgp25X743385.
6. Phillips H, Eccles J, Minnis H, Green J. ADHD: overdiagnosis or opportunity? Br J Gen Pract 2025; DOI: https://doi.org/10.3399/bjgp25X743397.
7. Shakespeare W. Hamlet. Act 1, Scene 5, 174–175.
8. Burrell A. Yonder: Access and quality of life, vaccine hesitancy, SABAs and acute cardiovascular events, and air quality. Br J Gen Pract 2025; DOI: https://doi.org/10.3399/bjgp25X743337.
9. Ellis C. Teaching medicine with poetry. Br J Gen Pract 2025; DOI: https://doi.org/10.3399/bjgp25X743349.
10. Avery T. Books: Kaiser Frederick’s Throat. Br J Gen Pract 2025; DOI: https://doi.org/10.3399/bjgp25X743373.
11. Choir of New College Oxford. Thou Visitest The Earth. YouTube 2015; 21 Feb: https://youtu.be/koTZ5DoLIDM (accessed 11 Sep 2025).
12. Pavey C. Thou Visitest The Earth. https://holytrinitychoirsmalvern.wordpress.com/anthem-for-the-week-1/thou-visitest-the-earth (accessed 11 Sep 2025).
Featured photo by Kati Hoehl on Unsplash.
