Overcoming the Monster

Ben Hoban is a GP in Exeter.

Most of our struggles are mundane, a steady shovelling to clear a path while snow falls from a lowering sky; neither our contract nor our humanity requires us to strap on armour and march, spear in hand, into the lair of some fanged and hairy terror to do battle. There is still a quiet heroism, though, in shovelling, especially as the light starts to fail and wolves roam. Looking after people in general practice often requires a certain heroism too, as paperwork silently accumulates, the list of urgent extras grows, and the risk of a missed diagnosis or complaint bares its teeth. How we understand our story makes a difference to how we go about the job, how effectively we do it, and how it leaves us feeling when we go home. Although the total number of stories must be infinite, most recapitulate a small number of underlying narrative structures and themes, familiar tunes played in a variety of styles. One of these proto-narratives is especially relevant to us as doctors: Overcoming the Monster.¹

The plot follows a sequence of five stages. First, we are introduced to the immature hero (male or female) and the monster: a dragon, tyrant, or some other undefined dark power. Next, the hero somehow acquires a selection of special abilities, allies or equipment, which seem to guarantee success in dealing with the monster. In the third stage, it soon becomes apparent, however, that the monster is far more powerful than we first realized. Our hero, undaunted, presses on to stage four, in which battle commences, but is soon in serious trouble and about to be defeated. In the final stage, just as disaster seems inevitable, the hero gains some kind of last-minute advantage, snatching victory from the jaws of defeat.

Naturally, good must triumph over evil, and yet there is little dramatic tension when the outcome of any fight is a foregone conclusion. The hero’s advantage therefore never lies simply in being stronger than the monster, but in using something other than strength: insight in finding a weakness to exploit; a willingness to pursue the more uncertain course of action because it feels right; or the ability to enlist the help of others. However powerful the hero, the monster is by definition more powerful, and so it is only by approaching things differently that the hero can defeat it. The subtext is that we mature not just through mastering our existing capabilities, but through balancing them with complementary ones: strength with skill; knowledge with wisdom; competence with care.

If we consider how this might apply to our work as doctors, the reality is that all too often, we undervalue what seem like the softer elements of these pairings. We often distrust fast, intuitive thinking, for example, preferring to reason things out slowly, logically, so that we can see our own workings.²  We privilege values such as objectivity, consistency and autonomy, but often overlook others like responsiveness, connectedness, and sensitivity to context.³ The motto of the Royal College of General Practitioners may be Cum Scientia Caritas, but Scientia usually seems to win. These splits reflect dual aspects of how our minds work, and of who we are: we lean into the world with one, experiencing and engaging, and lean back from it with the other, dissecting our experience and reconstructing the abstract concepts and narratives with which to make sense of it.⁴ We cannot manage with only half a soul, however hypertrophied; it should be obvious that we need both.

When we talk about general practice as “the integrating discipline,” we tend to mean that it integrates the different parts of our patients and their care.⁵ I would argue that the term applies equally to the integration of these complementary aspects of what we do as GPs, and perhaps also to the integration of different ways of working within a practice: one of the distinctive features of any band of heroes is its diversity; the uniform and faceless stormtroopers are always the bad guys. There is a great danger that as our workload continues to rise, we respond simply by working harder, faster, and in ways that are more focussed but also narrower, and ultimately less intelligent, less caring, and less effective.⁶ We are summoning up all our available strength to overcome the monster, and we are struggling. Is it possible that we need not just more strength, or more doctors, but also a renewed focus on the complementarity that makes us distinctive? We cannot keep absorbing more work indefinitely, but by choosing to build strong relationships within our practices, by giving patients the confidence to look after themselves better, and by rejecting the creeping “taskification” of what we do,⁷ we may yet be able to snatch victory from the jaws of defeat too.

References

1. The seven basic plots: Why we tell stories, Christopher Booker, Bloomsbury 2004
2. Thinking, fast and slow, Daniel Kahneman, Penguin, 2012
3. How the World Thinks: a Global History of Philosophy, Julian Baggini, Granta, 2018
4. The Master and his Emissary: the divided brain and the Making of the Western Mind, Ian McGilchrist, First edition Yale University Press, 2009
5. Denis Pereira Grey, General practice – the integrating discipline, British Journal of General Practice 2023; 73 (734): 388-390. DOI: https://doi.org/10.3399/bjgp23X734697
6. Scarcity: the true cost of not having enough, Sendhil Mullainathan and Eldar Shafir, Penguin, 2014
7. Nada Khan, Are we seeing more complex patients and, if so, why? British Journal of General Practice 2024; 74 (741): 177-178. DOI: 10.3399/bjgp24X736929

Featured photo by Anne Nygård on Unsplash