THE WAY AHEAD – from EQMC to SGA.

This is an updated version of a blog which first appeared in January 2023. A link to the original, entitled ‘Whither tomorrow’ along with other related blogs, can be found below.

‘The heart of man plans his way,
but the LORD establishes his steps’
Proverbs 16:9

I don’t know if it’s because of my ever greying hair or simply the result of wishful thinking on the part of those who are posing the question, but for the last year or so a day hardly seems to go by without one of my patients asking me how long I think I’ll remain a GP. Recently, and for a number of reasons, the idea of retirement has grown increasingly appealing, so much so that it now feels right to seriously consider the possibility of moving on.

When I think of how many times in my career I have considered giving up medicine, it is in some ways remarkable that I have lasted as long as I have! The first time I thought about chucking it all in was about a month into my A Levels. Back then I was hating Physics so much that I decided to give up studying science and with it the idea of one day being a doctor. But after a few wise words from my Dad I dropped Physics in favour of Biology and so continued to pursue the career I had set my heart on ever since the couple of weeks I’d spent in hospital at an impressionable age. And for a time things got better.

And so I clambered aboard the conveyor belt of medical education and got a place at Bristol. After a wobbly first couple of terms during which I again considered ending my medical career before it had even begun and I was briefly prescribed ‘prothiaden’ which, back then, was a fancy new antidepressant, I eventually settled into university life. But after failing to enjoy the third year which brought with it my first experience of clinical medicine, I intercalated, unconventionally late, in Psychology with the specific intention of leaving university with a degree that would offer me the possibility of a job outside of medicine. For a while I flirted with the idea of accepting the offer I was made to do a PhD but returned instead to Medicine and eventually graduated in 1991.

My year as a houseman wasn’t a happy one either and my wife will tell you how low I was during what, purely coincidentally you understand, was also our first year of marriage. She sometimes had to literally feed me breakfast in the morning, and put my shoes on to get me ready to leave for work. I even temporarily opted out of the NHS pension scheme, so convinced was I that I would not remain a doctor for long, But in time things got better again and I somehow survived my first year as a doctor.

GP training was also an initially miserable time, so much so that, before completing my training, I lined up a job in Psychiatry thinking I might follow this as an alternative career path. Six months of that though was more than enough and so, with my MRCGP now safely under my belt, I became a GP locum. One practice I spent three months at asked me to apply for the partnership that they were then advertising and, having done so, I was fortunate enough to get the post.

And so, in January 1997, I began what thus far have been 26 largely happy years at East Quay Medical Centre, the practice at which I still work. Initially I hated it though, and was genuinely convinced that, as well as being useless, everybody regretted taking me on a partner. But then things got better once again proving that, at least on occasions, things can, and do, improve over time.

That said, I’m not sure that medicine is getting better. On the contrary, I am concerned that the world of medicine has lost it’s way. I’ve been writing about this for well over a decade now but the situation only seems to be getting worse with every passing year. With the medicalisation of normal life and the overemphasis on clinical parameters rather than the individual to whom those parameters refer, modern medicine has begun to diminish what it is to be human. And it has diminished too what it is to be a doctor. What’s more, medicine has, for far too long, arrogantly acted as if it believed it had the power to bring about eternal life and never ending happiness. It spends far to long trying to do what it can’t and too many of those charged with that particularly task have been killing themselves and making themselves unhappy in the attempt.

And perhaps as a consequence, whereas once doctors were considered their patients’ advocate, it seems now that patients are too often perceived as problems, made up of those who have to be managed rather than those who ought to be cared for. But whilst I like to think that I and my colleagues at East Quay have tried not to fall into this way of thinking, it remains the case that doctors in general have, in recent years, been forced to work more remotely from their patients and, as an inevitable consequence of this, have, I believe, found themselves beginning to care for patients less, even as their patients have begun to care less about them.

Because absence does not always make the heart grow fonder.

It also seems to me that medicine has priced itself out of the market – with all that medicine can potentially do, it is now simply too expensive, not only in terms of the burden it imposes on the tax payer but also in terms of the personal cost paid by those who work in healthcare. The toll is too high and something really does need to be done about it.

I’ve been writing on a regular basis now for a little over four years. I find it helpful – so much so that this website is far too cluttered with posts. In his essay ‘Why I write’, George Orwell gave four reasons, suggesting that, to a greater or lesser extent, each one is present as motivating factors in all those who put pen to paper.

The first reason he gave, was SHEER EGOISM. I don’t deny it. I enjoy writing for writing’s sake but if occasionally someone likes what I write, if perhaps I manage to raise a smile or somebody finds something I’ve written helpful, I find that that brings with it a little extra satisfaction.

Next came AESTHETIC ENTHUSIASM. And once again I put my hand up to that one. I enjoy writing because I enjoy writing, even when no one else enjoys reading what I write! I like playing with words, finding an arrangement of sounds that rolls off the tongue and which is pleasing to at least my ear.

Thirdly on Orwell’s list, was HISTORICAL IMPULSE – the simple desire to write about how things are, to record for others what the truth is. Again mea culpa! I feel a responsibility to write about the state of the world, or at least that part of the world that I inhabit. And writing helps me think about what is going on around me, it helps me understand the realm in which I operate.

And the last reason Orwell gave for why writers write was POLITICAL PURPOSE, by which he meant a desire to influence others, to move others to think in ways that the writer themself thinks. And I suppose that’s true of me too, at least to some extent. Indeed it would, I suspect, be odd if it were not the case.

But there is, I think a fifth reason for why I write, one which is, perhaps, at least slightly different to those given by Orwell. And it’s this. The NEED TO BE HEARD.

There are some things that are so important to us, that we need them to be important to others. And for that to happen our concerns have to be heard, and felt, by others.

In an indifferent world it’s important that we listen to those we care about, to make a real effort to hear what they are saying. We may not be able to do much about what is spoken, not in any practical sense at least, but caring enough to recognise it matters to the one who is saying it is, at least, a start. Because to share a little in the experience of others, perhaps even shedding a tear ourselves as others express their sadness, draws us a little closer to the one who suffers, and makes a connection with the one who grieves, a connection that, too often in this frequently contactless world, we fail to make.

And so I write about the things that matter to me most.

I write about cricket – is there anything more important than the domestic cricket season and the violence being done to it by the introduction of franchise cricket? I doubt it, but even so, now is not the time for me to get back on that particular soap box once more.

I write about medicine – of how the NHS is broken and breaking the people who work within it. I write of how it bothers me immensely that patients aren’t getting the treatment they need, not, at least, in a timely fashion. And I write about how it bothers me immensely that people who I care about, people with whom I work, are too often close to tears because of what the job now demands of them.

And I write about other, more general, concerns that trouble me because it’s not only in relation to the world of medicine that people suffer. And irrespective of the reasons for that suffering, and especially when, rather than getting better things seem to be getting progressively worse, I find it helpful to express in what I write some of the sadness I am sometimes prone to feel.

And I write too about my faith – because if it’s everlasting life and infinite joy we want, we will need to look for it somewhere other than medicine. Without the faith which sustains me in difficult times, I really don’t know how I’d be able to cope with all that life sometimes entails. Because like the psalmist I believe that, though weeping may tarry for the nighttime, joy comes with the morning – holding this to be true irrespective of how long and dark the night may be or how far off the day still seems.

So as working in the NHS becomes evermore difficult, have my recurrent thoughts of wanting to leave medicine finally be realised? Have I decided to retire a couple of years earlier than the average age that GPs now hang up their stethoscopes? Well the answer to that question in ‘Yes!’.

But the reason for doing so is not the same as the one that caused me to consider giving up so many times in the past. Then my thoughts of quitting were largely linked to my feelings of being an inadequate doctor. Now, however, though still inadequate to meet the needs of all that is demanded of me, I have become resigned to my inadequacy. In his 2014 Reith Lectures, American surgeon Atul Gawande spoke of our ‘necessary fallibility’ – of how we all now inevitably make mistakes because it is simply not possible for us to know all that there is to know or be able to do all that we are asked to do.

Medicine has, in some respects at least, become something that I have lost faith in. I don’t want to work in an environment which forces those in it to be more concerned for their own welfare than the welfare of others. There’s a lot of talk these days about being kind, generally accompanied with the caveat that our kindness should extend to ourselves. But if we’re to be kind to those we interact with, that is inevitably going to mean that sometimes we will need to be unkind to ourselves, to sometimes make sacrifices for the sake of others. But here’s the thing – when we do, I believe that, rather than suffering, we are enriched by our actions. Sometimes real success comes as a result of our losing everything. Given what once took place on ‘a green hill far away’, there is, I believe, historical precedent for holding such a view.

And I’ve seen a little of this in my own life too. Some years ago, on my day off, a parent phoned the practice regarding their 8 year old son who had been experiencing diarrhoea and vomiting. He was given wholly appropriate advice for home management and advised to call again in the event of any deterioration. The next day the father did indeed call back but proceeded to inform me that all his son’s symptoms were improving. But there was something about the fathers tone of voice that unsettled me and so, at around 6.30 that evening, I called him back and learnt how the child had subsequently significantly deteriorated. Though I was not on call, I offered to do a home visit, an offer that was gladly accepted. When I eventually arrived, the lad had the most obvious meningism that I had ever encountered and I duly gave him a stat dose of iv benzyl penicillin and called for an ambulance which, as they did in those days, duly arrived and whisked him off to hospital in good time.

Now as it happened, that evening I had been invited to a party of a friend who was celebrating her 80th birthday. Inevitably I was very late. When I arrived, several guests expressed their concern for me, imagining, given my tardiness, that I must have had a bad day. I hadn’t though. Though entailing an interruption to my plans, being where I was genuinely needed was hugely rewarding, it was a joy to have been able to help that evening. And today the lad is a young man, one who is still my patient, and always thanks me every time he sees me, foolishly imagining that it was me who saved his life rather than the clever bods at the hospital who did all the hard work.

I’m not sure though that modern general practice is conducive to that sort of doctor-patient relationship anymore. If it isn’t, not only is it a great shame, but it also makes losers of us all, irrespective of whether we are doctors or patients. Sadly the way General Practice used to be is now over. Whilst I would like to think we could abandon medicine by rote and return to a simpler and more thoughtful way of working, I fear that there is now no going back. The horse has bolted and the stable door has been left flapping in the wind.

But more positively, and far more importantly, my retiring from medicine is because the opportunity has a risen for me to do something that I would far rather do. And so I am delighted to announce that, as from December 1st, I will, God willing, take up the position of South West Regional Representative for the Slavic Gospel Association (SGA), an organisation which, as well as delivering vital aid to those who need it, shares my very great desire to bring the good news of Jesus Christ to the people of Eastern Europe.

Furthermore, now that the colorectal screening that I recently had the dubious pleasure of undertaking hasn’t resulted in a spanner being thrown in the works, I am at 56, of an age when I may yet be able to give 10 good years to this new chapter of my life – significantly more than I’d have remained in medicine.

Inevitably there are downsides to my moving on – I will of course miss my patients but, because of the way medicine is heading, the sad truth is that I already feel somewhat less connected to them than I once did. And I will miss those who I have worked alingside, colleagues who I am pleased to count amongst my very best friends.

Back in January I wrote of my concern that, were I to leave, I might prove difficult to replace, not because of anything special in myself, but because of the ongoing and deepening GP recruitment crises. Providentially though, after months of trying, recent attempts by the practice to find new clinicians have been successful. And so I am confident that my leaving now will not destabilise the practice which has been such a large part of my life, the practice that has cared for the many patients of whom I have become so very fond, and the practice which remains and is made up of colleagues who I am sure will continue to provide an excellent service to the good folk of Bridgwater.

So I will miss working at East Quay but I am, at the same time, tremendously excited by this next chapter of my life, one which I hope will, with God’s help, prove to be every bit as worthwhile as the years I have spent in medicine.

And perhaps even more so.

For those interested in learning more about SGA, there website address can be visited here

Furthermore, please feel free to get in touch or share this blog if you or a church group you know might be interested in me popping up at a Sunday service or midweek meeting to tell you more in person. I would be delighted to come and meet with you.

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Related blogs:

To read ‘Whither tomorrow?, the original version of the above blog, click here

To read ‘Lewis Capaldi – Retired Hurt: The Need for Kindness’

To read ‘Three Times a Patient’, click here

To read ‘Professor Ian Aird – A Time to Die’, click here

To read ‘On Not Remotely Caring’, click here

To read ‘On Approaching One’s Sell By Date’, click here

To read ‘The Abolition of General Practice’, click here

To read ‘Contactless’, click here

To read ‘An Audience for Grief’, click here

A selection of other blogs related to medicine.

To read ‘The Dr Scrooge Chronicles’, click here

To read ‘The Dr Mungo Chronicles’, click here

To read ‘Paddington and the Ailing Elderly Relative’, click here

To read ‘Vaccinating to remain susceptible’, click here

To read ‘Eleanor Rigby is not at all fine’, click here

To read ‘General Practice – still a sweet sorrow’, click here

To read ‘On being overwhelmed’, click here

To read ‘General Practice – is time running out?’, click here

To read ‘Blaming it on the Boogie’, click here

To read ‘Health – it’ll be the death of us. Is there institutional arrogance in the NHS?’, click here

And a selection of other blogs on Christian themes:

To read ‘The Resurrection – is it just rhubarb?’, click here

To read “Hope comes from believing the promises of God”, click here

To read ‘Faith and Doubt’, click here

To read ‘What becomes of the broken hearted? Sorrowful yet always rejoicing on Palm Sunday’, click here

To read ‘Why do bad things happen to good people? Sorrowful yet always rejoicing on Good Friday’, click here

To read ‘Was it not necessary that the Christ should suffer these things? Rejoicing, though temporarily sorrowful, on Easter Day’, click here.

To read ‘T.S. Eliot, Jesus and the Paradox of the Christian Life’, click here

To read “Why do bad things happen to good people – a tentative suggestion”, click here

To read “Suffering- A Personal View”, click here.

To read “Luther and the global pandemic – on becoming a theologian of the cross”, click here

To read ‘The Sacrifice of Isaac – Law or Gospel?’, click here

To read ‘Water from a Rock’, click here

To read ‘Real Power’, click here

To read ‘Foolishness – Law and Gospel’, click here

To read ‘The Promise Keeper’, click here

To read ‘The Rainbow’s End’, click here

To read ‘True Love?’, click here

To read, ‘But this I know’, click here

To read ‘I’ll miss this when I’m gone – extended theological version’, click here

To read ‘On being confronted by the law’, click here

To read ‘The “Already” and the “Not Yet”’, click here

To read ‘Rest Assured’, click here