A healthy man is, above all, a man of this earth, and he must, therefore, only live the life of this earth for the sake of order and completeness. But as soon as he falls ill, as soon as the normal earthly order of his organism is disturbed, the possibility of another world begins to become more apparent, and the more ill he is, the more closely does he come into touch with the other world.1
We do not always understand the worlds inhabited by our patients but because of this, do not assume that our patients must travel these worlds alone. Taking time to find out what it's like for our patients is the first step in forging an enduring doctor-patient relationship. When our patients know that we are travelling with them, and that we will not abandon them, they will accept our foibles, even our errors. But how can we cope with this big commitment-big enough for one person, let alone a few thousand of our dependent patients? How can we do all this without destroying ourselves? Do we give in to the highest bidder? Here are some insights from a woman in a crisis with too many conflicting roles: daughter, mother, lover, and so on: There is a battle going on for my soul ¦ and I cannot just give it to the highest bidder. I have an interest in it too ¦ I have a duty to many people and somehow I will discharge it. I have a duty also to some continuing part of myself. I have ¦ ripped open my self-protective layers. I see now what I am. It's not a question of œhappiness. I don't value my own more-or much less than anyone else's. It's something more lasting: it's a question of being faithful to an essence.
If we spend day after day in surgery without attending to our other roles we are not necessarily better than a person who leaves work on time, so enabling a visit to a grandparent, or a dialogue with a daughter, or time for recreation. The medical world encourages the dangerous delusion that we are somehow inadequate if we do not give our all. What gives rise to this is the delusion that the best unit of measurement of our medical lives is the single consultation. This is how we are assessed, as if there were no valid distractions during consultations-as if our own needs were non-existent, and 100% of the focus is placed on the patient sitting in front of us. But what if you should not really be seeing this patient at all, but should be out on a visit which might or might not be urgent? Or would it be better to be on the phone, talking to a possibly suicidal patient who has missed their appointment? Perhaps you need to do all three. Then you will do none of them well. If we are going to be successful in primary care, with its unending responsibilities, we have to recognize that the best doctors may not do anything very well. The best doctors just make the least bad decisions on how to spend their time, and themselves. As with the woman above, they do not simply give their soul to the highest bidder. Don't feel guilty about this. To give yourself to the highest bidder would be a betrayal: not even saints do this.
1 Dostoevsky Crime And Punishment Tr D Magashack, Penguin 305, www.bartleby.com/318/41.html
2 Sebastian Faulks 2001 On Green Dolphin Street, Hutchinson, 239
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