This non-fiction extended essay was published in 1967, it was written by John Berger (1972 Man Booker Prize winner) and photographs are taken by Jean Mohr. It is set in rural England in an impoverished and struggling community. Berger and Mohr follow a country doctor, John Sassall, whose career serves as the focus of the essay.
John Sassall, the main character, starts his career thriving on medical emergencies, impatient with non-specific symptoms and the absence of clear-cut physical diagnoses and underlying pathology.
‘That was the happiest time of my life, doing major surgery in the Dodecanese.’
He moves gradually towards an empathic listening and companionship with his patients and their families, striving to recognise who they are and the meaning of their illness to them. Physical and psychological intimacy becomes central to his relationship to his patients. Sassall establishes a brotherly relationship with his patients, which was very different to the paternal relationship which existed between most doctors and patients at the time.
‘He began to notice how people develop. A girl whom three years before he had treated for measles got married and came to him for her first confinement. A man who had never been ill shot his brains out.’
Sassall is a highly competent and dedicated physician, ’He sees to it that he stays well informed’. He feels compelled to use his occupational life in a quest to explore basic questions about the nature of human relationships and community. This need drives him to be an exceptionally good physician and to involve himself deeply in the life of his rather insular community. While Sassall is an unusual man and physician, many aspects of his experiences in dealing with patients cast light on doctor-patient relationships in general.
The simple task of turning on the electric blanket on fifteen minutes before a patient arrives shows the deep level of care Sassall has for his patients and it highlights his commitment to making them as comfortable as possible.
The consultation with the sixteen year old girl highlights Sassall’s view of the doctor-patient relationship and it also gives us an insight into his view of the doctor’s role in the community. He is very subtle in the way he address the pregnancy issue and is very quick in getting to the root of the problem.
‘Do you like working in the laundry?’
His attempt to help the young girl find more enjoyable work is very kind and generous, and though giving her a few days off borders on unprofessional behaviour, it shows the need to be flexible in G.P practice and in medicine in general for the greater good of the patient.
‘Come up again on Wednesday and I’ll phone the Labour Exchange and we’ll talk about what they say’.
The way he consoles her is almost therapeutic. It highlights Sassall’s role in the community, he plays a key role in looking after the locals’ health, both mental and physical.
‘The fact that you’re crying means you’ve got imagination. ‘
This essay is a reflection on the meaning of ‘good’ doctoring, the naming of illness and the ambiguity of scientific medicine in the context of general practice. Sassall is committed to the fraternal bond that develops over years with his patients. Berger illuminates, through John Sassall, the deep potential of medicine, and particularly general practice, to express solidarity with people as they move through their lives.
‘‘That’s where I live, where you’re putting that needle in.’ ‘I know’ Sassall said, ‘I know what it feels like.’’
The description of Sassall’s qualities as a doctor stand as a guide for all doctors in understanding the doctor-patient relationship and particularly for GPs in seeing their role as more than just scientific and approaching the practice of medicine in a holistic way, acting as a guide and helper in their communities. Sassall sees the patient as the central character in the practice of medicine.
‘He was straight, not afraid of work, easy to talk to, not stand-offish, kind, understanding, a good listener, always willing to come out when needed, very thorough’
I enjoyed reading this extended essay, it cast a new light on the doctor-patient relationship which has definitely influenced and altered how I view General Practice, and the way I see medicine’s role in society.