‘It was not that she was out of the ordinary’ writes Polly Morland near the start of her compelling and beautifully written book A Fortunate Woman, ‘Put simply, she is a doctor who knows her patients. She is the keeper of their stories, over years and across generations, witness to the infinite variety of their lives. These stories, she says, are what her job is all about. They are what sustain her, even in days as hard as these.’
Do those words resonate with you? They certainly do with me, now more than ever as increasing workload and changing systems threaten the continuity and quality of care that we can provide. Published this year, A Fortunate Woman chronicles through Morland’s eyes the life and work of an unnamed country GP during the pandemic. The Fortunate Woman is a model of the compassionate, thoughtful, and humane doctor that we all strive to be. She understands her patients as people, how they are rooted into their context, community and landscape and the fascinating interplay of the biological, social and psychological domains of illness. The book chronicles the difficult days we went through practising during the pandemic, including vivid pictures. I particularly relate to the picture of her putting on her PPE next to her parked bike on a home visit, remembering when I got my apron stuck in the chain and I entered the house masked up but with a torn plastic apron covered in bike chain oil. At the heart of the book though are the compelling, moving patient stories that she is witness to, revealing all the beauty, humour and tragedy of everyday lives. This is what makes her a fortunate woman, and indeed all of us to be fortunate, witnesses to the extraordinary every day.
If the title seems familiar to you, it is because it is inspired by the book A Fortunate Man. Written by John Berger this book blended text and photographs to tell the story of a country GP named John Sassall working in the same valley in the Forest of Dean in the 1960s. Long considered a medical classic, students and trainees have been encouraged to read it ever since and it is said to have inspired many doctors into General Practice, including the GP in A Fortunate Woman. Guilty confession: I didn’t like it. Sassall’s evolution in the book from a narrow-minded surgeon intolerant of minor complaints to holistic, patient-centred GP is revealing but I found the prose dense, the philosophical allusions opaque and Sassall as a character obsessive, dogmatic and at times unlikeable.
Sassall is considered a fortunate man in Berger’s book because through his vocation, and his almost slavish devotion to his patients, his work consumes and fulfils him. Yet he works in isolation, seems to sacrifice his personal for his professional life, is prone to recurrent bouts of depression and I suspect what we would now call burnout. That’s not very fortunate, nor ideals we want to inspire in the next generation. Tragically he killed himself 15 years after the book was written. I agree with a recent essay in the Lancet A Fortunate Man? that the book should indeed be read by trainee doctors, but not to view Sassall as a role model but because it offers useful warnings about how not to practise.
Polly Morland’s A Fortunate Woman, however, is a totally different and in my humble opinion a much better book and inspirational for all the right reasons. At a time of a barrage of negative publicity directed towards GPs, it is a book that reveals the positive impact that a caring GP has on the lives of their patients. The GP in A Fortunate Woman works hard, but she also understands the need for self-care. She has a supportive team behind her, both at work and home, she is reflective, in touch with nature and the landscape (beautifully depicted in the book, both in words and pictures) and through walking, she reaps the therapeutic benefits of exercise and fresh air. Work gives her meaning, but she has balance.
A Fortunate Woman is a great read for the writing and stories it contains alone, but it is also a compelling argument for the importance of continuity of care and the need for us to have the time to be able to listen to and understand our patients and to develop doctor-patient relationships based on mutual respect and trust, at a time when we really need it. This is not just misty-eyed nostalgia wanting to return to a ‘golden age’ of General Practice, we have good evidence that continuity of care improves health outcomes with higher satisfaction rates and lower costs RCGP, COC 2021. Similarly, empathy and compassion have been shown to improve healthcare outcomes BJGP2013, but these are hard to achieve without time to listen. Preserving continuity and compassion in healthcare may seem like aspirational ideals during a workload and staffing crisis, but aspirations are worth fighting for and reminders such as A Fortunate Woman of what inspired us to be GPs in the first place can in the meantime help to sustain us.
As A Fortunate Woman ends, ‘after the longest of winters, comes spring’ and with her patients vaccinated, a return to face-to-face consulting, new staff and a trainee our Fortunate Woman is beginning to feel hopeful again: ‘She crouches down next to her bike to peer into a hole in the wall where a stone came loose a few weeks ago. Inside, there is now a nest. New life, she thinks.’
So, a very big thank you to Polly Morland and to our unnamed colleague, the wonderful subject of ‘A Fortunate Woman’, for inspiring us this year and giving us hope for next.
Wishing you Season’s Greetings and a happy, healthy and fulfilling 2023.