Liam Farrell: Continuity of care is the heart of general practice

You can't have everything. Or at least all the available evidence points overwhelmingly to that conclusion. While some people are easy to be good to, a pleasure to look after, others aren't. But even if they aren't, we still have to walk that long road together and trudge uphill to our own squalid Calvary.

Being a patient is no guarantee of sainthood; patients can be bastards, just like anyone else (I know this to be true, because I was one). But it has never been a doctor’s place to stand in judgment, or to discriminate between the sinner and the saint, and our vocation is to care for everyone, no matter how obnoxious.

We carry a heavy burden, but it is a high and noble calling. If a task is too easy there is no true valour, and it’s why our training is so rigorous; 'Hardness ever of hardiness is mother'.

Illness can touch the heart, remind us of our primal fears, induce in us a humble appreciation for our own condition and embody the rage we sometimes feel when we are forced to consider the cold indifference of this imperfect world; Joe has walked with me through the Valley of the Shadow of Death so often that our footprints are indelibly etched into the ground.

Or not.

'It is easier to understand mankind than to understand one man,' said somebody important, and this is the heart of the mystery of general practice. I may not be an expert in any particular disease, but when it come to knowing Joe and what makes him tick and what import to give his complex and ever-changing symptomatology, I am the world authority (though unfortunately there are no lucrative conferences in Monte Carlo on this fascinating topic).

In reality my main task with Joe is telling him again and again (and again) what he doesn’t have. We have danced this dance for many years now, but there really isn’t any satisfaction to be gained. It’s more like the lack of postcoital afterglow after very vigorous sex: there’s just a sense of relief that you survived without disfigurement.

'Of all that is written, I love only what a person hath written with his blood,' said Nietzsche.

Or, in Joe’s case, my sweat.

  • Dr Farrell is a GP from County Armagh. Follow him on Twitter @drlfarrell

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