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GPs encounter a broad spectrum of human emotions in any one day. The young mother delighted with her new baby but stressed and tearful from lack of sleep. The nervous teenager looking for contraception but afraid to ask, fearful of being judged. The middle- aged man, facing redundancy, unable to tell his wife. The grandmother making little of her memory lapses, trying to conceal the fear that she is on the brink of Alzheimer’s. We never know what we are inviting into our consulting rooms each time we open the door. We may have completed GP training and have been deemed competent in paediatrics, obstetrics, medicine, psychiatry and general practice, but how well does this equip us for the thousands of people we will meet who will require not only our medical knowledge, but our ability to connect, to see what they cannot show us, hear what they cannot say, and understand what they have not yet understood themselves?
Many times, we do not live up to these requirements. We complete a consultation with a sense of unease, of not getting to the heart of the matter, the real agenda often remaining hidden from doctor and patient. Sometimes, however, we have a perfect consulting experience. We know when to speak and what to say. We know when to remain silent, letting the consultation unfold, nothing hidden. “Thank you, doctor,” says the patient as they leave and we know they mean it. We finish those consultations glad that we turned up for work today and knowing that we will turn up again tomorrow for the same reason. We have not lost ourselves in another’s suffering. We have added to their wellbeing and in doing so have boosted our own.
To the casual observer, it could seem like all of this happens effortlessly. That consultations are just random encounters, the outcome in the hands of the gods. But understanding other people’s suffering and being prepared to accompany them on their journey of acceptance, recovery or both does not happen by chance. It requires constant effort, both in and out of the consulting room. It requires good medical knowledge so that we can recognise illness and know how best to treat it. It requires good observation, listening and communication skills so that we can identify illness and apply our knowledge appropriately. It requires an understanding of how illness effects people, a knowledge of personality types, family dynamics and cultural mores. It requires us to imagine what it feels like to be young, middle-aged and old. To imagine living with illness, unemployment, work stress or an abusive partner. It requires us to appreciate the joy of a new baby after years of childlessness, the reunion of a father and child after years of living apart, the relief of hearing that the CT scan is negative. Every day, we experience a whole spectrum of emotions vicariously, moving quickly from one to the next before heading home, re-entering our own lives and returning to our own joys and sorrows.
GP training consciously addresses the skills required for uncovering hidden agendas in the consultation and emphasises the importance of self-care. But is this enough, and what about those of us long since finished with GP training? Is there any way that we can help ourselves recognise, understand and accept this vast array of human behaviours and emotions?
In 2013, US researchers showed that reading literary fiction, as distinct from popular fiction, is an effective method of understanding the psychology of characters and their behaviours. In particular, it helps us accurately infer the feelings of others. Popular fiction, on the other hand, tends to be formulaic and rely on plot more than character to retain the readers’ interest. Popular fiction is enjoyable and beneficial for other reasons but is not as effective in helping us understand our world or the world of others. In literary fiction, the authors create complex characters that disrupt our expectations and defy stereotypes. People are inconsistent, messy and illogical, as in real life. Fyodor Dostoyevsky’s Crime and Punishment provides an exposé of the mind of a man who will find no peace until he is punished for his crime. Alan Hollinghurst’s The Line of Beauty invokes our sympathy for the young gay man looking for love and connection but subsequently destroying both himself and those who care for him. Bernhard Schlink’s, The Reader wrestles with the question of loving someone who has committed atrocities.
There is no human emotion or dilemma that is not found in some of these great novels. There are many others that can help us achieve a deeper level of understanding of the world and the people in it. So, if you are someone who enjoys a good novel, choose wisely and read with abandon. It is all for a good cause.