How doctors learn

Patients teach us lessons that take years to absorb

Deep learning takes a long time. It requires multiple teachers, opportunities for reflection, for making mistakes, and for integrating acquired knowledge, skills, and insights into practice. General practitioners are well placed for such learning, with patients being our most effective teachers.

It has often been observed that wisdom is what remains after the facts are forgotten. But this is only true if we have the time and interest to absorb this wisdom. I have yet to meet a GP who does not, throughout the course of even the briefest conversation, allude to some new learning or insight gained on a typical working day, usually recounted with humor and empathy. The comedian Dara Ó Briain said, “[s]cience knows it doesn’t know everything, otherwise it’d stop.” GPs, like science, know we don’t know everything, but that is what keeps us adapting, reflecting, and changing according to the needs of our patients while remaining open to whatever lessons we need to learn.

Some lessons are learnt and forgotten, others finally sink in after years of practice. Here are seven things my patients taught me in 2025.

1. No matter how many appointments I provide for patients, there will never be enough.

2. No matter how much time I spend with a patient in a consultation, it will never be enough. There will always be the things left unsaid, unexplored, unexplained, and unexamined.

3. Patients believe that the standard (10-15 minutes) consultation is too short when they are the ones in the consulting room, but feel this is more than enough time for anyone to spend with the doctor when they are the ones in the waiting room. They may not say this, but springing from their chairs like greyhounds from a stall, every time I stick my head into the waiting room lets me know how they feel.

4. Patients have come to expect that their complete medical history is recorded on the computer, but never seem to wonder about how it gets there.

5. Patients have enormous trust in their GP. Even the presence of an artificial intelligence (AI) recording platform in the consulting room is acceptable when introduced by their own GP. In the six months or so since using this tool, only one patient was hesitant and even she changed her mind after a brief explanation of the usefulness of AI.

6. Patients never doubt that their doctor will be 100 per cent confidential; a belief comparable only to the sanctity of the priest in the confessional many years ago.  

7. When patients attend a new doctor, they make up their minds about that doctor’s competence and capacity for compassion within a few minutes. It is almost possible to ‘see’ this happen as a new patient settles or remains guarded in my presence. A type of, what I call, ‘holding trust’ develops, where, I imagine, they feel ‘safe enough’ to relax and be vulnerable. If this doesn’t happen in the first consultation, it is difficult to create it in later encounters.

Some of these lessons have taken years to absorb fully, but for me they provide a certain freedom. Freedom to let go of the things I cannot change, to stop trying to please everyone all the time, and not to overestimate my role in the patient-doctor relationship. Some things are simply beyond our control and we can only do our best with what we know. And even when we know something to be true, it can still be difficult to integrate it into practice. Regardless of my experience and constant reflection, I still grapple with daily challenges such as:

1. How to stop and rest when feeling overwhelmed.

2. How to desist from trying to deliver on every request at every consultation in the false belief that this will save time and effort in the long run.

3. When to recognise the serious disease lurking in the shadows of repeated mundane and seemingly inconsequential complaints.

4. When to be still as tears drop from a patient’s cheek and not distract myself by reaching for the tissues.

5. How long to be a witness to distress before busying myself on my computer.

6. When to speak or not to speak.

7. When to gently nudge someone in the direction of another doctor when the relationship is not working. To say: “I might not be the best doctor for you at this time. You need someone who does not presume to know you quite so well, who will respond to your tune with a new melody, not one so rehearsed that it plays itself every time I see your name on the screen.” But 2026 is a new year with the possibility of new lessons and experiences.