Book Review: Doctors on the Edge
| Published date | 01 June 2001 |
| Pages | 29-30 |
| Date | 01 June 2001 |
| DOI | https://doi.org/10.1108/13619322200100018 |
| Author | Clare Wilkie |
| Subject Matter | Health & social care |
The Mental Health Review Volume 6 Issue 2 June 2001 ©Pavilion Publishing (Brighton) 2001 29
his may not be the book to give
to your eager nephew or niece who is thinking of
applying for medicine or, perhaps, to the final year
medical student who is considering general practice
as a career. In Doctors on the Edge inner-city general
practice is presented as highly stressful and highly
demanding: rewarding, of course, and a great ideal, but
exacting an almost impossible price from the doctor.
The book is the fruit of a long research project by
Linden West, a senior lecturer in education at the
University of Kent. Through the late 1990s he
conducted a series of searching semi-therapeutic
conversations with 25 GPs in the East End, addressing
all aspects of their personal and professional lives.
None of these GPs fitted the stereotype of the GP
as successful, white, married family man with 2.4
children, a home-based wife and a BMW in the drive.
Some were Asian or black, some gay, some women
struggling to combine domestic and professional
responsibilities and some, men or women, trying to
incorporate non-mainstream political, personal or
spiritual agendas into their work and lives. Themes of
constant, overwhelming patient demand, of very high
expectations placed on the doctors by themselves or
their families, of guilt and the perception of inadequacy
and failure recur in some form through almost all the
doctors’ stories.
From the mental health point of view many of
these doctors were, as the book’s title implies,
extremely vulnerable and some indeed described
episodes of overt mental illness or times when it had
been absolutely imperative for them to take stock of
their lives and make substantial changes. Iconic in the
book is the figure of Dr John Sassall, John Berger’s
‘Fortunate Man’, the supremely committed rural
general practitioner who cared for his powerless and
voiceless patients at the expense of his own emotional
wellbeing, and later actually committed suicide. Some
of the East End doctors seemed, perhaps for reasons
of guilt or questionable political analysis, to have little
interest in measures which would have protected
them from the constant demands of patients without
impairing care. One gave patients her home phone
T
Book Review
Doctors on the Edge
By Linden West
London: Free Association Books (2000)
number. Another had no appointment system,
dreaded Monday morning because of the waiting
room full of patients and began his surgery at 7.15am
or earlier because the patients began knocking on
his door then. A third accepted calls from a patient
insisting on immediate private referral, while he
was actually doing a vaginal examination in another
patient’s consultation. Many seemed to feel not just
understandable compassion for their poor and power-
less patients, but a culpable responsibility for their
poverty: so that saying no to any request or need
would have felt like a betrayal or a failure. Such an
overwhelming idea of the doctor’s role and work was
proving almost unsustainable for many of the doctors.
Story and narrative play a large part in this book.
Substantial parts of several chapters are virtual
transcripts of the doctors’ descriptions of their lives:
and, just as the psychiatric case history is often much
more interesting than the subsequent discussion of
diagnosis and formulation, these stories are absolutely
gripping. Any doctor of any kind, from Stornoway to
Deal, would find much here that is extremely familiar
and perhaps extremely painful in its articulation.
Linden West says towards the end that he has
attempted to create space for doctors to tell their
stories, which is true. Rather less gripping is the
prolonged and slightly worthy discussion at various
points in the book of the function of story and narrative
in creating meaning and empowering the teller.
Psychoanalytic modes of thought are also omnipresent
in the book – the author is training to be a therapist –
and it appears that many of the conversations with
individual doctors almost took on the form of a
therapeutic session. It is not clear what the doctor’s
response was in some cases to the researcher’s formu-
lation of his or her life in Freudian or Kleinian terms.
One constant theme in the book felt rather out of
date. This was the perception of medicine in general
as a monolithic, masculine, arrogant enterprise,
dominated by science and unable to question itself,
extend its remit, alter its methods of working, admit
to emotions or empathise in any way with suffering,
vague and disorganised humanity. There are scores of
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