19 July 2022

A timely check-up on the GP’s vital role in the community

Updating John Berger’s 1967 classic, A Fortunate Woman shares the devotion and anguish of a modern family doctor.

Photo by Richard Baker

In the snow-bound January of 1947, a new GP arrived in “the valley”. He had served as a navy surgeon in the war, but now he was a country doctor, there to stay. Eighteen months later, each of his patients received a terse letter: “You are now part of the National Health Service, so you don’t need to pay me any more, thank you very much.” He remained for 35 years.

This was “Dr John Sassall”. How capable he was, how eccentric, how dedicated and how unlikely, nowadays, was revealed in John Berger’s classic 1967 book A Fortunate Man. Sassall was a friend and Berger shadowed him for some months, along with the Swiss photographer Jean Mohr. The subtitle of their collaboration is The Story of a Country Doctor. It is not a story as such; it proceeds through a series of vignettes, psychological explorations, case studies and in-depth enquiries into the relationship between one man and his calling, his patients and his environment.

Berger’s book opens with the kind of drama Dr Sassall enjoyed. He’s driving his Land Rover, one hand on the horn, to the scene where a woodsman is lying crushed by a fallen tree. Few GPs would, or could, do that now, even if they wanted to. However, the book ends with a question that has possibly become more relevant as time has passed: an enquiry into how we value a human life.

Sassall was a doctor; he was fortunate because he was also a witness to his community, a keeper of the rolls. He was able to pursue what he wished to pursue. Also, he was probably bipolar. Eventually, 15 years after Berger’s book was published, and following the death of Sassall’s wife, Betty, the doctor killed himself. Later editions of Berger’s book contain an afterword. Berger looks back “with increased tenderness on what [Sassall] set out to do and what he offered to others, for as long as he could endure”.

It’s worth reading A Fortunate Man as half of a diptych, followed by this new book, A Fortunate Woman, immediately afterwards. The latter came about through a perfect alignment of coincidences. The author, Polly Morland, is a journalist and film-maker with a kindly, dramatic writing style and a feel for the human story. In 2020 she was clearing her mother’s house, after her mother, suffering from Alzheimer’s, had been moved into a care home. It followed, she writes, a “frightening and chaotic” year of “doctors and paramedics, nurses and social workers”. They had all been “well meaning and professional”, but none had known her mother “before all this started, nor stayed long enough to get to know her now”.

Morland found a book that had fallen behind some shelves. It was A Fortunate Man. When she opened it, she immediately recognised from Mohr’s photographs the valley where she had lived for a decade. Morland didn’t know the book, but she did know the current GP, who had been practising in the valley for 20 years. She wrote to her and received a warm reply. The GP was more than familiar with Berger’s book and Dr Sassall’s reputation; it had formed a crucial part in her own development as a doctor and the choices she had made.

In his portrait of Dr Sassall, Berger is capable of profound insight and political analysis. However, he deliberately ignored the contributions of Sassall’s wife – although the doctor and Betty were a team. A footnote reads: “I do not attempt in this essay to discuss the role of Sassall’s wife or his children. My concern is his professional life.” Could Berger have imagined that Sassall’s 21st-century successor might be a woman? He wrote that “if his training were not so long and expensive, every mother would be happy for her son to become a doctor.” Now most GPs are daughters.

Following Morland’s approach, there followed months of conversations and long walks to build a portrait of a contemporary GP who, like her predecessor, has made the choice, insofar as she is able, to become a lynchpin of “the valley”. In presenting “the doctor”, who is not named, the author removes herself from the text, becoming invisible as a camera, tracking the physician at work and in her leisure (with horses, in nature), going in for a close-up, sometimes panning out to show the whole landscape, listening in on a conversation.

The book maps on to Berger’s by likewise offering some case histories of the kind that might feature in a TV drama. Here too the doctor drives, walks, cycles to remote cottages, to scenes of sadness and dismay, fear, stoicism and horror accidents. (All cases have been “reimagined and reconfigured” so as to retain patient confidentiality.) There are also the day-to-day, in-person, ten-minute appointments – or there were, before the pandemic.

[See also: The best books for summer 2022]

This book deepens our understanding of the life and thoughts of a modern doctor, and the modern NHS, and it expands movingly to chronicle a community and a landscape – “the valley” itself is a defining feature of people’s lives. It explores the choices the doctor made in her young life, and the difficulties, decisions, risk assessments, ethical questions and occasional spells of anguish that make up a GP’s normal day, as well as the jokes, tea and levity. There are farmers so stoical they can go on calving for ten days despite a broken femur, babies with earache, transgender teenagers, bewildered elders, blood and, eventually, Covid. All her patients seem to agree their doctor is “a good listener”.

Listening has become even more crucial. Ten-minute appointments are bad enough. Covid meant doing that behind a mask and face-visor, in scrubs made of old duvet covers. Now there is the telephone consultation. In the before-times, the doctor made a point of accompanying a patient from waiting room to consulting room, because it gave her a chance to assess their mobility and demeanour. Now there is the phone. The doctor has become adept at reading a voice, its hesitancies, emotions, evasions; 16 calls in a morning is the norm.

Every reader will meditate on their own encounters with GPs. Of her doctor, Morland writes: “Her life’s work is not simply about the application of a body of knowledge to an assortment of human objects… it is a pursuit meaningful in and of itself.” The word “relationship” is often used. The doctor says that hers is the only branch of medicine founded on relationships.

There is a compassionate, almost melancholy tone to both books. Perhaps it is the black and white photographs. Morland also worked with a photographer, Richard Baker. Here we have landscapes through the seasons, and shots of the doctor at ease and in action. Perhaps the elegiac touch is because we know that the family doctor is being pushed out of existence. NHS funding cuts mean that GPs are worked into the ground, and patients diverted to call centres. This is a false economy. Morland presents an extraordinary statistic: “a year’s worth of GP care per patient costs less than two emergency presentations at hospital”.

Do away with the local doctor, her bike and wellies, her familiar car, her listening ear, her “accumulated knowledge” of yourself, your family and circumstances, a doctor you say hello to on the street, who recognises you “as a person, rather than a pathology” – remove her, and our whole heath system collapses too.

A Fortunate Woman: A Country Doctor’s Story
By Polly Morland
Picador, 256pp, £16.99