A Fortunate Man: The Story of a Country Doctor

How is it that Sassall is acknowledged as a good doctor? By his cures? This would seem to be the answer. But I doubt it. You have to be a startlingly bad doctor and make many mistakes before the results tell against you. In the eyes of the layman the results always tend to favour the doctor. No, he is acknowledged as a good doctor because he meets the deep but unformulated expectation of the sick for a sense of fraternity. He recognizes them.

This individual and closely intimate recognition is required on both a physical and psychological level. On the former it constitutes the art of diagnosis. Good general diagnosticians are rare, not because most doctors lack medical knowledge, but because most are incapable of taking in all the possibly relevant facts - emotional, historical, environmental as well as physical. They are searching for specific conditions instead of the truth about a man which may then suggest various conditions. It may be that computers will soon diagnose better than doctors. But the facts fed to the computers will still have to be the result of intimate, individual recognition of the patient.

On the psychological level recognition means support. As soon as we are ill we fear that our illness is unique. We argue with ourselves and rationalize, but a ghost of the fear remains. And it remains for a very good reason. The illness, as an undefined force, is a potential threat to our very being and we are bound to be highly conscious of the uniqueness of that being. The illness, in other words, shares in our own uniqueness. By fearing its threat, we embrace it and make it specially our own. That is why patients are inordinately relieved when doctors give their complaint a name. The name may mean very little to them; they may understand nothing of what it signifies; but because it has a name, it has an independent existence from them. They can now struggle or complain against it. To have a complaint recognized, that is to say defined, limited and depersonalized, is to be made stronger. The whole process, as it includes doctor and patient, is a dialectical one. The doctor in order to recognize the illness fully - I say fully because the recognition must be such as to indicate the specific treatment - must first recognize the patient as a person: but for the patient - provided that he trusts the doctor and that trust finally depends upon the efficacy of his treatment - the doctor's recognition of his illness is a help because it separates and depersonalizes that illness.

However, re-reading it at one sitting very recently, I recognised the limpid beauty of some of Berger’s prose, the subtlety of his descriptions of nature and of human interactions, and his insights into the needs of ordinary people faced with illness, anguish and loss. His – or is it Sassall’s? – understanding of the role of the general practitioner as a witness and a “clerk of record”, needs to be widely understood, and never more so in these days of therapeutic miracles and performance indicators, when the unmeasurable essence of patient care can so easily be overlooked.

Speakers will include Iona Heath, Tony Calland (who was a partner in John Sassall's practice), Patrick Hutt (a recently qualified doctor and author of Confronting an III Society), Jane Simpson (junior doctor), Michael Rosen (broadcaster and writer) and Sukhdev Sandu (critic and writer). They will talk about what the book means to them and what it still has to tell us almost four decades after it was first published.

On the evening of 26 April 2005, nearly forty years after its publication, and as part of a short London season of events based around the work of John Berger, over 200 people, many of them doctors, packed into one of the lecture theatres at Queen Mary College, London, to testify to one extraordinary book which had shaped their lives and political beliefs. The event was sponsored by the Royal College of General Practitioners, who have just republished it.

How is it that Sassall is acknowledged as a good doctor? By his cures? This would seem to be the answer. But I doubt it. You have to be a startlingly bad doctor and make many mistakes before the results tell against you. In the eyes of the layman the results always tend to favour the doctor. No, he is acknowledged as a good doctor because he meets the deep but unformulated expectation of the sick for a sense of fraternity. He recognizes them.

This individual and closely intimate recognition is required on both a physical and psychological level. On the former it constitutes the art of diagnosis. Good general diagnosticians are rare, not because most doctors lack medical knowledge, but because most are incapable of taking in all the possibly relevant facts - emotional, historical, environmental as well as physical. They are searching for specific conditions instead of the truth about a man which may then suggest various conditions. It may be that computers will soon diagnose better than doctors. But the facts fed to the computers will still have to be the result of intimate, individual recognition of the patient.

On the psychological level recognition means support. As soon as we are ill we fear that our illness is unique. We argue with ourselves and rationalize, but a ghost of the fear remains. And it remains for a very good reason. The illness, as an undefined force, is a potential threat to our very being and we are bound to be highly conscious of the uniqueness of that being. The illness, in other words, shares in our own uniqueness. By fearing its threat, we embrace it and make it specially our own. That is why patients are inordinately relieved when doctors give their complaint a name. The name may mean very little to them; they may understand nothing of what it signifies; but because it has a name, it has an independent existence from them. They can now struggle or complain against it. To have a complaint recognized, that is to say defined, limited and depersonalized, is to be made stronger. The whole process, as it includes doctor and patient, is a dialectical one. The doctor in order to recognize the illness fully - I say fully because the recognition must be such as to indicate the specific treatment - must first recognize the patient as a person: but for the patient - provided that he trusts the doctor and that trust finally depends upon the efficacy of his treatment - the doctor's recognition of his illness is a help because it separates and depersonalizes that illness.

However, re-reading it at one sitting very recently, I recognised the limpid beauty of some of Berger’s prose, the subtlety of his descriptions of nature and of human interactions, and his insights into the needs of ordinary people faced with illness, anguish and loss. His – or is it Sassall’s? – understanding of the role of the general practitioner as a witness and a “clerk of record”, needs to be widely understood, and never more so in these days of therapeutic miracles and performance indicators, when the unmeasurable essence of patient care can so easily be overlooked.

Speakers will include Iona Heath, Tony Calland (who was a partner in John Sassall's practice), Patrick Hutt (a recently qualified doctor and author of Confronting an III Society), Jane Simpson (junior doctor), Michael Rosen (broadcaster and writer) and Sukhdev Sandu (critic and writer). They will talk about what the book means to them and what it still has to tell us almost four decades after it was first published.

On the evening of 26 April 2005, nearly forty years after its publication, and as part of a short London season of events based around the work of John Berger, over 200 people, many of them doctors, packed into one of the lecture theatres at Queen Mary College, London, to testify to one extraordinary book which had shaped their lives and political beliefs. The event was sponsored by the Royal College of General Practitioners, who have just republished it.