The patient-clinician relationship is at the core of medicine. Morland shares the story of a country doctor to illustrate how healthcare has evolved from doctor- to relationship-centered care.
Some books transcend generations. And some books lead us to other books, and this is certainly true with Polly Morland’s brilliant and timely analysis of “A Country Doctor’s Story.” Her book is both a sequel and a non-sequel to John Berger and Jean Mohr’s “A Fortunate Man (AFM),” published in 1967.
Morland discovered the book at the back of her parent’s bookshelves: “I found a book, unopened for nearly fifty years,” that led her to discover that she knew the place that Berger was writing about. “I knew that river, that field. I knew that tree.” That marvelous, serendipitous moment led to Morland writing “A Fortunate Woman (AFW),” realizing that there was a strong connection between the country doctor in Berger’s book and in her book; they were both running the same rural general practice but with a time-lapse of about fifty years.
The coincidences don’t stop there. A year ago, I mentioned to the GP and writer Dr. Gavin Francis about my wish to lecture on AFM with my colleague Dr. Theodora Tseligka. Dr. Francis wrote the introduction the 2015 edition: “’A Fortunate Man’ is a masterpiece of witness: a moving meditation on humanity, society, and the value of healing.’” He sent me a copy of his review of Morland’s book, in which he writes about “Morland’s reflective and insightful book about those meetings and conversations [with the woman GP], examines the work of the GP and is, therefore, a tribute to ‘A Fortunate Man,’ as well as a re-examination of its themes . . ..”
These interweaving and entangled coincidences are breathtaking, but we will concentrate on Morland’s re-examination of themes since they are fundamental for the future well-being of the doctor-patient relationship, which has been, is, and should always remain, the core of medicine.
“A Fortunate Woman” is a story about the life and work of a female GP, who, after spending a few years in a sought-after position as a junior doctor in a busy London hospital, decides to quit this “conveyor-belt culture” and relocates–unknowingly–to the same valley where John Berger’s protagonist had practiced, another “fortunate” coincidence. She highlights that here she gets to spend time with the patients of the small community and establish a continuity of care. She can avoid complacency and develop a closer relationship with the patient as a person; effectively, this GP is “fortunate” to be able to relish the encounters with her patients as a unique opportunity to listen to their stories, have difficult conversations, and ultimately, care for them with decency and kindness until the end of their days.
For Morland, being a doctor is a state of “becoming rather than knowing,” building a more holistic relationship-based medicine that relies on self-awareness, empathy, compassion, honesty, and trust. It’s exactly this trust that encourages patients to disclose their innermost thoughts (like, “my body does not match me”) and awkward moments of truth (“I wanted you to know, doctor, and I do feel better for telling you about it. Less breathless, I think. Thank you.”
This book unveils the challenges of a modern female GP, who’s driven by “a crushing sense of responsibility” to offer the best possible care–even during the terrifying hardships of the pandemic–while managing her fears candidly, as well as the accompanying emotions and personal insecurities. Most notably, the story unfolds amidst a scenic landscape that is a prominent character in the book, as depicted by the beautiful black and white photographs by Richard Baker, “which is like a book that cannot know who will read it, or how its stories will shape their lives.”
It’s a celebration of life’s journey with all its unpredictable permutations and uncertainties, in nature and human life, that requires “a diligent and adaptive engagement of both heart and head” to address. This book should most definitely be read together with Berger’s since students and practicing doctors will be reminded of the core of medicine: the doctor-patient relationship. Morland emphasizes how medicine has transformed from doctor-centered care to patient-centered care to relationship-centered care. This should never be forgotten, now more than ever.
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.