Review published on February 14, 2018.
In this collection of fifty-four essays John Launer explores a wide range of topics, and dilemmas, which confront doctors, and their patients, during the practice of medicine. A central theme is that doctors need to find ways of being more authentic in their interactions, to discover how to step outside the sometimes too narrow constraints of their professional personas and to learn to truly listen to what their patients are trying to communicate. His experiences, both as a GP and as a medical educator, enable him to write with authority about the complexities of what is involved in becoming a good doctor, one who listens to and respects his patients, sees them in a holistic way and involves them in the search for a diagnosis and in any subsequent treatment plans.
Whilst able to be constructively critical and challenging of the behaviour of some of his colleagues it became clear that the author fully recognises some of the pitfalls he and they face when trying to do their best in the huge, often unwieldy and increasingly bureaucratic, NHS. His reflections always felt very balanced and his respect for most of his colleagues, as well as patients, underpinned all his writing. He writes with eloquent passion, gentle humour and occasional rage, managing to combine a degree of entertainment with his role as an educator in a way which is both impressive and for me, as a former psychotherapeutic counsellor and lecturer, enviable!
In essay 42, entitled “Close Readings” he drew on his English studies, at school and university, which required students to concentrate closely on just a few lines of poetry, or a paragraph from a novel. The aim of this close and critical scrutiny was to attempt to understand not only what it was that the author was trying to communicate, but also what could be learnt from this to gain insights into life and the human condition. His belief that this approach should be an integral part of the training of medical students, and of ongoing training, is one which would surely reap dividends – for doctors and patients alike! I think that just one of the many reasons that this book has made such a profound impact on me is because each one of his essays seems to encapsulate this approach.
In his essay on “Taking Risks Seriously” he explores how occasional “courageous and effective risk-taking” with their own emotional reactions can enable doctors to engage more effectively with their patients. He believes that this used to happen more in the past, when GPs often got to know their patients over many years. However, they have become increasingly risk-averse because they are now more fearful of “lawyers, managers, commissioners and regulators” and are therefore more inclined to “follow orders”, to take refuge within strict boundaries. Through reading this collection of essays it became clear to me that John Launer is someone who is prepared to take emotional risks in his interactions because he believes passionately that relationships matter between doctors and patients and can often be an essential tool in the diagnostic process.
It is impossible to really do justice to this book without taking each and every essay and subjecting it to the “close reading” recommended by the author. However, if I were to do that I would be writing a review which would be almost as long as the book! As this isn’t possible, all I can do is implore you to get a copy and discover its powerful reflections for yourself. I know that it is one to which I will return because there is such depth in these essays, none of which is longer than four pages but each of which is thought-provoking and wise.
I also find myself wanting to suggest that, not only should it be essential reading for every single medical student, but that every qualified doctor should be required to re-read it every year in order to reflect on the wisdom, caring and respect for patients which are contained within it – and then to ensure that they incorporate these same qualities into their ongoing practice!
Linda Hepworth 5/5
How Not to be a Doctor by John Launer
Gerald Duckworth & Co Ltd 9780715652145 hbk Apr 2018
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