A Fortunate Man is the story of a community GP, John Sassal, working in the 1960’s in rural England. It is told by John Berger and visualised by Jean Mohr.
Berger describes Sasall’s approach in detail, an approach that goes beyond diagnosis, prognosis, and treatment. He takes an interest in his patients. He respects and demands that people use their agency. He is sensitive. When needed, he pushes people to think further. He is a container of people’s intimate thoughts. Was this the norm then or was Sassall an exception to how doctors treated their patients? How does this approach fit with the 10 minute slots GPs allocate to patients visiting surgeries today?
The doctor took her temperature, looked at her throat and told her to stay in bed for two days. Then he resumed the conversation.
‘Do you like working in that laundry?’
‘It’s a job.’
‘What about the other girls there?’
‘I don’t know.’
‘Do you get on with them?’
‘You get stopped if they find you talking.’
‘Have you thought of doing anything else?’
‘What can I do?’
‘What would you like to do?’
‘I’d like to do secretarial work.’
‘Who would you like to be secretary to?’
She laughed and shook her head.
Living in the context was inextricably related to the doctor’s way of being towards his patients. In his view, the community possessed qualities and a secret of living which he lacked but could learn. Seeing the same faces routinely was to witness how people developed. Berger names Sassall as the “the clerk of the foresters’ records’, a role demanded by the people in the community. They ask him to be an witness of their lives, an objective point of reference, a record they can consult from time to time.
What develops between the doctor and his patients, the people living in the community, is a relationship beyond epithets.
There is a lot of overlap between what Sassall does, and what Rose describes as ‘staying in the difficult middle’. The doctor puts a lot of value on learning and science, but he is not subservient to method and tools. He gets close to the patient to recognise him fully. He sees his illness in the mix of what Berger calls ‘total personality’. Closeness, though, means being part of someone’s anguish. It is not an easy spot for anyone, let alone a specialist. And it can be dangerous, for example when too much attention is placed on the intangible and too little on the good things that have been responsible of progress.
What develops between the doctor and his patients, the people living in the community, is a relationship beyond epithets. Berger does not describe the relationship in terms of adjectives but in terms of a recognition process. Patients come to a/the doctor in need for recognition, of their illness and of their selves. They want the doctor to recognise their illness so they can separate it from their identity. And they want to recognise themselves in the doctor because they want to be known, as individuals. Without this two-level recognition, of seeing the patient as a person, indicating a specific treatment will be difficult.
What is the outcome of an ordinary doctor? Berger argues this is a social question. A better question would be, what is the value of a human life? How can people whose cultural deprivation had made them settled on the foreseen intellectual, emotional, and spiritual mimimim be helped? This is as relevant today as it was in the 1960s.