John Sassall is a GP in the Forest of Dean. In the 1960s. Berger and his photographer collaborator Jean Mohr spent three months with him.
Sassall was part of his community. But this is not a romantic story. If exemplifies craft. The continual bringing together of medical training with an intimate understanding of the patients’ social context. In the network meeting it was compared with Richard Sennett’s description of the rhythm of building wisdom, the 10,000 hours or more to master a skill or discipline, the working through resistance and difficulty.
Learning was part of Sassall’s ethic. Knowledge and techniques were constantly evolving. He had to keep up to date. He never rested on ‘common sense’. His relationship to knowledge was dynamic, not static. Nor did he imagine himself to be all knowing. He had the ability to work with uncertainty. He was ready to shift his position.
But there is a paradox.
Sassall was slow. Today GPs are fast. A case every 10 minutes fast.
Sassall read what he wanted to read, and decided on what he counted to be robust evidence. Since the 1980s we have had evidence based medicine.
It is hard to imagine a more relational doctor than Sassall. One more integrated into his community. No doctor could practice like Sassall today.
But the health of the nation was better in the 80s than in Sassall’s 60s. And better again by the turn of the century. (It appears declining again now).
John Berger’s book A Fortunate Man didn’t judge Sassall on these grounds. He judged according to his craft. He asked about the value of soothing pain. Berger asked himself how it compared to the results of his own craft, of writing, or painting. He concluded “Like an artist, or like anybody else who believes that his work justifies his life, Sassall – by our society’s miserable standards – is a fortunate man.”
The inquiry into general practitioner turned mass murderer Harold Shipman ended the practice of lone doctors serving a community. Sassall committed suicide a few years after his wife’s death.
John Berger and Jean Mohr. A Fortunate Man: The Story of a Country Doctor