From Balint to square-bashing: 50 years’ experience of general practice

Published on Jul 1, 2016in British Journal of General Practice5.386
· DOI :10.3399/BJGP16X685921
David Zigmond3
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Abstract
Health care’s increasing employment of complex technology is often accompanied by a disinheritance of our human complexity. This inverse relationship is undesigned but ever-more important since ‘modernisation’ promises beneficent efficiency for all, yet our common experience is, increasingly, of enduring amidst stressed demoralisation. The profound cultural changes are paradoxical, complex, and difficult to understand. The following personal history offers an explanation: ‘ The truth is rarely pure and never simple. ’(Oscar Wilde, The Importance of Being Earnest , 1895). Nearly 50 years ago, as a medical student, I chose to stay with a country town GP, Samuel, to experience general practice. He was a subtly-mannered man whose open intelligence and warm heart had found a welcome home in his work. What I witnessed, and what we then spoke about, roused the beginnings of my own lifetime vocation. Samuel urged me to read a recently-published book that, he said, was greatly helping his work’s sense of personal purpose and direction. The book was The Doctor, His Patient And The Illness. I had not heard of either the book or its author, an older Hungarian refugee and psychoanalyst, Michael Balint. Samuel described his understanding of the book and its history — how Balint had become interested in the inexplicit and unformulated personal aspects of illness patterns and behaviours, and how these were reflected in broader, recurring themes — in patients’ lives, and then in the consulting room. Balint wanted to explore, with doctors, the personal experiences beyond designatory diagnoses and treatments: the realms of human meaning and understanding. To fulfil this quest he captured the intellectual interest and then time commitment of a few London GPs, initially for a decade. They met weekly to describe, explore and understand their emerging human stories and experiences with patients. This was done through candid, …
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1 Author (Pardeep Grewal)
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Zigmond’s article in the July BJGP is brilliant.1 It describes to us exactly how personal contact has been replaced by computers. Although I am retired, I resent this modern intrusion. I have heard anecdotally of patients saying …
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