Ed Hellen Matthews, John Bain
Scottish Cultural Press, £7.95, pp 126 
ISBN 1 84017 030 1
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Rating: ★★★
Resistance to the health reforms of the 1990s has taken many forms, but among general practitioners a recurrent theme has been the threat to personal care and the doctor-patient relationship. Matthews and Bain have set out to show us what it means to be a family doctor in Scotland, in the words of 11 general practitioners practising in a variety of settings. These chatty interview accounts of general practice in deprived inner cities, suburbs, rural villages, and remote Scottish islands and highlands vividly illustrate the meaning of personal care.
In the inner city a 9 year old boy is brought in by his grandmother for a psychiatric referral. She is worried that he will not survive secondary school because he prefers reading indoors to setting cars on fire. Counselling services in the same practice reveal unresolved grief over socially unacceptable deaths such as young men killed while driving stolen vehicles. Island doctors arranging for their patients to get to the mainland hospital by ferry have to cope with cuts in the ferry services. Patients in rural areas make their requests to accommodate their doctor’s schedule, including a man prepared to wait until the next day after a heart attack.
A recurrent theme is the importance of personal relationships and the general practitioner’s role in the community. All the contributors, who are not named, are clearly committed to their patients and to their communities. Terminal care is identified as a particularly rewarding part of general practice. Several comment on the disappearance of the traditional Scottish granny, and how this has increased patients’ dependence on the health service. The fluid boundaries of general practice are a double edged sword: general practitioners participate in people’s lives but increase their workload in doing so. Rationing is an issue: the doctors would rather be their patients’ advocate than the rationer, and health in deprived areas might benefit more from spending on jobs and housing rather than health care. Several contributors pay tribute to their practice teams.
General practitioner educators still use Berger and Mohr’s book A Fortunate Man (published in 1967) as a way of introducing newcomers to a traditional model of general practice, in which the doctor’s role as a member of the community is celebrated. Doctors Talking is a contemporary vehicle for the same kind of message. I think it could be usefully read by medical students, preregistration house officers, and anyone else who wants to know general practice at its best. Its inspiring message may counterbalance the negative images that seem to be deterring young doctors from choosing general practice.