Not long after Labour's first landslide victory, I attended a lecture by someone from the Department of Health. It was a rather odd experience. The DoH apparatchik had the appearance one would expect from superimposing all the features of an identikit box: a sort of homogenised Warren Beatty. His prose had the same sort of rather amorphous allure. Both speaker and speech would not have looked out of place in the colour supplements, between an in depth profile of Liz Hurley and a full page advertisement for Häagen-Dazs ice cream. And yet after I had listened to the speech I felt oddly better, in the same way one does after listening to Alastair Cooke on the radio: a wiser person, a confidante. It took some years for the sense of betrayal to be complete.
Last week I sat opposite another apparatchik as he explained that, because our list size was 90 patients short of the required number, we could not have a full replacement for a retiring partner. I tried to explain that we are a small, rural, non-dispensing, low earning practice. I said that we offered an extremely high level of personal care, and that we performed many procedures that would normally be carried out in hospitals. But this was of no interest to him. We were 90 patients short, and that was that.
I returned home, shaking and sweaty. On the kitchen table were piled recent missives from the DoH. They spoke of the need for more doctors, of more support for primary care, of the need for excellence and personal care. The gulf between the vacuous words before me and the unblinking indifference of the bureaucrat was breathtaking.
It was my first brush with the field of medical politics, and I felt stunned and impotent. There was about the experience a surreal passivity I normally associate with dreams: when events implode on you randomly and your fate, like that of Ulysses, is contingent on the petty jealousies of flawed gods.
Richard Smith asked a few weeks ago why doctors were so unhappy. Maybe it is because so much of what we do because we genuinely believe in the NHS is unacknowledged. Maybe it is because we seem to be powerless in the face of autocrats who do not like doctors.
But are we downhearted? Well, yes we are a little, actually.