Author: Polly Morland (with photographs by Richard Baker)
Publisher: Picador, London UK, 2022
Paperback ISBN 978-1-5290-7114-6
A fortunate woman: A country doctor’s story is a contemporary portrayal of the life and work of a female country general practitioner (GP) in a small and isolated rural setting in the UK. Over 50 years earlier, the author John Berger and photographer Jean Mohr spent 6 weeks in the same place and published a book, which is also a portrait – in both words and pictures – of Dr John Sassall (a pseudonym), the local GP: A fortunate man: The story of a country doctor.
Polly Morland’s book opens with an engaging story of emptying out her family home after her mother died. At the back of a bookcase, a paperback copy of Berger and Mohr’s book falls out. On opening it, she sees a photograph of a rural scene and then recognises that it was taken in the same rural valley where she lives. From this happenstance, she makes contact with her local GP, Dr R, and chronicles her life and work over a 12-month period. This takes place in 2020, when the world and this rural community were reeling with the impact of the COVID-19 epidemic. The additional connection between these two books is the revelation that Dr R read A fortunate man as a high school student and during her medical training years. It was the portrayal of Dr Sassall that inspired her to pursue a life as a doctor. Even more serendipity comes with the reality that she ends up working in his former practice.
Berger’s tweed-coated Sassall is a somewhat idealised and heroic figure. He is very much a solo practitioner. His patients are fortunate to have 24-hour care available to them from a dedicated doctor. But the irony of his involvement in the care of others is that his own story is unfortunately tragic. It is in Morland’s book that we gather more detail of his mental health struggles, the support he gets from his wife and the sad denouement of his life after she died and he retired.
Morland’s portrait of the bike-riding, path-wandering Dr R reads as a more grounded, modern and real-time biography. We learn that she has a supportive family and provides care in a team-based practice. The support she gets and gives to her colleagues is warmly acknowledged by Morland. However, she still has long and difficult working days and nights. Dr R is seen as being fully engaged in providing the essential care that her patients need. Her empathy and rapport are portrayed as extensions of the connectedness and continuity that she has with her rural community. She is also a real person and has her own family and life in the valley.
The books prompt reflections on the differences between the two eras. Dr R is not on call for 24 hours. But she still manages acute life-threatening emergencies and does home visits. There are more referrals, and the surgical procedures that used to be done in the cottage hospital are now undertaken in larger centres. In the valley, the foresters have gone, and the number of farms has shrunk. However, the rurality of the community persists. Dr R provides the same level of continuity of care and knows her patients just as much as Dr Sassall did. They are both keepers of their patients’ stories. But her consultations are portrayed with a much greater expression of patient-centred practice than back in 1966.
The geography, demography, weather, trees, plants and animals are not what you would encounter in an Australian country town. However, it would be a mistake to assume that the experiences depicted in the stories and photographs are just quaint snapshots, peculiar only to Dr R’s British country practice.
The concluding pages of Morland’s book offer a well-researched appraisal of the enormous value of general practice to national healthcare systems. Reflecting on her observations of Dr R’s attributes and skills, she makes a compelling argument. This is for communities and policymakers to not only recognise the value of relationship- based continuity of care, but also promote its underappreciated personal, social and economic value in maintaining the integrity and quality of human life.
A brief review like this cannot do full justice to the richness of the stories and reflections connected to the central theme of what it is like to be a GP, especially one working in a rural setting. All GPs deal with human suffering and provide essential components of whole-person and continuing care. So, the stories in the book do have a universal resonance. If you get a copy and read about Dr R, you may appreciate that some of her experiences and insights are also like your own.