A Fortunate Woman: A Country Doctor’s Story - The Top Ten Bestseller, Shortlisted for the Baillie Gifford Prize

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In May, the Commons Health and Social Care Committee held an evidence session on continuity of care. They heard from Dr Jacob Lee about what it’s like to see someone in a practice that doesn’t have personal lists. “You are trying to read their notes and get a feeling for what has been happening in the past. It makes the consultation really challenging when you are looking at blood test results and letters for patients you do not know because they are split between the different GPs who are in that day. It is so inefficient and difficult to try to do a good job for that individual.” A remarkable, gripping and inspiring book that itself must surely become recommended reading for today’s trainee GPs… a gust of fresh, clear, contemporary air. Reading the Forest

A Fortunate Woman review: John Berger’s classic upated - New

I loved this book. It has, at its core an examination of what used to be called a "family doctor" embracing the element of continuity of care. Sadly, although modern general practice (and many patients) aspires to cling to this principle, it has been eroded year on year by both the pace of life and the number of doctors per capita. The Aspen partnership merged five smaller practices in a purpose-built complex, in common with trends across the country, to give it the scale to create specialist teams and to spread risk. “There is,” Hodges says, “always the threat in small partnerships of being the last man standing; if you are in a partnership of two and your partner resigns then you have all the financial liability of an asset you are not allowed to sell.” You have the sense that making 100 potentially hazardous decisions an hour takes its toll. It’s one of the reasons that it’s hard to retain reception staff, though most here have been in the job for several years. “The anger has got much worse,” Hodges says, “whipped up by parts of the press.” He shows me a report of an earlier call where a patient had screamed abuse. This was “Dr John Sassall”. How capable he was, how eccentric, how dedicated and how unlikely, nowadays, was revealed in John Berger’s classic 1967 book A Fortunate Man. Sassall was a friend and Berger shadowed him for some months, along with the Swiss photographer Jean Mohr. The subtitle of their collaboration is The Story of a Country Doctor. It is not a story as such; it proceeds through a series of vignettes, psychological explorations, case studies and in-depth enquiries into the relationship between one man and his calling, his patients and his environment.Listening has become even more crucial. Ten-minute appointments are bad enough. Covid meant doing that behind a mask and face-visor, in scrubs made of old duvet covers. Now there is the telephone consultation. In the before-times, the doctor made a point of accompanying a patient from waiting room to consulting room, because it gave her a chance to assess their mobility and demeanour. Now there is the phone. The doctor has become adept at reading a voice, its hesitancies, emotions, evasions; 16 calls in a morning is the norm. Morland writes about nature and the changing landscape with such lyrical precision that her prose sometimes seems close to poetry' - Christina Patterson, The Sunday Times This will have an impact on all of us at some point. But without more widespread recognition of the problem, we might not even notice what we are missing out on. A longitudinal study of continuity of primary care in England published in 2021 showed that not only were fewer patients able to see their preferred GP, but fewer even had a preferred GP in the first place. We have, it seems, forgotten to expect, or even to want, a doctor who knows our stories. That experience of a doctor-patient relationship that’s more than transactional is slipping from collective memory. And if it’s something you have never known, why on earth would you cherish it, or fight for it?

A Fortunate Woman - Polly Morland

Morland writes about nature and the changing landscape with such lyrical precision that her prose sometimes seems close to poetry . . . There has been no shortage in recent years of books about healthcare . . . With this gem, Morland has done something similar for general practice. Let’s just hope the policymakers listen. The book maps on to Berger’s by likewise offering some case histories of the kind that might feature in a TV drama. Here too the doctor drives, walks, cycles to remote cottages, to scenes of sadness and dismay, fear, stoicism and horror accidents. (All cases have been “reimagined and reconfigured” so as to retain patient confidentiality.) There are also the day-to-day, in-person, ten-minute appointments – or there were, before the pandemic. Timely… compelling…[the] vital perspective of a single frontline clinician… A delicately drawn miniature. Financial Times In his portrait of Dr Sassall, Berger is capable of profound insight and political analysis. However, he deliberately ignored the contributions of Sassall’s wife – although the doctor and Betty were a team. A footnote reads: “I do not attempt in this essay to discuss the role of Sassall’s wife or his children. My concern is his professional life.” Could Berger have imagined that Sassall’s 21st-century successor might be a woman? He wrote that “if his training were not so long and expensive, every mother would be happy for her son to become a doctor.” Now most GPs are daughters.Insightful, moving … instructive when so many practices are in crisis. A Times Audiobook of the Year 2022 In A Fortunate Woman, with its beautiful photographs by Richard Baker, Polly Morland has written a profoundly moving love letter to a landscape, a community and, above all, to what it means to be a good doctor. The anonymous inspiration of Morland’s book – who becomes a kind of emblematic GP everywoman – is Dr Rowena Christmas. I spoke to her about some of the book’s implications, and her current practice in Monmouthshire. She outlined the weight of medical evidence that supported Morland’s argument. “If you have an ongoing medical problem, you’re better to see the doctor that you’ve been seeing regularly. Studies that show that patients who’ve seen the same GP for a year or longer are 25% less likely to use out-of-hours services or be admitted to hospital in emergency, and have better outcomes in all sorts of ways.” A Fortunate Woman’ is the best book I’ve read about general practice for a long time. Astonishingly perceptive, it shows how a committed GP can keep human values alive in an increasingly impersonal NHS – and why we urgently need more like her. Professor Roger Neighbour OBE, former President, Royal College of General Practitioners

A Fortunate Woman by Polly Morland | Baillie Gifford Prize A Fortunate Woman by Polly Morland | Baillie Gifford Prize

I laughed out loud at several scenes, and wiped away tears at others; this evoked human drama and life’s ebbs and flow in all its complexity, bound up by a love for the wild surroundings of the valley practice, haunted and inspired by the original book (and GP) on which this is based: “A Fortunate Man.” Rachel Rutter near her practice in Stroud. ‘For a long time now, we have in essence been firefighting the daily triage list.’ Photograph: Gareth Iwan Jones/The Observer

Morland writes about nature and the changing landscape with such lyrical precision that her prose sometimes seems close to poetry’ - Christina Patterson, The Sunday Times A beautifully written book about a doctor working as a general practitioner in the Wye Valley. The book focuses on the relationship between the doctor, her community and the landscape. I know this not because I am a doctor myself, but because I’ve spent the last two years studying one. Over many months, I observed a remarkable female GP at work in the same rural practice portrayed in A Fortunate Man, John Berger’s classic account of a country GP in the mid 1960s. In the course of around 130,000 patient encounters over more than 20 years, she has built something that many doctors no longer enjoy: high-quality, longstanding relationships with her patients. If the title seems familiar to you, it is because it is inspired by the book A Fortunate Man. Written by John Berger this book blended text and photographs to tell the story of a country GP named John Sassall working in the same valley in the Forest of Dean in the 1960s. Long considered a medical classic, students and trainees have been encouraged to read it ever since and it is said to have inspired many doctors into General Practice, including the GP in A Fortunate Woman. Guilty confession: I didn’t like it. Sassall’s evolution in the book from a narrow-minded surgeon intolerant of minor complaints to holistic, patient-centred GP is revealing but I found the prose dense, the philosophical allusions opaque and Sassall as a character obsessive, dogmatic and at times unlikeable. I was consoled and compelled by this book’s steady gaze on healing and caring. The writing is beautiful' - Sarah Moss, author of Summerwater and Ghost Wall

A Fortunate Woman: A Country Doctor’s Story Kindle Edition A Fortunate Woman: A Country Doctor’s Story Kindle Edition

Last week, I went to Gloucester to see a doctor. I was armed with headlines that placed the city and its surrounding county at the sharpest end of the current crisis in general practice. More than 30,000 patients in Gloucestershire had to wait more than a month for a GP appointment in September, a figure that had doubled in a year. Meanwhile, since the pandemic, doctors and nurses and reception staff have been leaving jobs and partnerships in unprecedented numbers. (There is a current shortfall of at least 4,200 GPs across England, with notable gaps in the south-west.)

It’s the boiling frog analogy,” Hodges says. “The water’s not been comfortable for a decade, but it’s now very noticeably warmer. It will soon reach a threshold where there is a collapse.” All human life is here in this evocative portrayal of the challenges and joys of rural family doctoring in modern times. Enthralling and uplifting. James Le Fanu, author of The Rise & Fall of Modern Medicine I was consoled and compelled by this book’s steady gaze on healing and caring. The writing is beautiful. Sarah Moss, author of Summerwater and Ghost Wall This was exactly my cup of tea. A beautifully written portrait of a rural GP whose tender care for her patients elicits such trust, admiration and even friendship that it seems almost alien in our transactional medical system. I thought this book was brilliant. In all honesty, I assumed when I first saw the title that it was a straightforward memoir by a country GP, written by her, the usual run of the mill type stuff. Little did I know it was linked to a previous book A Fortunate Man: The Story of a Country Doctor, and the GP practice in Morland's title is the same one as featured in that book.