It's unfashionable to say it, but I really enjoy seeing my patients. They are warm, trusting, and they immensely appreciate what we do for them.

Most practices have an exact cross-section of the local population on their lists, so we see the whole variety of personalities and approaches to life that makes working with people such a pleasure.

As time goes on, it becomes more than a purely clinical doctor-patient relationship.

Let me give you some examples. I've changed the names to preserve confidentiality.

Sam
16 years ago I attended a home delivery in the early hours of the morning. To be honest, the baby arrived so quickly that I arrived just too late. The delightful parents had just had their third child.

Sam was a lively little boy. I saw him and his parents often because of his severe eczema and asthma. He was always cheerful, even when scratching away.

Recently, in a local restaurant with my family, I noticed one of the young waiters giving me a grin - it was Sam in his first job.

Mr & Mrs Jamieson
This couple is in their late seventies. Mr J had an MI 15 years ago, and one of my GP colleagues resuscitated him when he had a cardiac arrest. This didn't stop him being a workaholic, and he continued to enjoy working until well into his 70s. He saw me for his yearly CHD (coronary heart disease) check, and for "permission" to go on working.

Mrs J, as cheerful as her husband, saw me for regular hypertension checks and to attempt (unsuccessfully) to get me to persuade her husband to retire.

Unfortunately, last year Mr J had a severe stroke. He was too disabled for his wife to be able to look after him at home and he now lives in a local nursing home. It's been very sad to see such a positive, active man suddenly become so severely disabled.

In spite of the appalling disability resulting from the stroke and subsequent depression, I still enjoy seeing them and trying to help them. Both are desperate for him to go home, and we are trying to arrange some trial home visits.

George
George was in his late 50s. Sadly, early last year he was found to have inoperable cancer. On discharge from hospital he was suffering from severe nausea, lethargy and abdominal pain form his liver metastases.

I visited him at home and, with the help of his wife, worked to get his symptoms under control. We discussed his diagnosis and prognosis - I was struck by his quiet, fatalistic approach.

Typically, as soon he was feeling well enough he insisted on coming to see me at the Surgery rather than letting me visit him.

As time went on, he needed increasing levels of medication to ease his symptoms. I came to admire his and his wife's love for each other, and the way that each helped the other - and their doctor - come to terms with his decline.

He died at home with his family around him. I was pleased by how full the Church was at his funeral - it's easy for us to forget how what happens to one of our patients can affect such a large number of people.

The next week the family came to see me at the surgery to say "thank you". It was an emotional meeting for all of us.

So, what's the down side?
I do get upset by patients' diagnoses and their deaths. I naively thought that this would get easier as time went on - it doesn't. The longer you're in a practice, the more emotionally attached you gets to your patients, and the more difficult it is to dissociate yourself.

Another point: as we have cross-section of the local community on our list, we also have our fair share of less pleasant patients. Luckily, this is a minority, albeit a memorable one. Also, most people are on their best behaviour when they come to see us.

For that small number of patients that you don't enjoy seeing, there is no easy way out - they will continue to be your patients until you or they move away.

Written by: Michael Harris

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This page was last updated on: 26 January 2008