Not all the trainees that came to work with Jessica, now 47, were good. One, Helena Banks, appeared incapable of concentrating for more than forty-five minutes, and had such a ‘direct’ medical approach she habitually missed clues given by patients. Despite all the training, she had not developed any real sensitivity to non-verbal signs, nor an engagement with the emotional side of the job. In Helena, Jessica saw something of her own approach in the early years, when she focussed overmuch on finding pathology, rather than seeking to understand the patient’s response to disease and helping them manage it. Yes, you needed to be a diagnostician, but once the disease, if found, had a name, you had to carry on, and remain engaged. Well that was Jessica’s idea of being a GP.
They met, as trainee and supervisor, and Jessica found herself getting increasingly annoyed. Helena had no insight. She thought she was doing pretty well. Jessica described her observations and how she thought Helene could improve. It didn’t go down well, but nevertheless Helena agreed to try to adopt some of the approaches suggested to her.
The following week Jessica supervised a morning list. A 36 year old father came in. He had been complaining of stomach pain for three months. After three visits, another GP had arranged for him to have an endoscopy at the hospital. All clear. Good news. And here we was today, coming for more advice. Jessica knew this man’s story. He had lost a child to a rare tumour three months before the pain came on.
Helena read through the report. She actually used the words, ‘Good news!’ Nothing wrong here. Sensitive stomach. Nothing more to do. She wasn’t rude, she wasn’t too fast, but she missed the point. It was all related to the man’s bereavement.
Jessica let Helena continue, and watched the poor man leave. As Helena moved to call in the next patient Jessica intervened. She needed to talk. Now.
Helena looked unimpressed by her trainer’s insistence that she should have delved more deeply into the man’s story. What was happening at home? Were there other children? Did the family receive counselling? Was there anything more that could be done? The pain was a manifestation, surely, of the tragedy.
But Helena glanced out of the window.
Is there somewhere you need to be! Jessica almost shouted. She knew now, Helena could not do this job properly. It was time for someone to tell her. She responded only to the most direct approaches.
“Helena. I think I should do the rest of this surgery.”
“Why?” Animosity there.
“You’re… I’m not sure you have taken in what we spoke about the other day. About looking under the surface…”
“You’re saying I’m not a good GP.”
“I’m saying there’s still a lot of room for improvement, outside your diagnostic skills. We can work on it further… but sometimes, it’s necessary to stand back and ask yourself… would you really enjoy a career in this type of medicine? You are still very early on and have options…”
“You think I should give up?”
“No. But I think you need to consider carefully, it’s your entire working lifetime…”
But Helena knew what Jessica meant. And Jessica, having said goodbye to Helena for now, looked up at the ceiling and blew out through pursed lips. God, that was hard.
Only later, during the last consultation, did it dawn on Jessica that she done to Helena as Jeremy Stackson had done to her. Blown her off course. Her words had been delicately silvered, her delivery more thoughtful, but the message was the same. You’re in the wrong game here. You don’t have the equipment. It’s time to leave.
Hard words in a hard world.