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Towards an understanding of the flourishing practitioner
  1. P D Toon
  1. Correspondence to Dr P D Toon, Centre for Health Sciences, Institute of Health Sciences Education, Queen Mary, University of London, Abernethy Building, 2 Newark Street, Whitechapel, London E1 2AT, UJ; p.d.toon{at}qmul.ac.uk

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Dr J is nearing retirement. She has been a partner in her practice for 20 years, and before that an assistant in another practice for 7 years. Most mornings she looks forward to the day’s work. She has known many of her patients for years, and their visits feel like meeting old friends; they in turn are always pleased to see her. Her surgeries usually run late but no-one minds much. She attends a refresher course at her old medical school each year, and thumbs through the BMJ most weeks. Two evenings a week are devoted to her other great passion, choral singing, while weekends are spent visiting friends or with her grandchildren. She is a fortunate woman.

Dr K can’t wait for retirement. He is bored and irritated with the stream of whining humanity coming through his doors with their trivial, mostly self limiting complaints for which he can do little or nothing—and sometimes he shows it. He feels overburdened by administration, and sickened by the “tick-box” culture which has overtaken general practice. His patients frequently grumble about him to the receptionists (who in turn grumble among themselves about his poor timekeeping and the unwillingness of patients to see him). He lives for evenings when he does crossword competitions and weekends when he mends and races classic cars. He is an unfortunate man.

There is much discussion of low morale within the medical profession, and lack of confidence in the profession from outside it.1 There is an extensive literature on burn out2 and on the sick doctor.3 Reading this, one would imagine that no one would willingly take up medical practice, and any sane person would be anxious to abandon it. In fact, despite the difficulties and demands, many doctors appear to find their work interesting …

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