All photography: Richard Baker, from A Fortunate Woman (Picador, out 9 June 2022)
NASGP: Hi Polly. When you were writing ‘A Fortunate Woman’, what was it like shadowing the GP?
Polly Morland: Well, how the book came about in the first place is probably part of this story. This wasn’t a story that I’d set out to find – in a sense, the story found me.
I discovered the dusty old Penguin paperback from the late 1960s down the back of my elderly mother’s bookcase. She had just moved into a care home and I was clearing her house when I found this copy of ‘A Fortunate Man’, by John Berger.
I’d read some Berger before but I had not read this. I opened it and as many of your readers will know, the book contains these rather haunting black and white photographs. I saw a photograph of a landscape, specifically the valley that I live in. This was an astonishing moment, I was thinking, hang on: a book about a country doctor based in the valley. Because we are a small community, I know of the general practitioner who serves that community today. And I knew that she was well respected and loved by the community here.
So I got in touch with the doctor and I asked her: Have you ever come across a book that was written during the 1960s about the GP working in this area? And she said yes, it had a huge influence on her when she was a teenager, and when she went on to training.
Before we started, we had a fairly complicated discussion over some weeks, back and forth, to try and work out how we could work together. We knew we had to work in a way that didn’t undermine doctor-patient trust and ensure that the process was absolutely watertight from a confidentiality point of view. But from the beginning, for both the doctor and for myself, there was a sense of serendipity in this story coming together. We both felt strongly that it was an incredibly important time to revisit that story: because so much has changed in those five decades since the original book was written.
‘[Baker’s] photographs both give a sense of the place in which the story is set this valley, its woods and its river, and some of the people who live there.’ (Photograph by Richard Baker, taken from ‘A Fortunate Woman’ by Polly Morland, 2022).
But secondly, there was the pandemic. There were periods when I couldn’t be in the surgery at all because it would have undermined covid protocols. So instead we took a lot of very long walks together in this ravishing landscape in which we both live. We’d walk in the woods or along the river, often in the evening because that’s when the doctor wasn’t working. We would put on head-torches and we would walk and talk about what it means to be a doctor in a place like this, and at a time like this , when primary care was under unprecedented pressure.
It was very much a relationship that evolved over many months. This kind of journalistic access has a tempo to it that’s both more measured and more organic. There’s something really rich that has come from this more protracted period of contact with the doctor in the book that has allowed me, as a journalist and documentarian, to dive deeper.
I should also mention the photographs. Just as John Berger’s ‘’A Fortunate Man’’ included these beautiful black and white photographs by Jean Mohr, ‘’A Fortunate Woman’’ has wonderful black and white photographs taken by a brilliant documentary photographer, Richard Baker. I’ve worked with him before on another book.
His photographs both give a sense of the place in which the story is set this valley, its woods and its river, and some of the people who live there and he also took some photographs, with patient consent within consultations at the surgery. Now, obviously, for reasons of confidentiality, the photographs of consultations don’t connect to any particular story in the book. But they do give a visual sense of that doctor-patient relationship in a way that I think is vivid, and I really hope adds to the storytelling.
NASGP: I wonder whether your doctor ever gave you feedback on how she found the process.
PM: Yes, she did. We talked a lot throughout. We were feeling our way. The book at some level is about trust, and the nature of trust and how you build trust in a medical context and with patients. It is about the relationships and the mutuality of that trust. In some tiny way, our own process together was itself one of building trust, flowing in both directions. It was built in a gradual way. I’m sure there were times when the doctor must have thought, my goodness, do I have time for this? She’s an extraordinarily busy woman, and is a quite astonishing figure in terms of energy, both physical and intellectual, and curiosity. We just, between us, worked it out as we carved out the time.
The doctor said something really interesting to me quite early on in the process, I think it was in an email: ‘I really enjoyed our conversation the other day, she said. As GPs, we’re taught to listen. So it’s really unusual to talk about yourself and your own work.’
I think she found the process time-consuming at points, but rich and interesting too. This is, to some extent, the power of the documentary process. There’s something about explaining your world to an outsider, who asks questions about why it’s important and what’s important in a way that is valuable in all sorts of walks of life.
So certainly, my impression was that she found it positive. Feeling as passionately as she does about relationship-based care, her practice and community, and her place within the NHS and the Royal College of General Practitioners, having the chance to talk about why the doctor-patient relationship matters so much, was something of enormous value to her I think.
‘Anonymity also allows those bigger, broader, more universal ideas to float to the surface’. (Photograph by Richard Baker, taken from ‘A Fortunate Woman’ by Polly Morland, 2022).
Her anonymity is at one level a way of creating discretion around her professional practice and around this quite small community. The book wasn’t, for her, about putting herself centre stage or getting 15 minutes of fame. It’s about showing rather than telling, and using stories as a way of exploring ideas – using stories almost as a tool to explore some of those ideas. So at another level, there’s a sense in which, in a deep way, the anonymity also allows those bigger, broader, more universal ideas to float to the surface.
In this respect, I was greatly influenced by reading Berger because there’s a universality about the doctor in ‘A Fortunate Man’. Dr Sassall is a pseudonym, it’s not the old doctor’s real name. I felt that there was something valuable about that approach in terms of stripping back the layers and, and reaching for something universal about the doctor-patient relationship and how it plays out today, 20 years into the 21st century.
NASGP: What surprised you, and what did you learn about general practice?
PM: This will appear comic to an audience of general practitioners, but as an outsider, a non-medic, the sheer range and scope of what you’re dealing with – in a morning surgery, for instance – was really surprising. It blew my mind that you might one minute be dealing with a very, potentially dangerous mental health crisis, then you’re dealing with maybe you’re dealing with the safeguarding issues, and maybe you’re dealing with some bunions.
That sheer scope and range, and at such speed! Holding all of that, in real time, was astonishing to me and helped me appreciate the work of general practitioners. You have to reset every 10 minutes, reset, reset, reset, in order to approach the next consultation with a kind of a blank slate and an open mind and a listening ear. To be able to do that was astonishing to me.
I suppose the other thing that surprised me was the extent to which this story of an individual rural GP, working 20-plus years in the same small community, how that story actually touches on issues that are tremendously current, and hotly debated within the Royal College as well as medicine at large. Just a few weeks ago, I watched an online session of the Commons Health And Social Care Committee on continuity of care. Some of the issues the doctor and I had been discussing, in this one particular story and one particular setting were in fact ideas that ripple out right across general practice. It gave the project a real and renewed momentum. The further the research progressed, it began to feel more and more important to tell this story.
NASGP: What kind of feedback have you had from readers so far?
PM: So the book’s only just come out, so we’re at the moment where one hopes that it will be read and enjoyed by people both within medicine and beyond. I mean, that’s been a real balancing act, you know how you want a story that will be resonant for doctors who, at some level, knows lots of this already. So how do you tell a story that is engaging, profound and meaningful for them, but also appeal to a broader, wider mainstream readership?
We’ve had lots of very positive feedback from within the medical academy. Hearing it from doctors felt like a source of enormous relief to me, because I was apprehensive as to how the book would land within the medical community.
It felt to me that it was time to tell this story about the value of the relational within general practice. Much of the medical literature does so in terms of facts, figures, studies and percentages, but stories have their place as well. And that’s really what I do as a storyteller: to tell stories that in some senses inform that body of scholarship around general practice, that lie behind that research: well that felt like a really valuable thing to do.
Of course I also want readers outside medicine, as well as within medicine, to read ‘A Fortunate Woman’ because, above all, it’s their story. It’s a story about patients. And it’s the story of why we have to look after primary care. And why do we really have to fight for what’s valuable within this backbone of the NHS.
