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At the heart of general practice since 1960

There are times when doing nothing can be meaningful and positive

The Hippocratic Oath tells us to 'first do no evil'. It is a diktat that GPs can readily identify with, as for many of the patients we see each day there is little that can be done. And little that should be done, beyond listen, sympathise and chronicle suffering.

The Hippocratic Oath tells us to 'first do no evil'. It is a diktat that GPs can readily identify with, as for many of the patients we see each day there is little that can be done. And little that should be done, beyond listen, sympathise and chronicle suffering.

Much of my daily surgery consists of people I know. When I arrive and look at my list I can see a mental image of all the patients who are due to see me. I know their little idiosyncracies, their histories and life stories, and also my own role in looking after them. My own little room is a statement of who I am and what I am like as a doctor.

On the wall I have a framed copy of the Hippocratic oath that I bought from a shop in Delphi, Greece, a few years ago. Now I don't think I qualify as an oracle at all, and indeed many might regard this little framed picture as something of an affectation. Every now and again I look at it and muse on the third of a century I have called myself ‘doctor'. What does it signify, apart from a little tourist tat?

But it should mean something to all practising doctors, and the main thing is says to me at the moment is the concept of Primum non nocere - or ‘first do no evil'. However, the translation I have does not actually say this - the closest we get is ‘The physician must...have two special objects in view with regard to disease, namely, to do good or to do no harm.' This is from Hippocrates' other writings.

I spend quite a lot of my time trying to live up to this concept, and protecting my patients from unnecessary and possibly noxious investigations. This is a difficult thing to achieve as we are hardwired into the concept of seeing a problem, proposing a solution and watching somebody get better. But for many of my patients, this simply does not happen, and every day I am reminded that part of my role is to stand by and observe the process of illness, and note it: a chronicler for the common man.

In about half the patients I saw today, I did nothing exceptionally active. I listened, I sympathised, I did little - the opposite of Veni, Vidi, Vici; not I came, I saw, I conquered, but I stopped, I listened, I did nothing.

One of my patients has had crippling vertigo for 3 years now. Only in her fourties, she has had a huge variety of tests, appointments, drugs and diagnoses, and has seen very clever people in a tertiary hospital, and has ended up with a diagnosis of idiopathic vertigo. In other words, nobody has a clue. The clever consultants passed her between departments, and then to a progressively junior group of doctors, and in the end I wrote to them (at the patient's behest) to discharge her from follow up.

She now only comes to see the Jobbing Doctor. I have to walk her from the waiting room to my room and back, otherwise she would fall over. She finds this distressing, as other people think she is drunk. Every time I see her I have an overwhelming sense that I have failed her. I have not cured her vertigo, I have not come up with the brilliant diagnosis so beloved of fictional programmes like House MD.

No, I stop. I listen. I do nothing. This doing nothing is quite an art form. It must be done in a positive and meaningful way. The patient must understand what you are trying to achieve. She has her expectations of me and I clearly deliver what she really wants. I suppose it is to mark her suffering. To listen to her. To protect her from investigating zeal.

To chronicle her suffering.

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