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Should we care for patients like we care for our own families?

Thirteen years ago, I arranged to visit my grandparents. At the time they were living in Khartoum, Sudan. I spent the first years of my life growing up in Khartoum, before the political situation there became fraught. We moved to a more affluent Middle Eastern country but often went back for family holidays.

One of my striking memories from the journey to sub-Saharan Africa was a day trip I went on with some friends of friends. I sat in the back of a pick-up truck and we drove out to a ‘resort’ upstream on the Nile. My limited grasp of Arabic meant that I barely understood what was being discussed once we got there. It turned out it was the acquisition of grilled chicken.

As we sat on the riverbank eating the chicken and licking our lips, I became aware of small eyes watching us. To my right there was a huddle of three small children that looked like they had been lifted from a Band Aid video from the mid 1980s. Grubby rags hung off their bony shoulders. Flies had settled in the corner of their eyes. They didn’t make a sound.

One of the men I was with finished his chicken, dropped all the bones into the small plastic bag it had arrived in and threw it in the direction of the children. Like dogs sniffing out scraps, they pounced on the bag and pulled out the bones. I couldn’t watch.

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On the journey back to my grandparent’s house, images of the children played on my mind. The journey was too rough and noisy to facilitate a conversation, so I pondered over the emotions the children had provoked in me privately.  

In time, I learnt that I had to separate myself from the suffering of those children. To preserve my sanity, I realised that I couldn’t really care for them as if they were my own family. Caring is hard and can be emotionally draining as well as rewarding. To try to care about these children every day for the rest of their lives would have completely drained me. It was a hard and pragmatic decision to make.

As a GP I encounter the suffering of patients every week. Some patients are dying, others have chronic pain, others have demons that speak to them or remind them of horrendous past experiences. In the same way that I separated myself from the child-beggars of Sudan, I separate myself from my patients’ troubles.

I listen, I empathise, I problem-solve and I care – but not like I care for my own family.

Dr Samir Dawlatly is a former secretary of the RCGP’s adolescent health group and a GP in Birmingham.