I have a favourite consultation.  Actually, I have a lot of favourite consultations, but this one is pretty high up there.  It happens every 18 to 24 months on average.

I will have met with a family, and we’ll have got to know each other on a journey (naff word, but can’t find one better) over a few years.  And, as these things happen, we reach that point where it’s the last time we meet.

We exchange a few words.  Very occasionally a card may exchange hands.  The family get up to leave.  The father – usually the father – has his hand on the handle of the consulting room door, is about to turn it to emerge back into the real world.  And there is a pause, and I think “It’s coming, my favourite bit is coming…”  Hand still on the doorknob, he turns and says:

“Don’t take this the wrong way doc, but I hope we never see you again”.

And that’s it.  That for me is the pinnacle of my career.  There’s a hurried reassurance from me that, no, I don’t take it the wrong way.  There is more shaking of hands, and then they are gone, and I’m left with the feeling, which I store up in that good place I keep for when the bad stuff happens.

Medicine, practiced well, is the art of engineering your own irrelevance.  This requires a little explanation.  Consider two extremes:  Dependence and Independence.  As with the  Aristotlian Golden Mean  most of us wish for and achieve the middle in our relationships – interdependence.  What this means for me is that I hope that my family, friends and colleagues get a great deal from me, and if I were to exit their lives they would miss me, for my personality, for, well, me.  But I hope that the two extremes don’t happen:  I hope they neither completely fail to notice, nor fall apart.

It’s interesting that this works into management and leadership too.  We’re all familiar with the office despot who engineers things that when they go on leave for a couple of weeks things fail – nobody can work out the code for the photocopier, find the spare staples etc.  What the good manager, good leader needs is for people to miss them but not notice that much – “Oh, you’ve been on leave for a couple of weeks?  Great – did you have a good time?”  Obviously it does not escape me that this requires massive suppression of the ego.  Which brings me back to medicine.

Nobody wants a doctor in their life.  Actually, I’ll correct that.  The majority of straight thinking folk would prefer to avoid any contact with doctors (or other healthcare professionals for that matter).  With some people ongoing contact is necessary.  Many of us go into medicine in order to – in that cliché of medical school interviews – to “help people”.  But actually, the bit when we’ve done our job the best is when people don’t need us any more.  They may still like us, we may still enjoy each other’s company, but we they don’t need us.  We’ve engineered our own irrelevance.

So, Bob, this is why, while I can understand your post – and the specific needs of your patient group – I think it’s our job to make sure that folk don’t depend on us.  The success of this is the empty nest, and if we dread it, it should be for the freely acknowledged- and healthy -interdependence, and nothing more.