Dark, quiet, and desolate. At 7.45 am on the mornings after Christmas, the streets look sad and neglected. A few Christmas lights blink unconvincingly. No traffic, no pedestrians, no kids going to school, and no radio except the news. But, the surgery lights are on, cars parked outside, shutters open, patients waiting…

One of the toughest days of the year. No one comes to the doctor on these lay days between Christmas and New Year unless they have to, need to, or have no one else to turn to. It’s not just that we have been closed but, in the days and weeks running up to Christmas, people have forgotten or hidden their difficulties, displaced by the communal seasonal hysteria so their problems have been queuing up for a while. There are, of course, lots of sick children, with coughs and colds, and diarrhoea, but many quite poorly with acute respiratory infections, bronchiolitis, and worse. Adults with chest pain, urinary infections, worrying lumps and bumps. And, lots of home visits—some worried relatives but mostly real illness. But, these are the easiest problems to solve.

As the tide of Christmas goodwill ebbs, those most vulnerable are high and dry. Dark days even darker for those depressed, families broken by alcohol, relationships shredded, the bereaved even more bereft, illness looming larger when Christmas fades. The insoluble problems. General practice has spoiled Christmas for me—I can no longer enjoy the buzz and build up without seeing the sadness behind the sentimentality, the angst behind TV advertisements, the violence behind the alcohol. But, the hidden illness that patients suffer most at this time of year is loneliness. Pain, suffering, and isolation. And we all look towards the New Year and hope it might be better.

Domhnall MacAuley is primary care editor, BMJ